Chapter XX: Part 20

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

_On myopia._ This section also is taken from Oribasius or Aëtius.

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

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

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

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

_For ulcers with inflammation._ Triturate equal parts of lycium (_catechu?_) and meconium with honey, and inject.

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

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

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

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

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

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

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

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

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

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

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

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

* * * * *

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

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

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

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

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

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

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

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

Serapion and Rhases treat the complaint exactly like our author.

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

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

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

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