Chapter XXI: Part 21

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Scribonius gives prescriptions similar to those of Galen.

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

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

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

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

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

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

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

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

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

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

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

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

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

SECT. XXV.—ON AFFECTIONS OF THE FACE.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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