Chapter XXXI: Part 31

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

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

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

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

* * * * *

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

“Tollere nodosam nescit medicina podagram.”

(Pont. i, el. 4.)

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

SECT. LXXX.—FOR CORNS AND CALLOUS FLESH.

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

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

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

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

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

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

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

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

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

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

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

_For bloody nails._ Mix fine flour with pitch, and apply.

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

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

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

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

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

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

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

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

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

_For bloody nails_, Nonnus recommends a mixture of verdigris and axunge.

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

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

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

END OF VOL. I.

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