Book Third (part 2 of 2)

Book Third (part 2 of 2)

COMMENTARY. See Hippocrates (de Locis in Homine, 40); Galen (de Med. sec. loc. ix); Aretæus (Morb. Chron. i, 15); Celsus (iii, 24); Cælius Aurelianus (Tard. Pass. iii, 5); Aëtius (x, 18); Oribasius (Cur. Loc. Affect. iv, 99); Actuarius (Meth. Med. i, 11); Nonnus (188); Pliny (H. N. xi, 37; xxvi, 76; xxviii, 64); Ruffus Ephesius (ii); Palladius (de Feb. 6); Alexander Aphrodisiensis (Probl. i, 90); Octavius Horatianus (ii, 14); Scribonius Largus (31); Marcellus (de Med. 22); Serapion (iv, 9); Avicenna (iii, 15, 1); Avenzoar (i, 14, 6); Haly Abbas (Theor. ix, 33; and Pract. vii, 41); Alsaharavius (Pract. xviii, 11); Rhases (Divis. i, 64; Contin. xvi.)

With regard to the etymology of the term icterus: in the first place, Aretæus derives it from the animal ictis, which the Scholiast on Nicander pronounces to be a wild ferret. On the identity of the mustela and ictis, see further Pliny (H. N. xxix, 16.) Schneider determines it to be the mustela furo. (Ad Aristot. H. A. vi, 30.) Isodorus would seem to agree with Aretæus, in his derivation of the term Orig. Suidas, however, derives the word from ἰκτῖνος, a species of kite, and Pliny from some unknown bird of the imaginary name of icterus (H. N. xxx, 11.) We have no hesitation in saying that we are disposed to follow the authority of Aretæus.

Hippocrates directs us to give at first fatty things, and to use the bath for three days; then to abstain from these things, and purge both the belly and the head, and give diuretics. But he forbids cholagogues, which, he says, only increase the disorder of the system. We have stated in the Second Book, Sect. IV, his views regarding jaundice occurring in fever. His commentator Theophilus explains that jaundice arises from obstruction of the ductus choledochus. Hippocrates lays it down as a rule that in cases of jaundice it is a bad symptom when the liver is hard. (Aphor. vi, 42.)

Our author follows closely the views of Galen. He remarks that, when in fever the bile is suddenly determined to the skin, it proves critical, and is easily removed by baths of sweet water, and friction with a discutient or rarefying oil. When the disease proceeds from obstruction of the vessels of the liver, he directs the administration of hot and detergent things, such as gentian, birthwort, and centaury. When occasioned by inflammation of the liver, the remedies suitable to that disease will be proper. When inflammation and obstruction are combined together, they are to be removed by relaxants and detergents. He gives from Andromachus and Archigenes a long list of compositions for jaundice; but we must be content with explaining his general principles without entering upon the detail of his practice. Galen, in another place, remarks that the poisons of certain reptiles occasion jaundice. (De Loc. Affect. vi, 8.) This fact is confirmed by modern observation. See Van Swieten (Comment. 916); Dr. Simson (paper on Jaundice, vol. i of the Medical Essays and Observations); and Rogerius (i, 47.) By the way, the ancients maintained that the primary action of certain poisons is exerted upon the liver. (See Book Fifth, XLII.)

Aretæus insists that jaundice is produced not only by disease of the liver, as generally supposed, but likewise by affections of the spleen, stomach, kidneys, and colon. He further states that jaundice is sometimes engendered by the condition of the general system. He appears to allude to non-elimination of the bile. When the biliary ducts are obstructed, the bile regurgitates from the gall-bladder, and mixes with the blood in the liver, whence it is carried all over the body. In this case the alvine discharges are white, owing to their not being mixed with bile. When the spleen is the seat of the disease, the skin is of a dark yellow colour. He maintains that jaundice likewise arises from affections of the stomach and also of the colon, as digestion is partly performed in the latter viscus. But we must not follow out his description any further, as it is too long for our limits.

Celsus having described the disease, directs us to cure it by abstinence for one day, and then by opening the bowels; if fever is present, the suitable remedies are to be applied, but otherwise scammony or bitters, such as wormwood, are to be given. Some, he says, cured the disease by attenuant food and diuretics, but Asclepiades rejected the latter, and gave salt water as a purgative. Celsus approves of a salt Greek wine, baths, and so forth. During the whole course of the complaint he directs the patient to use friction, and take exercise; and if it is winter to have recourse to the bath, but in summer to swim in the sea. He approves of all kinds of exhilarating sports and amusements, whence the disease, he says, has got the name of regius morbus. Isidorus, in like manner, says of it: “Regium autem morbum inde estimant dictum quod vino bono et regalibus cibis citius curatur.”

Pliny directs us to cure jaundice by producing perspiration with the root of the cyclaminus or sow-bread.

Cælius Aurelianus says that jaundice is brought on by indigestion, or by cathartic medicines which have been taken and have not operated. Sometimes, he says, it is attended with enlargement or scirrhus of the liver, and sometimes, though rarely, the spleen and stomach are affected sympathetically. If the attack is violent, he does not disapprove of venesection; after which the sick are to be restored by soothing treatment, exercise, and food of easy digestion. The accessory symptoms, such as hardness of the liver, spleen, and stomach, are to be attended to; and the bile is to be carried off from the system by administering acrid clysters, and giving infusions of wormwood or wild succory. He also approves of sternutatories such as elaterium; of masticatories given while in the warm bath, and of determining to the skin by sudorifics and medicines which produce pruritus. He also recommends change of air, gestation, swimming in water, frequent vomiting excited by simple means, and acrid food such as capers, squills, &c. He approves likewise of giving a thin wine, and the decoction of hellebore when the disease is protracted; but disapproves of the indiscriminate use of cholagogues, cathartics, and diuretics, such as scammony, and colocynth, with wormwood, birthwort, St. John’s-wort, anise, &c. He thinks mental relaxation and serenity of great consequence to the cure.

Aëtius gives an accurate account of the disease, but his views are very similar to those of Aretæus. He maintains that there are other causes of jaundice besides obstruction of the duct of the gall-bladder. When the affection is not critical, he recommends bleeding and purging. He says that strong purging with colocynth, scammony, and other drastics is required to produce revulsion from the skin. He also approves of deobstruents and diuretics, which are to be given while the patient is in the hot bath. He speaks of sternutatories and sialogogues, like our author. He likewise strongly recommends emetics (iii, 119.)

The treatment recommended by Oribasius, Actuarius, Nonnus, and Octavius, is very little different from our authors. According to Actuarius, the colour of the urine which is characteristic of jaundice is the cærulean, that is to say, the colour of a ripe cherry, or of a dark-coloured wine. (De Urinis, vi, 7.) Theophilus in like manner states that the cærulean-coloured urine indicates jaundice. (De Urin. 6.)

Ruffus the Ephesian describes very correctly the situation and use of the gall-bladder, and remarks, that when its duct is obstructed jaundice is produced, in which case the stools are white and clayey. Aëtius’ recommendation of emetics is upon his authority.

Alexander Aphrodisiensis states that the constipation of the bowels in jaundice is occasioned by the want of the natural bile, which serves as a stimulant to the intestines. For the same reason, he adds, the stools are of a whitish colour.

According to Leo, jaundice arises either from obstruction or from the conversion of the blood into bile by the heat of the system. He also adds that jaundice is sometimes critical.

The poet Lucretius (iv, 333) and the philosopher Aristippus take it for granted that persons in jaundice see every object tinged with yellow. (Sextus Empiricus, adv. Math. vii, 195.)

According to Serapion, a redundance of yellow bile in the body is occasioned either by the system’s not being properly purged of it, or by an over-secretion of it, or by a combination of these causes. Obstruction, he says, may take place either in the liver itself or in the gall-bladder. Sometimes, he remarks, the liver having been inflamed, becomes as hard as a stone, or its ducts are obstructed so that the blood becomes mixed with bile, and in this state is carried over the whole body. He adds, that perhaps the whole gall-bladder is affected, or only one of its ducts, namely, either the superior one, by which it receives bile from the liver, or the inferior, by which the bile passes down to the intestines. In like manner he afterwards states, that sometimes the superior duct losing its tone and becoming obstructed, the bile becomes mixed with the blood; or, the inferior being obstructed, the bile regurgitates to the superior, and becomes intermixed with the blood. And sometimes, he says, the affection arises from the gall-bladder being over-distended in like manner as the urinary bladder sometimes is. When the disease is from obstruction he recommends attenuants, purgatives, emetics, and the other remedies directed by the Greeks. A similar account is given by Avicenna. Like Aëtius, he approves of venesection in certain cases, in opposition to Galen, who, as a general rule, forbids to let blood in jaundice. (De Purg. Virt.) Avicenna also describes the species of jaundice connected with disorder of the general system, described by Aretæus. Avenzoar says that the ducts are obstructed aut verruca aut pustula. The exact signification of these terms cannot easily be determined, but it seems probable that they refer to gall-stones. But the following passage of Haly Abbas puts it beyond a doubt that the ancients were acquainted with hepatic calculi or gall-stones: “Some,” he says, “relate that calculi are formed in the liver, cæcum, and colon.” (Theor. ix, 34.) Haly directs us, when jaundice is connected with inflammation, to bleed, and purge with myrobalans, hepatic aloes, &c. He also makes mention of emetics among his general remedies. When connected with obstruction, particularly of the gall-bladder, he recommends bleeding at the arm, a decoction of wormwood, hiera, scammony, and various remedies of a like nature. To remove the yellow colour of the eye he recommends the tepid bath, and the application to the eyes of the fumes of vinegar. For the cure of jaundice of the spleen, he prescribes the common remedies, and mentions one which he says he learnt from a woman, and found very effectual. It was a draught containing lentils, fennel, and the urine of a boy not come to puberty. Jaundice being a disease which often goes off without any remedies, has been, in all ages, a favourite with empirics. Alsaharavius treats of the disease in much the same terms; recommends bleeding when it is connected with an inflammatory cause, and attenuants, bitters, purgatives, and the hot bath according to circumstances. Rhases, who gives a very full account of jaundice, states that the disease generally arises from obstruction either in the liver or its ducts. He particularly recommends drastic purgatives, such as scammony, along with wormwood, fennel-seed, and the like. When inflammatory symptoms are present he approves of bleeding and the warm bath.

SECT. LI.—ON PROLAPSUS OF THE NAVEL.

The causes and surgical treatment of protrusion of the navel will be treated of in the Surgical part of the work. But, since some restore the parts to their natural state by medicines, we must now mention that method of treatment: Of fissile alum, dr. v; of lees of wine, dr. viij; of rose-oil, dr. x; of unripe gall-nuts, dr. ij; dilute with wine; make to the thickness of honey; and wash with it; and put on externally a sponge soaked in oxycrate, and surround it with a bandage.—Another: Of the outer skin of bruised beans, of galls, of pomegranate flowers, equal parts; boil in water, and when dissolved pound carefully, and wash with it; and apply the sponge, as formerly said.—Another: Of the parings of lead, dr. xvj; of hemlock, of manna, of ceruse, of the juice of hypocistis, of each dr. j; dissolve in wine, and use as above described.

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COMMENTARY. See in particular Oribasius (Morb. Curat. iv, 117.) It is not necessary to multiply authorities, as all entertain similar views upon this head. The following is a simple receipt given by Celsus: “Cicutæ et fuliginis, denar. j; cerussæ elotæ, denar. iv; plumbi eloti, denar. viij; ovis duobus; quibus etiam solani succus adjicitur.”

Haly Abbas properly remarks that the umbilical hernia is a protrusion of the omentum or intestine at the navel. He recommends various astringent plasters, containing cypress, galls, alum, &c. (Theor. ix, 36; Pract. vii, 51.)

SECT. LII.—HOW TO MAKE THE CHIN AND PUBES CONTINUE LONG FREE OF HAIRS; ON THE PRESERVATION OF THE GENITAL ORGANS; AND, AMONG OTHER THINGS, OF DEPILATORIES.

Mix equal parts of Cimolian earth and ceruse with the juice of henbane, so as to have the thickness of the bath-sordes; then add of oil of lentisk, q. s.; pound and use.—Another: Pound together the juices of hemlock, of deadly nightshade, of henbane, and of the most tender leaves of lupine, and an equal portion of fleawort, and use, having first scrubbed the part and washed. But for some days previously the patient must drink water.

A depilatory for removing the hairs. Of the slaters which live about houses and roll themselves into balls, dr. ij; of sandarach, dr. iv; of quicklime, dr. viij; of old vinegar, one cyathus; of the lixivial ashes of figs, one cyathus; boil in a pot, and use in the bath.—Another, simple and devoid of smell: Of quicklime, one sextarius; of sandarach, oz. j; boil as aforesaid, and use. But the subject of depilatories is treated of along with the Diseases of the Eye.

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COMMENTARY. Depilatories have always been made of similar ingredients to those which enter into our author’s prescriptions, that is to say, arsenic and quicklime have generally entered into the composition of them. The following is one from Baptista Porta: “Constat vivæ calcis partibus quatuor, redactis in pulveris modum, auripigmenti singulari, et decoque.” (Mag. Nat. ix, 4.)

It appears from many passages in the Roman Satirists that the practice of applying depilatories to the obscene parts was common in ancient times. Persius says:

“Tu cum maxillis balanatum gausape pectis, Inguinibus quarè detonsus gurgulio extet?”

(Sat. iv, 37.)

See the learned note of Casaubon; also, Juvenal (Sat. viii, 114), and the note of the Dauphin editor. The Fathers inveigh against this immodest practice. See Tertullianus (de Pallio), and Clemens Alexandrinus (Pædagog. ii, 3.) According to Athenæus, the Tuscans were anciently much given to the use of depilatories. (Deipnos. xii, 14.) See also Apuleius (Metamorph.)

As this subject possesses little interest now, we need not enlarge upon it.

SECT. LIII.—ON BUBONOCELE, ENTEROCELE, AND HYDROCELE.

Protrusions of the bowels occasioned by rupture of the peritonæum are of a very difficult nature, but those from relaxation are of easier cure; for happening commonly to children of a humid temperament, they, for the most part, can be cured without a surgical operation, by the application of remedies and suitable bandages. The under-mentioned remedies are to be applied; but I must mention, in the first place, that these diseases differ in situation only; for, when the intestine remains in the groin, it is called Bubonocele, and when it falls down into the scrotum, it is named Enterocele. Wherefore, take of pomegranate-rind, dr. x; of unripe gall-nuts, dr. v; boil in three cyathi of austere wine; pound and apply, having previously reduced the intestine and bathed the part with cold water. Loose it in ten days; the patient remaining on his couch thirty days, and drinking of the decoction of cypress with wine; or of cypress balls, three oboli, in diluted wine. This medicine is applicable to children.—Another agglutinative application: Of the roots of comfrey, of the juice of horehound, of bitter almonds, of gum, equal parts.—Another: Of turpentine, oz. iss; of wax, of frankincense, of myrrh, of isinglass, of snails with their shells, of each oz. j; macerate the ichthyocolla previously in vinegar for three days.—Another: Of cypress-balls, i. e. spherical fruit, oz. j; of galls, oz. j; of pomegranate-rind, oz. ss; of taurocolla, oz. iij; of manna, of frankincense, oz. ss; of comfrey, oz. ss; of snails with their shells, oz. j; boil the balls and rind in astringent wine for a considerable time; triturate; mix the other ingredients, and when they are added, use.—Another: Of aloes, of pomegranate-rind, of frankincense, of the juice of hypocistis, of artificers’ glue, of pitch, of bitumen, oz. iss; of sweet wine, q. s.—Another more complex application, which will answer also with adults, when the disease is not of long standing: Of chrysocolla, of taurocolla, of sarcocolla, of ichthyocolla, of gagate-stone, of blood-stone, of Syrian sumach, of manna, of acacia, of each, oz. iss; of the stone pyrites, of native sulphur, of the breathing magnet, of fissile alum, of manna, of frankincense, of each, oz. j; of Brutian pitch, oz. v; of snails with their shells, oz. j; of the dross of silver, oz. iv; of galls, oz. j; of squamæ stomomatis (scales of steel?), oz. j; of copper, oz. j; of bitumen, oz. vj; of myrtle-oil, q. s.; mix the dry things with astringent wine, until the preparation is of such a thickness as not to stain, and then use. If they cannot lie in a recumbent posture, bind the application firmly with a triangular bandage of thick materials and sufficient to retain the intestine. Let them abstain from flatulent food, much wine, frequent baths, strong motion, such as running, leaping, loud crying, and the like. For hydrocele, so as to evacuate the fluid: Of pepper, c grains; of bay-berries, lxxx; of nitre, dr. xx; of wax, dr. xl; mix with half a hemina of oil, and use.—Another excellent application: Of the flower of Assian stone, dr. vj; of grapes deprived of their stones, dr. ij; of Ethiopian cumin, dr. viij; of red nitre, dr. viij; having triturated, apply, fomenting with it late and early. Some also add of sulphur, dr. viij.—Another: Mixing unslaked lime with bath-sordes, apply with cerate; and mix some nitre with the unslacked lime.—Another: Having burnt the root of a cabbage, add the ashes to old axunge that has been melted, and remove it every third day. To prevent a collection of water, use the following malagma: Of wax, lb. iiss; of pitch, oz. iv; of ammoniac perfume, oz. iv; of liquid alum, oz. iss. The plaster of the white poplars and the other epispastics are also applicable.

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COMMENTARY. As these diseases will be treated of more fully in the Sixth Book, it is unnecessary to say much about them at present.

Our author is most indebted to Aëtius (xiv, 22.) Nonnus recommends astringent applications of a similar nature. (192.) When there is difficulty of reduction, Rhases directs the use of the warm bath perseveringly. Haly Abbas remarks that protrusion of the bowels will sometimes occasion constipation, pain, and death. He says nothing of an operation for relieving the strangulation. Alsaharavius declares that he had found all the applications recommended for the cure of these complaints utterly ineffectual after they are fairly formed. He directs us to return the protruded parts, and secure them by means of a bandage, along with a pad of lead and a plaster of pitch, &c. The Surgical treatment of these complaints is minutely described in the Sixth Book.

SECT. LIV.—ON INFLAMMATION OF THE TESTICLE AND SCROTUM, AND ON THE OTHER DISEASES OF THESE PARTS.

You may recognize inflammation of the scrotum from the pain being felt at the slightest touch of the hand, and from the heat and hardness appearing intense; whereas, when the testicle is inflamed, a slight touch does not give pain, which is only felt when the part is firmly pressed by the fingers, while the redness and hardness appear less at the surface; but, upon grasping it firmly, a deep-seated hardness meets the fingers; and fever is sometimes present. To inflammations of the testicles, in particular, venesection is applicable at the ancle; and to all these, in general, cataplasms and cerates. Cataplasms are to be applied, of the flour of beans boiled in diluted wine, with fat dried grapes deprived of their stones; or, boil the root of cumin or asphodel, and, having pounded, mix with an equal part of the flour of dried barley-meal, and apply as a cataplasm; or, linseed in diluted wine; or, fenugreek in honied water; or, the root in honied water; or, the recent lees of wine, with the flour of barley-meal; or, groundsel and green coriander, with dried grapes deprived of their stones. But if there is much heat, apply a cataplasm of the leaves of henbane with wheat-flour, or that of chick-peas; or, of the leaves of sweet-flag, or of unripe gourd. When the affection is protracted, and attended with hardness, boil the root of wild cucumber in honied water, and, having triturated with the flour of darnel, apply as a cataplasm. And this is an excellent remedy: Of dried grapes deprived of their stones, oz. v; of boiled chick-peas, oz. iss; of cumin, oz. j; of sulphur, oz. ix; of nitre, oz. j; of rosin, oz. iiiss; triturate altogether with honey, and apply as a cataplasm. The following are convenient cerates: Of oil, one cyathus; of Colophonian rosin, oz. vj; of plumbago, of cumin, of dried grapes, of the flour of beans, of each, oz. iv; of wax, oz. ij; boil the plumbago with the oil to a proper consistence, then add the wax and rosin, and, taking it off the fire, pour it half cooled upon the pounded figs and flour.—Another: Of the oil of dill and of roses, of wax, of pine-rosin, of each, oz. v; of cumin, oz. iiss; of asses’ dung, oz. iss; triturate the cumin with the asses’ dung, and when the cerate is cooled mix and levigate; then, placing in a rag, use, applying above it wool out of oil from unripe olives; or, use equal parts of butter and rosin. If from sweats there be ulcers in the scrotum, sprinkle powdered gall or alum upon fat and goats’ gall, and anoint. For testicles affected with aphthæ: Having first anointed with Cimolian earth and water, allow it to dry, and wash with warm water; then, having triturated dried myrtle and a small quantity of alsander, apply as a cataplasm. Excrescences upon the testicles are cured by the application of the lixivial ashes of the vine mixed with wine and water. When there is pruritus of the scrotum, triturate finely nitre, stavesacre, dried figs, and moist alum with vinegar and rose-oil, and anoint with it in the bath; but after the bath, rub in the white of an egg with honey.

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COMMENTARY. On diseases of the obscene parts, consult Hippocrates (Epidem. v, 4, et alibi); Galen (Sec. loc. ix; Loc. Affect. vi, 6); Celsus (iv, 21, viii, 18, vi, 18); Aretæus (Morb. Chron. ii, 5); Oribasius (Loc. Affect. iv, 102); Aëtius (xi, 32, xiv, passim); Actuarius (Meth. Med. i, 15, iv, x); Nonnus (192); Alexander (viii, 9, 10); Cælius Aurelianus (Pass. Tard. v, 5); Marcellus (32); Octavius Horatianus (ii, 11); Moschion (de Morbis Mulierum); Scribonius Largus (233); Avicenna (iii, 20, 1, 2); Avenzoar (ii, 3); Haly Abbas (Theor. ix, 37; Pract. viii); Alsaharavius (Pract. xxii); Rhases (Divis. 79; ad Mansor. ix, 101; Contin. xxiv.)

Hippocrates relates a case of prurigo scroti which was removed by hot baths, but the patient afterwards became dropsical and died.

Many of our author’s remedies are taken from Galen, but he has copied most closely from Oribasius and Aëtius.

The treatment of inflammation of the testicles, as laid down by Celsus, is very judicious, namely, bleeding at the ankle, a cataplasm of the flour of beans boiled in mulse with pounded cumin and boiled honey, and other similar applications. When it becomes indurated, linseed or the seed of fenugreek boiled in mulse, or the like, are to be applied. When the testicles swell from a blow, blood must necessarily be extracted from them, more especially if they are livid.

Avicenna is particularly full upon these and all the other diseases of the obscene parts. For pruritus of the testicles and scrotum he recommends bleeding, cupping in the vicinity of these parts, the application of leeches, hot fomentations with acacia, sal ammoniac, &c., and the other remedies mentioned by Paulus. For apostemes he directs us to bleed in the arm and ankle, and to use applications similar to those of our author. Rhases recommends bleeding in the arm and ankle, and at first cold applications, consisting of vinegar and rose-water, which, if the complaint does not abate, are afterwards to be exchanged for suppurative ones. Haly’s treatment is nearly the same. Alsaharavius, like Avicenna, treats inflammation of the testicles by bleeding in the arm and ankle, and using various local applications of a cooling nature. For pruritus he recommends applications containing ceruse, sulphur, nitre, sal ammoniac, and strong vinegar. Rhases mentions that he had an enlargement of the right testicle for which he took an emetic, whereby a manifest reduction of the swelling was produced, and by a repetition of this process the complaint was entirely removed.

SECT. LV.—ON GONORRHŒA AND LIBIDINOUS DREAMS.

Gonorrhœa is an involuntary discharge of semen, taking place frequently without erection of the privy member, owing to weakness of the retentive faculty. In this case it will be proper to keep the patient in a state of rest, covering the loins and pubes with compresses out of wine, oil of apples, or that of the flowers of the wild vine; and cataplasms may be afterwards applied, made of dates, apples, flowers of the wild vine, acacia, hypocistis, sumach, and the like. He may also be made to sit in a hip-bath of the decoctions of lentisk, of bramble, and the like, in wine, or even in water, and use desiccative food. After a little while, he may take gymnastic exercises, by which both the general system and the affected parts will be restored to strength. Redundance of semen has been treated of sufficiently in the First Book, under the head of Hygiene; and there, too, impotence is treated of. A cool couch is beneficial in cases of libidinous dreams; also, laying on the right or left side; all medicines of a cold nature rubbed into the loins, such as coriander, hemlock, ceruse, and purslain, all of which are to be used with vinegar.

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COMMENTARY. Celsus recommends strong friction, affusion of cold liquids, swimming in cold water, food and drink of a cooling nature, avoiding everything flatulent and calculated to engender semen, applications such as rue and vinegar to the part, avoiding lying upon the back, and so forth.

Aretæus, in his chapter on Gonorrhœa, makes some very ingenious speculations on the effect which the semen genitale exerts upon the development of the moral character. He remarks that a long-continued draining of the semen sometimes occasions paralysis: he alludes to the tabes dorsalis, a disease well described by Hippocrates. He properly states that gonorrhœa proceeds from relaxation of the genital organs. With regard to the treatment, he recommends at first cooling and astringent applications to stop the flux, but these are afterwards to be exchanged for calefacients and rubefacients. Castor, mint, and the theriac are to be taken internally, along with strong exercise.

Galen defines gonorrhœa to be an involuntary emission of semen, arising from debility of the genital organs, especially of the spermatic vessels.

Aëtius gives a full account of gonorrhœa from Galen, and of oneirogmon from Philagrius, but his treatment is little different from our author’s. For the latter he directs the patient to take such things as are calculated to prevent the formation of semen, as rue, calamint, the chaste-tree, &c.; and further recommends astringent and refrigerant applications, lying on a hard bed, wearing a plate of lead on the loins, and abstaining from the usual provocatives to venery.

The practice of Alexander is exactly the same as that of Aëtius.

Cælius Aurelianus treats oneirogmon upon much the same principles, namely, by cooling applications and injections, the cold bath, astringent food, and so forth. He makes mention of a disease of the genital organs, which we have met with in practice, although we do not recollect to have seen it noticed in any modern author, unless Heberden alludes to it (Comment. 80.) It is an emission of bloody semen in actu venereo. He directs it to be treated by astringent and restorative remedies.

For oneirogmon, the Pseudo-Dioscorides recommends an infusion of the seed of lettuce and purslain, the decoction of nymphæa, &c. (Euporist. ii, 100.) Dioscorides himself recommends hemlock. (Meth. Med. iv, 79.)

Avicenna and Rhases follow the treatment of our author. For the oneirogmon, Haly Abbas recommends various refrigerant and sedative medicines, such as purslain, coriander, lentils, fleawort, poppies, roses, &c. For gonorrhœa he recommends bleeding; emetics if connected with repletion; sleeping in a cold place; various anodyne, astringent, and refrigerant medicines, such as henbane, poppies, roses, lettuce, &c. He also directs a plate of lead to be worn over the loins. Alsaharavius treats minutely of these complaints according to the nature of the exciting cause. His general remedies for gonorrhœa are of a refrigerant and cooling nature, such as citrons, pomegranates, lettuces, henbane, &c. with a plate of lead and other cooling applications. For oneirogmon he recommends liniments of camphor and opium, lying on a hard bed, and refrigerant medicines. Rhases recommends styptic applications, snow, the plate of lead, and the cold bath. He speaks also of rubbing the parts with myrrh, henbane, and opium.

On the pollutio nocturni somni referred to in Deut. xiii, 13, see Isidorus (Comment. in Deut. 20.) Pliny treats of certain herbs which excite, and others which dispel, the “somnia veneris.” Martial, in his epigram addressed to Ponticus, expresses himself in terms of just abhorrence against the detestable vice of manustupration. Galen, however, relates a story of it with disgusting sang froid.

SECT. LVI.—ON SATYRIASIS.

Satyriasis is a palpitation of the genital organ, accompanying some inflammatory affection of the spermatic vessels, with erection; and, if the palpitation do not cease, it is apt to terminate in paralysis of the spermatic vessels, or in spasms. Those affected with convulsion die speedily, having at last inflation of the belly and cold sweats. This complaint sometimes, though rarely, affects women. Wherefore we must open a vein without loss of time, keep the patient upon a spare diet without wine, and purge the belly, not freely but gently, every day. The best articles of food are beet, mallows, a little of the herb mercury, and the soup of the shell-fishes. A simple clyster is no bad remedy. Diuretics must be avoided; and medicines of a cold nature are to applied to the loins, such as the juice of nightshade, of purslain, of henbane, or of hemlock. It may be necessary, also, to rub the penis and the perineum with some soothing and cooling things, such as litharge, Cimolian earth, and ceruse, dissolved in vinegar, water, sweet wine, or rob. It is hurtful to lie on the back. He may drink of the root of water-lily, iris, and maiden-hair. Rue is beneficial both in gonorrhœa and satyriasis. Give, likewise, food from grain in small quantity, and do not gratify the thirst. When the affection is protracted, cupping with scarifications, may be had recourse to; or, if a plethora be present, we may evacuate by leeches. A cataplasm of raw barley-meal may also be applied to the belly.

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COMMENTARY. Aretæus has drawn a lively but disgusting picture of a person affected with this complaint, which it is to be hoped that the “march of improvement” in morals has now rendered of rare occurrence. He calls it a most unseemly disease. According to his account, it will even prove fatal occasionally, and that within the space of seven days. He says the natural cure of it is a diarrhœa coming on with bilious discharges. This venereal mania, he says, is to be cured by bleeding from the arm or ankle to deliquium animi, purging with hiera, and wrapping the genital organs and adjoining parts with wool dipped in rose-oil and wine, or in decoctions of such narcotics as hemlock, nightshade, mandrake or poppy; the applications in either case being frequently changed. When these things do not succeed, the neighbouring parts are to be cupped or leeched; and in case of necessity the afore-mentioned refrigerants are to be changed for calefacients, such as the oil of privet, or the Sicyonian oil. This treatment, he remarks, will prove soothing to the nerves. He also recommends castor and a refrigerant diet, from which wine and flesh are to be excluded. It appears, therefore, that our author’s treatment is mostly taken from him.

Oribasius pronounces satyriasis to be a fatal symptom in acute fevers; and Professor Sprengel confirms the justness of this observation. (Hist. de la Méd. t. ii, 188.)

Cælius Aurelianus gives a very circumstantial account of this disease. His treatment differs from that of Aretæus in this respect—that he disapproves entirely of the refrigerant applications, and, instead of them, recommends soothing ones, namely, emollient oils, a hip-bath of oil and water, and the like. He approves also of bleeding, cupping, and leeching.

Octavius Horatianus treats it upon nearly the same principles, that is to say, he recommends fomentations with the vapours of hypocistis or hemlock, hard friction, exercise, and astringent food.

There is nothing original in the treatment of the Arabians. Haly Abbas recommends calefacient and desiccative medicines internally, such as agnus castus, rue, cumin, &c. He also permits the use of narcotics with desiccants, such as coriander, henbane, lettuce, and opium. To the member he directs us to apply a cataplasm containing the oil of roses, lettuce, coriander, and camphor; and when this fails, some opium is to be added. He enjoins hard exercise.

Alsaharavius recommends much the same treatment as our author, namely, bleeding from the arm or foot, diluent and refrigerant draughts, cooling applications containing vinegar, ceruse, &c.; and, if these do not succeed, leeches.

SECT. LVII.—ON PRIAPISM.

Priapism is a permanent enlargement of the penis, which is swelled both in length and circularly, and there is no venereal appetite attending it. The part is swelled by a flatulent spirit engendered from viscid and gross humours by a moderate heat. It is clear, therefore, that the part is not to be heated but cooled moderately, with rose-cerate beat up with water, and with the cerate of chamomile applied to the penis and loins. The diet and medicines should be of an attenuant nature, without being manifestly heating. We must also apply those things which are found, by experience, to be naturally efficacious. We may, therefore, give them also to drink of the water-lily and the seed of the chaste-tree, and mix green rue with their condiments. Yet this must not be given at the commencement, since it is heating, but after the use of other attenuants. If we practise evacuation, it must be by vomiting; for that by the belly often occasions a defluxion to the neighbouring parts. Exercise and friction are to be had recourse to for dispelling the flatus. In none of the cases which we have been mentioning does coition answer, unless when we have reason to suppose that there is a redundance of semen owing to restraint from enjoyment.

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COMMENTARY. Many of the ancient authorities make no distinction between satyriasis and priapism, but, according to Cælius Aurelianus, the former is an acute and the latter a chronic disease. Prosper Alpinus, the modern Methodist, says, there is this difference between satyriasis and priapism—that in the former there is violent venereal desire, whereas, in the latter, there is continued erection, but no desire nor emission of semen. It seems, in short, to be a sort of chronic chordee.

Our author, Oribasius, Aëtius, and Actuarius, follow the principles of treatment laid down by Galen. The latter speaks of the anti-aphrodisiacal medicines mentioned by our author.

Alexander forbids the use of such things as are of an intensely cold nature, especially astringents and narcotics. He recommends friction, exercise of the upper parts of the body, and abstinence from flatulent food. All incentives to venery are of course to be avoided.

Avicenna agrees with the Greek authorities respecting the anti-aphrodisiastical properties of rue. Like them, he recommends emetics, but disapproves of drastic purgatives. When the affection is of an inflammatory kind, Haly Abbas recommends general bleeding, cupping, leeches, and applications of a cooling nature, such as vinegar, purslain, solatrum, gourd, &c. Alsaharavius recommends various refrigerant and anodyne remedies, internally and externally.

SECT. LVIII.—ON IMPOTENCE OF THE PARTS.

Those having this complaint have lost their venereal desires, and have become depressed in spirits on that account. The cause of it is a paralysis of the parts, or a defect of semen. Those things which engender semen are treated of under the head of Hygiene in the First Book; and there, too, the incentives to venery of a simple nature are mentioned; and we must now add those which are stronger. Wherefore we must use in general those applications called acopa which are recommended for paralysis; but in particular levigate a burnt swift (stellio), and, adding oil to it, anoint the great toe of the right foot, and then try the venereal act; and when you wish to give over, wash away the ointment from the toe. And the composition from swifts called polymigmaton is a very efficacious application; or propomata from medicines which rouse to erection must be taken, such as this: Of pepper, of pine-nuts, of Macedonian parsley, of the shavings of hartshorn, of turpentine, equal parts; mix with honey.—Another: Of raw chick-peas, of pine-nuts, of each, oz. ij; of rocket, of pepper, of each, oz. j; mix with honey, and give two drachms in wine. And the compound medicine called satyriaca, and such like, will be applicable. But we must also attend to the other causes of the complaint, and apply remedies corresponding to them.

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COMMENTARY. This Section is mostly abridged from Aëtius (xi, 35.)

Octavius Horatianus recommends moderate exercise, friction of the extremities, and particularly of the groins, with pepper, euphorbium, and the like; applying plasters (dropaces) of the same to the groins and loins, or making suppositories of them; giving flatulent food, such as rocket, pepper, and the seeds of tares; lying upon a downy bed; having the attendance of females; and indulging in obscene reading.

See a long list of aphrodisiacal medicines in Myrepsus (40); and in Avicenna (iii, 20, 1, 18.) In the latter we remark the nettle, lupine, rocket, asparagus, parsley, cresses, beans, cinnamon, and an animal called dabet alurel, which we conjecture to be the stellio or swift. Haly Abbas treats minutely of this affection, according as it arises from paralysis of the part or defect of semen. In the latter case, as he considers the state of the parts to be connected until a dry and cold intemperament, he recommends juicy flesh, beans, vetches, sweet wine, and so forth. He approves of a hot bath in which violets have been boiled. He also gives calefacients, such as rocket, ginger, asparagus, onions, and the like. Alsaharavius mentions various causes of impotence. One of them is, “excessus delectationis ad illam quam diligit.”

The aphrodisiacal properties of rocket are mentioned by Juvenal (Sat. ix, 134.) See also Pliny (H. N. xix, 6.) Juvenal appears to allude to aphrodisiacal friction. (Sat. vi, 52.)

Athenæus gives a marvellous account of the efficacy of aphrodisiacal medicines. (Deipnos. i, 11.) See the thirty-sixth Section of the First Book of this work.

SECT. LIX.—ON MATTERS RELATING TO THE GENITAL ORGANS AND ANUS.

Ulcers on the pudenda and about the anus, when free from inflammation, require very desiccative applications, such as that from burnt paper, dried burnt dill, and burnt gourd. For humid and recent ulcers, aloes is a good application, when sprinkled on them dry in a fine powder. But the medicine which gives least pain, and is as efficacious as any other, is pompholyx. If the ulcers are more humid, the bark of the pine by itself and bloodstone are proper; but if the ulcers are also deep, manna must be mixed with them; and if the ulcer be spreading, we must apply a cataplasm of dried lentil with pomegranate-rind, and use the plaster called Coracum from oxymel, the trochisk called Bithynus, and that from paper. Fissures in the privy parts and anus are remedied by roasted rosin (colophony?) rubbed with rose-oil, so as to become of the consistence of bath-sordes, and having the yelk of an egg and opium mixed; or the ashes of the dried leaves of ivy burnt, when pounded with rose-oil in a leaden mortar, may be applied. And the trochisk from wine and oil and that from Phrygian stone are excellent applications for fissures and foul ulcers about the corona glandis, more especially when the prepuce cannot be drawn back.—Another simple application, which also blunts acrimony: Of cadmia burnt and washed, oz. ij; of the rose-leaves stripped of their nails (i. e. the white parts of the leaves), oz. vj; sprinkle it dry, having first wiped the part with wine.—The following is an application for condylomata: Of chalcitis, of uncleansed wool, of cerate, of hart’s marrow, of bramble-leaves, equal parts, with cerate; and that from wine and oil in like manner. But if a concealed ulcer is found on the penis within its opening (the urethra), which is discovered from pus or blood being evacuated without urine, it may be cured by first washing it with honey diluted with much water, and then with milk, and then mixing with the milk the collyrium of aster; or the white trochisk, or that from lotus is to be put into a leaden mortar, and the parts anointed, by dipping a feather in it; and then a small twisted tent of scraped linen may be anointed with it and applied. A most excellent application is the one containing of galls, of pompholyx, of starch, and of aloes, equal parts, triturated with rose-oil and the juice of plantain.

For pains of the privy parts. Apply equal parts of butter and of rosin, both properly melted; or apply equal parts of myrrh and of roasted rosin (colophony or fiddlers’ rosin?) triturated with the juice of the plantain.

For swelling of the penis. Of tender vine-leaves, dr. j; of ceruse, dr. v; triturate and apply; bathe with cold sea-water; enjoin rest; and apply bandages to the penis. The lixivial ashes of vine-twigs applied with vinegar cure thymous tumours of the penis, and do not permit them to increase again; and so in like manner the ashes of the burnt bark of willows. In general the thymus, myrmecia, and acrochordon will be eradicated by strongly corrosive applications, and become dead when treated with septics. But, in particular, elaterium when applied with salts is useful, also unripe figs with vinegar, nitre, and flour, and the juice of the fig when rubbed in; the burnt head of an anchovy pickled, verdigris calcined with native sulphur, the juice of tithymallus (spurge?) when rubbed in, the leaves of basil with copperas, or the fruit of the large sunflower applied with wine.

For inflammation of the anus. Of ceruse, oz. iv; of pompholyx, oz. j; or of soft cadmia, of frankincense, oz. j; of the juice of endive, one hemina; mix, adding the juice by degrees until it be all consumed, and then having made a cerate of two ounces of wax, and one pound of rose-oil, mix; and having shaved the part, soften with this strongly. Inject by an instrument for extricating pus, and apply a bandage above. It is of use for inflammatory fissures, and ulcers of the anus attended with heat or pruritus.

For erysipelas about the anus. Of diachylon plaster, lb. j; of rose-oil, q. s; of pure bread, lb. j; of saffron, oz. j; of opium, oz. j. The saffron and opium are macerated in must, and the bread in water; then, when they are pounded, the diachylon and rose-oil are put into them and allowed to soften. It is also applicable to gout attended with the greatest heat.—Another, applicable also to inflammation of the anus: Triturate ceruse with wine and rose-oil in a leaden mortar with a leaden pestle, anoint with it; or, having triturated ceruse, the white of an egg, and rose-oil in the same mortar until it become of the consistence of bath-sordes, anoint with it.

For acute pain of the anus. Of the tender leaves of henbane, of the tender leaves of purslain, of crumbs of bread soaked in wine, of the yelks of roasted eggs, equal parts; of rose-oil, q. s. After fomenting the part with the decoction of roses and melilots, apply this cataplasm.

An excellent application for inflammation of the anus, and, excrescences thereof. Of ceruse, of litharge, of ammoniac perfume, of bdellium, of each, scr. vj; of turpentine, oz. j; of wax, oz. ss; triturate the powders with the juice of nightshade, of henbane, or of purslain; and having mixed the soluble articles, take, and having softened them with rose-oil, use. And the composition called Phicotyche, and that from plumbago, are excellent applications for inflammations of the fundament. And the trochisks from lotus, from winter-cherry, and that from roses are esteemed applications for the anus and privy parts.

For excrescences of the anus. When these excrescences are inflamed, we must use the general applications already mentioned, and in particular the following trochisk: Of ceruse, oz. iij; of pompholyx, oz. j; of litharge, oz. ij; of mastich, scr. iij, add to the juice of henbane. When they are free from inflammation, sprinkle the ashes of burnt cypress balls, having first washed the parts with wine, or the ashes of the burnt peel of dried gourd, or of the bones of dates in like manner, or the ashes of eggshells and of fennel; or having mixed the juice of pomegranate leaves with an equal portion of white wine, wash with it for seven days. For callous excrescences: Triturate quicklime and arsenic with strong vinegar. It will answer well if you anoint with it in the sun.

On hemorrhoids or piles. When piles discharge more than is proper, the consequence is, that the system is reduced to a watery state, and they lose their appetite. There is risk both from the hemorrhage becoming too profuse, and from its being altogether suppressed; and therefore the treatment is attended with difficulty. Wherefore, when the piles are numerous, one ought always to be left for the sake of purging the system. Some also are seated high up and do not make their appearance, which renders them difficult to be cured. Blind piles discharge nothing, but are on that account more painful than the others. On them, therefore, rub the juice of sow-bread, which will open them. For immoderate discharges, take of the Egyptian thorn, of the leaves of the elder, of mugwort, of each, oz. v; boil in eight heminæ of water to one-half, and add of ironwort oz. iv. The herbs are then to be thrown away, and to the decoction the following things are to be added in powder: Of melanteria, of round alum, of each, dr. viij; of litharge, dr. iv; of galls, oz. iij; of misy, dr. ij; of endive, dr. ij. Dissolve this powder in the decoction, and bathe with it seven times in the day; but on the following day bathe with an equal quantity of another preparation of the same kind, and on the third in like manner. If any part of them remain on the fourth day, pierce it with a needle, and if it has any feeling, or bleeds, prepare a decoction like the former, but add only one-half of the powder; but when you have washed until it touch with the powder, that they may be properly burnt. For the inflammation apply a bread-poultice.—Another: Having soaked pure bread in primary sauce, and haring burnt it in a new pot, triturate, and apply it, having first bathed with wine. It is applicable also to excrescences.—Another: Of endive, dr. ij; of chalcitis, dr. j; of misy, dr. j; of copperas, dr. iij; of fissile alum, dr. ix; of burnt copper, dr. j; of melanteria, dr. j; use in a powder. The food for those who have immoderate discharges should be such as forms but little blood, and is not excrementitious, of a desiccant and astringent nature, such as chondrus soaked in oxycrate, rice, and halica, and of pot-herbs, intybus, succory, and purslain, and of wines such as are astringent. For blind piles, food of an opposite description is proper, but particularly the fish called calamary, the cuttle-fish, polypus, the torpedo, and the cartilaginous fishes; for these things raise a tumult in the blood. Emmenagogues are also proper remedies in this case.

For procidentia ani. Of the fruit of heath, of galls, of ceruse, of acacia, of the juice of hypocistis, of pine-bark, of frankincense, of Aminæan myrrh, equal parts; apply in a powder, having first bathed with austere wine.—Another: Of the dross of lead, of Syriac sumach, of each, oz. viij; of the flowers of roses, dr. iv; of Aminæan myrrh, dr. ij; use like the first.—Another: Of pine-bark, of manna, of litharge, of each, dr. viij; of dried cypress balls, of plumbago, of each, dr. ij; use as directed above. Bathing with the patient’s own urine while yet warm is also useful.

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COMMENTARY. Consult most of the works referred to in the fifty-fourth Section.

The first part of this Section is almost entirely taken from Galen (sec. loc. ix); the remainder seems to be abridged from Aëtius (xiv.) Galen (Meth. Med. v, 15) insists strongly that diseases of the penis should be treated with desiccative instead of epulotic applications.

No ancient author has treated so fully of diseases of the genital member as Celsus (vi, 18.) His description of the ulcers upon it is very minute. Ulcers, he remarks, are found either upon the prepuce, or on the glans, or beyond it on the member itself. If dry, they are first to be bathed with warm water, and then lycium (catechu?) out of wine, or the lees of oil boiled with the same, or butter with roses is to be applied. If there is a slight discharge, they are to be washed with wine; then honey and a fourth part of turpentine-rosin are to be added to the butter and roses for an application. When there is a purulent discharge it is to be washed away, and the part dressed with an application containing pepper, myrrh, saffron, and misy, boiled in austere wine to the thickness of honey. He mentions various other escharotics containing ærugo, alum, and the like. When at any time inflammation comes on, a cataplasm must be applied. Spreading ulcers are to be treated with applications containing the escharotics we have just mentioned. When a watery sanies runs from the sore it is to be treated with basilicon (tetrapharmacon) melted with roses and some frankincense; and it is to be frequently bathed with hot water and covered up from the cold. The tubercles called phymata are to be burnt down with medicines or a cautery of iron, and when the crust falls off, the squama æris is to be sprinkled on the part. Cancerous sores are to be extirpated by escharotics, as by a composition of quicklime, chalcitis (sulphate of copper?) and arsenic; or they are to be cut out and the part burnt. Phagedænic sores in like manner are to be burnt with medicines or the actual cautery.

Avicenna approves of Galen’s rule of treatment stated above. When sores are recent, he recommends in particular aloes, and when more humid, burnt copper. When an incarnant is required, frankincense is to be mixed. Prurigo is to be cured by venesection, purging, and liniments containing nitre, alum, sal ammoniac, or even stavesacre with vinegar or rose-oil. For prurigo, Alsaharavius recommends lotions of sea-water, decoctions of chamomile, saffron, and camphor pounded with vinegar, and the like applications. For hard pustules he recommends various corrosive applications, some of which contain arsenic. Haly Abbas remarks that ulcers on the genital membranes are attended with the same symptoms as those on other parts.

On diseases of the anus. Celsus has likewise treated very fully of these complaints. For rhagadia or fissures he recommends first the hot bath, and afterwards cooling ointments, such as old oil with litharge, and unwashed wool spread with a composition of liquid cerate and roses. The regimen is thus tersely pointed out: “Liquida, lenia, pinguia, glutinosa, meliora sunt.” The tubercle called condyloma is said to derive its origin from inflammation, and is to be treated at first by making the patient sit in a hip-bath of water having vervain boiled in it; and then lentil with some honey, or a composition containing chalcitis, or alum with ceruse and litharge, or the like, is to be applied. If these do not succeed, the escharotics, such as verdigris, antimony, &c., or even the more powerful caustics are to be used. He treats hemorrhoids upon much the same plan as our author. He begins by inculcating that there is danger in suppressing them suddenly. They are to be treated at first upon the soothing plan, by baths, emollient applications, and those directed for fissures. When these fail, strong caustics are to be applied, such as the composition consisting of arsenic, squama æris, and quicklime. Next day they are to be pierced with a needle. In certain cases he prudently directs bleeding from the arm. Procidentia ani is to be treated in the first place by fomenting the gut with austere wine and the like, and replacing it; and then applying the leaves of willow boiled in vinegar, a linen compress, wool, and a bandage. Fungous ulcers are to be bathed with tepid water, if in winter, or with cold if at any other season; and then sprinkled with squama æris, or dressed with a cerate containing the same with quicklime, &c. If these do not succeed, the parts must be burnt with potential or actual cauteries.

Galen remarks that diseases of the anus are difficult to cure, because the part is possessed of great sensibility, and is exposed to be irritated by the alvine discharges, which contain bile, ichor, and the like. Styptic substances, which do not produce much irritation, are most proper for them, such in particular are many of the metals. He gives a long list of applications recommended by Andromachus, Asclepiades, and others, the principal ingredients of which are ceruse, litharge, alum, rose-oil, and the like. For procidentia ani he recommends various astringent applications containing galls, sumach, roses, pomegranate rind, burnt lead, litharge, &c.

Aëtius gives a long account of these complaints, but we must be content with a brief summary of it. He treats procidentia ani in the first place with astringent applications, containing galls, hypocistis, austere wine, and the like; but when these things do not succeed, he directs us to burn the verge of the anus with the actual cautery. Hemorrhoids he advises us to extirpate with the knife; but when the patient will not submit to this operation, he directs us to burn them with caustics, such as arsenic, quicklime, and the like. He recommends various combinations of these medicines for condyloma, acrochordon, and thymus.

Octavius Horatianus may be consulted with advantage; but as his general plan of treatment is not very different from that of Celsus, we shall not give an abstract of it.

For rhagadia Marcellus recommends a composition of litharge and rose-oil. He gives an interesting description of the process of curing hemorrhoids by an application containing arsenic, chalcitis, misy, and the like. This remedy is strongly recommended by the Pseudo-Dioscorides. He says that a mixture of equal parts of arsenic and sandarach will make them drop off in half an hour. (Eupor. i, 214.)

The Arabians treat these diseases upon the same principles. Avicenna describes three kinds of hemorrhoids. The first kind are like warts; the next are of a bloody nature; and the third are intermediate between these. He treats them, like the others, either by a surgical operation, or by powerful caustics, containing arsenic, quicklime, and the like. When hemorrhoids are gross, and do not yield to ordinary treatment, Haly Abbas directs us to apply septics, such as arsenic, quicklime, &c.; and when they become black, to dress them with ceruse ointment, or a mixture of rose-oil and the whites of eggs. Procidentia ani he treats, like Celsus, with astringents, such as galls, hypocistis, recrementum ferri, &c. For fissures he recommends emollient ointments containing ceruse, basilicon, wax, &c. Alsaharavius also approves of septic applications containing arsenic, &c. When the piles are old and callous, however, he prefers the surgical operation. He also prudently recommends gentle purgatives. Rhases directs, in cases of procidentia ani, when the anus is swelled, and the gut cannot be got readily replaced, the patient to be put into a warm bath and emollient applications used; afterwards astringents are to be substituted, and a bandage applied. He recommends us to extirpate hemorrhoids with the knife, the cautery, or caustic medicines; but advises bleeding in the first place. He says that when dressed with sandarach they speedily drop off. In prolapsus, when the anus is swelled, he directs us to bathe the parts with a decoction of mallows, &c., then to smear them with mucilaginous substances; to replace the gut, and secure it with a bandage.

The primary sauce mentioned in this Section of our author is thus explained by Lister: “Liquamen optimum. Istud garum a Paulo Ægineta vocabatur πρωτειον, seu primarium, quod nobilissimum illud esset.” (Ap. Apicium, vii, 6.) It was called garum nigrum and garum sociorum by the Romans. (Galen, Med. sec. loc. iii.) It is thus described by Martial:

“Expirantis adhuc scombri de sanguine primo, Accipe fastosum munera cara garum.”

(Epigr. xiii, 56.)

In the ‘Geoponics’ it is called garum hæmation. (xii.)

SECT. LX.—ON AFFECTIONS OF THE UTERUS; AND, FIRST, OF THE MENSTRUAL DISCHARGE.

With most women the menstrual discharge begins about the fourteenth year of their age; a few have it earlier, in their thirteenth or twelfth; and not a few are later than their fourteenth in having it. There is no limited time for the continuance of it, many having it only for two or three days, most women for five days, some for seven, and a very few have it for twelve days. The menses cease about the fiftieth year of age, a few have them till sixty, and with some they begin to disappear about thirty-five, particularly with such as are fat. When, therefore, the evacuation is delayed, it will be proper to have recourse to baths and potions before the expected period, such as the frequent draughts from sesame, or the headed leek boiled together with pepper and rue. But they must be drunk in Cretan sweet wine. Having drunk a cotylé of it, let the woman excite the flow of the menses by walking; and let her eat calamary, cuttle-fish, and polypus, and other things of the same kind, for they are particularly adapted for raising a tumult in the blood.

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COMMENTARY. The following is a list of the ancient authors on midwifery: Hippocrates (de Nat. Mulieb.; de Morbis Mulier.; de Steril.); Galen (de Med. sec. loc. ix, et alibi); Aretæus (Morb. Chron. ii, 11); Oribasius (Med. Collect, iv; Synops. ix); Ruffus Ephesius (i); Actuarius (Meth. Med. iv); Aëtius (xvi); Soranus (de Arte Obitat.); Nonnus (103); Celsus (iv); Octavius Horatianus (iii); Pseudo-Dioscorides (Euporist. ii, 80); Moschion (de Morb. Mulier.; Isagoge Anatomica, xxix); Meletius (de Nat. Hom. 24, seq.); Marcellus (de Medicam. xxxiii); Eros (apud Gynæcia); Pliny (H. N. xxviii, xxx); Avicenna (iii, 21); Serapion (v); Avenzoar (ii, 5); Averrhoes (Collig. iv, 60); Albucasis (Chirurg. ii); Haly Abbas (Theor. ix, 39; Pract. viii); Alsaharavius (Pract. xxv); Rhases (ad Mansor. ix; Contin. xxii.)

The ideas entertained by the ancients respecting the nature of the menstrual discharge may be best learned from Aristotle (de Generat. Animal, i, 19.) Our limits will not permit us to do justice to his theory of conception. It may be proper to state, however, that he holds the menses to proceed from a sanguineous superfluity (περίττωμα) in the system. This theory found a strenuous advocate in his great commentator Averrhoes (Collig. iii, 29); and Button’s views on this subject are very little different. Hippocrates, in like manner, taught that the male semen is a superfluity collected from all parts of the body, and fancied that if any part of the parent was maimed, the semen was defective, and gave rise to a similar defect in the child engendered. (De Aere et Aquis, 52.) Pythagoras called it the froth of the blood and the superfluity of the aliment. (Plutarch de Placitis Philos. v, 3.)

Dutens gives a learned account of the ancient theories on the generation of animals. Suffice it to say, that Empedocles, Hippocrates, Aristotle, and most of the philosophers taught that all animals derive their origin from ova; but that Democritus and a few others maintained that they are produced from spermatic animalcules. (Origine des Découvr.)

It appears to have been the popular belief in ancient times that the moon exercises a certain influence on the womb; and hence Homer refers the sudden deaths of women to Diana. See Eustathius (ad Iliad, xx, 59.)

We may allude in this place to the ancient belief in superfœtation. See Hippocrates (de Superfœt.) Asclepius, a commentator on this work, relates a singular case from his own personal knowledge. (T. ii, 470, ed. Dietz.) Aristotle relates several curious cases of superfœtation. (H. A. vii, 6.)

SECT. LXI.—ON RETENTION OF THE MENSES.

The menstrual evacuation is sometimes retained owing to a weakness of the whole body, and sometimes owing to a particular affection of the uterus itself, from local coldness, or a blow, or a congenital intemperament, or from some sustained injury, for the most part from abortions, or from a primary affection of some of the more important organs, such as the liver, belly, and chest, or from some such part labouring under a chronic affection. When suppressed, it becomes the cause of many and protracted complaints. If, therefore, the discharge be suppressed or delayed, owing to a primary affection of any of the internal parts, we must first direct our particular attention to the cure of the part originally affected, and afterwards think of the uterus. The symptoms of these we have already mentioned. When none of them therefore is present, it is clear that the uterus is the original seat of the complaint; and when neither the age, habit, nor any other thing prevents, we must have recourse to venesection, yet not before the regular period of menstruation, but ten days after it is past. The quantity to be taken must not be more than two pounds and a half, nor less than one; and whether we bleed or not, we must purge with the hiera of colocynth, giving it to the amount of two drachms, in six heminæ of honied water. But when fever is present, it is not expedient to purge with hiera, but it will be advisable to open a vein during the first days of the fever. After the purging, we must give recruiting things for a few days, and afterwards recommend exercise by walking, friction of the lower extremities, and the bath. The most proper food will be that which is of easy digestion and humid, such as all sweet pot-herbs, and fishes taken from among rocks, the more tender parts of fowls, milk, honied cakes, thin white wine not very old; flesh and pulse, except ptisan, are improper. When the accustomed period is at hand, give of sea-fishes the cartilaginous, and the mollusca, as they are called, and the testacea, and headed leeks (porrum capitatum), boiled with rue and pepper; and let the woman drink the decoction of them, and apply ligatures to the lower extremities for three or four days. When the expected period is at hand, the ligatures are to be removed, and she is to take beforehand fragrant draughts of myrrh, to the amount of an obolus, or the size of a bean; or of castor with must, or with honied water; or the decoction of mugwort; or of sage after the bath in must, and in that of wormwood. The wine of wormwood should be drunk as a propoma during the whole time of treatment. When the period has gone past, and no discharge, or at least none of any consequence has taken place, we must open a vein at the ankle, and abstract blood; but after the seventh or eighth day we must purge with hiera; and after the fourth day a calefacient plaster (dropax) is to be applied to the lower part of the belly, loins, and thighs. Having drunk water for three days, let a cataplasm, made of equal portions of mustard and soaked bread, be applied until the equinox, after which let the patient bathe. Next month, let dried figs instead of bread be mixed with the decoction of fenugreek, of mallows, of pennyroyal, of rue, and of mugwort. And let oil of lilies (susinum) or of marjoram be injected into the vagina; and let the pessary called Enneapharmacus, or the Olibanius be introduced. A pessary consists of carded wool, rounded to the shape of the finger, and impregnated with the medicines. This mode of treatment is generally sufficient for restoring the menstrual evacuation; but if stronger medicines are required, they are as follows: Illyrian iris drunk with wine and cyperus, the root of wakerobin, cassia, the schenanth, valerian, a decoction of the root of elicampane, myrrh to the size of a Grecian bean drunk with must in half a hemina of honied water, and two heminæ of the decoction of dittany, and ammoniac, and sagapene. To persons whose stomachs are less easily deranged, a small quantity of opopanax, made into a little ball, and steeped in boiled honey, may be given. Moreover, certain common seeds are calculated to promote the menstrual evacuation, but in an inferior degree, such as fennel, cumin, parsley, Cretan carrot, hartwort, bishop’s weed, sison, chick-peas, juniper-berries, and all the diuretics. But the following things are to be applied per vaginam: Myrrh triturated with the decoction of wormwood, or of lupines; or triturated with the juice of rue; bdellium, in like manner; storax, the gum of the wild olive, and that of the juice of rue, in like manner; or the long birthwort made into the form of a collyrium; and so also the root of the great centaury, or of hellebore, or of the juice of scammony, and the medullary part of the wild gourd by itself, and mugwort formed with rue and galbanum, applied in the form of a fumigation. These things are calculated also to expel the fœtus.

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COMMENTARY. One may find in Hippocrates a long list of medicines possessed of real or imaginary virtues as emmenagogues; such as cantharides, myrrh, peony, cumin, elaterium, squills, the fruit of juniper, seseli, thyme, St. John’s wort, rue, castor, elicampane, nettle, sage, &c. Of these some were given by the mouth, and others applied upon pessaries. He also recommends fumigations with aromatics. The pessaries were supposed to be likewise capable of producing abortion; but Hippocrates, in his Oath, forbids to give them to pregnant women. It appears from Juvenal that fœticide was a very common practice in his time (see Sat. vi); and various methods of performing it are described by Avicenna (iii, 21, 2), which we forbear to explain, lest our pages should be instrumental in increasing the frequency of this disgusting crime. It would seem that the ancient Lydians practised some Malthusian process to prevent conception. See Athen. (Deip. xii, 11, with the notes of Casaubon and Schweigh.) Aristotle says that, with this intention, some anointed the os uteri with oil of juniper, or with ceruse and frankincense mixed with oil. (H. A. vi, 3.) Aëtius makes mention of a mixture of alum, galbanum, with wine, &c. being used for this purpose. (xvi.)

Although Galen has treated very fully of this disease in different parts of his works, and has explained satisfactorily the nature of emmenagogues, we shall pass him by on the present occasion, in order to afford us more room for doing justice to the views of Aëtius, whose account of amenorrhœa we consider decidedly the best we ever met with. Aëtius says that barren and pregnant women, singers, and dancers do not menstruate, the menstrual superfluity in the latter being consumed by too much exercise. It is undoubtedly true, as he remarks, that those who take strong exercise have less discharge than women who lead an indolent life. Sometimes, too, he says, a fat or lean state of the body will occasion suppression of the menses, because fat persons have too little blood in their veins, it being consumed in forming the fat; and hence too they seldom conceive, or, if they do, their offspring is puny. In those, too, who are much emaciated, the necessary sanguineous superfluity is wanting. The menses may likewise be suppressed from disease, such as loss of blood, profuse perspirations, vomiting, purging, or cutaneous eruptions. Callosities, cicatrices, and other diseases of the uterus will likewise occasion suppression. His treatment is judiciously varied according to the cause of the complaint. Suppression, he says, brings on heaviness, torpor, pain of the loins, of the hindhead, of the root of the eyes, &c. When suppression arises from a hot temperament, it is to be treated with cooling and diluent food, such as ptisan, milk, lettuces, domestic kids and lambs, tender fishes and fowls, grapes, cucumbers, and a white watery wine. Baths of common water are to be used. When connected with a cold temperament, the patient is of a pale leaden colour, and her urine watery. She is to live upon food of a heating nature, with a generous fragrant wine, or the wine made with salt water, and must take active exercise. The suitable medicines are those of a calefacient nature, such as thyme, calamint, cassia, spikenard, or savin, taken in a white old wine. He also recommends myrrh, assafœtida, opopanax, castor, sage, rue, cumin, and the like, all of which are to be taken immediately after the bath; and when these do not succeed, he directs us to purge or give an emetic. Pessaries too may be used, but the more acrid substances, such as elaterium, cantharides, and white hellebore, must be rejected, as they are apt to occasion irritation and inflammation. Of his long list of prescriptions for pessaries, we shall merely notice the one consisting of turpentine, myrrh, honey, and saffron. When occasioned by fatness, the principal reliance is to be put upon an attenuant diet, but suitable fomentations and potions must not be neglected. Guarded purging with drastic cathartics, such as scammony or spurge, has often a good effect. Strong pessaries are likewise proper. When the suppression is connected with plethora, the patient experiences pains about the loins and lower part of the belly at the accustomed period, and a marked fulness of the veins is perceptible. It is to be cured by copious bleeding either from the arm or foot, by quietude, and the use of common fomentations. Restriction as to the bath and food must be enjoined. When connected with emaciation, the constitution is to be recruited by suitable exercise and regimen, not neglecting pessaries and potions. When occasioned by vitiated humours, such as bile or phlegm, the body is to be purged with the proper medicines, and the parts fomented. Fragrant articles are to be mixed with the food. The pessaries are to be made of elaterium, sow-bread, or the like, if bile prevails; but of anemone, pepper, or colocynth, if phlegm. When a bleeding at the nose is the cause of suppression, it is to be cured by sweating, vomiting, or other evacuations. But in this case, and when the suppression arises from barrenness or excessive labour, no marked inconvenience is felt, only conception cannot take place. When occasioned by an indolent course of life the proper remedies are suitable labour, exercise, gestation, a thin white wine, and living on attenuant and humid food. When the complaint is not connected with any of the causes or states above described, it is to be presumed that it is occasioned by some organic disease, which must be treated accordingly.

The same subject is well treated of by Avicenna, but we cannot afford room for even an outline of his account. Like our author, he approves of tight ligatures around the thighs, bleeding from the saphena; and among his emmenagogues we remark savin, musk, castor, and myrrh. All these occur also in Scrapion’s list. Haly Abbas recommends baths medicated with various stimulant articles, such as fennel, rue, chamomile, parsley, &c. He mentions pessaries and suppositories, or tents prepared with attenuant and stimulant medicines, such as myrrh, wild marjoram, rue, savin, hellebore, colocynth, wormwood, bulks gall, &c. He also speaks of fumigations with the vapours of aromatics, such as castor, olibanum, lignum aloes, &c. He approves of bleeding from the saphena, and of applying cupping-instruments to the thighs, especially when there is any determination to the nose. When connected with corpulence, he enjoins strong exercise, attenuant food, restricted diet, and purgatives. Alsaharavius treats fully of this complaint upon nearly the same plan as Aëtius. He says the stronger emmenagogues are wild mint, juniper, black hellebore, mastich, myrrh, colocynth, gentian, &c. To relieve the pains which sometimes precede menstruation, he recommends the tepid bath, moderate exercise, and attenuant food. Rhases recommends bleeding at the ankle, savin, purging with hiera, black hellebore, &c.; pessaries of the same, the hot bath, and stimulant friction.

Eros strongly recommends repeated bleeding at the ankle, the tepid bath, purgatives, diuretics, and emmenagogues, such as savin, calamint, myrrh, &c.

SECT. LXII.—ON IMMODERATE MENSTRUATION AND UTERINE HEMORRHAGE.

Immoderate discharges in women take place, sometimes from retention of the menses which break out more copious than usual, and sometimes after parturition at the full time, when they cease spontaneously for the most part; and frequently after miscarriages, when a violent hemorrhage often takes place, and proves dangerous. In the first place, then, we must apply ligatures round the members, at the armpits and groins; give to drink oxycrate not cold; sprinkle with oxycrate; and apply to the parts a large quantity of wool squeezed out of wine and oil, or rose-oil, or oil of apples, or myrtle-oil. For food, we may give chondrus soaked in oxycrate, or rice, or alica; but prohibiting wine, we may give austere hydromel, omphacomel, or the like. The patient may take propomata of pomegranate flowers in oxycrate, or the juice of hypocistis, or of acacia, or lycium, or Samian earth, or unripe grapes dried, or rhubarb, or the ashes of cork burnt in an Italian earthen vessel; or she may eat sesame soaked in oxycrate until it become soft. The following substances introduced into the vagina stop hemorrhage: The juice of hypocistis, or of acacia, with manna, being triturated with vinegar. An admirable application is a sponge soaked in wine or liquid pitch, and applied; or the ashes of it burnt when applied with vinegar or oxycrate; and in like manner the ashes of cork burnt in an Italian earthen vessel. But astringent epithemes applied externally are beneficial; and cataplasms from dates and quinces, containing also pomegranate rind, or the tops of bramble, or acorns of the holm oak, or the leaves of lentisk, wild pomegranate flowers, acacia, hypocistis, galls, or alum; but more particularly the following: Taurocolla is macerated in oxycrate until it is dissolved, and is then spread upon a strong rag, and glued to the loins. The agglutinative plasters are also powerful remedies, such as the Harmonium, Icesium, Athena, Melinum, Indicum, and the like. Pessaries are to be used for the hemorrhage; mixing the inner part of galls powdered and rosemary with water, apply; or the flowers of the cultivated pomegranate, or the sweet pomegranate in like manner, or powdered knotgrass. The following is a compound one: Of fissile alum, of the inner part of galls, of the juice of acacia, of manna, of each, dr. iv; the yelks of four roasted eggs; these powders are rubbed with the juice of plantain, and mixed. In using it a pessary of wool is impregnated with it, dipped into rose-oil, and applied. And dry-cupping by large instruments applied frequently under the nipples acts powerfully by revulsion. The following is a composition for a hip-bath, in which a person having hemorrhage may sit: Of the heads of sharp rush, of myrtle, of roses, of the leaves of rhamnus, of bramble tops, equal parts; boil in water, which let the patient use for a hip-bath.—Another: Of the bark of sweet pomegranate-root, of myrtle, of the rind of cypress, of each, p. iij; of galls, p. j; boil in a sufficient quantity of water. Inject with an uterine syringe the decoction of plantain, or of endive, or of knotgrass, or of nightshade, or of perdicium, or of fleawort, or of hypocistis, or of acacia; and let these things also be applied with wool, or by the finger, or a speculum, or a long-shaped feather, to the mouth of the uterus. And the trochisk of Andron, when injected by an uterine syringe, with some of the decoctions formerly mentioned, or with astringent wine, is an active remedy.

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COMMENTARY. Aëtius gives a very full account of these complaints, but nearly in the same terms as our author. He condemns the practice of applying sponges soaked in cold posca, because, he says, they prove injurious to the uterus by producing too much coldness. Galen remarks that pregnant women have sometimes discharges of blood from the veins of the os uteri. We can attest the correctness of this statement.

Oribasius and Actuarius treat these complaints like our author.

Octavius Horatianus directs us to subject the parts to the vapours of such astringent articles as pomegranate-rind, roses, and galls; or to apply to the parts a sponge soaked in posca, or wool squeezed out of some of the styptic juices. He also recommends us to produce revulsion by means of cupping-instruments applied to the breasts. He further directs us to apply to the parts epithemes of astringents, especially Theban dates boiled in wine or vinegar.

Moschion gives a very sensible account of uterine hemorrhages, for which he recommends perfect quietude and sponging with cold water and vinegar, or if that fail, with astringent decoctions, &c.

Soranus, in like manner, gives a very accurate detail of the symptoms and treatment of uterine hemorrhage.

Rhases recommends venesection (but does not point out the cases in which it is applicable); astringent trochisks containing the recrementum ferri; cupping-instruments applied to the breasts; stuffing the vagina with wool smeared in the mixture of frankincense, wild pomegranate-flowers, galls, antimony, acacia, and alum. He also recommends epithemes, and when these things do not succeed, pessaries made with escharotics. In uterine hemorrhage after delivery, he recommends cold astringent applications, and bandages to the extremities. Haly Abbas correctly remarks that uterine hemorrhage sometimes proceeds from plethora of the system, in which case he properly recommends bleeding. When connected with thinness of the blood, he recommends incrassant food. He also makes mention of the usual astringent applications consisting of galls, vinegar, and the like. Serapion and Alsaharavius lay down similar rules of practice. Avicenna, however, is the fullest of the Arabian authorities upon menorrhagia. Like Haly, he states that it sometimes proceeds from plethora, when he recommends us to produce revulsion by bleeding at the arm. When connected with debility, he prescribes astringents. When it proceeds from ulcers, he approves of a combination of agglutinative, astringent, and narcotic medicines. His general treatment during an attack is almost the same as that recommended by Paulus. He mentions acidulated water, vinegar, camphor, alum, galls, &c. Some of his prescriptions contain opium, which is an anticipation of the modern practice in such cases.

SECT. LXIII.—ON THE FEMALE FLUX.

This is a defluxion of the uterus, by which the whole body is purged. Wherefore that which is evacuated is of the same colour as the prevailing humour. It is red when from the ichorous part of the blood; white, from phlegm; pale, from bitter bile; and black from black bile; and sometimes it is watery. If the blood is discharged pure as in venesection, we must attend carefully, lest there be any erosion of the uterus. The flux is recognized by the following symptoms: The parts are moistened with fluids of various colours; the patient is pale; is not nourished; and loathes her food; and is affected with difficulty of breathing when she walks; her eyes are swelled; and the discharge sometimes is accompanied with pain, and sometimes without it; with ulceration or without it; and the ulceration is inflammatory, foul, or clean. Wherefore, when the affection is of a humid nature, we must endeavour to remedy the general system by administering such things as are desiccants, without being manifestly of a heating nature. The whole body is to be rubbed, and anointed with honey properly boiled, and we must give diuretic medicines, such as water in which asarabacca and parsley have been boiled, and evacuate the whole body by the bowels. In addition to these, purslain when eaten, and the juice of it when drunk, are beneficial. Also the flowers of the wild pomegranate, the fruit and flowers of bramble, that part of an oak which is under the membranous part of the trunk, and that which is below the peel of the acorn. Horse-tail in particular stops a red discharge, when drunk with water or wine; or hypocistis; the fruit of lentisk sodden with wine and drunk; Samian aster, Lemnian earth, the rennet of a hare, or of a kid, or of a lamb, or of a calf, or of a stag; grape-stones triturated, myrtles, dried unripe grapes, the bark of the pine, and those things recommended for uterine hemorrhage, unless the most drastic. When the flux is attended with pain, we must inject with an uterine syringe, or clyster instrument, the juice of alica, or of ptisan, or of tragus, or of rice, with some of the anodyne medicines. And during the exacerbations we must soothe; but during the remissions (for it has its periods) we must try to alter the system by different kinds of gestation, walking, vociferation, anointing, cupping, dropaces to the parts above, insolation, friction, depilatories, detergent ointments, sinapisms, emetics from radishes, a restorative regimen, baths, wine, and variety of food.

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COMMENTARY. By the term female flux, Ruffus describes the complaint now called the whites; but our author applies it to any vitiated state of the menstrual discharge.

Hippocrates has given a very good description of the symptoms which sometimes attend leucorrhœa, namely, swelling of the face, paleness of the countenance, enlargement of the belly, anasarca of the limbs which pit upon pressure, short breathing, debility, and so forth. He admits the difficulty of curing such complaints, but directs it to be attempted with diuretics, epithemes, masticatories, a desiccative diet, and exercise. He details many interesting histories of the complaint.

The account which Aretæus gives is nearly the same as our author’s. It is sometimes, he says, attended with a white discharge, and sometimes with a red, of which there are several varieties. It occurs at irregular periods, and in some instances when it continues long it will prove fatal by hemorrhage. The symptoms are various according to the nature of the discharge. His chapter on the treatment is lost.

Aëtius has treated of the red flux and of the white separately. When the discharge is red, he begins with venesection, and then applies to the parts sponges soaked in astringent decoctions, the preparation of which he has described at great length. When the discharge is white, he recommends gestation, vociferation, walking, friction, and applications which are both astringent and detergent. Galen correctly remarks that women of a loose phlegmatic habit of body are most subject to the whites.

Oribasius and Nonnus are little different from our author.

Octavius Horatianus approves of an astringent and desiccative regimen. His advice is to produce vomiting frequently with radishes, to use exercise gradually increased, to change the air frequently, and to apply depilatories, calefacient plasters, and sinapisms to the part. If the discharge is copious, and attended with pain, he advises bleeding.

Eros recommends fumigations with the vapours of various herbs, after which calefacient oils are to be applied upon wool to the part.

The works of the Arabians contain nothing remarkable on this head. Haly Abbas recommends venesection when the discharge is bloody; but, if it consist of other humours, he directs us to administer medicines which promote their discharge; and also to use astringent and stimulant pessaries. Alsaharavius recommends the same medicines, and likewise in particular the warm bath.

SECT. LXIV.—ON INFLAMMATION OF THE UTERUS, AND CHANGE OF ITS POSITION.

Inflammation of the uterus takes place from several causes; for it may arise from an injury, from retention of the menses, from cold and inflation, not unfrequently from abortions, and from parturition after a misconception. Inflammation of the uterus is accompanied with acute fever; pain of the head and tendons, of the balls of the eyes, of the wrists and of the fingers; retraction of the neck, and retroversion; sympathy of the stomach; and the mouth of the womb is shut up; the pulse small and dense. If the inflammation be weak, they have not violent pain in the uterus; but if it be strong, the pain is of the pulsatory kind, which, when the whole of the uterus is affected, darts through the whole of it, but when the inflammation is confined to a spot, the pain indicates the seat of it. When, therefore, the posterior parts only are inflamed, the pain is in the loins, and hardened lumps of fæces are confined by the compression of the rectum; but when the anterior parts are affected the pain is seated at the pubes, and there is strangury or dysuria from pressure on the bladder. When the sides are inflamed, there is tightness of the groins and heaviness of the limbs; but when the fundus is affected the pain is principally near the navel, with swelling thereof; and when the inflammation is in its mouth there is pain in the hypogastrium, and if the finger be introduced per vaginam, the mouth of the womb will feel hard and unyielding. As to the treatment we must, in the first place, use embrocations of wine and oil, or of wine and rose-oil to the pubes and loins, by means of folds of clean wool without a bandage; and abstinence from food is to be persevered in for three days, after which we are to let blood from the arm, if nothing contraindicate. The patient is to be supported with chondrus out of honied water, bread, or soft eggs, every alternate day. But after the fifth day we are to apply a cataplasm made of fine flour, linseed, or fenugreek, with honied water, in which the heads of poppy have been boiled and thrown away, and oil along with them. But if the inflammation be of an erysipelatous nature, and cannot endure heat, boil melilot in must, and having pounded, add the yelks of roasted eggs, with rose-oil, oil of apples, or of saffron, and apply as a cataplasm; or having boiled dates in diluted wine, pound with fine polenta, and some of the afore-mentioned ointments, and apply as a cataplasm; and when the complaint is on the decline add the cerate of nard or of privet. Throughout the whole treatment the patient must sit in hip-baths prepared from the decoction of fenugreek, linseed, mallows, mugwort, and oil; and those who cannot bear these heating things must use rose-oil dissolved in hot water. Recourse must be had to pessaries, and injections prepared from the sordes of unwashed wool and butter, stag’s marrow, the grease of geese, the ointment called Susinum, and Tuscan wax. When the patients can endure heating things, the pessary called the Golden will suit with them, and the Enneapharmacus; but when they cannot endure heating things, the pessaries are to be prepared from eggs, rose-oil, the fat of geese, or of domestic fowls. For inflammations attended with a greater degree of heat, melt diachylon-plaster in a double vessel with rose-oil, and add the juice of plantain, or of endive, of succory, or of intybus. Or use the following: Of the fresh fat of geese, or of swine, dr. iv; of the cerate of roses, or of the Susinum, oz. ij; of the yelks of roasted eggs, oz. j; of saffron, dr. j; of myrrh, three oboli; of opium, two oboli; or, instead of opium, the decoction of poppy-heads. When the pain is great, give poppy-juice (opium) to the size of a lentil, with woman’s milk, or the juice of fenugreek, as an application per vaginam. For inflammation with hardness, dissolve the ointment called Tetrapharmacum in rose-oil, and introduce or inject. And when there is derangement of the position of the uterus, it is to be treated like inflammation during the violence of the attack; but, during the remissions or decline, emollients are to be applied; and when the complaint is protracted, alteratives (metasyncritica) are to be used. But if there is hardness externally, we must have recourse to malagmata; that from melilots, that of Muasræus, the Icesian, that from apples invented by Serapion, and that from wheat. The diet at first should be light; but when the complaint begins to decline the patient may use the bath, and take a more varied and generous diet.

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COMMENTARY. Aëtius has given from Philumenus a very circumstantial account of the symptoms and treatment of inflammation of the uterus; but, upon the whole, it is little different from our author’s. He also gives, from Aspasia, a fuller account of displacement of the uterus. Without doubt he alludes to retroversion and anteversion of the uterus, as they are called in modern works on midwifery. These cases generally occur in the first months of pregnancy, but there are instances of their happening in the unimpregnated state. (See Burns’ Midwifery, i, 19.) The symptoms, as described by Aëtius, are sufficiently well marked; retention of the fæces, owing to the rectum being obstructed by a tumour; pains in the region of the pubes, and sometimes retention of urine. He directs us to draw off the water by means of a catheter, and to bleed, give emmenagogues, and apply pessaries according to circumstances. Avicenna and Haly Abbas make mention of displacement of the womb, but they appear to have derived all their information from Aëtius.

We shall give a brief outline of Serapion’s treatment in cases of uterine inflammation. He properly begins with bleeding first from the arm, and afterwards at the ankle. He then gives a laxative medicine, and applies a plaster to the region of the uterus. When the complaint is at its acme, he directs us to use fomentations prepared by adding sedatives to such medicines as pomegranate-rind, endive, fleawort, fenugreek, chamomile and dill. When the inflammation does not abate, he directs us to encourage suppuration by the combination of maturative with calefacient medicines, such as a plaster containing fenugreek, barley-flour, figs, pigeon’s dung, &c. Haly’s plan of treatment is little different: General bleeding according to circumstances; cooling draughts composed of purslain, violets, spinage, &c.; plasters of violets, camphor, &c.; hot baths prepared with melilot, mallows, linseed, &c. When there is heat in the parts, he directs us to introduce oil of roses, with the whites of eggs, the grease of hens, &c. to which opium may be added. When the pain is violent, he particularly recommends cooling injections. Alsaharavius recommends bleeding from the arm and at the ankle, diluent and cooling draughts, local applications containing opium, seed of fenugreek, plantain, house-leek, &c. and the tepid bath.

Rhases says that when the womb is displaced, there is vehement pain with distension of the parts; the woman cannot rise nor sit but with difficulty; the urine is retained and sometimes the fæces. He directs us to restore the uterus to its position by drawing its mouth in the opposite direction. Displacement of the womb is also briefly noticed by Hippocrates (de Morb. Mulier. i); by Dioscorides (Meth. Med. i, 37); and by Soranus (Ap. Phys. et Med. Min. ed. Ideler, 256.)

Many of the ancient authorities describe the uterus as consisting of two cavities, separated from one another by a membrane. See, in particular, Theophilus (Comm. in Hipp. Aph. ii, 469, ed. Dietz.) Galen, however, would appear to have been better informed (t. v, 789, ed. Kühn.) The uterus, moreover, is correctly described by Soranus (Ap. Phys. et Med. Min. 256), and by Moschion. (vi.)

SECT. LXV.—ON ABSCESS OF THE UTERUS.

When the inflammation is converted into abscess, all the symptoms formerly mentioned become more intense; and, besides, there are irregular attacks accompanied with rigor, which at first are attended with intense pain; but when suppuration has fairly taken place, there is some remission of it. About the time of the abscess’ bursting, the pains, however, become more keen and seem to attack in a pungent manner; the fevers formerly slight become more oppressive; sometimes there is obstruction of the urine, and sometimes of the fæces, occasioned by the pressure of the affected part of the uterus. Sometimes there is swelling in the region of the pubes, and a sense as it were of fluctuation, when the abscess is large. Abscess in the more exposed parts is discovered by means of the surgical instrument called dioptra, or the touch of the finger, and from the pains being more violent, owing to the nervous nature of the mouth; as when the collection is in the fundus and vagina it is attended with less pain, and no swelling is felt heavy upon the finger, and the mouth of the womb appears less tumid. Wherefore we must promote suppuration by cataplasms of fenugreek, linseed, barley, or wheaten flour intermixed with boiled figs, and sometimes with pigeons’ dung. Let the patient often use the hip-baths recommended for inflammation, and pessaries of turpentine, myrrh, grease of wool and butter. When the abscess bursts, if the matter pass to the bladder, we must give milk to drink, and draughts from the seeds of cucumber; but if it is discharged into the rectum we must throw up injections of lentils and pomegranate-rind. But if it burst into the womb, provided the pus be pure, we may inject rose-oil, or whitened oil, or the ointment composed of four ingredients, which is called basilicon, or fresh butter; but if a thin fetid ichor is discharged, as from a spreading ulcer, we must use an astringent injection of myrtles, dates, and dried lentils; and after the discharge of the humours, if there he inflammation, we must persevere with the cataplasms and hip-baths. When the aposteme is seated about the mouth of the uterus, and does not burst, after the parts which cover the pus have become thin, we must endeavour to procure the evacuation of the pus by a surgical operation, as will be explained in the Surgical part of the Work.

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COMMENTARY. Our author abridges the account given by Aëtius, but has omitted some things of importance. Aëtius directs us, when the abscess is forming, to apply fomentations by introducing a piece of sponge into the vagina, and to steam the uterus by means of a tube calculated to convey the fumes to it. When the pain is violent, poppy-heads are to be added to the cataplasms. The poppy is an ingredient in several of the cataplasms mentioned by Serapion. Avicenna’s treatment is perfectly similar. Oribasius remarks that an abscess may burst by the os uteri, the bladder, or into the rectum. When it makes its way into the rectum, Haly Abbas prescribes clysters composed of such articles as lentils, pomegranate-flowers, Armenian earth, rose-oil, ceruse, dragon’s blood, gum arabic, the yelk of an egg, and vinegar. His general treatment consists of pessaries, plasters, injections into the vagina, and clysters of various cooling and emollient articles.

SECT. LXVI.—ON ULCERATION OF THE WOMB.

The uterus is often ulcerated from difficult labour, extraction of the fœtus, or forced abortion, or injury of the same occasioned by acrid medicines, or by a defluxion, or from abscesses which have burst. If, therefore, the ulceration be within reach, it is detected by the dioptra, but if deep-seated, by the discharges; for the fluid which is discharged varies in its qualities. When the ulcer is inflamed, the discharge is small, bloody, or feculent, with great pain; but when the ulcer is foul, the discharge is in greater quantity, and ichorous, with less pain. When the ulcer is spreading, the discharge is fetid, black, attended with great pains, and other symptoms of inflammation; irritation is produced by relaxing medicines, and relief by the opposite class. When the ulcer is clean, the fluid is small in quantity, consistent, without smell, thick, white, with an agreeable sensation. When the ulcer is inflamed, we must use those things recommended for inflammations. When it is foul, we must inject the juice of ptisan with honey, or basilicon ointment with the oil called Susinum; or honied water, having fenugreek, mallows, bran, or lentil without its husk, boiled in it; and in order to clean it the more, horehound or vetches may be added; or mixing with honey the flour of vetches, or iris, or round alum, or the like, we may inject them; and externally we may apply cataplasms of the same things mixed with honied water. And this medicine is particularly applicable: The finest saffron is triturated with a woman’s milk, and being added to rose-cerate with the grease of a goose, is rubbed upon flocks of wool. But the following is a more effectual application, and one proper for violent pains: Poppy-heads are mixed in diluted must for three days, and then boiled until they become soft; then rose-leaves, dr. v, and saffron, dr. iij, are pounded together, and the decoction of the poppy-heads mixed with them; then wax, dr. ij, melted with rose-oil, are poured on them, and applied on a pessary, anointing with rose-oil. The same good effects may be derived from the preparation of eggs, saffron, rose-oil, the grease of a goose, and stag’s marrow. And the Egyptian ointment without the verdigris answers admirably for the cure of ulceration. When the ulcer is spreading and attended with inflammation, we must apply a cataplasm of warm bread mixed with hydromel, oil, marshmallows, fenugreek, and fatty dates. We must inject also the juice of plantain, of nightshade, of knotgrass, and of endive, first by themselves, but afterwards with austere wine or vinegar. When the ulcer spreads and is without inflammation, we may inject more tonic remedies, such as the decoction of pomegranate-rind, of roses, of olive shoots, of cypresses, of quinces, of bramble, of myrtles, of lentisk, of buckthorn, of sumach, in astringent wine, and afterwards with alum, acacia, lycium, and hypocistis. A hip-bath is also to be prepared from these decoctions. When these things do not succeed, we must use an injection, at first of paper with oxycrate, and then of vinegar, or of the powder called anthera, or of chalcitis, or of copperas, in the same liquids; or of the remedies for dysentery. We must allow wholesome food in small quantities. When the ulcer has become clean, we must bathe more frequently, administer food freely, and give wine, so that the body may soon recover its flesh. In place of a pessary, we may inject the preparation from mulberries, mixed with calamine, Cretan cistus, or plumbago. Externally we may apply the epulotic plaster to the abdomen and loins; for the powers of cataplasms, as well as those of plasters, may be thus communicated by the insensible pores of the skin.

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COMMENTARY. Our author has described the treatment of ulcers in the womb so fully and judiciously, that little of importance can be added to it. It is mostly compiled from Aëtius, who, in his turn, professes to have copied from Archigenes, Aspasia, and Asclepiades.

Aretæus says that of ulcers in the womb some are broad, attended with pruritus and a discharge of thick matter without fetor. These are not dangerous. But when the discharge is thin, ichorous, and fetid, when the lips of the sore are callous, and when it spreads like a phagedenic ulcer, it is of a malignant kind. His chapter on the treatment is lost.

Unfortunately there is also a hiatus in the text of Celsus, which detracts from the value of his account.

Octavius Horatianus recommends a potent remedy for putrid ulcers of the uterus which supervene upon wounds. It is a trochisk formed of arsenic, quicklime, sandarach, burnt paper, and the like. Although the case recently reported of the man who killed his wife, by introducing into her vagina the oxyd of arsenic, ought to teach us caution, we can certainly conceive that such an application, if properly managed, might prove safe and effectual. It ought also to be kept in mind that the orpiment of the ancients was less virulent than the arsenic of the moderns.

Scarcely any additional information is to be learned from the Arabians. The following application recommended by Avicenna seems to be a judicious one: Take equal parts of litharge, ceruse, and sarcocolla; make a cerate with wax and rose-oil. When the ulcers are attended with a bloody discharge, Haly Abbas directs us to use pessaries and injections of an astringent nature, consisting of galls, hypocistis, plantain, rose-oil, and the like. When the discharge is whitish and purulent, he recommends the tepid bath and injections of barley-gruel, honey, &c. For relieving the pain he recommends an ointment containing litharge, frankincense, axunge, fresh butter, strained wax, and rose-oil. Alsaharavius recommends similar remedies.

SECT. LXVII.—ON CANCER.

Of cancers in the womb, some are attended with ulceration, and some are without it. In those cases in which the part is not ulcerated, a tumour is found about the mouth of the womb, hard, unequal, callous, of a feculent colour, and red, but sometimes also somewhat livid; and they have violent pains in the groins and abdomen, the lower part of the belly, and the loins, which are exasperated by handling and complicated applications. When the cancer is ulcerated, in addition to the pains, hardness, and swelling there are phagedenic and unequal ulcers to be seen, which for the most part are foul, callous, white, and having ugly scabs on them; but some appear clean, some feculent, or livid, or red, or bloody. The discharge from them always is a thin ichor, watery, black, or tawny, and fetid; but blood also is sometimes discharged along with the other symptoms of an inflamed uterus already mentioned. Wherefore the complaint is incurable, as Hippocrates has pronounced, but may be alleviated by hip-baths from fenugreek, and mallows, and by cataplasms of a like nature. And the exacerbations of the complaint may be much alleviated by common mallows, or marshmallows, softened by boiling in honied water, and pounded with a little rose-oil, and applied; and by a cataplasm of dried figs and melilots, rue, frankincense, and navew bruised carefully with oil, and also by that from dates boiled in must, containing also the yelks of eggs, and fine flour; or that from poppies with coriander, knotgrass, or endive. These things are to be applied during the violence of the pains; after which a cerate may be applied from rose-oil, or myrtle-oil, or the oil from the flowers of wild vines, or that of apples with dates boiled in must. But one particularly recommended is that from the sediment found in copper vessels, which being burnt, is reduced to a powder, and mixed with the cerate of roses until it acquire the consistence of a plaster. These are the external applications. But oil applied internally is soothing to the parts. And when they become ulcerated, the milk of a woman may be injected, and the tepid juice of plantain. But if they bleed, the infusion of knotgrass with a little rosemary proves soothing; and so also do pessaries medicated with saffron, women’s milk, and the juice of poppies, and the sordes of unwashed wool. But the following is one of the best applications, and answers also for affections of the anus: Of washed Italian litharge, oz. vj; of male frankincense, of the sordes of unwashed wool, of fresh axunge, of newly-made butter, of Tuscan wax, of each, oz. ij; of rose-oil, oz. iv; triturate the litharge with the juice of endive, and add to the other things when melted. Food of easy distribution and wholesome may be given, and some watery wine; avoiding acrid food and repletion, for they are apt to be troubled with indigestion.

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COMMENTARY. Hippocrates (de Morb. Mulier. ii, 24) gives a long account of cancer of the womb, which, when fairly formed, he pronounces to be utterly incurable. He directs us, however, to try the effect of fumigating the womb by introducing into it a pipe attached to a pot. Steams from garlic and the fat of seals are to be applied in this manner.

Aëtius gives from Archigenes exactly the same account as our author.

Aretæus describes the ulcerated cancer, and that kind in which there is no ulceration. He calls them chronic and fatal diseases.

Haly Abbas pronounces the disease to be incurable, but directs us to soothe the sufferings of the patient by various anodyne preparations. For this purpose he gives directions for the formation of several pessaries and injections, the principal ingredients of which are linseed, chamomile, fenugreek, coriander, beet, poppies, and the like. Alsaharavius also approves of such anodyne applications. Rhases enjoins abstinence from everything of an acrid nature, and such articles as engender black bile.

We will see the treatment of cancers in general detailed in the Fourth Book.

SECT. LXVIII.—ON SCIRRHUS AND SCLEROMA.

The uterus becomes scirrhous, sometimes all at once without any preceding complaint, but most frequently after having been preceded by inflammation, which has neither been resolved nor converted into an abscess. The disease called scleroma is a species of scirrhus, most frequently forming about the neck of the womb, and having also some swelling, but less resisting, and attended with moderate pain. These are accompanied with displacement to the opposite parts, swelling powerfully resisting in proportion to the pain, with heaviness and difficulty of motion, not of the limbs only but of the whole body, and aversion to exertions. When not properly cured, a dropsical cachexia supervenes. In the commencement we must have recourse to venesection, or purging with the hiera of Archigenes; then to cataplasms of dried figs, grease of wool, nitre, or wormwood, and cupping with scarifications; and to the soothing ointments (malagmata), namely the Polyarchium, that from seeds, and that from bay-berries; to hip-baths prepared with the decoction of dried figs, mugwort, pennyroyal, and marshmallows; to pessaries of turpentine, galbanum, myrrh, iris, and the grease of wool; to dropaces and the use of the natural baths, namely, the nitrous and bituminous. When the strength permits, a course of hellebore may also be tried.

An emollient pessary. Of Pontic wax, of nard ointment, of each, oz. iij; of the ointments of iris, that of privet, and that called Gleucinum, of each, oz. ij; of the grease of bears and geese, of butter, of the sordes of unwashed wool, of stags’ marrow, of turpentine, of each, oz. j.—Another: Of poley, dr. ij; of myrrh, dr. iv; having triturated with Mindesian wine, and mixed it with Irinum, give to be applied.—Another: Of Tuscan wax, of the fat of calves, of turpentine, of stags’ marrow, of Attic honey, of old oil, equal parts. The following is an alterative which answers also for inflation: Of the dried white grape without its stones, oz. iij; of the leaves of the green rue, oz. ij; of sea water, oz. iss; of cumin, dr. iv; of honey, q. s.; having anointed the pessary, dip it in the oil of privet, and apply. And the pessary called golden, the Libanian, and the Enneapharmacus suit well with this affection; but the Titian is more particularly applicable.

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COMMENTARY. Our author’s account of these diseases is taken from Aëtius, who professes to copy from Soranus the Methodist. None of the other authorities has treated of them so fully. Bernard justly remarks (ap. Nonni Ep. 208) that if the ancients had not been familiar with inspectiones cadaverum, they could not have described the diseases of particular parts of the uterus so accurately as they have done. Actuarius briefly states that scirrhus of the uterus is to be treated by applications of a digestive and emollient nature, namely, emollient oils and fats, mixed with such things as galbanum, bdellium, and the like.

Of the Arabians, Avicenna is the most minute, but his treatment is borrowed from the Greeks. Haly Abbas remarks that scirrhus has a tendency to terminate in dropsy, and it is attended with sallowness, weakness, loss of appetite, amenorrhœa, swelling of the breasts and belly. His remedies are similar to those for cancer.

See an interesting account of this disease by Lodovicus Mercatus (ap. Gynæcia, 951.)

SECT. LXIX.—ON THE MOLE.

The mole, too, is a scirrhous tumour, forming sometimes at the mouth and sometimes in the body of the womb, conveying to the touch the sensation of stone, and being attended with retraction of the parts above, and emaciation, paleness, loss of appetite, retention of the menses, and swelling of the breasts, so as in certain cases to raise suspicions at first of a conception; but in process of time the true nature of the complaint is developed. Sometimes also it raises suspicions of dropsy, from which it is to be distinguished by the hardness of the swelling, and from there being no sound of water when tapped by the fingers, as is the case in dropsy. In certain cases, however, the disease actually terminates in dropsy, which for the most part proves incurable. In some cases, it also brings on a discharge of blood. In general, therefore, it is proper that the patients should lie in a small, dark, and moderately cool house, upon a firm couch, with their feet raised, and in a state of quietude; for motion provokes discharges of every kind. And the swelling and hardness are to be cured by the remedies which we have mentioned for scirrhus and scleroma of the uterus; dropsical effusions by those recommended for dropsy; and hemorrhages by those for the flux. Some call by the name of mole an unorganized mass of flesh which forms on the coats of the womb, and is delivered like the fœtus. This species is to be managed by a relaxing treatment, so as to be speedily discharged.

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COMMENTARY. By the first species of mole, fibrous tumour of the ovaria and perhaps also scirrhus of the neck of the womb are meant to be described. The other species is now well understood, and is described by many ancient authors. See an account of it at the end of Aristotle’s ‘History of Animals;’ also Pliny (H. N. vii, 15, and x, 64); Hippocrates (de Steril. xx); Plutarch (t. i, 252, ed. Xylander); Nonnus (212); Rhases (ad Mansor. ix, 88; Cont. xxii); Moschion (de Morb. Mul. 125); Actuarius (Meth. Med. i, 56.) Galen and Avicenna agree in representing the true mole as a corruption of the male semen, and consequently they believed that it never occurs in virgins. Hanneman and other modern authorities maintain the contrary. See ‘Dissertations on the Mole’ by Van Swieten (Comment. 1326), by Ambrose Paré (de Hom. Genit. xxxiii), by Martinus Akakia (ap. Gynæc. 773), by Lodovicus Mercatus (ap. Gynæc. 1013), by Leonardus Jacchinus (Comment. in Rhasis, ix, 71), and by Ruysch (Anat. Chirurg. Cent.)

Aëtius gives an account of the former species, but it is little different from our author’s. He recommends, in the first place, emollient applications of all kinds, namely, baths, pessaries, and fumigations, and afterwards dropaces, sinapisms, and the like. The same plan of treatment is pursued by Avicenna. Haly Abbas and Alsaharavius describe the two species of mole in exactly the same terms as our author. Rhases also describes the two species of mole, namely, the one which is hard and round, and the other or soft species to which the name is now generally restricted.

Hippocrates relates a curious case of a calculus which was discharged from the uterus of a woman sixty years old, who had long felt pain in that region dum venere uteretur. Aëtius also makes mention of the uterine calculus. Lodovicus Mercatus gives a curious account of this subject (Gynæc. 969.) Michaelis Angelus Morus relates a singular case of a woman who died of uterine calculi. (Mangeti Bibl. Chirurg. xviii.)

SECT. LXX.—ON INFLATION OF THE UTERUS.

The uterus becomes distended with air from cold, from abortion, or difficult parturition: its mouth being shut up, or a clot of blood being fastened in it. The air is sometimes contained in the cavity of the uterus itself, and sometimes in the pores of its body. These cases are attended with swelling about the pubes and hypogastrium, with hardness, and a pungent pain, shooting as far as the diaphragm, the stomach, and the groins. When tapped with the fingers it sounds like the swelling of tympanitis. Wherefore it is to be cured, in the first place, by venesection, if nothing prohibits its use; and then, during the exacerbations, by abstinence from food; by embrocations with oil of rue; by hip-baths of the decoction of rue, of pennyroyal, of mugwort, of cassia, and the like; by cataplasms from the seeds of parsley, of cumin, of fennel, of anise, of bishopsweed, and of the flower of iris; by dry cupping, and cupping with scarifications. But when the complaint is protracted, we must have recourse to purging with the hiera picra, dropaces, sinapisms, and the use of the natural baths. Let the midwife introduce her finger well oiled, and extract gently, if possible, the thrombus lying in the womb, by breaking it down, and then apply a cataplasm of figs, of nitre, and of wormwood. Emollient epithemes should be used, such as the Polyarchian, that from seeds, and that from bay-berries. The pessaries should consist of rue, honey, and nitre; but the following one will be particularly applicable: Of fat figs pounded, dr. j; of cumin, dr. ij; of aphronitrum, dr. j. But, owing to its acrimony, let it be previously dipped in milk. Emollient pessaries are also proper.

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COMMENTARY. This complaint is mentioned by Hippocrates (Epidem. vii), and by Galen (Meth. Med. xiv, 7, and de Causis Sympt. iii, 2.) Our author’s account of it is taken from Aëtius. Octavius Horatianus and Nonnus direct similar applications, only the former says nothing of bleeding. Haly Abbas, in like manner, omits venesection, but recommends applications consisting mostly of carminative substances, such as parsley, birthwort, dill, rue, and fennel. They are to be used in the form of baths, fomentations, and injections. Alsaharavius recommends bleeding, anointing the womb with oil of rue, baths prepared with rue, chamomile, mace, cumin, &c. cupping-instruments applied to the pubes, and so forth. Avicenna and Rhases refer to Aëtius and Paulus, and treat of the complaint in like manner.

See a full account of this disease by Lodovicus Mercatus (ap. Gynæc. 944.)

SECT. LXXI.—ON UTERINE SUFFOCATION, OR THE HYSTERICAL CONVULSION.

Uterine suffocation is a rising up of the uterus, affecting sympathetically the most important parts, as the carotid arteries, the heart, and the membranes of the brain. The patients experience, when the attack is at hand, languor of mind, fear, atony of the limbs, paleness of the countenance, and sadness of the eyes; and when the suffocation comes on there is deep sleep, mental aberration, loss of the senses and of speech, with contraction of the limbs; the cheeks then begin to redden, and the countenance becomes turgid; but when the attack is going off, some moisture is to be felt about the genital organs; and rumbling of wind in the intestines precedes the remission. The uterus is then gradually relaxed, and thus they recover their understanding and senses. The disease comes on periodically like epilepsy, and is occasioned by the uterus being gorged, or from semen or some other matter having become putrid in it. Of those attacked with it the greater number speedily recover, but some die suddenly during the paroxysms, their pulse becoming dense and palpitating irregularly, and then asphyxia taking place; a little perspiration bedewing the surface of the body; and the respiration being at first feeble but afterwards becoming completely stopped. This affection attacks most frequently in winter and autumn, especially young women who are prone to venery, the barren particularly, if their sterility be brought on by medicines, and others of a cold nature. During the paroxysms, therefore, ligatures are to be applied around the extremities, and the limbs and whole body rubbed as for the recovery of persons in deliquium animi. Things of a strongly fetid smell are to be applied to the nose, such as an extinguished lamp, castor, liquid pitch, gum vernix, burnt wool and rags. Some have even brought close to the nose a chamber-pot containing stale urine or fæces. It answers well to apply a cupping-instrument to the groins and hypogastrium, with great heat, either performing dry cupping or cupping with scarifications. When the complaint is protracted, carminatives will prove useful, such as collyria introduced into the anus, or cumin and nitre with honey. Hardened fæces may also be discharged from the bowels by means of clysters, lest by their presence they occasion pressure; and, in order to draw back the uterus to its situation, fragrant ointments are to be injected into the parts, such as those of marjoram and Indian leaf. Mustard may be applied to the nose and likewise to the feet, in the form of a cataplasm. One should call aloud to them in a shrill tone of voice, and rouse them thereby; and sternutatories of castor, fuller’s herb, and pepper may be applied. When the paroxysm remits we may compel them to vomit, and keep them from food altogether or allow them but little. After the seventh day we must purge them with the hiera from colocynth. After the third, we must apply cupping-instruments to the loins and flanks, and then we may give a draught of castor, sometimes in a decoction of mugwort and sometimes in honied water; for in some cases this alone is sufficient for a complete cure. But hip-baths and emollient pessaries are also to be applied. Such is the treatment for the paroxysms; but for the recovery of the general system, we begin with venesection and proceed to purging with hiera, and then give the medicine called picra from aloes to the amount of dr. j, with three cupfuls of honied water in succession, or dr. ij with six cupfuls at intervals. Dropaces, cupping, and sinapisms must also be used, and the acopa from euphorbium; then exercises, friction, vociferation, and, last of all, the use of the natural baths.

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COMMENTARY. See Hippocrates (de Nat. Muliebri); Galen (sec. loc. ix, de Loc. Affect. vi, 5); Aretæus (Morb. Acut. ii, 11); Celsus (iv, 20); Moschion (de Morb. Mul. 129); Eros (ap. Gynæcia); Aëtius (xvi, 78); Oribasius (Synops. ix, 47); Leo (vi, 20); Actuarius (Meth. Med. iv, 8); Nonnus (210); Alexander Aphrodisiensis (Probl. ii, 64); Serapion (v, 27); Avicenna (iii, 20, iv, 16); Haly Abbas (Pract. viii, 12; Theor. ix, 39); Alsaharavius (xxv, 2, 12); Rhases (ad Mansor. ix, 87, and Contin. xxii.)

From the days of Hippocrates to those of Actuarius, and long afterwards, the hysterical convulsion was accounted for in the manner explained by our author. It accords not well with modern ideas upon the subject; and provided it be admitted as a fact that men are sometimes, though rarely, seized with hysterical convulsions, there can be no doubt but the ancient hypothesis must at once fall to the ground. Perhaps a stickler for the ancient doctrine, while he admitted with Aretæus that men are subject to complaints resembling hysterics, might hold with a late intelligent writer, Mr. Tait, that men are never affected with the real hysterical convulsion.

According to Hippocrates, this complaint most frequently attacks antiquated virgins or young widows. If the womb, he says, ascend to the liver, the patient suddenly becomes speechless, her teeth are fixed, and her colour becomes pale. His treatment consists of applying a tight swath round the middle, giving fragrant wine, applying fetid things to the nose, and fragrant things to the uterus. The belly is to be purged, and castor and fleawort given internally. Herodotus, the historian, mentions that the ancient Scythians used castor for the cure of complaints of the uterus. (iv.)

Galen is at great pains to explain how the uterus is retracted upwards and to the sides by its ligaments, but his explanation is too long for our limits, and therefore we must content ourselves with referring the curious reader to it. (De Loc. Affect. u. s.) He says, in another place, that when uterine suffocation takes place, there is loss of sense and of motion, a small feeble pulse, and sometimes asphyxy. He recommends agaric and plantain in wine; smelling to bitumen, castor, liquid pitch, cedar rosin, &c.; fumigating the parts with hartshorn, and applying to them rue and honey upon wool.

Celsus thus marks the distinction between the epileptic and hysterical convulsion: “Interdum etiam sic exanimat ut tanquam comitiali morbo prosternat. Distat tamen hic casus, eo quod neque oculi vertuntur, nec spumæ profluunt, nec nervi distenduntur; sopor tantum est.” If the strength permit, he approves of venesection, or of cupping the groins without scarifications; then fetid things are to be applied to the nose, and fragrant things to the uterus, the whole body is to be rubbed, sinapisms are to be put to the lower part of the belly, and castor, gith, and dill given internally.

Aretæus surpasses every other ancient author in his description of this affection. He sets out with pronouncing the uterus to be, as it were, an animal within an animal, wandering upwards, downwards, and to either side, being attracted by fragrant things and flying from fetid. When, therefore, it ascends upwards, it occasions compression of the liver, diaphragm, lungs, or heart, and sympathetically with the last, also of the carotids. It is accompanied with heaviness of the head and loss of sensibility. Nearly allied to it, but yet a different affection, is a complaint which attacks men, having therefore no connexion with the uterus, and not being relieved by fetid things. He says that, when the attack proves fatal, the pulse sinks and becomes irregular and intermittent, there is a strong sense of suffocation, loss of speech, loss of sensibility, respiration unequal or not even perceptible, sudden and unexpected death. For some time after the countenance does not put on the appearance of death, but is redder than natural, and the eyes project. He also gives a good account of the treatment, which, however, cannot be said to differ in any material respect from that of Galen and Celsus, as explained above. The same may be said of Oribasius, Nonnus, and Octavius.

Aëtius is very minute in his description. He remarks that after respiration by the mouth is stopped, the arteries may continue to beat, as is the case with reptiles in winter. The disease, he says, is occasioned by a flatulent refrigeration, and not by inflammation, as Soranus has said.

Actuarius accounts for the complaint and describes it in the same terms as the preceding writers. As it occurs principally with virgins and widows, he prescribes for them the Hudibrastic mode of wooing widows!

Eros gives the same account of the symptoms and treatment as the others.

Moschion, however, disapproves entirely of the common practice of applying fetid things to the nose, ligatures to the extremities, and fragrant pessaries to the uterus. On the contrary, he recommends warm fomentations, injections of warm water thrown into the uterus, rubbing the body with warm hands, and when the disease gets into the chronic state, giving alteratives (metasyncritica) and hellebore.

According to Leo, men who have been long restricted from venery are subject to the hysterical convulsion.

See, in Alexander Aphrodisiensis, an ingenious explanation why fetid substances applied to the nose and fragrant ones to the parts below were supposed to prove beneficial in such cases. It is too long for our purpose.

The account which Plato gives of the nature of the uterus and the phenomena of hysterics ought perhaps not to be taken in too literal a sense, considering that philosopher’s well-known propensity to mystification. He says, that part in women which is called the womb being an animal desirous of generation, if it become unfruitful for a long time, turns indignant, and, wandering all over the body, stops the passages of the spirits and the respiration, and occasions the most extreme anxiety and all sorts of diseases. (Timæus.)

The Arabians describe and treat the complaint exactly like our author. Serapion says that the uterus is delighted with fragrant things, and flies from fetid, not because it is an animal but from a natural property. He recommends ligatures to the extremities, purging with hiera picra, bleeding if not contra-indicated, the application of fetid things to the nose, and of fragrant things to the uterus, and so forth. Avicenna states that the affection arises from the menstrual discharge or semen being retained in the uterus. Haly Abbas adopts this explanation. He says the uterus affects the brain and heart sympathetically, giving rise to apoplexy, epilepsy, and other serious complaints. Young women, especially widows, are most liable to it. He says it is often periodical like epilepsy. His treatment consists of ligatures to the extremities, with friction, sprinkling rose-water on the face, applying fetid things to the nose, and the other means used in cases of suspended animation. At the same time he directs us to apply fragrant things to the parts of generation, and dry cupping to the hypogastric region. This is the treatment during a fit. To remove the tendency to the affection he recommends the warm bath medicated with wormwood, bay-leaves, marjoram, &c. fetid pills, hiera picra, and the like; and when connected with suppression of the menstrual discharge, he directs bleeding at the ankle, or even at the arm, if there be fulness and redness of the face. If the woman is unmarried, he recommends a change of life. Alsaharavius states that there is this difference between the hysterical and the epileptic convulsion, that in the former the woman does not lose her senses nor emit foam at the mouth. Like Haly, he directs us to bleed at the ankle when the menses are obstructed, to apply cupping-instruments to the thighs and hypogastric region, and to take diuretics and emmenagogues. There is nothing peculiarly interesting in Rhases, as his account of the disease is collected from preceding authors. One of them seems to say that the ascension of the uterus is not real but apparent. He remarks that affections of the uterus are attended with pain of the occiput.

SECT. LXXII.—ON PROLAPSUS UTERI.

Prolapsus of the uterus takes place rarely indeed, but from a variety of causes; for it is occasioned either by a woman’s falling from a height and pitching upon her bottom, whereby the ligaments are ruptured which keep the viscus in its position; or by the tearing away of the secundines, which drag the uterus along with them when they adhere, as in difficult labour; or by the awkward performance of embryotomy; or by a blow, or mental emotions, such as when the loss of children has been communicated, or an irruption of the enemy, or by a dangerous voyage, or some such cause, by which the uterus has fallen down, owing to a relaxation of the whole system, or owing to paralysis and atony of the parts, which happens most especially to those in the decline of health. It is towards its mouth that it falls down. Some, indeed, have related that the whole uterus has been prolapsed, which is incredible; for how could it have been reduced and fixed in its place? Wherefore, we must first evacuate the hardened fæces by a clyster and bring about a discharge of the urine, in order that the uterus may be freed from all compression, and then place the patient in a supine position, having her bottom elevated, her thighs bent, and her legs separated; and then take a hasp of wool, in figure and thickness resembling the female vagina, and this being bound round with a slender piece of cloth, and dipped in the juice of acacia, or of hypocistis dissolved in wine, is to be applied to the uterus, and all the projecting part pushed upwards gently, until the whole swelling is restored to the vagina; after which the pubes is to be covered externally with a piece of sponge squeezed out of oxycrate; and the woman is to be laid with her legs stretched out and applied so that the one may lie over the other. After this, cupping-instruments with much heat are to be fixed to the navel and the loins on both sides, and things of a fragrant smell applied. On the third day, while the wool is still remaining in the vagina, let the woman sit in a hip-bath of dark-coloured austere wine slightly warmed, or in a decoction of myrtle, lentisk, and pomegranate-rind. After these things, let the wool be taken away and another fold applied soaked in the medicine. Cataplasms are to be applied externally to the hypogastrium, of dates, polenta, or dried lentils, and pomegranate-rind with oxymel. And every third day let the same thing be done until the cure be completed. But if the prolapsed part cannot be reduced, and mortify in the course of time, we may take it away without apprehending any danger: for they relate that the whole uterus, having become mortified, has been taken away, and yet the woman lived.

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COMMENTARY. This complaint is particularly well treated of by the Father of Medicine. He has even described the case of a complete procidentia, when, he says, the uterus hangs down like a scrotum. Hippocrates directs us to make cold applications to the pudenda; to wash the part with an astringent lotion, and restore it to its place. He afterwards gives directions to make the woman lie upon her back with her legs crossed and tied together; and if the disease be likely to return, he recommends cupping and pitching of the hypogastrium.

Celsus mentions prolapsus, and recommends for it hip-baths of salt or astringent water, and local applications of a styptic nature after the womb has been replaced.

Aretæus, with his usual talent for description, draws a melancholy picture of a woman labouring under a complete procidentia uteri. He says it is occasioned by abortions, violent concussion, or severe labour; and explains very well how this happens from relaxation or rupture of the ligaments of the uterus.

Our author takes his account almost word for word from Aëtius, who acknowledges his obligations to Soranus.

Alsaharavius recommends nearly the same plan of treatment as Hippocrates; and directs us, when the attempts at reduction fail, to extirpate the womb by an operation. Avenzoar relates a case in which he saw the whole uterus projecting externally. He did not know the issue, only he was sure that the disease subsisted for a considerable time. He also relates another case upon the authority of a friend of undoubted veracity. Haly Abbas likewise mentions that the uterus sometimes protrudes fairly out, and enumerates the same causes of the complaint as our author. He relates that cases have occurred of the whole uterus having become putrid and been removed entire. Rhases, Avicenna, and Serapion, appear to have derived all their information from Aëtius and Paulus. Rhases directs us to bathe the parts with styptic decoctions, to put the woman into a bath medicated with roses, myrrh, &c., to reduce the womb, and retain it with compresses soaked in an astringent solution.

Eros recommends baths composed of the decoctions of acorns, pomegranate-rind, sumach, galls, &c.; also astringent fomentations, and a cooling diet.

The ancients appear not to have used pessaries made of solid materials, such as wood and metals.

SECT. LXXIII.—ON PHIMUS IN THE UTERUS.

Phimus takes place about the mouth of the womb, either in consequence of ulceration or of inflammation terminating in scirrhus. We must cure it by emollient hip-baths of oil and water, and of the decoction of fenugreek, applying cataplasms of a like kind, and introducing emollient pessaries. But if the complaint be protracted, we must have recourse to vapour-baths and fumigation with aromatics. The phimus may be dissolved by a pessary of the sordes of unwashed wool, nitre, and turpentine-rosin, being simply an obstruction of the mouth of the womb.

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COMMENTARY. Imperforate hymen and other obstructions of the vagina requiring a surgical operation will be treated of in the Sixth Book. The case here treated of is simply an obstruction of the os uteri by a callous substance. The emollient treatment by pessaries here recommended appears very proper. Aëtius makes mention of a more efficacious but dangerous application, namely, a piece of sponge spread with an ointment containing arsenic, alum, &c. Hippocrates had recommended an application containing verdegris. (De Steril. xii.)

Avicenna treats the complaint solely by a surgical operation. Alsaharavius approves of the emollient treatment, such as decoctions of mallows, fenugreek, linseed, &c.

SECT. LXXIV.—THE CURE OF STERILITY.

It is a common direction, applicable both to the man and the woman, to preserve the whole body in a proper temperament, by exercise, food, baths, and everything else in moderation. What is most especially to be attended to is, not to allow them to get into a fat habit of body; for fat persons are unfit for the propagation of children, owing to the want of agreement in their genital organs, and because they do not emit much semen. Nor are those who are much emaciated more so. All things which are heating and moderately flatulent assist, such as taking heating wine in moderation; and of pot-herbs, the rocket, clary (horminum), hedge-mustard, and the like; but they must, by all means, abstain from calamint and rue. When conception will not take place, owing to some cacochymy, we must purge it away, or dilute it by a proper diet. But women must attend particularly to the state of the uterus, and that the menstrual evacuation be not obstructed. When, therefore, the monthly purgation is near, the woman must attend particularly to take food and drink in moderation, and also some of those things which promote the discharge, such as the fragrant and acrid pot-herbs, as scandix, samphire, fennel, parsley, and alsander. And the intemperaments of the womb must be rectified. Wherefore the cold intemperaments of the uterus are indicated by retention of the menses, a cold and incrassating diet, and some torpor about the pubes, loins, and legs; and these persons, if they become perfectly congealed in habit, have no venereal desires at all. Wherefore we must endeavour, in every other way, but particularly by all kinds of fomentations, and by fumigation with aromatics, to recall the natural heat. And it will not be at all improper to drink of castor and of some of the aromatic seeds, such as cumin, anise, the flowers of pennyroyal, and the fruit of junipers, mixing some pepper with each. Fumigations of the womb may be applied either by sitting on a proper chair, and receiving the vapours which arise, or by injections of hot water in which sage, mugwort, rue, cumin, pennyroyal, sweet flag, and the aromatic seeds have been boiled. A cataplasm of any of them may also be applied to the lower part of the belly. The epitheme of Polyarchus is also appropriate. Frictions of the lower part of the belly and nates are no less proper. The woman may also use pessaries of myrrh, rue, galbanum, and castor, having previously fomented with honied water or salt water. The pessary called Goné is also an excellent one. Warmer intemperaments of the uterus are indicated by the whole body being hotter than usual, by the menses being voided in small quantity and with pain, and by the privy parts of the woman being ulcerated. They are to be remedied by such things as are moderately moistening and cooling, such as the pot-herbs, lettuces, mallows, blite, gourd, cucumber, pompion, orach, and purslain, and by the other articles of food of a like nature; and we must apply to the bladder, abdomen and loins, all cooling things, such as cataplasms and liniments made of the juices of herbs. If the woman cannot conceive owing to humidity of the uterus, it is indicated by there being much moisture of the parts during the venereal act, and by the menses being thin and in great quantity. A desiccative diet, therefore, suits with these cases; also exercises and frictions of the upper parts; emetics and dry food in moderate quantities. It will likewise answer well to strengthen the uterus by austere medicines, such as the decoction of lentisk, of myrtles, of roses, and of sumach; or also by that of pomegranate flowers, of the tender shoots of bramble, and of galls. When the uterus is drier than common, it is to be cured by the opposite remedies, I mean by baths and unguents, a moistening diet of pot-herbs, wine in moderation, and that not very old. But if conception be prevented by thick humours, and if they be of a pungent nature, the woman must be purged in a way suitable to each humour, and more particularly with the picra from aloes; then an injection with the whey of women’s milk is to be administered, and a more suitable diet thought of. Pituitous humours are to be evacuated by exercise, sudorifics and emetics, or downwards by the bowels. The following medicine may be given: Of dodder of thyme, of euphorbium, of pepper, of carrot-seed, of the seed of Macedonian parsley, equal parts; triturate all together, and give to the amount of two drachms to drink. This purges well and heats the womb, so that it often makes the menses flow in cases where this discharge was stopped. As soon as this correction has become apparent, and the menses flow properly, then one must enjoy the woman as soon as the menstrual evacuation stops. When flatus in the womb prevents conception, the symptoms of which may be recognized from what we have said on inflation of the uterus, it is to be cured first by a spare diet, and administering cumin, dill, parsley-seed, and that of rue and anise; and by giving many of the aromatics, some to drink and others by pessaries. When the mouth of the uterus is shut up, it must be opened by injections of aromatics, and by using fomentations from mallows, linseed, fenugreek and oil, and sometimes of honey; or, by the stronger ones, composed of mugwort, fleabane, calamint, pennyroyal and chamomile. In addition to these we may use turpentine, nitre, wild cucumber, elaterium, cassia, and tar-water. When the mouth of the womb gapes, the diet, fomentations and medicines should be of a desiccant nature and astringent; and the flowers of pomegranates, lentisk, the roots of brambles, myrtle-berries, and those things applicable for a humid intemperament. Distortions of the uterus are to be rectified by fomentations and emollient pessaries. In such cases, coition a posteriori would seem to promote conception.

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COMMENTARY. Hippocrates, in his ingenious work on Sterility, assigns the following causes for a woman’s not conceiving: First, because the os uteri is turned obliquely from the passage to it. Second, because the inside of the uterus being too smooth, either naturally or in consequence of the cicatrices of ulcers, it will not retain the semen. Third, when, owing to suppression of the menses, any obstruction takes place about the os uteri, it is apt to prevent impregnation. Fourth, when menstruation does not take place, the veins of the uterus become so gorged with blood that they do not retain the semen; or, on the contrary, the same effect may arise from profuse menstruation whereby the retentive faculty of the vessels is weakened; or a return of the menstrual fluid in too great quantity may wash away the semen. Fifth, prolapsus uteri, by rendering the mouth of the womb hard and callous, prevents impregnation. The treatment is delivered at so great length that we cannot venture even to give an abridgment of it.

Aëtius treats very fully of sterility, but his views are much the same as our author’s. See also Oribasius (Synops. ix, 45.)

In cases of sterility, Octavius Horatianus directs us to ascertain whether the os uteri be turned aside or shut up. He delivers the treatment of these cases with singular minuteness. His principal remedies are pessaries, which of course are composed of various ingredients. We shall give the composition of one of the simplest of them in his own words: “Nullo etenim remedio meliore et magis innoxio, aut corrigi matrix poterit, aut purgari, quam usus nitri suppositione.” That is to say, a suppository of soda is one of the safest and most effectual remedies.

Serapion, like Aëtius and Paulus, regulates his treatment entirely upon the principle of correcting the intemperaments, which he considers as the most common causes of sterility. A humid intemperament, he says, occasions sterility in the same manner that wet ground proves injurious to seed which is sown upon it; and a hot intemperament dries up the semen as the earth scorches the seed during the heat of the dog-days. Such being his ideas of the causes of sterility, one can readily comprehend his principles of treatment. Avicenna, Rhases, and Avenzoar likewise direct their attention to the correction of the intemperaments, but also recommend attention to any other local complaint about the genital organs. Haly Abbas, among other remedies, directs us to correct the state of the uterus by means of stimulant fumigations. One of his prescriptions contain arsenic. This would prove a potent but dangerous application. Alsaharavius expresses his distrust in the virtues of many specifics which had long retained celebrity for the cure of sterility. Like the others, he directs us to find out the cause of it, and remove it if possible by suitable remedies.

Plutarch thus enumerates the causes which had been supposed to explain why a woman does not conceive after every act of coition. Diocles, the physician, maintained that it is either because no semen has been emitted, or less than necessary; or because it does not contain the prolific principle; or from a deficiency of heat, coldness, moisture, or dryness; or from relaxation of the uterus. The Stoics held that it is from the obliquity of the penis, so that it does not project the semen straight forward; or from the disproportion between the genital members. Erasistratus taught that it is occasioned by callosities and fleshy excrescences; or from the uterus being more spongy or smaller than natural. (De Placit. Philos. v, 9.) The causes of barrenness are fully and ingeniously treated of in the tenth book of Aristotle’s ‘History of Animals,’ which, however, is of very doubtful authenticity.

SECT. LXXV.—ON FISSURES, CONDYLOMATA, AND HEMORRHOIDS OF THE UTERUS.

Fissures occur about the mouth of the uterus from difficult parturition, and at first they escape notice while the pains from the labour are recent; but afterwards they are slightly felt, either upon manual inspection or during coition, when they bleed, owing to the friction. They are also discovered when the vagina is distended, for ruptures in the circle of the mouth are perceived. In these cases all surgical aid, and medicines of an irritating nature, must be avoided, and recourse had to the simpler hip-baths and pessaries. The medicine called Tetrapharmacon diluted is befitting. But if it be callous, we must use that from paper, with rose-oil. If they cannot bear the strength of it, mix Illyrian iris with turpentine, and apply it. When the ulcers are cicatrized, it will be proper to use the medicine from cadmia, or some of the applications to the anus, such as that from litharge. It sometimes happens that these fissures, becoming chronic, are converted into condylomata, in which case the callus is to be removed by similar remedies, and the condylomata cicatrized. Hemorrhoids form about the mouth and neck of the uterus, which will be discovered by the speculum; for eminences may be detected which, during the exacerbations, are painful, bloody, and red, but, during the remissions, are wrinkled, free from pain, somewhat livid, and emit a slight discharge. If possible, therefore, in these cases, one must seize upon them during the remissions with a forceps and cut them out; or if not, we may touch them with astringent medicines, sometimes applying dried pomegranate-rind with galls, or something such; and sometimes using those recommended for hemorrhages of the uterus, which will apply both for fluxes and hemorrhoids. These are recognized by the uterus discharging blood constantly, or if at intervals, not in the menstrual period.

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COMMENTARY. This section is mostly compiled from Aëtius (xvi, 97, 107.) The astringent applications recommended by Aëtius contain alum, pomegranate-rind, ceruse, litharge, burnt lead, hypocistis, &c. For condylomata, the Pseudo-Dioscorides recommends an application containing arsenic. (Euporist. ii, 218.)

Avicenna and Rhases give a similar account of these complaints. They direct us to apply to hemorrhoids either such astringents as those directed above, or to remove them by a ligature. Haly forbids caustic medicines, as they may prove injurious to the uterus; and prefers extirpating them by a surgical operation. For fissures he directs us to use basilicon, with the fat of a duck or hen, and oil of violets, along with pitching and cataplasms. Alsaharavius directs us to extirpate hemorrhoids by an operation; and when the basilicon ointment does not succeed with the condylomata, to treat them similarly. As the ancients have not described polypus uteri by name, we are inclined to think that they must have comprehended it and all the other tumours about the uterus under the general appellation of hemorrhoids.

SECT. LXXVI.—ON DIFFICULT LABOUR.

Difficult labour arises either from the woman who bears the child, or from the child itself, or from the secundines, or from some external circumstances. From the woman in labour, either because she is gross and fat, or because her whole womb is small, or because she has no pains, or is affected with fear, or because the uterus or some other part is inflamed or otherwise diseased, or because, from some natural weakness, she is unable to expel the fœtus, or because the labour is premature. From the child, either because it is too large; or small, and of little weight; or from its having a hydrocephalous head; or from being a monster, such as having two heads; or because it is dead; or, although alive, because it is weak and unable to advance outwards; or because there happens to be several children, as Herophilus relates a case of five; or because the position is preternatural. For the natural position of the child is, first, when its head presents with the hands bent upon the thighs, and having its head directly applied to the mouth of the womb; and next to that, when it descends by the feet, and there is no turning aside. All the other positions except these are preternatural. Or from the secundines, either because the membranes cannot be torn, owing to their thickness; or because they have been torn prematurely, owing to their thinness; for when the waters are evacuated unseasonably, the fœtus gets out with difficulty, from the dryness of the parts. From external circumstances, either from cold contracting or immoderate heat dissipating the powers, or from some accidental occurrence. Wherefore, if the difficulty of parturition arise from constriction, and, as it were, impaction of the fœtus, we must first endeavour to produce relaxation by injecting frequently hot sweet-oil with the decoction of fenugreek, of mallows, of linseed, or with eggs, as a paregoric. Then we must apply cataplasms to the pubes, abdomen, and loins, of linseed, or of honied water, or of oil and water; and use hip-baths of a similar nature. We must also avail ourselves of the relaxation produced by baths, if neither fever nor any other cause prohibit; and the woman is to be moved on a couch in a moderately warm air. Some have had recourse to powerful shaking, and have applied sternutatories. If the woman be in low spirits, she is to be encouraged; and if she is inexperienced in labour, she is to be directed to keep in her breath strongly, and to press down to the flanks. If she be in a swoon, she is to be resuscitated by such strong-smelling things as are not stimulant; and when moderately recovered, she is to be supported with a little food. A woman that is fat is to be placed in bed in a prone position, bending her knees upon her thighs, in order that the womb, being carried to the abdomen, may present with its mouth direct. By means of the fingers the mouth is to be smeared with cerates or fatty substances, and gently dilated. And if there be any complaint in the parts, it must be previously attended to; and hardened fæces when retained must be expelled by an emollient clyster. The membranes may be divided either by the fingers, or by a scalpel concealed within them, the left hand directing it. And some of the fatty liquids may be thrown up into the uterus by a syringe. When the fœtus is in a preternatural position, we may restore the natural position, by sometimes pressing it back, sometimes drawing it down, sometimes pushing it aside, and sometimes rectifying the whole. If a hand or foot protrude, we must not seize upon the limb and drag it down, for thereby it will be the more wedged in, or may be dislocated, or fractured; but fixing the fingers about the shoulders or hip-joint of the fœtus, the part that had protruded is to be restored to its proper position. If there be a wrong position of the whole fœtus, attended with impaction, we must first push it upwards from the mouth of the womb, then lay hold of it, and direct it properly to the mouth of the uterus. If more than one child have descended, they are to be raised upwards again, and then brought downwards. Everything is to be done gently, and without pressure, the parts being smeared with oil. The time for placing the woman on the stool is when the mouth of the womb is open and meets the finger, and when rupture of the membranes is at hand. If, owing to the death of the child, or any other cause, it do not advance, we must proceed to embryotomy.

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COMMENTARY. Hippocrates has treated fully of Difficult Parturition in the first book of his treatise ‘de Morbis Mulierum,’ from which we shall select a few remarks to give the reader some idea of his practice in these cases. When the child presents doubled at the mouth of the womb he directs us to push it upwards, and rectify the position so that the head may come down. When a hand or foot of a living child protrudes, it is to be pushed up in like manner, and the head made to present. When the leg or arm of a dead child protrudes, it is best, he says, to proceed in the same manner if possible; but otherwise they are to be amputated at a joint and the head opened. The process of opening the head is minutely described by him. He advises us likewise to open the chest when any difficulty of delivering it is experienced. When in feet presentations the head is retained after the body is delivered, he advises us to introduce a hand between the os uteri and the head and deliver it. When the secundines are retained, he orders us to extract them slowly, and for this purpose directs that the woman being placed on a stool, the child not having been separated is to be allowed to hang down, so that by its weight it may produce separation; and, lest its weight should occasion too strong pulling, he advises it to be laid on wool, or bladders filled with water, which being perforated, the child shall sink down gradually and draw away the placenta. We shall have occasion to treat of this practice further in the Sixth Book.

Aristotle states that delivery takes place naturally by the head, but sometimes preternaturally by the feet. (H. A. vii, 7.)

Celsus directs us when the child is dead, to introduce the hand, finger by finger, into the womb, and examine the presentation, which will be the head, the feet, or the body laid transverse. He states that the object of the operator is to bring down the body either by the head or the feet. When the arm presents, he directs us to bring down the head, which is to be seized by means of a hook fixed in the eye, ear, mouth, or forehead, and cautiously pulled along; and in doing this he properly directs us to pull with one hand and keep the other fixed at the instrument. When the feet present, they are to be brought down and delivery accomplished in this way. When the child lies across, he recommends us, if the position cannot be got rectified, to fix the hook in one of the armpits and pull it down; but if other means fail, he directs us to divide the body at the neck and extract the parts separately. In extracting the secundines, he properly directs us to stretch the cord gently with the left hand, and introducing the right into the uterus, to separate the placenta from the womb and remove it along with the coagula of blood lying there.

The causes of difficult parturition, and the methods of remedying them, are more fully treated of by Aëtius than by any other ancient writer; but, as Paulus evidently copies from him, we shall merely supply a few things which our author has omitted. Among the causes of difficult labour, he mentions too compact a union of the ossa pubis. When the woman is too young or too old, he justly remarks that she wants strength to accomplish delivery readily. He mentions that in the delivery of twins, the two children may get entangled. He means, probably, that the head of the one may follow the delivery of the breach of the other. Of this singular complication, a fatal case was published in the ‘Edinburgh Medical and Surgical Journal’ some years ago. He expresses himself favorably with respect to feet presentations. All cross presentations are said to be difficult to rectify, but the child is to be brought by the head or the feet according to circumstances. When delivery is retarded by rigidity of the parts, he strongly recommends the warm bath. When fulness of the bladder occasions obstruction, he properly directs the urine to be drawn off by a catheter. When a foot or hand presents, he directs us not to pull down the part, lest it become more firmly impacted, or lest it should be fractured or dislocated; but the projecting part is to be pushed up and the position restored.

According to Eros, one of the most common causes of difficult parturition is heat and tumefaction of the external parts. In this and in other cases, he directs the patient to sit in a bath prepared with emollient herbs, and to get the parts about the belly rubbed with oil of violets or of roses.

Serapion treats this subject in nearly the same terms as our author. Like the Greeks, he approves of emollient oils and baths to produce relaxation. The same practice is recommended likewise by Rhases. When the membranes are tough, he advises us to tear them with the fingers, or to open them with a knife.

Avicenna has treated of difficult parturition with his usual accuracy, which exhausts every subject he handles. He states that the expulsion of the child is performed by the abdominal muscles. This was the opinion of Galen; and we are inclined, upon the whole, to think it pretty correct. He approves greatly of the bath, both before labour has come on and during the time of it. When delivery is difficult, owing to the size of the child, he directs us to apply a fillet round the child’s head, and endeavour to extract it. When this does not succeed, the forceps are to be applied, and the child extracted by them. If this cannot be accomplished, the child is to be extracted by incision, as in the case of a dead fœtus. This passage puts it beyond a doubt that the Arabians were acquainted with the method of extracting the child alive by the forceps.

Albucasis recommends us, when the membranes are tough, to perforate them by the finger or a spatumile. When the waters are discharged, he directs us to press down the woman’s belly so as to make the head descend. If it does not come down readily, he advises us to give a clyster, and afterwards to apply compression to the belly. Albucasis also approves of the tepid bath. To promote the delivery of the secundines, he recommends us to make the woman sneeze and retain her breath.

Alsaharavius (probably the same as Albucasis) treats fully of the causes of difficult labours. When occasioned by dryness and constriction of the vagina, he recommends baths, fomentations, and clysters, containing the decoctions of mallows, fenugreek, and linseed; and also directs the parts to be rubbed with warm oil. When obstruction of the rectum by fæces prevents delivery, he advises us to administer a clyster. When intense cold is the cause of the difficulty, he recommends clysters of hot oil, and the warm bath. When the membranes are tough and retard delivery, he directs the midwife to break them with a sort of reed or needle.

Haly Abbas mentions imperforate hymen among the causes of difficult labour. Such cases have been reported by modern writers on midwifery. See Baudelocque (§ 341), and Burns (Midwifery, x.) Fabricius ab Aquapendente relates a very curious case in which conception had taken place without rupture of the hymen. (Œuvres Chirurg. ii, 81.) When the difficulty arises from fatness and debility of the expulsive powers, Haly directs us to rub the parts with warm olive-oil, or other such emollients, and to make the woman sit in a bath prepared with chamomile, melilot, &c. He mentions, as an internal remedy, the infusion of a swallow’s nest (alcyonium?) When the difficulty proceeds from cold, he recommends the use of the tepid bath; and when from the contrary cause, he advises cooling things to be applied. According to Rhases, difficult parturition may arise from the mother, the fœtus, or the secundines. He appears to have considered all presentations unnatural except the head. In the other cases, he says, the life of the mother or child is endangered, although, he adds, many living children are born by the feet. When delivery of the head is found difficult, he recommends ligatures or fillets. When the feet or hands present, he directs us to restore the position, or if that is impossible, to bring down the feet. Many of his authorities mention the warm bath and lubricants.

From the sketch which we have given above, it will be seen that the Arabians have made mention of the forceps; but that most probably the Greeks and Romans were unacquainted with this instrument, as far, at least, as appears from their works on medicine which have come down to us. It is deserving of remark, however, that in the house of an obstetrix which has been excavated in Pompeii, there was found an instrument of art bearing a very considerable resemblance to the modern forceps. It is a well-known fact in the history of inventions that many useful discoveries have long been kept as family secrets. This was the case even of a late date with the Chamberlains, who were the first in modern times to use the forceps.

SECT. LXXVII.—ON ISCHIATIC DISEASE.

Ischiatic disease, being of the class of arthritic complaints, is distinguished solely by the cause of it being seated in the hip-joint. The cause of it then is a thick and pituitous humour fixed in the articulation of the hip-joint. The pain in these cases extends from the parts about the buttocks and groins to the knee, and often as far as the extremity of the foot. When we see such a patient, in the beginning of the complaint, after the evacuation of the hardened fæces by a clyster, we must abstract blood from the arm at intervals; but if the disease be of some standing, we must abstract the blood from the ankle of the affected leg. During the exacerbations we must use this embrocation: Of the oil of privet, viij cyathi; of vinegar, iv cyathi; of nitre, ij cyathi; of rosemary-seeds, j cyathus; to be rubbed in hot with unwashed wool. After which a cataplasm is to be applied of the flour of bitter lupines with oxymel; or of the flour of darnel with rosin, the root of the wild cucumber, nitre, calamint, rosemary-seeds, and bay-berries. Calamint alone with oxymel, or honied water, will form a proper cataplasm. And we may rub the parts with this paregoric-plaster: Of wax, dr. x; of turpentine, dr. xxv; of verdigris, dr. vj; of myrrh, of galbanum, of iris, of each, dr. vj; of gum vernix, dr. v. But they must take the propoma containing Cyrenaic juice to the size of a bitter vetch, or a drachm of castor with three oboli of opopanax. And the rind of the root of capers in a draught, or added to the cataplasms, is of use. When the pain is great, anodynes may have place, such as the antidote of Philo and that from two peppers. This injection is to be used: Of honey, iss cyathus; of oil, iss cyathus; of water, ij cyathi; of nitre, dr. viij; of turpentine, dr. iv. These are to be injected warm, and the anus fomented, that they may be the longer retained. It evacuates mucous matters, and sometimes blood when it affords more relief. But if the complaint be prolonged, which is rare, we must repeat it frequently, instead of the water substituting the decoction of centaury. Blood is also evacuated by injecting the seed of treacle-mustard, and the juice of elaterium, and the Sicyonian oil prepared from it, or from the roots of the plant. The brine also of pickled fish, or of pickled olives, may be properly injected. Cupping-instruments may be applied to the hip with much heat and with scarifications, or sometimes leeches may be used. When the affection is protracted, we must proceed to purging either with the hiera, or giving of the medullary part of colocynth properly triturated to the amount of a drachm in two cyathi of honied water, more or less, according to the strength of the patient and the good state of his bowels. And let rue be boiled in the honied water. The pottage made with colocynth purges excellently. In some cases emetics from radishes have proved beneficial at the commencement. During the remissions we may apply dropaces to them, and use the restorative unguents (acopa) from euphorbium, and particularly the one called the complex. The natural baths also are proper; or if these be not at hand, they may bathe in the others; using the restorative ointments formerly mentioned, and the compound ones,—the Æsculapian, and that composed of equal portions of euphorbium, adarce, black hellebore, castor, pellitory, pepper, and wild grape dried. After the bath, we must sprinkle upon the skin while still warm, of dried pitch, oz. iij; and of native sulphur, oz. ij; and let the part be covered with paper. If even these things do not succeed, a remnant of the disease remaining, it will be proper to apply a cataplasm of mustard along with dried figs, or by itself. These complaints are completely removed by the Iberian herb, which some call lepidium, and some the wild cardamus (cress). And the shrub which grows among us, having leaves resembling those of the bay, but much larger, is of approved efficacy, not only in ischiatic, but in other chronic complaints; but it is by far most efficacious in summer. Or if it should not have shooted out its leaves, we must bruise the rind of the root with axunge, so as to form a plaster; and then, spreading it on a thick rag, apply to the parts affected with the pain, namely, to the whole buttocks and thighs; and allow it to remain until the part become black, or, at all events, until the cuticle become livid; then take it away, and, having washed, apply this cerate: Of opopanax, oz. iv; dissolve in ij cyathi of vinegar; and add to the cerate of privet. If they do not admit the use of such caustics, we must use the plasters called extirpative, among which is the following: Of wax, of pine-rosin, of each, dr. xij; of wild pigeon’s dung, of recent lees of burnt wine, of each, dr. vj; of galbanum, dr. iss. And the plaster called the Lioness is of the extirpative kind. Those composed from strained lye and nitre are also proper. And some have continued to drink certain potions for a whole year, among which is the one composed of four ingredients: Of wall-germander, lb. j; of gentian, oz. ix; of round birthwort, oz. ix; of the dried seed of rue, j sextarius: pound these things together, sift, and give every day a spoonful to the patient when he has an empty stomach and his digestion is good, with two cyathi of cold water; and continue this for a year, until the complaint cease. And the medicine composed of seven ingredients, and that which takes its name from Proclus, are of the same reputation. Exercise may be taken by walking, frequent bending of the body, leaping, and running. The food should be moderately attenuant and digestible. If ischiatic disease do not yield to any of the remedies now mentioned, it sometimes terminates in suppuration; and sometimes, from a relaxation of the ligaments, the thigh is dislocated at the joint. Wherefore, when the affection is protracted, we must burn the joint in three or four places (as will be described in the Surgical part of the Work), and the ulcers are to be kept open for many days.

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COMMENTARY. Consult most of the authors referred to in the next Section.

Hippocrates gives a pretty correct account of the symptoms which attend an attack of morbus coxarius, or ischiatic disease. He says it most commonly arises owing to the fluids of the joint being dried up by exposure to the sun. It is accompanied, he justly remarks, with pain of the loins and vertebræ of the back, shooting down even to the knees. A sharp hot pain, he adds, is frequently seated in the groins. Upon any motion the most piercing cries are extorted. (De Dieb. Judic. 6.)

In ischiatic disease Galen recommends general bleeding, and most especially, emetics, which, he says, by occasioning a determination upwards, operate more beneficially than purgatives in this complaint. He disapproves of acrid embrocations, but approves of cupping. He also allows stimulant clysters of colocynth. He gives a long list of local applications from Andromachus, Asclepiades, and Democritus. He makes mention of the Iberian herb; for further information respecting which we refer the reader to Matthiolus (ad Dioscorid. i, 147), and Bernard (ad Nonni Epit. 215.) It was the Lepidium Iberis. He recommends, in certain cases, the part to be beaten with rods. (Meth. Med. xiv, 16.) See also Pseudo-Dioscorides. (Euporist. i, 240.)

Celsus says that morbus coxarius is a painful complaint and difficult to cure. He recommends warm cataplasms and fomentations, with various applications of an emollient or stimulant nature. If inflammation come on, cupping-instruments with scarifications are to be applied; diuretics are to be given; and the belly is to be opened if constipated. He also approves of friction, and even of forming issues by burning with a red-hot iron.

Various methods of performing the operation of burning are detailed by Aëtius, as will be explained in the Surgical part of this Work.

Cælius Aurelianus gives a long and interesting account of this complaint. Among the symptoms he mentions the lengthening and shortening of the limb, the wasting and paralysis of it. The periosteum, he says, is principally affected, but likewise the heads of the muscles. He correctly states that, when the complaint is protracted, collections are apt to form in the joint. He approves of the emollient treatment, the application of wool dipped in sweet oil, fomentations, and bleeding from the arm. He recommends gentle purgatives and clysters, but condemns the use of drastic cathartics, such as scammony, hellebore, and the like; because, he says, they occasion irritation. When the pains are protracted he approves of scarifications and leeching, after which the vapour of sponges squeezed out of hot water will be of service. He also makes mention of the bath of oil and various emollient ointments. He describes several methods of applying heat to the part, but condemns them in general, upon the principle that they increase the local irritation. He disapproves of diuretics as recommended by Diocles, and otherwise animadverts freely upon the practice of the other sects.

The Arabians adopt the views of Galen and his followers with little addition or alteration. Thus Serapion recommends bleeding from the arm and ankle; clysters of drastic medicines, such as colocynth, centaury, hermodactylus, &c.; soothing applications externally; quieting medicines internally; emetics consisting of radishes, vinegar of squills, or even of white hellebore. When these do not succeed, he recommends us to form an issue by burning the part with a red-hot iron. Avicenna agrees with Galen in condemning discutients and recommending emollients at the commencement, and in preferring emetics to cathartics. For this purpose he particularly mentions a solution of nitre and vinegar. When the disease is combined with inflammation, Haly Abbas directs us to begin with venesection if not otherwise contraindicated. He enjoins the necessity of abstaining from taking much food and things of difficult digestion. He directs us to pour water of a moderate temperature over the part, and to rub it with an emollient oil; but he forbids refrigerant and astringent things, as they are apt to drive the humour inwards. He joins the others in recommending particularly the hermodactylus (soureniaron), both by the mouth and in clysters. When other means fail to remove the pain, he directs us to apply a cupping-instrument with strong heat over the joint, or even to use the actual cautery. Alsaharavius recommends the same general plan of treatment. He directs the patient to abstain from the use of wine, or if he cannot observe this regimen, he recommends him to use the bath and friction with glass (pounded he probably means). He gives very excellent admonitions to guard against indigestion, and to avoid all things of a cold nature.

On the ancient cauteries for disease of the hip-joint, see Book Sixth, Sect. LXXII.

Most of the earlier modern writers approve of the application of the actual cautery for the cure of sciatica. See Rogerius (i, 74.)

SECT. LXXVIII.—ON GOUT AND ARTHRITIS.

It is not weakness of the parts alone that occasions gouty and arthritic complaints; for then the paroxysms would be without ceasing, inasmuch as the debility is always present in the weak parts. Neither is a humour the sole cause, for then the complaint had not attacked the joints only. But the disease is occasioned by a preternatural humour and a weakness of the parts meeting together. For when the nutritive power of the parts becomes debilitated from repletion with food inducing dyspepsia, the prevailing humour, fixing in some of the joints which are already in a weak state, and stretching the nervous ligaments, produces pain. For the inflammation is not an original affection of the nerves of volition; as then it would have affected also the parts between the joints, such as the middle of the legs, thighs, arms, and forearms; but those of volition are affected sympathetically. When, therefore, the humour is seated in the joints of the feet only, the complaint is called podagra; but when the cause is diffused over all the joints of the body, we commonly call it arthritis, in which the vertebræ, scapulæ, jaws, and every other joint are attacked with the disease. In certain cases the ears, teeth, and pharynx, and sometimes even the liver and spleen participate in the arthritic pains, when, if there is not a speedy translation of the disease to the joints, the patients will be in urgent danger. The prevailing humour is sometimes bilious, sometimes sanguineous, sometimes melancholic, but for the most part it is pituitous and crude, being engendered by excess of food, indigestion, and want of exercise. When the disease is protracted in the joints, the humours become thick and viscid, so as to form what are called tophi or chalk-stones. Sometimes the humour is of a compound nature, so that the disease is difficult to distinguish, and difficult to cure, or nearly incurable. The precursory causes of this affection for the most part are immoderate labour, violent walking, frequent exercise on horseback, the unseasonable use of venery, cold drink taken unseasonably, eating of much cold or unwholesome food, and drinking much wine. And some from accidents, as a blow, a sprain, or the like, have experienced the first attack of this complaint, the materials of the disease having previously remained quiet in the system until roused by the proximate cause. Sorrow, care, watchfulness, and the other passions of the mind, not only excite an attack of the disorder, but also generate a cacochymy either primarily or incidentally. Wherefore the causes of the complaint, as I have said, are various; but the differences of the noxious humours are in so far easily detected, being discovered by their colour and other symptoms. A bilious rheum, in addition to paleness and redness of colour, occasions a sensation of heat and acute pain, and is speedily determined to the skin, nor is it attended with much swelling. It is exacerbated by heating applications, and relieved again by cooling, which, for the most part, is the case with all the others, but more particularly when the exciting cause is bilious. Fever also frequently comes on at the height of the paroxysms, and then they are thirsty. Thus also you will find the skin darker when from a melancholic humour; white and watery when from a pituitous, in which case the pain is more latent and more slowly occasions swelling; and the colour is sanguineous when a bloody humour prevails. In order to form a more decided diagnosis, you will be assisted by taking into account the previous mode of life, and so forth.

The cure of rheums from a bilious humour. The commencement of the cure, when from yellow bile, more especially if the quality of it occasion the disorder, should be the evacuation of the offending humour by purgative medicines, such as that from rhodomel, that from quinces, the antidote called picra, and aloetic pills. During the paroxysms, we may apply externally rose-oil with the yelk of an egg, and some wine, rubbing the part gently with it; and apply the herbs of a cold nature, such as nightshade, purslain, henbane, houseleek, marsh-lentil, endive, poppy, knotgrass, rose-leaves, and the like. These things may be sometimes rubbed in, and sometimes applied in the form of a cataplasm, with crumbs of bread soaked in oxycrate, or from barley-meal with rose-oil. When the inflammation of the joints is of an erysipelatous nature, a decidedly paregoric application is the peel of a fresh gourd laid on the part, or the fleshy part of a pompion or cucumber, both alone and with bread; or the leaves of perdicium (pellitory of the wall?), and ivy with bread and fine polenta. And fleawort boiled in barley-flour mitigates the inflammatory heat in a wonderful manner; and so also the rose-cerate cooled with some of the frigorific juices, and that prepared from the flour of beans. It is prepared thus: Of wax, oz. v; of chamomile-oil, oz. iiss; of rose-oil, oz. iiss; of the flour of beans, oz. ss; the yelks of five eggs.—Another, a cataplasm: Pound green mallows boiled; and having made fleawort to the consistence of bird-lime separately, mix together; then add the red part of eggs and chamomile-oil, and apply as a cataplasm. When the pain is great and difficult to endure, we must have recourse to preparations of saffron, of horned poppy, and of opium, triturating them with oxycrate, and then using them in the form of liniments, or of cataplasms with crumbs of bread. Galen makes mention of this one: Of poppy-juice (opium), dr. iv; of saffron, dr. j; triturate with milk of a cow or of a goat; or add the inner part of bread, and having softened it by touching it with a little rose-oil, use for a cataplasm. Or triturate the opium and saffron with the milk, and add to the rose-cerate. And the cerate made from the torpedo and the oil of the same are possessed of similar properties.—And this one in like manner: Of crumbs of bread soaked in water or in oxycrate, and of houseleek, or of nightshade, or of purslain, and of the fleshy parts of dates, and of poppy-seeds, equal parts; of roasted yelks of eggs and rose-oil, q. s.; form a cataplasm. The use of narcotics must not be continued, but until the violence of the pain be abated; for the frequent use of them occasions impaction and tophi, and makes the difficulty of motion to be protracted. After the use of anodynes, then, we must have recourse either to diachylon dissolved in oil of chamomile, or the composition from marshmallows, or some such application. After we have warmed the congealed parts, we must strengthen them by a plaster of dates dissolved in vinegar and rose-oil or wine and rose-oil. Or, if the weight of the plasters prove troublesome, we may rub in the juice of acacia with oxycrate, or lycium along with saffron, horned poppy, and the juice of perdicias in oxycrate. The diet should be cooling and moistening, such as ptisans, and spoon-meats from chondrus, and of pot-herbs, the mallows, the lettuce, and the endive; and of birds, more especially the young of domestic fowls; and of fishes, those caught in rocky places, and the sea-urchin, shell-fish, and the like. Let them avoid all things that are heating and form pale and yellow bile, old wines both the yellow and dark, and repletion. Let them use baths of sweet water, even at the time of the defluxions, as far as regards the cause of them, unless something else prohibit. Let them avoid violent passion, abstinence, acrid food, drinking of wine, immoderate labour, and venery.

The cure of rheums from a sanguineous humour. In those cases in which the prevailing humour is sanguineous, we must have recourse to venesection without delay, and also in cases where the prevailing humour is phlegm or black bile; since in them the humour is for the most part contained in the veins, proving injurious by its quantity rather than its quality. We must have recourse then to venesection only at the first attack of the disease; since those who have had already frequent attacks of rheumatism are injured rather than benefited by the loss of blood, more especially when the body is naturally cold or weak. After the evacuation of the blood, if there was more than a plethora of blood, we must have recourse to purging with hiera after a short interval. And the Julian oxymel is a purgative suitable to these cases. Those who reject such purgative medicines may use these pills: Of aloes, of colocynth, of black hellebore, of scammony, of each, oz. j; of euphorbium, oz. ss; of nitre, oz. ss; mix with the juice of cabbage, and give according to the patient’s strength. It will be better, however, if prepared with the juice of quinces.—Another pill given to gouty persons in the paroxysms, during the remission, and from whatever humour: Of aloes, oz. vj; of agaric, oz. ss; of saffron, oz. ss; of costus, oz. j; of spikenard, oz. j; of schenanth, oz. j; of balsam fruit, oz. j; of cassia, oz. ij; of scammony, oz. ij; of dodder of thyme, oz. iiiss. A moderate dose is scr. ij; and a full one, scr. iv. Pills of Armenian stone also purge in a wonderful manner, being particularly applicable in arthritic cases, whether given at the commencement, in the decline, or during the remissions of defluxion. And since some avoid scammony because it is bad for the stomach, we may give them these things when a pituitous matter prevails: Of the medullary part of colocynth, of black hellebore, of bdellium, of gum, of aloes, of each, oz. j; of Alexandrian nitre, of euphorbium, of each, oz. ss. The dose is scr. iv. Instead of the gum I have substituted dodder of thyme. Some, in the paroxysms of all arthritic diseases, have recourse to purging with hermodactylus; but it is to be remarked that the hermodactylus is bad for the stomach, producing nausea and anorexia, and ought, therefore, to be used only in the case of those who are pressed by urgent business; for it removes rheumatism speedily, and after two days at most, so that they are enabled to resume their accustomed employment. I knew a person who did not give the substance of hermodactylus, nor any of the compound medicines containing it; but boiling the plant itself with some of the common remedies, such as anise or parsley, he gave the decoction to drink; and it was wonderful how those who got it, after having evacuations of the bowels, were freed from the rheumatism. It is necessary, however, as I said, because the medicine is bad for the stomach, to correct the mouth of the stomach afterwards by stomachics and tonics, along with things that are moderately heating. Alexander says that purging by coronopodium is preferable to that by hermodactylus, as it procures evacuation and relief from pain, and at the same time is not bad for the stomach. But topical applications are to be had recourse to in cases of pituitous rheumatism. When the pain is moderate, a green cabbage-leaf may be applied, and also parsley, fleabane, and the straight vervain; but when the pain is violent, take of the flour of fenugreek, p. iij; of the flour of darnel, p. j; of the flour of chick-peas, p. j; make a cataplasm with honied water, or thin wine, with a little oil of privet, or of nard, more especially if in winter. And the ashes of burnt cabbage-roots, or of their stalks, when formed into a cataplasm with axunge, have proved beneficial to many; but, in order that it may prove soothing, the axunge must be fresh, whereas, if we wish it to be discutient, it must be old and salted. And in like manner the dung of oxen, when boiled in honied water with barley-meal, or fresh moist dung applied with the leaves of cabbage; and so also goats’ dung by themselves, or boiled with barley-flour in oxycrate. And since some have derived relief from seemingly opposite remedies (for a mixture of various humours confounds the diagnosis), we must state the materials thereof promiscuously. Wherefore the wild and garden orach in a cataplasm with bread are beneficial, or the leaves of petty mullein, triturated with bulbi and bread, or with polenta, or the cataplasm of raw barley-meal. Upon the whole, when the cause of the complaint is obscure, we must change sometimes to medicines of the same class, and sometimes to the opposite, not continuing long with the same application when it does not afford relief. These things we see every day occur in professional matters. And often a certain remedy proves beneficial to one joint, while another joint of the same patient similarly inflamed is not only not benefited at the same time, but occasionally is even injured by it. And this is a wonderful circumstance, that one and the same joint, when treated with the same remedy, is sometimes benefited, and soon afterwards exasperated. When a viscid and thick matter prevails, it is not perhaps relieved by calefacients, but the acrid and hot quality of the humour prevailing is to be soothed by frigorific remedies; nor is it at all wonderful that a matter naturally cold, in the time of the inflammation, should become heated and glowing, to say nothing of the admixture perhaps of bile. The flour of lupines with oxymel or oxycrate, or the root of laserwort, or of bryony, with bread, prevent the formation of tophi. And the following composition is safely soothing and moderately discutient: Of lycium, oz. j; of ammoniac perfume, oz. j; having triturated with very old wine and oil of unripe olives, boil, and add of the flour of beans, q. s.; and having boiled moderately, apply as a cataplasm. After the acme of the complaint, if a swelling be left, apply a cataplasm with the bulbi by themselves, or with fine polenta, until it produce excoriation; for in this manner they act. When not relieved by the cataplasms, we may have recourse to embrocations and affusions on the parts (more particularly if the extremities be affected), with chamomile, melilot, or centaury in decoctions. The preparation of capers has entirely relieved some. The following is the most active of all the applications: Having boiled thyme, marjoram, savory, and calamint in the most acrid vinegar, bathe the parts affected with the vinegar, not only once, but often in a day, with confidence. This has relieved many when suffering not only from phlegm but also from bile.

Some observe this practice also: The acorns of the ilex being powdered, are pounded and much boiled, and the joints of the extremities at the commencement of the rheumatism are fomented for a considerable time with the decoction, but it is poured from a sponge upon the inner parts; whereby the violence of the offending matter is repelled. It also is applicable to bilious cases; and, in like manner, immersion in hot water without any decoction. For pains occasioned by intense cold, or infarction of the joints, this is a powerful remedy: Of old oil, lb. iss; of Alexandrian nitre, lb. j; of turpentine, lb. j; of euphorbium, oz. j; of iris, oz. ij; of the flour of fenugreek, a sextarius and a half. In these cases the remedies recommended for ischiatics are excellently applicable. Many, in the case of those who are thus affected from a cold cause, apply, after the acme, mustard with dried figs and the other rubefacients, but some the preparation from cantharides. But these things prove injurious afterwards, unless one use the emollient applications, such as that from fuller’s herb, the one called Pyxis, that of Basilius, that from the fir-tree, that from the poplar, those called Promium and Lysiponium, and the stronger of the Acopa: in which cases sympathetic affections of the nerves and impaction of the humours particularly take place. And the application from the urine of a mule, more particularly if applied at the acme, is beneficial in the cold rheums: and, in like manner, the trochisk from the two hellebores is applicable for the œdematous and spongy swellings; also fomentation with the toasted salts; or otherwise affusion or embrocation with hot sea water; and the plasters prepared from salts, those from strained lye and nitre, and the cataplasms of a like nature after the acme. Food of a drier nature, and not excrementitious, suits well with these; also abstinence from food, or a spare diet, and refraining from frequent baths. Having bathed, they should be rubbed with nitre and the other unguents used for friction. In the decline, they should have recourse in particular to gymnastic exercises and friction of the joints, and the natural baths, or the sand baths, and emetics from radishes and food from grain. Those properly prepared for it may be vomited or purged with the white hellebore.

On rheums from a mixture of humours. Those labouring under a mixture of humours, after the evacuation of the blood at the commencement of the disease, should use the topical remedies already mentioned. When the sanguineous plethora is of a more bilious and acrid nature, recourse may be had to those things recommended for bile; when it is of a colder and more pituitous or melancholic nature, those afterwards mentioned, with the exception of such as are very acrid; and if protracted, these also may be used. And this cataplasm is applicable at the commencement: Pomegranate rind, sumach, and polenta triturated with wine, are applied in the form of a poultice.—Another: Having boiled the leaves of cabbage, and triturated carefully, add the lees of vinegar, two yelks of raw eggs and a little rose-oil, and having triturated, apply, changing it frequently. Let them take food that is attenuant and of little nourishment. Let them, therefore, abstain altogether from flesh and pulse, from much wine of a dark colour; and, if possible, let them abstain from drinking wine altogether. For I have known many persons who have abstained altogether from this article alone, and all of them derived benefit. Those who did so in the commencement of the complaint were entirely freed from it; and those who were later in doing so experienced afterwards fewer paroxysms, and these not of great severity. If, therefore, no inconvenience occur, or be dreaded from it, they should abstain from wine all their life. Those who from weakness or coldness of constitution appear to sink under this regimen, after abstaining from wine for two years, may gradually accustom themselves to take a small quantity of diluted wine. Those who refrain from wine should take instead of it a decoction of anise, or of some such seeds, avoiding altogether the use of the autumnal fruits, and other things of a cold nature, and also venery. Of those who attempt to get rid of the complaint by continuing under a course of medicines for a complete year, many who suffer from pituitous and redundant humours have been benefited thereby, whereas such as are of a hot and dry intemperament have brought on sudden death, the offending matter being translated to the intestines, kidneys, side, lungs, or some vital part. It is better, therefore, for those who are bilious and sanguineous, to abstain from wine; as from this course there is no risk of falling into the dangers just mentioned. Those who are affected with cold and redundant humours should take the theriac of vipers more frequently if they have good digestion in winter, but more rarely in summer; for it either removes the complaint altogether or renders it more moderate, and proves injurious to none of the afore-mentioned parts. And since some persons compel us to administer the medicines called Antidotes, you should be aware that the following are all of the same kind, namely, that from water plantain, that of Agapetus, those called Atacton and Octaidon, that of Proclus, that from water germander, that from coral, and many others. The safest of them all, and yet of approved efficacy, is the one from coral, which dissolves tophi that are formed in the joints. The properties of all these things, the manner of using them, and the precautions to be observed with regard to them, you will find described in the Pharmaceutical part of this Work; and also the composition of depilatories for arthritic complaints, and the mode of applying them to these habits, I mean the pituitous. Some, for the entire removal of the complaint, boil whole wolves in oil, wherewith they cure arthritic cases; some throwing them in alive, and others dead, into a large caldron. And in like manner they boil hyænas, making a discutient oil from them; and then filling the cistern of the bath with it, and putting the arthritic patients into it, they direct them to remain in it for a considerable time. By these means it happens that not only the swellings about the joints, but the whole body, is evacuated.

On tophi, or chalk-stones. Since tophi are often formed in the joints, sometimes owing to a thick and terrene humour seating in the parts, and sometimes owing to the use of applications which are immoderately discutient and desiccant without being emollient, it is proper to know that the most suitable remedies are such as are at the same time emollient and discutient. Wherefore, old suet, marrow, ammoniac, bdellium, very old oil, and storax, are emollient; and nitre, salts, strained lye, adarce, euphorbium, and the like, are discutient and desiccative. This is an excellent application for tophi in the joints: Very old and acrid cheese pounded and applied with a decoction of fat swines’ flesh, it also being old. For the chalk-stone breaking spontaneously, a discharge of it takes place every day. The composition from ham (which is prepared in two ways) is also an approved remedy, and those described from strained lixivial ashes (potash?). And this one is particularly excellent: Of aphronitrum, of turpentine, of protostacton, of virgin wax (i.e. bee-glue), of each, oz. iv; of wax, oz. ix; of colophonian rosin, lb. j; of oil, oz. xvj; mix together, and use for chalk-stones and apostemes. The composition from dragon’s blood is of wonderful efficacy for chalk-stones and many other complaints, but is difficult to procure. But that from walnuts is not only efficacious but at the same time easily procured; and is applicable not only to those who are strong, but also to those who are sensitive, if mixed with honey or the composition from anemone, in the proportion of two parts to one of the composition. When these things are not at hand, an equal proportion of ceruse may often be mixed with it.—Another for tophi: Having triturated red arsenic, mix with mistletoe of the oak, and use.—Another, which is applicable also for fistula and ægilops: Of oil, one sextarius; of litharge, oz. viiiss; of arsenic, oz. j; boil the litharge and the oil until they do not stain, then sprinkle the arsenic well levigated, and before it catch fire, take off and use. The compositions from the flower of Assian stone, when used during the intervals, are applicable to all the collections which form in the joints; and some of the ancients attest that they remove the complaint entirely. The composition from the flower of salt, when applied in like manner during the remissions, is believed to dissipate whatever swellings remain.

On the prophylaxis of gout. Gout and rheumatism, when formed, are among the most difficult of diseases to cure, except by the methods we have described; but, before being fixed, it is easy to prevent their occurrence by restricting the diet, giving only such food as is of easy distribution and not excrementitious, with a moderate allowance of wine, and increasing the exercise as far as proper. As a remedy, salts triturated with oil and rubbed into the joints, are of great use to all who are anxious to avoid falling into a gouty affection, unless they be of a dry intemperament. They ought to use it morning and evening through life, and the same thing is to be used after the decline of the inflammation.

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COMMENTARY. Consult Hippocrates (Aphor. vi; Prognost. 15); Galen (Comment. in Aphor. Hippoc., de Med. sec. loc. ix); Celsus (iv, 24); Serenus Samonicus; Aretæus (Morb. Chron. ii, 12); Scribonius Largus (41); Cælius Aurelianus (Tard. Pass. v, 2); Alexander (xi); Aëtius (xii); Oribasius (Synops. ix, 58); Actuarius (Meth. Med. i, 21); Nonnus (216); Marcellus (de Med. 35); Octavius Horatianus (ii, 21); Demetrius Pepagomenos (de Podagra); Psellus (Opus Medicum); Macrobius (Saturnal. vii, 4); Lucianus (Tragodopodagra); Serapion (iv, 25); Avenzoar (ii, 3, 28, ii, 7, 31); Avicenna (iii, 22, 2); Haly Abbas (Theor. ix, 41; Pract. viii, 32); Alsaharavius (Pract. 38); Rhases (Divis. 102, ad Mansor. ix, 90, Libellus de Morb. Junct., and Contin. xxvi.)

The Prognostics of Hippocrates will be admitted at the present day to be correct. Those who are old, or who have chalk-stones formed in their joints, or lead a laborious course of life, or have dried bellies, cannot be cured by any human means. Young persons not having tophi formed in their joints, and who live guardedly, and whose bowels will bear the proper treatment, may be cured. These complaints are best removed by dysenteries or other evacuations downwards. His principal remedies are purgatives administered by the mouth or by injection, and local applications of a cooling nature, and even pouring cold water on the foot. When the pain of the gout becomes fixed in a joint, he directs us to burn it with crude flax.

Seneca mentions it as a monstrous example of the depravity of his age, that the women, by their luxurious habits, had become subject to gout. (Epist. 95.)

According to Galen, gout and arthritic complaints are occasioned by a collection of some humour in the affected part. This humour may be blood, phlegm, or a mixture of phlegm and bile, or of blood along with these, or simply a crudity. This crude humour, he remarks, sometimes concretes into tophi. The first indication in attempting the cure is to evacuate the offending humour by bleeding or purging; and then repellent and discutient applications are to be used. He has given a great many prescriptions for these. He disapproves of the warm bath in rheumatic attacks; for, he says, although it appears at first to give relief, it ultimately aggravates the complaint. (Therap. ad Glauc. ii.)

For an able and full explication of the ancient theory of the humours, and the manner in which they give rise to arthritic complaints, we refer the reader to Macrobius (l. c.)

Unfortunately the chapter of Aretæus on the treatment of arthritic complaints has come down to us in a mutilated state. It appears however, that he trusted to hellebore as the great remedy in such cases. His local applications are wool dipped in rose-oil and wine; a sponge soaked in oxycrate, or such like cataplasms. When the disease is hereditary, he says it is generally incurable.

Celsus recommends various refrigerant and anodyne applications to the affected part, such as a sponge soaked in cold water, or in oil and vinegar, or the same soaked in hot water having poppies boiled in it, or a mixture of pitch, wax, and alum. The other points of his practice deserve attention, but we shall not enter upon them, as we wish to afford room for a fuller abstract of the doctrines of Alexander.

Gout, according to Psellus, is occasioned by an atony of the nutritive faculty, whereby a thick humour is collected in the system.

Scribonius Largus recommends his favorite remedy for local pains, namely, the application of a living torpedo to the part affected.

Alexander begins with noticing the common opinion that gout is irremediable by the art of medicine, which he affirms not to be the case provided proper attention be paid to the different varieties of it. There are, he says, many causes of the disease; for sometimes a hot blood flows into the cavity of the joint and occasions violent pains; and, in like manner, a defluxion of bile getting between the tendons and ligaments occasions pain by burning and stretching the parts: phlegm likewise, by producing cold and compression, becomes the cause of violent pains; and in like manner the melancholic humour, not only by its coldness and pressure but also by occasioning a sense of heaviness, brings on no ordinary paroxysms. Sometimes a simple quality of the humours, such as heat, cold, dryness, or humidity, will cause a defluxion. The prevalence of a bilious humour is ascertained by the absence of swelling; from the pain being rather a fiery heat than distension; and from the colour being red. The proper remedies in this case are cholagogues, which must not be of a heating nature nor offensive to the stomach; for when the stomach is deranged the nerves sympathise and rheumatism is the consequence. He gives prescriptions for a variety of such compositions containing scammony, agaric, and the like, mixed with pepper, &c. He particularly commends pills of scammony and wormwood. He also recommends cooling and anodyne applications to the affected parts, such as rose-oil with the yelk of an egg, and the like. He enjoins particular attention to the diet, in order to avoid such things as have a tendency to form bile. He recommends moderate exercise rather before than after a meal, but forbids to carry it to excess. He speaks favorably of baths of common water. He concludes this part with minute directions about the local applications: but, as we have already stated his principles, we shall not enter upon the detail of his practice. When gout is occasioned by phlegm the part is neither hot nor red; is benefited by calefacients and injured by refrigerants. For this variety he recommends particularly a combination of purgative and attenuant medicines, such as the Julian oxymel, which contained white hellebore, agaric, polypody, thyme, cumin, &c. After purging he greatly commends hot and attenuant medicines, in particular the composition from coral, which, among other ingredients, contained birthwort, spikenard, cloves, myrrh, &c. (Birthwort formed one of the principal ingredients of the celebrated Portland powder.) He describes various other antidotes containing bitters, attenuants, and calefacients. His local applications in this case are pounded cabbage, parsley-seed, or fleabane, if the pain is moderate; but otherwise he recommends anodyne cataplasms. Should these, however, rather produce an increase of the pain, he directs us to substitute instead of them discutient and repellent applications, such as decoctions of thyme, mint, &c. with vinegar. He also recommends various cerates with the same intention. Some, he says, have been benefited by stronger applications, such as blisters of cantharides, sinapisms, or the like; but he does not approve of the barbarous practice of burning with the substances called iscæ (see Aëtius and Paulus), nor of the above-mentioned rubefacients, but prefers a combination of emollients with discutients. When it is suspected that the gout proceeds from an overflow of blood upon the joint, he recommends us to have recourse to bloodletting, unless otherwise contra-indicated. He proscribes such articles of food as engender much blood, as all sorts of flesh, especially pork; also sweet wines and intemperance of every kind. He says he has known some cured by simply refraining from wine. He then gives directions for the formation of several topical applications which are of a repellent and discutient nature. He speaks very favorably of a sponge soaked in an astringent wine or oxycrate. He then gives ample directions for discussing Tophi or chalk-stones. He lays it down as a general rule that such applications should contain ingredients of a moderately calefacient, discutient, and solvent nature. Among the articles which enter into these compositions we remark litharge, old oil, sanguis draconis, nitre, turpentine, ammoniac, &c. He then states, that as some do not choose to submit patiently to the methodical plan of treatment, but insist upon getting medicines to allay at once the violence of the pains, he, although he did not in general approve of this practice, would now give an account of such remedies. For this purpose, he says, hermodactylus is particularly trusted to by some; and he admits that it seldom fails to remove a paroxysm, but affirms that it occasions more frequent returns of it. Some, he adds, have endeavoured to correct its prejudicial effects by adding to it cumin, mastich, or ginger, thinking that its action is narcotic; but this he affirms to be a mistake, for in that case it could not prove cathartic. He admits, however, that these things may prove useful by correcting its bad effects upon the stomach. He then gives various receipts for mixtures containing hermodactylus. As a specimen of them we may mention the first, which consists of hermodactylus, myrrh, pepper, and anise, to which scammony may be added. He recommends it, however, in general, to be given in the form of pills with aloes, scammony, elaterium, and colocynth. But, as mentioned by our author, instead of it he prefers the coronopodium. It is the same, we presume, as the coronopus of Dioscorides, or our buckthorn plantain (plantago coronopus L.), although the commentators are not agreed upon this point. (See Matthiolus.) Gesner supposes it a species of ranunculus, which he calls polyanthemon. Alexander then gives directions for various local applications of an anodyne nature, containing opium, strychnos, ceruse, wax, &c. We regret to say that so admirable a treatise should conclude with some frivolous directions for curing the disease by means of amulets of approved efficacy! However, the advocates of the Mesmerian system of animal magnetism do not hesitate to admit their remedial powers. On the periapta or amulets of the ancients, see Andreas Laurentius (de Marab. Strum. Sanat, 85.)

Our limits will not permit us to do justice to the account of the gout given by Aëtius. Like Aretæus, he maintains that the disease is hereditary. His general views of the nature of the complaint and his treatment are very plausible. He says it is occasioned by weakness of the part and a redundance of humours; that the proper treatment therefore consists in evacuating the humours by bleeding and purging, and afterwards in strengthening the part.

Cælius Aurelianus considers arthritis, podagra, and chiragra, as diseases of the same genus. The usual precursory causes are intemperance, indigestion, debauchery, cold, too much or too little exercise, and external injuries. Some, he adds, are of opinion that it is transmitted from father to son. He gives the symptoms of these complaints with his wonted accuracy. They are seated for the most part, he says, in the nerves, by which term he probably means the tendons and membranes. He remarks the well-known propensity which persons attacked with gout have to attribute the swelling and pain to a sprain or some such accident. If the belly be constipated, he advises us to open it by a simple clyster. He recommends us to abstract blood from the affected part by scarifications, which, he says, will occasion less irritation than cupping or leeching. Sponges squeezed out of hot water, or oil and water, or the decoction of fenugreek, are then to be applied to the part; for he thinks these preferable to a cataplasm, as it is often too heavy. When on the decline, he approves of bathing, spare diet, emollient ointments, and gentle exercise, beginning with gestation, and proceeding to the stronger kinds of it. When they can be borne, he approves of stimulant applications, such as dropaces, heated sand, and even sinapisms. He also speaks favorably of vomiting produced by radishes, hellebore, hip-baths of oil, fomentations with hot salt water, and swimming in hot water or even in cold. He particularly commends the naturally-medicated waters, or spas (as they are now called), such as those of Albula or Cutilia, which, he says, will either cure or mitigate the complaint. He disapproves of burning the joints (the reader will have remarked his general aversion to the cautery), and the indiscriminate application of various narcotics and other such things. He also condemns the free use of emetics, (which, he says, prove injurious to the stomach, and occasion a determination to the head,) of purgatives, acrid clysters, and diuretics. In short, his practice is not unlike that of our Sydenham. His grand rule is to keep upon a spare diet, or even to maintain complete abstinence at the commencement. The formula for his diacentaureo (as Van Swieten remarks) is the same as that for the Portland powder, namely, Aristoloch. rotundæ; gentianæ; sum. chamædryos; centaur. min. p. æquales. Cælius Aurelianus, Galen, Aëtius, Celsus, Aretæus, Oribasius, Scribonius, and Horatianus make no mention of the hermodactylus. Myrepsus and Actuarius make mention of a hermodactylus, but Matthiolus and the commentator on the former think theirs a different plant from the hermodactylus of the other Greek authors. This may be true, and yet the microscopic eye of critics often fancies it can see differences which other people are puzzled to remark. We may mention further regarding the practice of Cælius Aurelianus, that he speaks of soothing the pains of rheumatism, more especially of the hip-joint, by music. On this practice see also Aulus Gellius (iv, 13); Athenæus (Deipnos. xiv, 18); Apollonius (Hist. Marab.); Pliny (H. N. xxviii, 2.)

There is nothing very important in Nonnus, Octavius Horatianus, or Oribasius. We shall now give a brief abstract of the curious treatise on the gout by Demetrius Pepagomenos. The work is dedicated to the Emperor Michael Paleologus, who flourished about the year 1260; and it was published by Morel at Paris, A.D. 1558. The author commences by explaining the nature of that derangement of the animal economy which occasions this complaint. This he does at considerable length, but in much the same terms as Macrobius, to whom the reader has been already referred for an exposition of the humoral pathology. His physiological opinions appear to us to be highly ingenious and philosophical. He comes to the conclusion that gout is occasioned by a collection of humours in the affected joint, these humours being the product of imperfect digestion and of the retention of excrementitious superfluities, which ought to have been evacuated from the system. He says the procatarctic or remote causes of arthritic affections are, long-continued indigestion, repletion with food, drinking too much wine, venery, unusual exercise, indolence, and retention of the natural secretions. Venery, in particular, is said to weaken the tone of the nervous parts. He then proceeds to explain that when crudities are formed in the system, those parts which are strong and vigorous cast them off, which those that are weak cannot effect, and hence collections of such humours take place in them. The prophylaxis of the complaint, he remarks, is easily laid down, but is difficult to follow, namely, to observe great moderation in eating and drinking, and to avoid indigestion. His grand principle of practice is evacuation, which, according to the general rule laid down by Hippocrates, is the proper remedy for repletion. He then shows that vomiting is the mode of evacuation most applicable in this complaint, because it empties the stomach, which is the fountain whence the humours are derived. His comparison of the stomach to a fountain which irrigates all parts of the system is very appropriate, and is beautifully illustrated by him. He recommends, however, vomiting by simple means; and for this purpose directs the patient to swallow meat imperfectly chewed, radishes, leeks, &c. and, having drunk some honied water, to excite vomiting by tickling the throat with a feather or the finger. He forbids the use of strong emetics. His second method of evacuation is by purging, which he recommends to be done by pills containing aloes, hermodactylus, cinnamon, and scammony. He then proceeds to the cure when an attack has come on. In this case, he recommends us to begin with letting blood, unless the stomach be loaded with impurities, when an emetic must be premised, lest the emptiness of the veins produced by venesection should cause these crude humours to be conveyed over the body. Venesection, he remarks, is particularly applicable at the commencement, when there is simply a plethora of blood, but it is rather prejudicial afterwards when the fluids become altered in quality. In such cases, as he fully explains, purging is the proper remedy, especially when performed by hermodactylus, which, he says, he had found from experience to answer well, from whatever cause the disease had originated. He directs it to be combined with various calefacients and aromatics, such as birthwort, cinnamon, and pellitory. He then makes an ingenious reply to those who affirmed that the disease is not to be cured by purgatives, but that it is sometimes exacerbated by them. In such cases, he properly remarks, it is not the remedy that is in fault but the misapplication of it. Those who cannot bear cathartics by the mouth may have clysters given them; or the preparations from elaterium, juice of sow-bread, or the like, may be applied to the navel. He afterwards gives directions about the local applications, which are nearly the same as those recommended by Alexander. We will have occasion, in the Seventh Book, to discuss the question respecting the nature of the ancient hermodactylus; and we shall merely state here our own decided persuasion that it was a species of colchicum or meadow-saffron. It forms one of the ingredients of the celebrated Eau médicinale d’Husson. From the effects produced by the Eau médicinale we are inclined to think, however, that a certain proportion of hellebore must have entered into its composition, as we have never found the colchicum to act so violently as the eau is said to do. We have stated above that Cælius Aurelianus makes no mention of the hermodactylus. However, the great modern advocate for Methodism, Prosper Alpinus, speaks favorably of it, and says decidedly that it is the colchicum of the Greeks. It appears not to have fallen into disuse in his time. (De Med. Meth. ix, 4.)

The Arabians follow the Greeks closely in the general principles of treatment, only substituting certain articles introduced into the Materia Medica by themselves. Thus Serapion strongly recommends purging with myrobalans, prunes, and tamarinds. He, Avicenna, and Rhases, join in praising the virtues of the hermodactylus. Their local applications are similar to those of the Greeks. When the pain is violent, Serapion even approves of pouring cold water upon the affected part. Rhases approves of burning the joint in certain cases. Avicenna directs us to cover the part with oil and salt, and thus to apply the cautery gradually. Avicenna speaks more favorably of bathing in thermal waters than any of the other authorities. According to Haly Abbas, arthritic diseases are collections of superfluities of the system in some joint which is labouring under debility. These superfluities are said to be produced by repletion and indigestion. The debility is generally occasioned by immoderate exercise, intemperance, debauchery, or some such cause; and a joint having become weakened, all the impurities of the system are collected into it. He says that young persons and women who menstruate regularly are scarcely liable to the gout. He agrees with the authorities already mentioned in holding it to be hereditary. When the humour in the joints concretes into chalk-stones, he pronounces the case to be incurable. When the disease is produced by a sanguineous plethora, he recommends us to begin with bleeding, and then to use cooling lotions, or even to pour cold water on the joint. When these do not succeed, anodyne applications, containing opium, mandragora, lettuce, saffron, and the like, are to be used. When the pain has abated, any swelling which remains may be discussed by applying to the part a decoction of marjoram, melilot, chamomile, and the like. When the defluxion is connected with bile, he recommends first emetics, and then drastic purgatives, such as aloes, scammony, colocynth, and hermodactylus. But, if the patient’s stomach be weak, he recommends milder laxatives. When the defluxion is of a phlegmatic, that is to say, of a serous nature, he directs us to give the active cathartics already mentioned, especially hermodactylus; and, if it be the summer season, he advises us also to give emetics. He cautions us against using local applications of too stimulant a nature at first, lest they dispel the more fluid parts of the defluxion and leave the grosser behind. This is but a meagre sketch of his interesting account of arthritic diseases. Alsaharavius calls these complaints collections of phlegm, bile, or blood. He holds that they are often hereditary. Like all his countrymen, he approves of hermodactylus, which he gives in the form of pills, with myrobalans, colocynth, turbit, castor, opopanax, &c. When fulness of blood is present, he recommends bleeding.

The hermodactylus is recommended for the cure of arthritic diseases by the earlier of the modern writers on medicine. See Lanfrancus (ii, 3.)

Among the ancient treatises on gout, we have mentioned the tragi-comic poem entitled ‘Tragodopodagra,’ usually ascribed to the famous Lucian. It ridicules, with much humour and severity, the many pretended nostrums for this complaint. Among the remedial articles mentioned, we remark hellebore, nitre (soda), henbane, poppy, fenugreek, and galls. The ridicule thus bestowed upon the use of specifics for the cure of a complaint so complicated as gout, is no doubt well founded; but we ought not to be deterred, by the ill success of such a practice, from attempting to afford relief upon general principles, as ably laid down by Alexander, Demetrius, and Haly Abbas. We would fain impress upon the physician and his patient, that more than is usually believed might be accomplished in all arthritic diseases, by correcting the disorder of the digestive functions by means of a suitable diet and regimen; and that it is only when the constitution is radically unsound—when the joints are deformed by concretions, and the vital powers have been worn out by a long-continued course of debauchery—that we need adopt the discouraging opinion of Ovid, as expressed in the following line:

“Tollere nodosam nescit medicina podagram.”

(Pont. i, el. 4.)

SECT. LXXIX.—ON CHILBLAINS AND AFFECTIONS OF THE FEET AND HEELS.

Chilblains are ulcerous affections forming about the fingers and toes in the season of winter. They should be bathed with tepid sea water, or the decoction of beet, or of lentil, or of bitter vetch, or of the root of kingspear. After this, triturate boiled lentils with wine, and apply in the form of a cataplasm; or, apply figs triturated with oil; or, triturate equal portions of alum and barley-flour in wine, and apply; or use a cataplasm of dried lees of wine or of fresh bulbi triturated with wine; or boil garlic in oil, and having thrown away the garlic, melt a moderate quantity of wax with the oil, and apply; or boil pomegranate-rind in wine, and having triturated, add to the rose-cerate, and use, having previously fomented the part with the decoction of lupines; or apply manna and native sulphur with boiled honey. The juice of henbane rubbed frequently into the part removes the inflammation and pain.

The Marcellian application for chilblains. Having scooped out the heart of a turnip, put into the cavity two ounces of wax, and the same quantity of lentisk oil; and having boiled them in a double vessel along with sea water, brine, or the decoction of lupines, bathe the part with the fluid; and having cooled the cerate which is melted in the turnip, apply it. For ulcerated chilblains: Of frankincense, of fissile alum, of reddle, of rosin, equal parts; dilute with axunge, and use. For ulcers with inflammation, use the application called Hexapharmacon: Of oil, oz. ix; of bull’s tallow and gall, of each, lb. ij; of litharge, oz. vj; of colophonian rosin, oz. iv; of honey, oz. vj.

For fissures of the toes and of the whole feet. Anoint with liquid pitch; or, having burnt a river or sea-crab on coals, scrape off the shell, and having triturated it with oil, and made of the consistence of honey, and having wiped the fissures, apply. The inner part of squill boiled in oil and triturated with turpentine also answers well; and a goat’s horn burnt and mixed with axunge. One must first clear the callous part, and then use the medicines.

The plaster called the florid for fissures of the heels and soles. Of quicklime, dr. x; of ceruse, dr. xx; of wax, dr. xx or xxx; of fresh axunge, oz. vij; of colophonian rosin, oz. ix; of the juice of linseed, one cyathus; of sweet oil, oz. xl; nothing is so efficacious for softening the sole.—Another: Of goats’ seam, of wax, of oil, equal parts; use.—Another: Having boiled pomegranate-rind in vinegar, apply for five days; then, having cleaned it away, apply quicklime with oil, or with bath sordes.—Another: Having boiled squill in oil, throw away the squill when boiled: having melted some turpentine in this oil, use.

For fretting of the heels from long confinement in bed. Of wax, of oil, of litharge, of honey, equal parts. It answers with every ulcer of the soles, heels, ankles, and inner part of the toes, more especially if the sore be near the nail.

For foul ulcers in the sole, and also for those in the pudendum; To be applied on a pledget. Of lees of oil, one cyathus; of vinegar, one cyathus; having boiled in a copper vessel until of the consistence of honey, and triturated separately with ij dr. of the flakes of copper, and ij dr. of manna, add the ashes of a handful of soft unwashed wool which has been wrapped round a torch and burnt: mix all together, and use, diluting it with wine for wounds, and with must for those of the pudendum and sole.—Another: Of lees of oil, of scummed honey, equal parts. This also cleans the gums.

For fretting of the skin by shoes. The lungs of a lamb, of a swine, or of a goat, make a good application. The burnt leather of old shoes does not answer when there is inflammation; but when the inflammation is over it answers well. Or, apply onions with the grease of a fowl; or sprinkle the part with burnt gall; or dissolve acacia in vinegar, and anoint with it.

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COMMENTARY. See Hippocrates (Epidem. vii, 38); Celsus (v, 28); Scribonius Largus (86); Oribasius (Morb. Curat. iii, 56); Octavius Horatianus (i, 28); Aëtius (xiv, 73); Actuarius (Meth. Med. vii, 8); Nonnus (224); Avicenna (iii, 22, 2, and iv, 3, 2); Haly Abbas (Pract. iv, 17); Rhases (Divis. 125); Alsaharavius (Pract. xxix, i, 27.)

These affections of the extremities Celsus recommends, in the first place, to be bathed with hot water in which rapes or vervain have been boiled. If ulceration has not taken place, copper, as hot as possible, is to be applied to the part. If ulcerated, equal proportions of alum and frankincense, with wine, or pomegranate-rind, boiled in water and pounded, are to be applied.

The following application, recommended by Scribonius, might be useful: Cerussæ, lb. j; ol. myrtei, lb. j; lithargyri, dr. xxiv; ceræ Ponticæ, lb. j. Cerussa et spuma argenti coquuntur cum oleo, donec coeant, postea adjicitur cera.

For pernio, Aëtius gives a long list of applications, several of which are copied by our author. The ordinary ingredients of them are stimulants and astringents. The following may be pointed out as likely to be useful: Aluminis scissi, dr. x; lithargyri, dr. iv; myrrhæ, dr. j; ovorum albumina duo; vino et oleo myrteo; m. Aëtius also gives a variety of prescriptions for fissures and the other complaints of the feet.

The turnip is mentioned by Pliny as an application to chilblains. See also Galen (de Optima Secta, 16.)

Octavius Horatianus lays down very judicious rules for the treatment of these complaints. His applications, however, are much the same as our author’s. Thus, for chilblains, he recommends fomentations with salt water, or the decoction of beet, containing also alum; after which the part is to be anointed with melted wax. He also mentions, as proper applications, galls pounded with vinegar; a mixture of wax and melted pitch; a cataplasm of boiled lentils; the grease of geese, with wax and oil, applied in a tepid state; and the like. When ulcerated, he directs us to apply an ointment of litharge and axunge. For fissures he particularly recommends liquid pitch; or litharge mixed with ceruse, alum, and wine. When hairs are troublesome, they are to be cleared away with a fine piece of iron.

For fissures Rhases recommends the fat of a cock with galls. Alsaharavius lays down the rules for treating chilblains in all their stages with great precision. If the parts become red or black, he recommends us to make deep scarifications with a scalpel; after which the foot is to be put into hot water and allowed to bleed freely. His dressings are similar to those of the others. Haly’s treatment is like our author’s.

SECT. LXXX.—FOR CORNS AND CALLOUS FLESH.

Having first cleaned the corns, apply one of the septics, either verdigris, red arsenic, the powder for fistulæ, or the collyrium for fistulæ instead of gum mixed with ammoniac. A corn is a white circular body like the head of a nail, forming in all parts of the body, but more especially on the soles of the feet and toes. It may be removed in the course of some time by paring away the prominent part of the corn constantly with a scalpel, or rubbing it down with pumice. The same thing may be done with callus. The ashes of unripe lupines burnt, and mixed with honey, are of use; or misy added to liquid pitch; or gith, with the urine of a boy not come to puberty; or bean-meal boiled with vinegar. And this is an application of approved efficacy for the same purpose: Of cantharides, of copperas, of castor, equal parts; mix with turpentine until it become of the consistence of a plaster, and apply to the corn previously cleaned all around.—Another: Of burnt lees of wine, of quicklime, of mistletoe, equal parts, with strained lye, or the urine of a boy not come to puberty.

* * * * *

COMMENTARY. Aëtius delivers the treatment of corns fully, but his remedies, although similar to those of our author, are not of such ready application.

Celsus says that, by simply paring corns, the part may often be softened. Afterwards rosin mixed with a small quantity of the lapis molaris may be applied.

Avicenna states that, when the disease is not cured, it may end in cancer. Marcellus directs us to pare corns, and apply to them a composition of arsenic and turpentine rosin.

For corns Rhases recommends a composition of red arsenic, quicklime, quicksilver killed, with the ashes of acorns (impure potash?) and oil. He also joins Galen in recommending a composition of cantharides and arsenic. For the callus he recommends the juice of figs and of spurge. (Contin. xxxvi.)

SECT. LXXXI.—ON COMPLAINTS ABOUT THE NAILS; AND, FIRST, OF WHITLOW.

Whitlow is an abscess forming about the root of the nail. When, therefore, the whitlow is small and but commencing, galls with honey repress it, and prevent the formation of an abscess; or the trochisk of Musa, or the Here, in water. When a preternatural growth of flesh has taken place, the object is to consume and break it with things that are not of a corrosive nature. The sordes of the ears and lycium are also good for whitlows. When it suppurates, having opened it and evacuated the fluid, soak a sponge in water, and apply; or apply a cataplasm of lentils pounded with water; or palm-plaster with wine; or green or dried roses macerated in water, and pounded; or dried barley-flour with water. The flour of lupines mixed with honey, or wine and honey is good for whitlow. For ulcerated whitlows: Of verdigris, of litharge, of each, dr. iv; of sarcocolla, dr. iv; sprinkle of it what is sufficient, and apply externally a tent and sponge out of wine. And the flesh must be separated from the nail all around.

On pterygia. Pterygium is fungous flesh covering part of the nail, being caused by whitlow or the like; for which, sprinkle equal parts of arsenic and manna, and apply a tent out of wine and a sponge above it.—Another: Of chalcitis, of the flakes of copper, of pomegranate-rind, equal parts; add to a roasted fig and honey, first bathing the part with the decoction of the thickening matters put into ointments; and clean away the part of the pterygium when dried up.

For pterygia of the toes in a putrid state, and for ulcers of the pudendum. Of frankincense, dr. j; of the scales of copper, dr. j; of scraped verdigris called xyston, dr. iv; of honey, one cyathus; triturate in the sun until it become yellowish, and use upon a compress, having first bathed with wine.

A composition for quickly drying and curing pterygia. Of burnt sori, dr. ij; of frankincense, dr. ij; of verdigris called xyston, dr. j: having triturated with honey, apply to the pterygia. It is useful for the other malignant ulcers, and for lividity, and putridity of these parts.—Another: Add the flakes of copper to the flesh of dates, or of figs, and use.—Another: Having boiled and triturated pigeons’ dung in must with fine polenta, apply warm. And the flakes sprinkled by themselves dry up pterygia. We must always raise and remove with a scalpel the corner of the nail when it increases so as to hurt the pterygium.

For bruised nails. Apply a cataplasm of myrtle and the tender leaves of pomegranate.

For bloody nails. Mix fine flour with pitch, and apply.

To remove diseased nails. Add triturated sulphur to axunge, and apply.

How to remove leprous nails. Of mistletoe of the oak, of red arsenic, of fenugreek, of each, oz. ij; of cantharides, of deadly carrot, of each, oz. j; of vinegar, q. s.—Another: Of bee-glue, of Attic wax, of bitumen, of each, dr. ij; of native sulphur, dr. j. Let only so much oil be added that it may not stain. In using it, warm and apply it to the nails.—Another: Of liquid pitch, of wax, of colophonian rosin, of turpentine, of ammoniac perfume, of native sulphur, of aphronitrum, equal parts; evaporate until it does not stain.—Another, from the works of Ruffus, for leprous nails: Of cantharides, of native sulphur, of copperas, of each, oz. ss; of liquid pitch, oz. ij: having made into a plaster, apply to the nail, removing it every third day.

Another for removing leprous nails without ulceration. Of bitumen, of arsenic, of red arsenic, of native sulphur, of each, dr. iv; add to rosin and use, removing it every seven days.—Another: Mixing the flour of bitter vetches with sheep’s gall, or sheep’s urine, use; or unslacked lime with oil; or Chian mastich with opobalsum; or mixing copperas and native sulphur with mistletoe, spread what is sufficient on a skin, and apply; or triturate stavesacre with vinegar and use; or of turpentine rosin, dr. j; of red arsenic, double the quantity; apply to the root of the nail, and bind carefully. When the nail falls off, apply the myrtle-cerate, containing a small quantity of the composition from rosin.

* * * * *

COMMENTARY. See most of the authorities referred to in Section LXXIX.

Aëtius and Oribasius treat whitlow upon the same plan as our author, namely, by using cooling and astringent applications, such as galls, alum, and pomegranate-rind at the commencement; and after it has burst and fungous flesh has got up, by applying strong caustic and corrosive medicines, such as arsenic, verdigris, quicklime, and the flakes of copper. Neither of these authors, however, say anything about making an early incision of the part affected with whitlow, which must be considered a defect in their method of practice. Octavius Horatianus, however, seems to have had it in view to recommend an early opening, when he says, “Si saniem sanè collegerit, locum pungis.” In fact, it is as soon as the part becomes gorged with blood, and before the matter has had time to be properly formed, that an opening should be made.

Avicenna is exceedingly minute in his directions for treating whitlow. He recommends at first the finger to be put into hot vinegar. Then various astringent and repellent applications are to be used, among other ingredients containing camphor. These are afterwards to be changed for emollient and sedative applications prepared with opium. When matter forms, it is to be let out by a small opening. Haly Abbas recommends at first the seed of fleawort pounded in vinegar or snow, to cool and deaden the sensibility of the part. When these do not answer, he advises suppurative applications; and when the abscess does not open readily, he approves of an incision with the edge of a lancet. When the pain is violent and obstinate, he recommends opium, henbane, and vinegar to be added to the applications. He mentions that Hippocrates recommends an application of galls and vinegar for whitlow. Alsaharavius describes whitlow by the name of alcahas. He recommends us to bleed at the commencement, then to use a plaster of vinegar and opium, or a piece of cloth moistened in snow or cold water, and frequently changed, or to put the finger into hot oil. If these means do not succeed, suppuration is to be encouraged; and as soon as matter forms it is to be let out. Avenzoar describes a species of malignant whitlow, of which we have seen some few cases. He says it spreads up the hand, and occasions corruption of it. He recommends free incision, and relates a case in which very bad effects resulted from neglecting this practice. (iii, 2, 37.) This is perhaps the same disease that is described by Alsaharavius (Pract. xxix, 1, 25), and by Albucasis (Chir. i.)

Rhases says that common people put the finger into hot oil. He also recommends hot vinegar and hot water. (Contin. xxxvi.)

Celsus directs us to make an opening around scabrous nails, and then to apply a composition consisting of red arsenic, nitre, common arsenic, and liquid pitch. Under the use of this application, the diseased nails fall off and healthy ones come in their place. Haly Abbas and Alsaharavius also recommend applications containing arsenic. Alexander Aphrodisiensis mentions that leuce occurs more commonly on the hands than the feet, and in children rather than in adults. This arises, he says, from the feet being more exercised than the hands, and from children eating more voraciously than adults. (Probl. i, 146.) The compositions recommended in the ‘Euporista’ of Dioscorides for leprous nails are arsenic and water, sandarach, quicklime, and burnt lees of wine with pitch, the juice of thapsia and mustard with vinegar, &c. See also M. M. v, 122.

For bruised nails, Aëtius strongly commends a mixture of fossil salt with water and oil. Avenzoar speaks of privet (alcanna) with olive-oil.

For bloody nails, Nonnus recommends a mixture of verdigris and axunge.

Avicenna, among other applications resembling those of the Greeks, recommends a plaster of cypress-nuts and savin.

For pterygia, Celsus, among other applications, makes mention of a mixture of arsenic, quicklime, and chalcitis, in equal proportions. If this application fail, he directs us to use the actual cautery. Aëtius and Oribasius recommend the most powerful escharotics, such as verdigris, misy, sori, chalcitis, and arsenic. These applications are mentioned likewise by Rhases. (Contin. xxxvi.)

Pliny says of arsenic, “Tollit et pterygia digitorum,” &c. (H. N. xxxiv, 56.)

END OF VOL. I.

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

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