Chapter II: Appendix: To the Fifth Book (1)

On feigned Diseases, and the Detection of them 244

On professional Impostors 245

SIXTH BOOK.

1. Preface to the Surgical part 247

2. On burning of the Head for Ophthalmia, Dyspnœa, and
Elephantiasis 248

3. On Hydrocephalus 250

4. On Arteriotomy 253

5. On Angiology, or section of the temporal vessels, and
on burning the same 254

6. On Hypospathismus 256

7. On Periscyphismus 258

8. On suture of the upper Eyelid, and other modes of operating
for Trichiasis 259

9. On burning of the Eyelids by medicines 264

10. On Lagophthalmos, or Hare-eye 265

11. On the suture of the under Eyelid, and the burning of it
by medicines 266

12. On Ectropion, or eversion of the lower Eyelid 267

13. On Anabrochismus and burning with iron 269

14. On Hydatids 270

15. On adhesion of the Eyelids 272

16. On Chalazia, or tumours resembling hailstones 273

17. On Acrochordion and Encanthis 274

18. On Pterygia 275

19. On Staphyloma 277

20. On Hypopyon of the eye 278

21. On Cataracts 279

22. On Ægilops, or fistula lachrymalis 284

23. On imperforate Meatus Auditorius 286

24. On substances that have fallen into the meatus auditorius 287

25. On Polypus 289

26. On Maimed Parts 292

27. On Epulis and Parulis ib.

28. On the Extraction of Teeth 294

29. On constriction of the Tongue, or tongue-tied persons 295

30. On Antiades, or indurated tonsils 297

31. On the Uva 298

32. On thorny substances fixed in the pharynx 300

33. On Laryngotomy 301

34. On Abscess 303

35. On Strumæ, or scrofulous glands 307

36. On Steatoma, Atheroma, and Meliceris 309

37. On Aneurism 310

38. On Bronchocele 314

39. On Ganglion 315

40. On Venesection 316

41. On Cupping 324

42. On burning the Armpit 328

43. On preternatural fingers, and on persons having six fingers 329

44. On the operation of burning for Empyema 330

45. On Cancer 332

46. On male breasts resembling the female 334

47. On burning over the Liver 335

48. On burning over the Spleen 336

49. On burning over the Stomach ib.

50. On Dropsies 337

51. On Exomphalos, or Prolapsus of the Navel 340

52. On Wounds of the Peritoneum, and on falling down of the
Intestine or Omentum, where Gastroraphé also is described:
from the Works of Galen 342

53. On Deficiency of the Prepuce 346

54. On Hypospadiæum, or imperforate Glans Penis 347

55. On Phimus, or Phimosis ib.

56. On Adhesion of the Prepuce to the Glans 349

57. On Circumcision ib.

58. Of Thymi on the Penis 350

59. On Catheterism, and Injection of the Bladder 351

60. On Calculus 354

61. On the Parts about the Testicles 363

62. On Hydrocele 365

63. On Sarcocele and Tophi of the Testicles 369

64. On Cirsocele and Pneumatocele 370

65. On Enterocele, or Intestinal Hernia 372

66. On Bubonocele, or Inguinal Hernia 377

67. On Rhacosis, or Relaxation of the Scrotum 379

68. On Castration ib.

69. On Hermaphrodites 381

70. On Extirpation of the Nympha and Cauda Pudendi ib.

71. On Thymi, Condylomata, and Hemorrhoids about the Female
Parts of Generation 382

72. On Imperforate Pudendum and Phimus 383

73. On Abscess of the Womb 385

74. On Embryulcia and Embryotomy 387

75. On Retention of the Secundines 392

76. On burning the Hips 394

77. On Fistulæ and Favi 396

78. On Fistulæ in Ano 399

79. On Hemorrhoids, or Piles 403

80. On Condylomata, or Excrescences, and Fissures 405

81. On Imperforate Anus ib.

82. On the Excision of Varices 406

83. On the Dracunculi, or Guinea-Worms 409

84. On Amputation of the Extremities ib.

85. On Pterygia about the Nails 414

86. On a bruised Nail 415

87. On Clavi, Myrmecia, and Acrochordones 416

88. On the Extraction of Weapons 418

89. On Fractures and their Differences 427

90. On Fractures of the Bones of the Head 429

91. On Fracture and Contusion of the Nose 443

92. On Fracture of the Lower Jaw, and Contusion of the Ear 445

93. On Fracture of the Clavicle 447

94. On Fracture of the Scapula 450

95. On Fracture of the Breast-Bone 451

96. On Fracture of the Ribs 452

97. On Fracture of the Bones of the Loins and Pubes 454

98. On Fracture of the Vertebræ, Spine of the Back, and Os Sacrum 455

99. On Fracture of the Arm 464

100. On Fracture of the Ulna and Radius 464

101. On Fracture of the Hand and its Fingers 465

102. On Fracture of the Thigh 466

103. On Fracture of the Patella 468

104. On Fracture of the Leg 469

105. On Fracture of the Foot 470

106. On the Arrangement of the Limb ib.

107. On Fractures complicated with a Wound 472

108. On the redundant Callus of Fractures 476

109. On Distortion from the Union by Callus ib.

110. On Bones which have not united by Callus 477

111. On Luxations 478

112. On Dislocations of the Lower Jaw 479

113. On Dislocations of the Clavicle and Acromion 482

114. On Dislocation at the Shoulder 484

115. On Dislocation of the Elbow 489

116. On Dislocations at the Wrist and Fingers 492

117. On Dislocations of the Vertebræ of the Spine 493

118. On Dislocation at the Hip-Joint 498

119. On Dislocation at the Knee 505

120. On Dislocation at the Ankle, and also of the Toes 506

121. On Dislocations with a Wound 509

122. On Dislocation complicated with Fracture 510

PAULUS ÆGINETA.

BOOK FOURTH.

SECT. I.—ON ELEPHANTIASIS.

Well, in my opinion, did Aretæus the Cappadocian say, that the power of remedies ought to be greater than those of diseases; and that for this reason elephantiasis is incurable, because it is impossible to find a medicine more powerful than it. For if cancer, which is, as it were, an elephantiasis in a particular part, is ranked among the incurable diseases by Hippocrates himself, how much more is not elephantiasis incurable, which is, as it were, a cancer of the whole body? But the black bile from which this affection is formed, having a double origin, (for it arises either from the melancholic and feculent part, and, as it were, dregs of the blood, or from yellow bile, both being overheated); the first variety of the black bile produces the reddish elephantiasis, which is the more mild, or to speak more truly, less malignant variety; the others which are more malignant, being accompanied with ulceration of the whole body and falling off of the extremities, are produced by the latter variety, or that from yellow bile overheated. Wherefore, those who are already overpowered by the disease, must be abandoned; but when the affection is in its commencement, so as that none of the extremities has fallen off, nor the surface of the body become ulcerated, nor the hard swellings appeared, and the face merely appears foul, but not altogether unseemly, we must attempt the cure. For not a few, by merely burning the head, have prevented many who were beginning to be affected from being overpowered by this disease. Wherefore, at the commencement of the disorder, we must have recourse to venesection repeatedly, more especially if in spring, when the complaint is most apt to occur, and has its exacerbations. After an interval of a few days, say nine or ten, we may purge them with the pottage of colocynth, not once only but frequently, proportioning the dose of the medicine to its strength. Purging with hiera also suits well with them. After the interval of about ten days again, we must give them the vinegar of divided milk, not in less quantity than three heminæ, nor in greater than five, and on the following days they are to be supported with milk that is not divided into parts, or new-drawn milk; by which means, if the affection yield, the same food may be continued; but if it remains in the same state, after eating acrid things, they must be made to vomit with radishes and frumentaceous articles of food. After these things, purging with white hellebore is proper, twice if possible when in spring, but once only if in autumn. Those, however, who are thoroughly overpowered by the complaint, must be neither bled nor put on a course of hellebore. For neither can a translation of the disease from the superficies to the inner parts, nor a diminution of the offending matter, be any longer accomplished by these means; but the matter is to be determined to the stomach and bowels, and alteratives (metasyncritica), used to dry and constrict the skin. Dry-cupping is also to be applied over the mouth of the stomach and to the hypochondria, and dropaces used to the same places; but after a short interval, the same process is to be repeated, beginning by purging with hiera, and omitting the venesection, which would prove rather deleterious than beneficial. This process is to be repeated three or four times in a year, more especially in the seasons of spring and autumn. The draughts before meals, most suitable for them, are a cyathus of vinegar, with a cyathus of cedria, and two cyathi of the juice of unripe cabbage—they are given mixed together, morning and evening; or, the dried leaves of the herb ironwort, to the amount of a drachm in one cyathus of wine; or, a drachm of hartshorn and a cyathus of the vinegar of squills, is given after the morning walk every day; and other things are to be administered at the same season, such as drs. v of washed squills in honied water, or in honey, as a linctus; or Cyrenaic juice, to the amount of a bitter vetch, mixed with honey and butter; or, dr. ss of the shavings of hartshorn, with two cyathi of wine; or, drs. iij of Æthiopian cumin, with honey, as a linctus. But a more suitable remedy is a drachm of the theriac trochisk, triturated in a cyathus of fine wine, and drunk; and a drachm of the trochisk of squills may in like manner be taken in a draught. And they praise the juice of calamint as a most effectual remedy when drunk, and say that the dose to commence with is three cyathi, which may be increased to six. But of all others the theriac of vipers is the most effectual remedy, both in a draught and when rubbed in externally. But where plenty of these animals can be procured, nothing answers so well as eating the flesh of the vipers boiled in white broth, with much water, salts, leeks, and dill, to the separation of their back-bones, their head and tail being first cut off to the extent of four fingers’ breadth, and their entrails and skin taken away. And theriac salts are in the same celebrity when taken with other food. By using them thus, it happens that the scales, or, as it were, the bark, falls off from the skin.

The regimen is to be as follows: After sleep, having been first rubbed, and the bowels evacuated, let the patient have recourse to gestation and vociferation, then to friction and gymnastic exercises of all kinds, partly by leaping, but more especially by using the halcteres and leather bag. Having wiped off the sweat, let him be rubbed with the grease of a boar, of a wolf, of a goat, or of some winged animal, or with fresh butter; and after a short interval let him bathe, having his body anointed with the juice of fenugreek, of ptisan, or with a little ammoniac dissolved in vinegar. After the bath, having got his body wiped, let him anoint with the oil of lentisk, of wild vine, or of myrtles; and with a little wine, containing alum and ammoniac, so as to be of the thickness of the sordes of baths. Having had his body rubbed again with soft rags, let him rest for half an hour, after which, having drunk water, let him make himself vomit by putting his fingers or a feather down his throat. Having vomited, let him drink the wine of wormwood or of marjoram. The food should be barley bread, or a cake of dried barley flour, and of potherbs, the beet, the lettuce, the radish, leeks, and cabbage sweetened in two waters, and capers. Of sea animals, he may take oysters, pelorides, urchin, all shell fishes, limpets boiled with beets, and old pickle in place of medicine. But let him abstain from wine during the whole continuance of the complaint, and from venery; only he may take a little thin watery wine at the time of his recovery from the purging, at which season all acrid substances must be abstained from, except condiments. Give him ptisan, eggs and chondrus, milk and honey, with bread, mallows, dock, skirret, and fishes with tender flesh; and of fowls, those which contain wholesome juices; and of fruits, the fig, grape, and raisins: but of sweetmeats, those which are prepared from pine kernels, toasted almonds, or bastard saffron. He may take food twice a day, as it is injurious to subsist upon one meal. After taking care of the internal parts, let him use detergent ointments (smegmata) in the bath, from the decoction of beet, or of fenugreek with aphronitrum, soap, or myrobolan, and sometimes apply depilatories. Purslain triturated with vinegar is detergent and also the slender houseleek, and the roots of dock boiled in vinegar, and alum with salts, and red arsenic in equal proportions with wine and oil of lentisk. Also the composition for alphos, consisting of alcyonium, nitre, myrtle, sulphur, and the dried leaves of the wild fig, being rubbed in dry with vinegar; and that from the burnt shell of the cuttle-fish, and pumice, nitre, and burnt Cimolian earth, gum, unripe galls in equal quantity, sprinkled dry, or rubbed in with vinegar. And this one is admirable: Of the roots of dock a bunch to the amount of a handful, of natron, dr. xl; of frankincense, dr. xxv; of sulphur, dr. xxv; it is rubbed in with Egyptian vinegar. And this one is efficacious: Of arsenic, dr. x; of sulphur vivum, dr. viii; of costus, dr. xii; of quicklime, dr. iv; of wax, dr. iv; of dried bay berries, dr. xii; these things are mixed with the juice of white poplar leaves, or with a thick decoction, and they are rubbed in, having the consistence of honey.—_Another_: Two fasciculi of the roots of dock are to be boiled in vinegar, pounded in a mortar and triturated, then of alcyonium, lb. j; of aphronitrum, oz. viij; of sulphur vivum, lb. j; of the burnt shells of cockles, oz. iv; of chamæleon with its roots, oz. iv; these things are pounded together until they are of the consistence of the sordes of the baths, and are then rubbed in often in the sun, if summer, but if winter, in the bath, until it occasions sweating. And the dry smegma of Æsculapius would agree excellently with these cases, and all the smegmata about to be described, even unto those for alphos, and also those now mentioned, are applicable for those complaints. And the tumid excrescences, whether inflammatory or ulcerous, are to be rubbed with Indian buckthorn: or horned poppy, or aloe, or the Andronian trochisk, or that of Polyides; and let cataplasms be applied of chondrus with the juice of knot-grass or plantain; or of pellitory of the wall, triturated; and the leaves of the green Melisian herb, when pounded with axunge and applied, are wonderfully efficacious, for they redden the parts, but the redness is easily repressed by the application of bread; or of the cerate made from almond oil. By this means their natural colour is restored. When the parts are ulcerated, plasters are suitable: that from diphryges, and the apple one with wine, that called coracium, that made from oxymel, the Andronian trochisk, pompholyx and calamine. It is a symptom that the whole disease is becoming more moderate when the first ulcers are cicatrized. For the dyspnœa of persons labouring under elephantiasis give a draught of five or six slaters in three cyathi of honied water. And some of the general remedies described for dyspnœa will be applicable for them. Of the natural baths we must select, as being most particularly useful, the aluminous and chalybeate, and if possible, such as are cold. It is also particularly serviceable to drink them. And the use of the sand of the sea-shore has the same effect, and so have all the sudorifics. But since this affection is one of those which are easily communicable, no less so than the plague, they are to be removed as far as possible from cities, and lodged in inland and cold situations, where there are few inhabitants, if this can be accomplished; for so they may descend from thence to surrounding places. This is proper partly on their own account and also on account of those whom they might come in contact with. For they themselves will thus enjoy the use of a more commodious air, and they will not communicate the evil to others.

* * * * *

COMMENTARY. Consult Lucretius (vi, 1112); Celsus (iii, 25); Pliny (Hist. Nat. xxvi, 5); Scribonius Largus (102); Cælius Aurelianus (Pass. Tard. iv, 1); Marcellus (De Med. xix); Serenus Samonicus (11); Octavius Horatianus (i, 32); Isidorus (Orig. iv, 8); Vegetius (Mulom. i, 9); Aretæus (Curat. Morb. Chron. ii, 13); Plutarch (Symp. viii, Quest. 9); Galen (ad Glauc. ii, 10; de Causis Morb. 7); Oribasius (Morb. Curat. iii, 62; Synops. vii, 5); Pseudo Dioscorides (Euporist. i, 105); Aëtius (xiii, 120); Actuarius (Meth. Med. ii, 11, and iv, 15); Nonnus (Epit. 233); Psellus (op. medicum); Leo (vii); Myrepsus (De Med. comp.); Avicenna (iv, 3, 3, 1); Serapion (v, 14); Avenzoar (ii, 7, 12, 26); Albucasis (Chirurg. i, 49); Haly Abbas (Theor. viii, 15, Pract. iv, 3, ix, 69); Alsaharavius (Pract. xxxi, 2); Rhases (ad Mansor, v, 35, ix, 93, Contin. xxxv, 26.)

We owe the earliest notice which we have of this disease to the poet Lucretius, who briefly mentions it in the following lines:

“Est elephas morbus qui propter flumina Nili
Gignitur Ægypto in mediâ neque præterea usquam.”

Celsus says that elephantiasis is a chronic disease, almost unknown in Italy, but very common in certain countries. He calls it an affection of the whole body, even of the bones. The upper part of the body is covered with frequent spots and tumours, the redness gradually changes to black, the skin is thickened, and covered with hard asperities like scales; the body wastes, but the face, legs, and feet swell; and when the disease is protracted, the fingers and toes become buried in the swelling, and a slight fever comes on, which finishes the patient’s sufferings. Such is his description of the disease. His treatment consists in bleeding at the commencement, abstinence, then supporting the strength, purging, exercise, sudorifics, and friction. Baths are to be rarely used; fatty, glutinous, and flatulent articles of food are to be avoided, but wine is to be allowed, except at the beginning. The body is to be rubbed with pounded plantain.

According to Pliny, elephantiasis was never known in Italy until the days of Pompey the Great, when it was imported from Egypt, and raged for a time, but soon became extinct. He describes it as affecting the face in particular with hard, rough, black maculæ, which sometimes spread to the bones, the toes and fingers being swelled.

Serenus Samonicus, who is said to have flourished about the beginning of the third century, thus describes the disease:

“Est elephas morbus tristi quoque nomine dirus,
Non solum turpans infandis ora papillis,
Sed cito præcipitans funesto fata venino.”

His remedies are the juice of the bark of the juniper, the ashes and blood of the weasel, mint, and various external applications, consisting of ceruse, Egyptian paper, roses, &c.

Scribonius Largus recommends sulphur with common oil for lepra, “et quam elephantiam dicunt,” but he gives no description of the latter.

It is greatly to be lamented that Cælius Aurelianus’ account of elephantiasis has come down to us in an imperfect state. His description is entirely lost, and his detail of the treatment is in a mutilated state. It appears, however, that his views were similar to those of Celsus, and that he considered it to be a malignant disease, affecting principally the skin. He approves of rubbing stimulant ointments into the skin, and of using medicinal baths, especially the aluminous and chalybeate. When the applications produce ulceration of the skin, he directs us to treat it upon general principles. He makes mention of vomiting by radishes, and latterly by means of the white hellebore. He approves of a sea voyage and change of scene. He says the first author who described elephantiasis was Themison, the same person that is damned to everlasting fame in one of the lines of Juvenal: “Quot Themison agros autumno occiderit uno.” (Sat. x, 221.) If this statement be correct, it is clear that Celsus cannot be of so early a date as is generally believed, that is to say, the Augustan age, for Themison flourished towards the end of the first century, P. C. He was the founder of the Methodical sect. Cælius also blames Themison for recommending bleeding and vomiting unseasonably, and disapproves of his directions respecting the applications to the skin. It appears that he also disapproved of the theriac of vipers, and of giving to drink water in which red-hot iron had been extinguished. There can be no doubt, from the circumstances which he mentions, that the disease was thought contagious in his time.

Octavius Horatianus, who lived under the emperor Valentinian, gives a pretty full detail of the treatment, but his description of the symptoms is defective. He makes mention, however, of _maculæ_, which affect principally the face; he contends that the whole system is attacked with the disease, and that the flesh is corrupted. His remedies are much the same as those recommended by the other authorities, namely, bleeding, purging, vomiting, the theriac of vipers, and rubbing with the usual applications for scabies. He also speaks favorably of the natural and the sea-water baths.

Marcellus the Emperic, who is supposed to have flourished in the reign of Theodosius, recommends, like Serenus, mint, juniper, and mezereon, for elephantiasis. He describes it as being attended with hard excrescences of the extremities, eruptions on the face, and disease of the bones. He speaks of its being endemic in Ægypt.

The disease, elephantiasis, according to Isidorus, is so called from its resemblance to the elephant. The skin in it is hard and rough, from which it gets its appellation, because the surface of the patient’s body resembles that of an elephant; or because it is a mighty affection, as the elephant is one of the largest of animals.

Vegetius, the great ancient authority on veterinary surgery, describes elephantiasis as it affects cattle. The symptoms are hardness and roughness of the skin, squamæ, eruptions on the feet and head, and a fetid discharge from the nose. He approves of bleeding, and the other means recommended by the regular surgeons.

We shall next give the descriptions of the Greek authorities.

Aretæus gives a most elaborate but surely somewhat overstrained description of elephas, which he paints in colours the most hideous and disgusting. We shall endeavour to convey to the reader an idea of his sketch, stripping his picture of its flowery ornaments, and contracting its bulk. The disease is called _elephas_, he says, from its magnitude, _leontium_ or _morbus leoninus_, from the supposed resemblance of the eyebrows to those of the lion; and _satyriasis_, from the venereal desires with which it is attended. The disease is described as escaping notice at first, being deep-seated and preying upon the vitals, but afterwards it is determined to the superficies, commencing sometimes with the face, and at other times with the extremities. The belly is dry, because, as he ingeniously remarks, the distribution of the food is performed regularly, and the vitiated parts strongly attract the chyle to them as a pabulum to the disease. There are large callous eminences on the skin, and the veins appear enlarged, owing to a thickening of the vessels and not to a plethora of blood. The hairs of the head, pubes, and other parts of the body, drop off. The face in particular is affected with callous tubercles or warts, and it is not uncommon for the tongue, and most parts of the body, to be also covered with them. The eyebrows are thickened, stripped of their hair, and hang down like those of the lion. The general appearance of the skin, covered as it is with hard tubercles, and intersected with deep fissures, is said to bear some resemblance to that of the elephant. Sometimes particular members, such as the nose, feet, fingers, the whole hand, or the pudenda, will die and drop off; and it is not uncommon for incurable ulcers to break forth on different parts of the body. Dyspnœa, and a sense of suffocation, are occasionally present. He says, it is dangerous to have any intercourse with persons labouring under the disease, no less so than in the case of the plague, as both are readily communicated by respiration. He directs us, at the commencement, to abstract blood freely, because blood is the _pabulum morbi_. He recommends us to purge with hiera, and to procure vomiting by radishes, but more particularly by the white hellebore, upon which he bestows a glowing and eloquent eulogy. Like our author, he approves of the theriac of vipers. He makes mention of many external applications of a detergent nature, and in particular praises a soap used by the Celts for cleaning their clothes. He also commends natron, alcyonium, sulphur, alum, ammoniac with vinegar, and the like, for the same purpose. When the flesh is livid, he directs us previously to make deep incisions in it. The diet is to be plain and digestible; sulphureous baths are to be used: the patient is to swim frequently in sea-water, to take a sea voyage, and otherwise not neglect suitable exercise.

Plutarch informs us that it was disputed in his time whether or not elephantiasis was a new complaint.

Galen, as far as we can recollect, has nowhere treated very particularly of elephantiasis, but in his work ‘De Causis Morborum’ he has briefly mentioned that in this disease the nose becomes flattened, the lips thick, and the ears extenuated, the whole appearance resembling that of a satyr: and in his work entitled ‘De Curatione ad Glauconem’ he ranks elephantiasis with cancerous swellings, and says that the disease is common about Alexandria, owing to the heat of the place and the food of the inhabitants, which consists principally of lentils, snails, pickles, the flesh of asses, and the like, all which things have a tendency to engender the melancholic humour. The temperature of the place likewise, he shrewdly remarks, determines the superfluities of the system to the skin. He recommends the treatment which we have already had occasion to mention, namely, bleeding, purging, and the theriac of vipers. In the ‘Isagoge,’ the black and white hellebores are particularly commended. Galen elsewhere calls it contagious. (Lib. ii, Simpl. de carne viperæ.)

Oribasius gives no description of the disease, but briefly recommends the theriac of vipers, and in certain cases purging and bleeding for the cure of it.

The account given by Aëtius is principally taken from Archigenes, and is very circumstantial. The disease, he remarks, has been called by the several names of elephantiasis, leontiasis, and satyriasis. Suspicions, he says, have been entertained of its being contagious, and he is of opinion that it is unsafe to hold intercourse with those who are ill of the disease, as the air becomes contaminated by the effluvia from their sores, and by their respiration. The disease, he says, is insidious, for it begins in a concealed manner internally, and does not make its appearance on the skin until it is confirmed. Men are more subject to it than women, and intemperate climates predispose to it. The first symptoms of the disease are torpor, slow respiration, constipated bowels, urine like that of cattle, continued eructations, and strong venereal appetites; and when it is determined to the skin, the cheeks and chin become thickened and of a livid colour, the veins below the tongue are varicose, and eminences are formed all over the body, but especially on the forehead and chin. The body becomes increased in bulk, and is borne down by an intolerable sense of heaviness. Those affected with it become pusillanimous, and shun the haunts of men. Though the disease, when confirmed, is of the most hopeless description, he forbids us to abandon the sick at the commencement. His treatment is almost the same as our author’s: venesection at the beginning, purging with colocynth or hiera, and vomiting with radishes or white hellebore. Some, he says, having remarked that eunuchs escaped taking this complaint, have castrated themselves as a preventive. He makes mention of all the medicinal substances recommended by our author, namely, iron-wort, Cyrenaic juice, the theriac of vipers, &c. For the cutaneous affections he recommends a great many external applications, containing white hellebore, sulphur, rue, natron, aloes, and even arsenic. He also speaks of cataplasms, depilatories, and detergent ointments. He is very particular in directing that the diet be light and wholesome.

Actuarius calls elephantiasis a cancer of the whole body, which preys upon all the flesh, and derives its origin from black bile corroding everything like fire. The first symptoms of it are a falling off of the hairs of the eyebrows and chin, tumours on the face, an alteration of the appearance of the eyes, a change of the voice, turgidity of the sublingual veins, and afterwards cutaneous eruptions of an intractable nature. He then states that elephantiasis, lepra, psora, and impetigo are diseases of different gradations of malignity. In another place he has given the treatment, which is exactly the same as that recommended by Aretæus, namely, bleeding, purging with hellebore, detergent and desiccative applications to the skin, &c.

Some applications, seemingly of little efficacy, are recommended for elephantiasis in the ‘Euporista’ of the Pseudo-Dioscorides.

Nonnus, as usual, abridges our author’s detail of the treatment, and omits the description. He says it arises from a melancholic humour, which corrodes the extremities. According to Psellus, the disease is produced by _melancholy adust_ and the lees of putrid blood.

The account of elephantiasis given by Leo is brief and imperfect. The disease, he says, is produced by a melancholic humour, which has become putrid, and corrodes the extremities. It is, he adds, almost incurable, but may be benefited by purging with the dodder of thyme, by the theriac, and burning the head at the bregma. The affection, he says, is also called satyriasmus.

Myrepsus merely mentions some of the common remedies for elephantiasis, such as arsenic, turpentine, litharge, &c. He gives no description of the disease.

We now proceed to the Arabians.

Avicenna gives a very circumstantial account of elephantiasis, under the name of _juzam_ or _judam_, which his translator renders by _lepra_. He calls it a cancer of the whole body, which arises from black bile, and is sometimes attended with ulceration, and is sometimes without it. The disease, he says, is contagious: it is produced by living upon the flesh of asses, lentils, &c., and is endemic in Alexandria. It is sometimes called _leonina_, because the face assumes the stern appearance of the lion’s. He states that, although it begins internally, its first symptoms are manifested on the extremities. He then describes minutely the symptoms, namely, redness of the face, inclining to lividity; falling off of the hairs, enlargement of the veins, affection of the breathing, thickening, and discoloration of the lips; and afterwards ulceration of different parts of the body, corrosion of the cartilages of the nose, then falling off of the nose and extremities, loss of voice, &c. The treatment he gives with great minuteness, but as it is little different from that of the Greeks, we need scarcely enter upon it. Suffice it to say that he mentions early bleeding, purging with hellebore, colocynth, scammony, &c.; the theriac of vipers, the application of the cautery to the head, and so forth. Enough has been said to show that this description applies to the elephantiasis of the Greeks. Considerable confusion, however, has arisen in consequence of his translator applying the term _elephantia_ to a very different disease, namely, to an enlargement of the leg with varicose veins, now generally known by the name of the _Barbadoes leg_. This complaint he directs to be treated at first with local bleeding and astringents; but when ulceration takes place, it is to be remedied only by amputation.

Serapion, in like manner, describes the elephantiasis of the Greeks by the name of _lepra_. The face, he says, is swelled, livid, and covered with hard pustules, the hairs of the eyebrows fall off, the whole aspect becomes hideous, the voice is changed, the perspiration becomes vitiated, and ulceration seizes different parts of the body. The disease, he says, takes its origin from the liver, in which the office of sanguification is improperly performed. His remedies are bleeding, hellebore, the theriac, &c.

Avenzoar describes the _lepra_ as a cancer arising from contact with other lepers, or from unwholesome food. He recommends to purge away the melancholic humour with scammony, colocynth, black hellebore, &c. The _elephantia_ he describes as a disease in which the leg is swelled like the leg of an elephant. He considers it almost incurable.

Albucasis gives an account of the operation of burning the head for _lepra_, i.e. the elephantiasis of the Greeks.

The translator of Haly Abbas, namely, Stephanus Antiochensis, who says he wrote about the year 1127, describes the disease which we have been treating of by the name of elephantia. Like the others, Haly represents it to be a general cancer arising from black bile. He says it proves contagious by respiration. Among the symptoms, he mentions falling off of the ciliary and superciliary hairs, dryness of the nose, which sometimes falls in; in short, he enumerates the same symptoms as the preceding authorities. For the cure he directs us to bleed from the arteries behind the ears, those of the temples, or from a vein in the arm; to give emetics, such as hellebore; to avoid cold; to apply cupping-instruments to the scrobiculus cordis; to administer the theriac, &c. He recommends externally decoctions of beans and vetches at first; and afterwards stimulant lotions, containing arsenic, sulphur, quicklime, and so forth. He also applies the term elephantia, and sometimes elephas, to the swelled leg, which he considers to be a species of varix.

Alsaharavius describes four varieties of _lepra_, namely, the leonina, elephantia, serpentina, and vulpina. The disease, he says, may be contracted, 1st, by an hereditary taint; 2d, by the use of corrupted food, such as the flesh of buck-goats, cows, &c.; 3d, by contagion, through the medium of the respiration. He describes all the gradations of the disease with greater minuteness than any other ancient author. In its last stage, he says, the nose falls in, the hairs drop off, the voice is lost, ulcers break out on the skin, the extremities mortify and fall away, and the breath is fetid. His treatment varies according to the circumstances of the case, but, upon the whole, it is scarcely at all different from that of the others. By the name of elephantia he also describes the _swelled leg_, which he pronounces to be a very intractable disease. He directs us, however, to have recourse to bleeding, melanogogues, abstinence from gross food, emetics, and various external applications of a stimulant nature, among which he mentions burying the leg in hot sand.

The translator of Rhases also applies the term _lepra_ to the elephantiasis of the Greeks. The colour of the eye, he says, is changed, the voice becomes rough, the face is swelled, like a bladder, and red with nodes, the hairs fall off, and the extremities at last become swelled and ulcerated. There is nothing peculiar in his treatment. He describes, likewise, the _swelled leg_ by the name of elephantia or elephas. He says that, when tubercles arise on it, it is utterly incurable; but that when simply enlarged, it may be remedied by bleeding in the arm, cupping, emetics, attenuant food, and the like. In his ‘Continens,’ he calls the lepra (elephantiasis) hereditary and contagious. He says, it is a general cancer, arising from black bile. For the _swelled leg_ he recommends, as in his other work, bloodletting and emetics, with stimulant applications, containing pearlashes, sulphur, &c., and also tight bandages.

Such is the history of elephantiasis given by ancient authors.

The earlier of our modern writers on medicine, describe elephantiasis as a species of lepra, of which they enumerate four varieties, namely, elephantia, leonina, alopecia, and tyria. This arrangement is evidently taken from Alsaharavius. Such is the account which Platiarius gives of these diseases. In like manner, the Pseudo-Macer ranks elephantiasis with lepra:

“Est lepræ species elephantiasisque vocatur,” &c. Upon this passage Cornarius makes the following annotation: “Vulgus medicorum Arabas in hoc secuti lepram cum elephantiasi confundunt. Immo lepram pro elephantiasi accipiunt.”

Guido de Cauliaco’s account of the disease is also nearly the same as that of Alsaharavius. He states decidedly that the disease is contagious, and recommends bleeding, purging, the actual cautery, the theriac of vipers. (vi, 1.) Rogerius remarks that the disease is contracted _per coitum_. (i, 15.) And here, by the way, we may be permitted to state that we have long been convinced that the syphilis of modern times is a modified form of the ancient elephantiasis. This opinion is maintained by several of the writers of the Aphrodisiacus, and also by the learned Sprengel, who gives a very interesting disquisition on Syphilis in his ‘History of Medicine.’

It appears that the disease in its ancient form is still prevalent in certain parts of the world; as, for example, in the Sardinian States, where it is still looked upon as being both contagious and hereditary. It is also endemic in Norway: nay, it is reported to have broken forth with all its ancient character in the province of New Brunswick. In the East, elephantiasis and leontiasis are still considered as aggravated forms of leprosy. (See Heber’s Travels, ii, 50; and Niebuhr’s Travels, xxvii, 11.) We may be allowed to add, in conclusion, that a great mass of misapprehension has prevailed in modern times regarding the elephantiasis of the Greeks and Arabians. We trust the above sketch will remove the difficulties which formerly beset this subject.

SECT. II.—ON LEPROSY AND PSORA.

Both these affections consist of an asperity of the skin, with pruritus or wasting of the body, having their origin from a melancholic humour. But leprosy spreads over the skin more deeply in a circular form, throwing out scales which resemble those of fishes. But psora is more superficial and variously figured, and throws out furfuraceous bodies. In these cases we must premise venesection when the body appears more than usually plethoric; but, if not, we must by all means purge with those things which evacuate black bile. Externally we may use in common either of the hellebores; and have washed lime dried, and, when going to use it, we may dilute it in water until it attain the thickness of the wrestler’s sordes, and anoint.—_Another_: Of sage, of the tears of Æthiopian olive, of each, dr. viij; of the bark of capper’s root, of gum, of each, dr. xiij; anoint with vinegar, in the sun. Anemone, when applied, and the root of the white vine particularly, remove psora. But the following are compound remedies: Of the flour of darnel, one chœnix; of the white cardamom, dr. iv; of the scum of natron, dr. j; of copperas, dr. viij; of the middle roots of asphodel, dr. iv; having triturated them in vinegar, and made of the thickness of a cerate, anoint, having first applied nitre to the part; and having removed it, (which do about the third day,) and washed with cold water, again anoint.—_Another_: Of the juice of kings’ spears’ roots, oz. vj; of sulphur vivum, of manna, of each, dr. x; of natron, dr. viij; anoint, mixing with vinegar. The following simple remedies are particularly applicable for psora: Stavesacre, bitter lupins, cardamom with vinegar, the root of lily with honey, turpentine rosin, sulphur, chick peas, goat’s dung; and these compound ones—mix equal parts of chalcitis and misy with wine, and anoint the more humid kinds of psora.—_Another_: Boil the tender leaves of rose-bay in a sextarius of oil until they are dried, and, throwing away the leaves, add to the oil oz. iij of white wax, and, after it is dissolved, cool and sprinkle upon it oz. j of sulphur vivum, and anoint in the sun or in the bath. Some boil also squills with the rose-bay.—_Another_: Of diachylon, oz. ij; of wax, oz. ij; of oil of roses, oz. j; of litharge, oz. iij; of ceruse, oz. iij; of liquid pitch, oz. vj; of the dross of silver, oz. ij; of siricum, oz. ij; of vinegar, what will be sufficient for the trituration of the dry things.—_Another_: Of ceruse, oz. ss; of starch, oz. ss; of lead, oz. j; of red lotuses, or of alkanet, oz. ij; of wax, oz. vj; of oil of roses, oz. ix; boil the alkanet properly with the oil of roses, and then add the other things.—_Another_: Take ten eggs, or as many as are required, and having macerated in the most acrid vinegar until their shell become tender; boil in the vinegar the yelks of them; having triturated with rose-oil and what remains of the vinegar a moderate quantity of litharge, anoint, when of the consistence of the sordes of oil in baths.—_Another_: Three yelks of eggs out of vinegar; of rose-oil, oz. vj; of sulphur vivum, oz. iij; having triturated the yelks of the eggs and the sulphur with the vinegar, add the cerate. And litharge triturated with vinegar and rose oil, until it be of the consistence of a plaster, cleanses the most acrid kinds of psora; and the detergent ointments from dock, and the most of those for elephantiasis, answer well in general with leprosy and psora.

* * * * *

COMMENTARY. See Hippocrates (de Usu Humidorum, Epidem. ii); Galen. (Meth. Med. xiv; de Causis Sympt. iii, 6; et alibi); Oribasius (Morb. Curat, iii, 58); Aëtius (xiii, 134); Actuarius (Meth. Med. ii, 11); Nonnus (Epit. 234); Pseudo-Dioscor. (Euporist. i, 128); Leo (vii, 15, 18); Pollux (Onomasticon, iv, 9); Æschylus (Choeph. 274); Alexander Aphrodisiensis (Prob. i, 146, and ii, 42); Celsus (v, 28); Scribonius Largus; Octavius Horatianus (i, 31); Serenus Samonicus; Marcellus (de Med. xix); Isidorus (Orig. iv, 8); Psellus (op. Medicum); Vegetius (Mulom. iii, 71); Geopon. (xviii, 15); Serapion (v, 2); Avicenna (iv, 7, 2, 9); Avenzoar (ii, 7, 4); Haly Abbas (Theor. viii, 16; Pract. iv, 4); Alsaharavius (xxxi, 1, 2, 3, 4); Rhases (ad Mansor. v, 31 et seq.; Divis. 117, et seq.); Contin. (xxxvi.)

As in the preceding chapter, we shall here give a separate account of the views of the Greeks, Latins, and Arabians, beginning, in this instance, with the Greeks.

Hippocrates makes only casual mention of these diseases, and has nowhere marked their distinguishing characters. In one place he calls leprosy a blemish rather than a disease; and in another he remarks that some varieties of it itch before rain. He speaks of vinegar, and of lime and water as remedies for it. It is proper to apprize the reader that the two works quoted above from the Hippocratic Collection are, most probably, not genuine.

Galen also is very deficient on the subject of lepra, having nowhere given a complete description of it, although he notices it incidentally in many parts of his works. In one place he calls elephas, leuce, and alphos cognate affections. Alphos, he says, is much more superficial than leuce. In another, he attributes these complaints to the melancholic humour which becomes fixed in the skin. In the ‘Isagogue,’ which, however, seems not to be a genuine work of his, it is said that lepra is an affection of the skin, which becomes whiter and rougher than natural, the roughness resembling that from prominent psydracia. Psora is said to partake more of the nature of ulceration. Both are represented as arising from a saltish phlegm, and as being cured by phlegmagogues, and ointments rubbed into the skin. It is also stated that leuce is distinguished from lepra by there being no roughness of the skin in the former disease. In another place he mentions psora as a disease most inveterate to cure. (Facult. Natur. i, 13.)

Oribasius thus distinguishes leuce, alphos, melas, lepra, and psora from one another. Leuce is occasioned by a pituitous and viscid blood, which, in process of time, renders the colour white. Alphos arises in like manner, but the superficial skin only is affected, and not the whole flesh. When a pituitous humour is the cause of the complaint, it puts on the appearance of alphos, and when the melancholic, of melas. Lepra affects mostly the deep-seated parts, and psora the superficial. For all these complaints he recommends a mixture of lime and water and some other such things.

In the ‘Euporista,’ generally ascribed to Dioscorides, there is given a long list of medicinal articles for lepra, such as the flour of darnel with sulphur, hellebore with vinegar, verdigris, cantharides, &c.

Aëtius, copying from Archigenes, thus marks the difference between lepra and its cognate diseases. Lepra differs from leuce and alphos, inasmuch as lepra is distinguished by roughness and a sense of itching, and yet the skin only is affected, and when it is removed, the flesh below is discovered to be sound; but in leuce, the flesh below assumes an unnatural degree of whiteness, while the surface of the part is very smooth, and when rubbed it soon becomes red, especially in those who are readily cured; and alphos is altogether superficial, having the appearance of a scale fastened to the skin. Lepra differs from psora, inasmuch as in psora the substances which appear on the skin are of a furfuraceous nature, while in lepra they resemble the scales of a large fish. He omits the constitutional treatment so judiciously stated by our author, but his local applications are little different. They contain hellebore, sulphur, misy, verdigris, liquid pitch, cantharides, natron, copperas, myrrh, galls, vinegar, &c., mixed in various proportions.

Actuarius states that lepra is next to elephantia in malignity, and that it is distinguished from psora by spreading deeper and having scales of a circular shape like those of fishes; whereas, psora is more superficial, and its scales are furfuraceous and of no determinate shape. Both are attended with asperity of the skin, and itching. Leuce holds the same place to alphos that lepra does to psora, that is to say, leuce is more deep-seated, and affects the colour of the hair, while alphos is more superficial, and the hair is in general unchanged. For all these affections he recommends an application containing copperas, black hellebore, arsenic, and cantharides, mixed with oil, cedar resin, or rose oil.

Psellus states correctly that the scales in leprosy assume a circular shape.

Nonnus marks the distinction between these diseases very accurately. Lepra arises from a corroding humour, and hence scales fall from the surface of the skin, and it is attended with pruritus. But lepra is more deep-seated, and affects the skin circularly; whereas psora is more superficial and variously figured. Leuce and alphos albus and niger, he says, are allied; but leuce is deeper seated, so as to change the colour of the hairs, whereas the alphi are more superficial affections.

Pollux, like most of the others, states that in leuce, when the skin is pricked, it does not bleed, and that the disease is difficult to cure. Alphos and melas, he says, are easily cured.

Although Myrepsus has not described these diseases, he gives prescriptions for various compositions to remove them. The most active ingredients in them are hellebore, natron, sulphur, quicksilver, sal ammoniac, quicklime, bay-berries, &c.

Alexander Aphrodisiensis mentions psora among the contagious diseases, but says that lepra and leuce are not contagious.

Chrysostom alludes to the common opinion that psora is a contagious disease. The poet Æschylus gives a short description of leprosy in his ‘Chöepheræ’ by the name of lichenes. (l. 277.)

Celsus nowhere uses the terms lepra and psora, and therefore there is considerable difficulty in comparing his account of these cutaneous affections with the descriptions of the Greeks. Alphos, melas, and leuce, he describes very intelligibly, connecting them together by the generic term of vitiligo. We shall give his own characteristic description of these diseases:—“Ἄλφος vocatur ubi color albus est, fere subasper, et non continuus, et quædam quasi guttæ dispersæ esse videantur: interdum etiam latius, et cum quibusdum intermissionibus serpit. Μέλας colore ab hoc differt quia niger est et umbræ similis: cætera eadem sunt. Leuce habet quiddam simile alpho, sed magis albida est et altius descendit; in eâque albi pili sunt, et lanugini similes. Priora curationem non deficillimam recipiunt: ultimum vix unquam sanescit.” Another class of cutaneous affections he connects by the generic term of impetigo, and it is to be remarked that they are all squamous diseases, and not pustular, like the complaints to which Drs. Willan and Bateman have applied the term. His second species of impetigo (as Bateman remarks) appears to be the psora of the Greeks:—“Alterum genus pejus est, simile papulæ feræ, sed asperius rubicandiusque, figuras varias habens: squamulæ ex summâ cute discedunt, rosio major est, celerius et latius procedit, certioribusque etiam quam prior temporibus et fit et desinit. Rubra cognominatur.” His third species bears some resemblance to the lepra nigricans of Willan and Bateman:—“Tertia etiamnum deterior est: nam et crassior est et durior, et magis tumet, in summâ cute finditur, et vehementius rodit, _ipsa quoque squamosa sed nigra_, &c. Nigræ cognomen est.” His account of the fourth species seems to refer to the lepra vulgaris:—“Quartum genus est quod curationem omnino non recipit distans colore: nam sub-albidum est et recenti cicatrici simile: squamulas habet pallidas, quasdam subalbidas, quasdam lenticulæ similes: quibus demptis nonunquam profluit sanguis.” For all these diseases he recommends a composition containing sulphur, natron, and rosin.

Scribonius Largus describes several compositions, “ad lepram, quæ quasi impetigo est cum prurigine cutis,” and for scabies. They contain sulphur, Æthiopian cumin, vinegar, frankincense.

Serenus Samonicus makes mention of a few popular remedies for scabies, prurigo, and papulæ, but he gives no description of these complaints.

Octavius Horatianus recommends for scabies (meaning, we suppose, the psora of the Greeks,) bleeding, purging, frequent baths, and external applications containing natron, frankincense, and sulphur. He does not mention lepra by name, nor does he seem to allude to it at all.

Marcellus recommends for lepra a composition containing equal parts of natron, frankincense, litharge, and sulphur pounded with vinegar.

Vegetius says that the scabies of cattle “contagiosa est et transit in plures.” Probably Virgil alludes to the scab of sheep in this line: “Nec mala vicini pecoris contagia lædant.” (Ecl. i.) He mentions, as remedies for it, sulphur, litharge, pitch, hellebore, &c. (Georg. iii, 449.) See also Geopon. (xvi, 18, xviii, 15); Columella (viii, 5); and Gratius (Cyneget. 412).

Isidorus gives the following definitions of the complaints we have been treating of: “_Lepra_ vero cutis asperitas squammosa lepidi similis unde nomen accepit: cujus color nunc in nigridinem vertitur, nunc in alborem, nunc in ruborem. _Scabies_ tenuis asperitas et squammata est. Impetigo est sicca scabies; prominens a corpore cum asperitate et rotunditate formæ. Hanc vulgus _sarnam_ appellat.”

Justin applies the terms _vitiligo_ and _scabies_ to the diseases treated of in this chapter. See Hist. (xxxvi, 2.) We now turn to the Arabians.

In the Latin translation of Serapion, lepra and psora are described under the generic term of “impetigines in quibus excoriatur et scinditur cutis;” but they are further distinguished from one another by the specific titles of _albaras_ nigra and pruritus. The former is characterized as arising from the melancholic humour, and as casting off round scales. The latter is said to consist of pustules, which appear on different parts of the body, are variously figured, and cast off furfuraceous scales. The leuce is described by the name of _baras_, as arising from viscid, pituitous blood, and being produced by a defect of the assimilative faculty. In it the flesh itself is said to be changed to a white colour. If, when pricked with the head of a needle it bleeds, there is a probability of cure; but if it does not bleed, it is incurable. The two alphi are described by the names of _morphea alba_ and _nigra_. The morphea alba resembles the white albaras (leuce) only that in the latter the affection of the skin is more deep-seated, and the hairs in it are turned to a white colour; but in morphea the only change is in the external appearance of the skin. The morphea nigra (melas?) is said to resemble the albaras nigra (lepra nigricans?) only that it is more superficial.