Chapter III: Appendix: To the Fifth Book (2)

In the Latin translation of Avicenna by Bullonensis, alphos albus and niger are distinguished by the names of _morphea alba_ (or _alguada_), and _morphea nigra_; leuce by that of _albaras_; and lepra by those of _albaras_ nigra and _impetigo excorticativa_. The specific differences between them are stated with great precision. The morpheæ are superficial affections of the skin, but the albaras affects also the flesh, penetrating sometimes down to the bone. All these diseases are said to arise from a weakness of the assimilative faculty. In the _albaras_ nigra, or leprosy, the skin is said to be covered with scales, like those of a fish. Like the authorities formerly quoted, Avicenna states that in _alguada_ (alphos albus) the hairs do not change their colour, but that they do so in _albaras_. The puncture of a needle likewise extracts blood from the _guada_, but not from the _baras_.

Avenzoar makes mention of the _morphea_ alba and nigra, but has not described them particularly. These authors seem to have treated lepra and psora like the Greeks, by bleeding, melanogogues, and abstergent applications to the skin, such as the two hellebores, lime, lupines, &c.

In the translation of Haly Abbas, leuce is correctly described by the name of _lepra_. It is represented as a whiteness sometimes affecting the whole body, and it is said to be occasioned by debility of the assimilative faculty. When the hairs are white, and the skin does not bleed when pricked with a lancet or needle, the disease is incurable. Alphos albus is described by the name of _morphea_ alba, and is distinguished from the former by the whiteness being more superficial, and the colour of the hairs remaining unchanged. In the morphea nigra, that is to say the alphos niger, the colour is said to be black, owing to the prevalence of black bile, and if rubbed a furfuraceous scale falls off, and it becomes red. The lepra nigricans is described by the names of _impetigo_ and _sarpedo_, as an asperity of the skin, inclining to blackness or redness, and terminating in round scales, like those of fishes. For the cure of lepra, he directs us to abstain from all articles of food which engender phlegm, to take hiera of colocynth, with pepper, &c., and also the theriac of vipers, and various other internal medicines. He recommends various external applications, containing sulphur, arsenic, hellebore, spurge, &c.

Alsaharavius describes three varieties of _morphea_. 1st. The morphea terrestris, which is attended with furfuraceous scales on the skin, and tingling. This is evidently the psora of the Greeks. 2d. The morphea alba, which consists of a more superficial whiteness of the skin than the _albaras_ (leuce): this is the alphos albus. 3d. The morphea nigra, is like the former, only that the colour is black. This must be the alphos niger. All these affections he treats upon much the same principles as the Greeks, namely, by evacuants, and stimulant applications to the skin, such as sulphur, hellebore, &c. _Albaras_ he describes as a deep-seated whiteness of the skin, and directs us to prick the skin with a needle, and if it does not bleed the disease is to be set down as incurable. This, of course, is the leuce of the Greeks. He treats it upon much the same principles as the morpheæ. He appears not to make any distinction between the leuce and the lepra.

Rhases describes the lepra of the Greeks by the term _impetigo_; alphos albus by that of _morphea_ alba; alphos niger by that of _morphea_ nigra; and leuce by that of _albaras_. There is nothing very particular in his treatment of leprosy. It may be worth while to mention, however, that he strongly recommends leeches to the affected part, at the commencement. Scabies, he says, is formed by a salt diet, old wine, and neglect of the bath. For the cure of it, he recommends bleeding, purging, and various external applications, some of which contain quicksilver, nitre, vinegar, and the like. In his ‘Continens’ he gives a full account of these diseases, upon the authority of preceding writers. He gives the names of _baras_ to lepra, and _morphea_ alba to alphos. He recommends stimulant applications containing cantharides, nitre, with vinegar, &c. He says that he had found a mixture of sal ammoniac and oil of eggs an excellent application.

It will be remarked that the leuce of the Greeks, the leuce and fourth species of impetigo of Celsus, and the albaras of most of the Arabians, are the same as the _lepra vulgaris_ of Drs. Willan and Bateman; that the alphos of most of the Greek authorities and of Celsus, and the morphea alba of most of the Arabians, correspond to the _lepra alphoides_ of our English nosologists; that the melas, alphos niger, and common lepra of the Greeks, Celsus’ third species of impetigo and his melas, and the morphea nigra and impetigo of most of the Arabian translators, apply to the _lepra nigricans_ of our modern arrangement; and that the psora of the Greeks, Celsus’ second species of impetigo, and the scabies of Octavius Horatianus, and of most of the Arabian translators, comprehend both the _psoriasis_ and _scabies_ of Willan and Bateman.

Since many of the ancient authorities speak of _scabies_ as being infectious, they must have applied the term to the true itch, with which it is not likely, as Rayer maintains, that they were wholly unacquainted.

The earlier modern writers, such as those of the Schola Salernitana, Platearius, Guy of Cauliac, and Lanfrancus, jumble together the Latin and Arabian names, so as to produce no ordinary degree of confusion. Guy of Cauliac, indeed, maintains that there is little necessity for distinguishing lepra, alphos, melas, impetigo, gutta rosacea, and such like cutaneous complaints from one another, as they are all varieties of the same disease. Lanfrancus, however, is of a different opinion. (i, 3, 6.)

SECT. III.—ON LICHEN.

Lichen is formed by the mixture of a thin and acrid ichor with other gross humours, and passes readily into leprosy and psora; wherefore it requires to be treated by the most desiccative applications. After general depletion, if necessary, the following simple medicines will be proper: chick-peas, hellebore, the urchin which dwells among rocks, pitch mixed with cerate and rosin, the dung of the land crocodile, that of starlings fed solely upon rice. And many have cured the complaint when occurring on the chin, or other parts of the body, by this application alone: take several grains of wheat and place upon a stithy red-hot, and taking the fluid which flows from them while yet warm, anoint the part affected with lichen. The lichen of children is to be rubbed frequently with human saliva. The gum of the plum tree, when rubbed in, is beneficial in these cases. When the complaint is protracted, the leaves of the chaste tree, triturated with vinegar, are to be applied, or the leaves of capers in like manner. The following are compound applications: Dissolve sulphur with rosemary in vinegar, or with ammoniac, and anoint. A trochisk for lichen: Of artificers’ glue, dr. iv; of frankincense, dr. iij; of vinegar half a cyathus; dissolve in vinegar, and anoint.—_Another_: Of chalcitis, of gum, of each, dr. viij; of sulphur vivum, of misy, of each, dr. vj; of the flakes of copper, of acacia, of each, dr. ij; anoint with vinegar.—_Another_: Of sulphur vivum, of spuma nitri, of each, dr. iv; of the seeds of rosemary, lx; triturate with vinegar, and anoint only the part which is affected, not touching the sound skin. When dry, wash it away with cold water.—_Another_: Of white hellebore, dr. viij; of the flour of lupines, of burnt shell-fishes called buccina, of natron, of each, one chœnix; rub with it dry. They call that variety of lichen _agrius_ which is nowise remedied by moderately desiccative applications, and is exacerbated by more acrid ones. These cases are therefore to be treated by applications which are sufficiently strong, without being pungent, such as this: of horned poppy, of frankincense, of alcyonium, of bitumen, of sulphur, of gum, of each, oz. j; anoint with vinegar. Boil African pitch with vinegar, and, when dissolved, anoint.—_Another_, for lichen and prurigo: Of copperas, of sulphur vivum, of natron, of frankincense, equal parts; use for lichen with vinegar, and for prurigo with wine.—_Another_, for lichen: Of ammoniac perfume, of the flour of bitter vetch, of the flour of lupines, equal parts; add to vinegar.

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COMMENTARY. See Hippocrates (de Humor., de Affect.); Galen. (Isagoge, de Med. sec. loc. v); Oribasius (Morb. Curat. iii, 59); Aëtius (viii, 16); Actuarius (Meth. Med. ii, 11); Marcellus (19); Nonnus (236); Celsus (v, 28); Pliny (H. N. xxvi, 2); Serapion (v, 2); Avicenna (iv, 7, 3, 3); Alsaharavius (Pract. xxxi, 7); Rhases (Divis. 117); Haly Abbas (Pract. iv, 10.)

Dr. Bateman states, that the exact acceptation of the term lichen cannot well be ascertained from the writings of Hippocrates; but Dr. Willan affirms that he restricted it to a papular eruption on the skin.

In the ‘Isagoge,’ usually ascribed to Galen, two varieties are described, the lichen mitis, and the lichen agrius, in both of which scales are formed upon the skin, which appear almost ulcerated when they are removed. They are to be cured by cholagogues internally, and liniments externally.

Galen remarks the tendency of the disease to pass into lepra and scabies. To prevent this, he directs desiccative and detergent applications, for the preparation of which he gives various prescriptions. One of these, which bears the name of Pamphilus, is a powerful escharotic, composed of orpiment, realgar, burnt copper, and cantharides. (Med. sec. loc. v.) He says it affects principally the chin, but is apt to spread over the face.

Oribasius, Aëtius, Actuarius, and Nonnus, treat of the complaint in nearly the same terms as our author. Their translators improperly render it by impetigo. Leo ascribes the origin of the disease to hot and corrupted blood.

Celsus describes the lichen of the Greeks by the name of _papula_, of which he mentions two varieties. In the first, he says, the skin is merely roughened by small pustules, is reddened and slightly corroded; the middle is somewhat smoother, and it spreads slowly, generally in a round shape. This description would seem to apply to the _lichen circumscriptus_ of Drs. Bateman and Willan, although the latter author thinks that it possessed a wider signification. The second variety, he says, is called ἀγρία by the Greeks, and in it the skin is more rough, red, and corroded. The more it departs from the circular form the less tractable is it, and, unless removed, it is said to pass into impetigo. From this account it is clear that the lichen of the Greeks, in its original form, was different from impetigo. Celsus recommends friction with the saliva of a fasting person, and also mentions a composition containing natron, frankincense, sulphur, &c.

The translator of Serapion improperly renders the name of this affection by the term impetigo. His remedies are nearly the same as our author’s, namely, the saliva of a person fasting, compositions containing hellebore, natron, the ashes of starlings, &c.

In the translation of Avicenna it is likewise described by the name of impetigo. It is called a species of dry achor, by which is no doubt meant papula. It is stated that it has a tendency to pass into lepra or psora. The remedies which are recommended are human saliva, the chaste tree, capers, leeches (which are not mentioned by the Greeks), likewise gum arabic dissolved in vinegar, mustard and vinegar, salt water, the roots of king’s spear, &c. Haly Abbas recommends stimulant liniments of a similar kind.

Rhases briefly recommends lotions of vinegar and ammoniac, and, when it becomes inveterate, leeches, strong friction, &c. His translator also misapplies the term impetigo to it.

The lichen appears to be the cutaneous complaint which Alsaharavius describes by the name of _alcoab_. He represents it as a superficial ulceration, and mentions four species of it.

Dr. Willan confirms the statement of the ancient authorities, that the disease has a tendency to pass into lepra and psora. The species called _lichen tropicus_ by Dr. Willan, seems to be the _hidroa_ of Hippocrates (Aph. iii, 21); the _sudamen_ of Pliny (xxiii, 45); one of the _essere_ of Haly Abbas (Theor. viii, 17); one of the _alsara_ of Alsaharavius (Pract. xxx, 8); and the _hasef_ of Avicenna (iv, 7, 3, 8). See also Galen’s ‘Commentary’ (v, 261); ed. Basil. Galen says it is attended with pruritus, asperity, and ulceration. Avicenna and Rhases particularly commend bleeding, cleansing the skin, and the cold bath. Most of Rhases’ authorities in his ‘Continens,’ recommend for the _asaf_, or sudamen, cooling and astringent applications, containing roses, myrtles, galls, sandals, camphor, and the like. They attribute the complaint to profuse perspiration. In certain cases, Rhases directs us to allay the pruritus or tingling, with hot water and the flesh of melons. He also approves of purging with tamarinds and myrobalans. (Cont. xxxvi.) See also ad Mansor. (v, 30). Mercurialis is of opinion that Virgil alludes to the sudamina in the following lines:

“Verum etiam invisos si quis tentarat amictus,
Ardentes papulæ atque immundus olentia sudor
Membra sequebatur.”

(Georg. iii, 565.)

We shall briefly notice in this place the singular disease of the face which prevailed in the Roman empire during the reign of Tiberius, called _mentagra_ by Pliny, in his curious description of it, but which he says was named _lichenes_ by some. He represents it as a contagious disease, which was readily propagated by kissing. It attacked principally the higher class, the lower and middle ranks and women having generally escaped it. The seat of it was commonly the chin, but it sometimes spread over the whole face, and affected even the neck, breast, and hands. The only means of cure was burning with caustics down to the bone. (H. N. xxxvii; see also Marcellus, 19.) We are inclined to think that it must have been some variety of elephantiasis. Modern authorities have ranked it under _sycosis_, but it would appear to have been a much more intractable disease. The sycosis is distinctly described by Celsus, among the diseases of the hairy parts. He recommends for it elaterium, linseed, or figs boiled in water, &c. (vi, 3.)

SECT. IV.—ON PRURITUS, OR PRURIGO.

The prurigo occurring in old age is not to be thoroughly cured, but may be alleviated by the remedies mentioned below: but that which arises from a cacochymy in other ages, is to be cured by evacuation, being formed by a bilious or pituitous humour that has become putrid, or by a saltish one. It is known by attending to the age, temperament, diet, season of the year, situation, and the like. If, therefore, it appear to prevail in the blood contained in the veins, we must begin with venesection; but if it offend rather by its quality, we must evacuate it by corresponding medicines, and turn our attention to external applications. Wherefore we must use the bath at all times before a meal; and sometimes, after eating a little, it may be used a second time, for the affection is of difficult humectation. They are to be rubbed with the decoction of fenugreek, or of beet, or of barley-meal, or of wild or of garden mallows, or of ptisan; and along with these may be joined the flour of beans, or of lupines, or of myrobalan (ben), or of the detergent ointment called _peponaton_. If it is protracted, we may use the bath in like manner, and foment with the decoction of sage, of tamarisk, of the herb mercury, of marjoram, of pennyroyal, of bay berries, of the root of the wild cucumber, of capers, of strained ley, of vinegar and brine; and then the parts are to be sprinkled with dried natron, or with the lees of vinegar, or with the composition containing of spuma nitri one sextarius, of rosemary, of sulphur vivum, of each, lb. j, of cimolian earth, lb. ss; or this: of aphronitrum, of sulphur vivum, of burnt alcyonium, equal parts; to be used dry, or with some of the decoctions already mentioned; and, if you please, sprinkle some dried hellebore, without grease. But rub in with vinegar and oil, stavesacre pulverized, or sulphur, or red arsenic, or all together; or mustard, with the refuse of expressed myrobalan, and vinegar and oil; or with snails burnt and triturated with honey or the roots of dock, or the detergent ointments prepared from them, as described under the head of Elephantiasis; or with some of the applications for scabies. If the parts become ulcerated, use the plaster called parygron, or that prepared from pompholyx; or melt oz. j of wax in a cyathus of oil of privet, and sprinkle upon it of sulphur vivum oz. j. _Another_ application for prurigo: Of large nuts in a rancid state, oz. j; of sulphur, oz. j; triturate with the juice of parsley, and use in the bath with much friction. This alone has proved sufficient for the cure of many cases of scabies and prurigo; and green parsley by itself, when pounded and rubbed in while the patient is in the bath, has been of great service: and in like manner, pellitory of the wall and maple rosin dissolved with rose oil, and rubbed in.—_Another_: Bruise three ounces of pure and very white rice, and, having strained, triturate with strong vinegar until it become of the thickness of the sordes of the oil in baths; and adding separately of sulphur vivum pulverized, oz. j; and mixing properly, use in the bath with much friction. When there is a greater redundance of humours, it will be better to mix the ingredients in equal proportions.

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COMMENTARY. See Hippocrates (Aphor. iii, 31); Galen (Comment. et alibi); Oribasius (Morb. Curat. iii, 22); Aëtius (xiv, 20); Actuarius (Meth. Med. ii, 11); Nonnus (237); Alexander Aphrodisiensis (Probl. i, 24); Myrepsus (pluries); Pliny (xxviii, 5); Octavius Horatianus (i, 31); Marcellus (de Med. 4); Isidorus (Orig. iv, 8); Serapion (v, 6); Avicenna (iv, 7, 3, 6); Haly Abbas (Theor. viii, 17, and Pract. iv, 6); Alsaharavius (Pract. xxxi, 5); Rhases (Divis. 121); Avenzoar (ii, 7, 2.)

The prurigo of Dr. Willan is here distinctly described, and a suitable method of treatment recommended.

Hippocrates remarks that prurigo is common in old age. The reason which Galen assigns for this is, that the superfluities of the system are then not properly discharged by the skin. He says in another place, that pruritus may either be produced by external substances, such as nettles, squills, &c., or it may arise from indigestion and the neglect of cleanliness.

Oribasius gives an account of the disease not very different from our author’s. Among other applications, he recommends one consisting of opium mixed with liquid cerate.

Aëtius speaks highly of the sulphureous bath for the cure of this disease.

Actuarius characterizes the disease very well, when he says that it is allied to lichen, and that when rubbed either nothing runs from the place, or some slight humidity of various colour and consistence. He assigns, as a reason for its frequency in old age, that the pores of the skin then get constricted.

Alexander Aphrodisiensis assigns, as the reason why the warm bath proves useful in cases of pruritus, that it dispels the phlegm, which is the cause of the complaint.

Celsus gives a particular account of scabies, but says nothing of prurigo.

Octavius Horatianus recommends us, when the patient is young, to bleed, purge, and use baths medicated with frankincense, natron and sulphur. He also says that the cold bath, and friction with the oil of roses, myrtles, &c., will do much good.

Isidorus uses the term prurigo: “Prurigo vocatur perurendo et ardendo.” Marcellus also uses this term, and recommends much the same substances as the others.

This affection is clearly described by the Arabians, and is rendered pruritus by most of their translators. Serapion recommends us, if there is a sanguineous plethora, to bleed, and then to purge with myrobalans, colocynth, and black hellebore, and along with these the warm bath is to be used, and the liniments for removing the pruritus, containing vinegar, roses, nitre, &c. The prurigo senilis he pronounces to be incurable. Rhases and Avicenna recommend similar remedies. They treat of prurigo and scabies together, and there is no doubt of their alliance. Hence Bateman says that prurigo, when neglected, terminates in scabies. Haly Abbas says that scabies and prurigo arise from a saltish phlegm. Scabies, he says, consists of reddish pustules, which appear most frequently between the fingers and upon the arms. Prurigo, he adds, is apt to run into scabies. He recommends, as a lotion, vinegar with rose-oil, the use of the warm-bath, and other remedies like those of our author. Alsaharavius says that the disease arises from debility of the expulsive faculty of the body or constriction of the pores. He praises highly the hot bath. Avenzoar states that pruritus arises from bile or a sharpness of the blood.

Our author has omitted to treat of _phthiriasis_, for an account of which see in particular Cælius Aurelianus (de Tard. Pass. iv, 2); also, Aristot. (Hist. An. v, 32); Galen (de Comp. Med. sec. loc. i, 8); Pliny (Hist. Nat. xxvi, 86); Haly Abbas (Pract. iv, 7); Plutarchus (in Vitâ Syllæ.) The authorities quoted by Rhases recommend compositions consisting of stavesacre, white hellebore, arsenic, nitre, sulphur, sublimed mercury, and the like. (Contin. xxxvi.) Antiochus, Herod of Judæa, Philip II of Spain, and many other celebrated personages, are said to have died of phthiriasis. Virey accounts for the disease in the following manner: “Il est, en effet, tel tempérament muqueux, telle dégénération des humeurs lymphatiques, dans le phthiriasis ou la maladie pédiculaire, que ces insectes y trouvent une pâture inépuisable, qu’ils se propagent avec une extrême exubérance sous le peau, pénétrent dans le tissu cellulaire, et établissent d’énormes colonies parmi les ulcères qu’ils y forment.” (Hist. des Mœurs des Anim. ii, 207.) Aldrovandi gives a very full history of phthiriasis. (De Insectis, v.)

SECT. V.—ON LEUCE.

Leuce is a change of the skin to a white colour, occasioned by a viscid and glutinous phlegm. Since all the kinds of leuce are not curable, you may form a diagnosis of it in this manner. Pierce the leuce superficially, not deeper than the skin, with a needle, and if blood flow, the complaint may be cured; but if a milky moisture be discharged, it is incurable. Or, rub it with a rough woollen rag, and if the part become red, the complaint may be cured; but if it remain of the same colour, it cannot be cured. And those kinds which attack a great part of the body are to be supposed more difficult to cure than those which are confined to a small space, and old cases than recent. Some, therefore, in leuce, have approved of burning by iron, consisting simply of the application of heat. Others, dreading the pain of burning, and the scar arising from it, as being no less unseemly than leuce itself, have had recourse to escharotic medicines, such as they say will produce a scar of the natural colour. Others rejecting all these things on account of the difficulty of their application, have used dyes (paying more consideration to the deception than the utility which they produce,) which are, of all others, the most to be rejected, owing to the speedy renewal of the affection. We must use, then, the under-mentioned remedial powers: Of adarce, of rosemary seed, of sulphur vivum, of each, equal parts; bruise and strain singly, and then, having triturated together for a sufficient number of days, anoint in the sun, but not in great quantity, lest the skin be ulcerated; and, after some time, a little hellebore and galls may be added in like manner.—_Another_: Macerate the tops of the black fig in vinegar, and having triturated, mix equal parts of aphronitrum, sulphur vivum, and the fruit of tamarisk, and having rubbed natron into the part, anoint and expose to the sun, taking care lest an ulcer be produced. But Archigenes having mixed a sufficiency of quicklime with fig-leaves, used them in like manner: or, he says, having rubbed the leuce with white hellebore until the part perspire and become of the same colour as the rest of the body, anoint with sinopis or melian earth; or, having perforated them with needles until they bleed, anoint with sinopis in vinegar; or, having first rubbed them as formerly said, anoint with the fresh juice of figs, or rub in so much with the leaves of it.

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COMMENTARY. In the second Section we have stated so fully the nature of the leuce, and the difference between it and its cognate affections, that it will be unnecessary for us now to resume the subject. It is there mentioned that leuce is Celsus’ third species of vitiligo, and the _baras_ of all the Arabian translators, with the exception of Stephanus Antiochensis, the translator of Haly Abbas, who applies the term _lepra_ to it. It was therefore the white species of leprosy. All the medical authorities represent it as an intractable disease, not only the cuticle being altered in structure, but also the flesh below, and even the hairs, having undergone a change of colour. All direct us to prick the skin with a needle, and, if it bleed, the cure is to be attempted; but if a slight colourless fluid issue from it, the case is to be abandoned as hopeless. They consider it as arising from debility of the assimilative faculty of the part which can no longer convert the nutritive juices into their proper consistence. All recommend nearly the same treatment. The diet is to be regulated with a strict abstinence from gross food; if there be plethora, venesection is to be premised; then drastic purgatives and emetics are to be given, and the parts affected are to be rubbed with stimulant and caustic applications, containing hellebore, nitre, sulphur, misy, red arsenic, &c., or even the actual cautery may be applied. In short, all treat the disease in nearly the same manner as our author. (See in particular Serapion and Avicenna.)

Aristotle, we believe, is the first Greek writer who makes mention of leuce. He calls it a disease in which all the hairs of the body turn white. (Hist. Nat. iii, 11.)

“The snow-white leprosy” of the ancient Jews was the leuce of the Greeks. Moses describes very correctly the method of distinguishing it from the alphos and melas; (Leviticus, c. xiii.) The symptoms of leuce are given in the 3d verse; of the alphos in the 4th; of the melas in the 6th. He calls it contagious, which might lead us to suspect that elephantiasis was mixed up with the leprosy of the Jews. This opinion is further confirmed from what is mentioned by Josephus of its being said that his countrymen were driven out of Egypt because they were affected with leprosy. (See also Justin. xxxvi, 20, and Tacit. Hist. v, 3.) Now we know that elephantiasis was endemial in that country. (See chap. i.) The English translation of this chapter is very inaccurate, the translators having evidently failed to recognize the nice distinction between cognate diseases, laid down by the Jewish legislator.

Leuce is still common in tropical climates. Negroes affected with it are called Albinos. It is merely an aggravated variety of the _Lepra vulgaris_.

SECT. VI.—ON WHITE AND BLACK ALPHI.

The formation of alphos is similar to that of leuce, but the latter produces a deep change of the skin, so that the hairs grow of a similar colour, whilst the alphi affect the skin superficially, except that when continued, they extend more deeply, so that the hairs grow white, owing to the humour which causes it. From the pituitous humour then they are produced white, but black from the melancholic. Wherefore, a common application for both is washed lime dissolved in water, or, the root of dracunculus applied with vinegar; in like manner, either species of hellebore, the decoction of bitter lupines poured on the part, and their flour when applied as a cataplasm with vinegar or oxymel, the bark of the root of capers with vinegar, the root of lily with honey, onions with vinegar rubbed into the part in the sun, the dung of the land crocodile, and in like manner, that of starlings, when they are fed solely upon rice, and the burnt shells of the cuttle-fish. The following is a compound application: of alcyonium, of natron, of each, oz. ij; of white hellebore, of sulphur vivum, of each, oz. j; and some also add the burnt lees of wine.—_Another_: Of sulphur vivum, of the spuma nitri, of each, dr. iv; rosemary seeds, vij; triturate with vinegar. But rub only the part affected with alphos, not touching the unaffected parts, and when dry, wash with cold water.—_Another_: Of the flour of lupines, of buccina, and natron, of each, a chænix; of white hellebore, dr. viij; rub with it in a dry state.—_Another_: Of the flour of bitter vetches, lb. ij; of the seeds of rocket, of bitter almonds, of the root of the wild cucumber, of each, lb. j; triturate with wine and honey and anoint, and after an interval of an hour wipe it away with a sponge. It applies also for freckles, warts, and other spots on the skin.

A tried remedy for white alphos: of sulphur vivum, ii sextarii, of quicklime whitened, oz. iv; five whites of eggs, of nard-oil and vinegar, a small quantity. The sulphur is first pounded, then we add to it the oil of nard, and again triturate; then the vinegar is poured in, and the mixture is again triturated. But the quicklime is to be washed separately, once, twice, and thrice, and then we add it to the sulphur with the white of the eggs and triturate; and we pour out the collected fluid; but leaving a small quantity so that the ointment may admit of anointing, we use it thus.—_Another_ tried remedy: Take sulphur vivum, dried fig leaves, aphronitrum, alcyonium, Cimolian earth, and myrtle, use with vinegar.—_Another_ of Archigenes: Rub in equal parts of fig leaves dried in the shade, of sulphur, and of alum with vinegar, or of fig leaves, dr. iv; of nitre, dr. ij; of burnt alcyonium, dr. ij; anoint with vinegar in the bath. But red arsenic with one half of sulphur is excellent for removing the black alphos; thus having cleansed the part with natron, anoint with it in the sun. For white alphos: of copperas, of verdigris equal parts, of natron the double, rub without fat: or, of rosemary seeds, of sulphur vivum, of adarce, equal parts; triturate with vinegar, rub, and anoint; but when it is dry, bathe by rubbing. This applies also to the white species.

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COMMENTARY. We have again to refer the reader to the second chapter for an account of these complaints, and an exposition of the differences between them and the affections to which they are allied. It will be seen that they are varieties of the genus vitiligo of Celsus, and that they bear a near resemblance to leuce, from which they are chiefly distinguished as being mere superficial affections of the skin. The Arabians treat of them under the names of morphea alba and nigra. Dr. Willan makes them to be varieties of lepra, in which opinion we fully coincide with him.

The description of the two diseases by Actuarius is so precise that we shall give it in lieu of all the others. The alphi, he says, are superficial, but sometimes extend in depth, so that the hairs appear of the same colour. The white species is tried as to the depth it has spread, by being pricked moderately with a needle; when blood flows though the needle has only penetrated the skin, the disease is curable, but if the discharge be milky it is incurable, inasmuch as the flesh is converted into the disease. Others, he adds, rub the part with rough towels, and if it become red they have good hopes, but if it remain of the same colour they abandon all hopes of recovery. They are of a more aggravated nature when they affect different parts of the body and are inveterate. The alphi, he says, are generally milder than leuce, and can be cured by gentler means, but when they become inveterate they require similar treatment. The difference between the white and the black alphos is produced by the colour of the prevailing humour.

There is scarcely any difference of opinion among the authorities respecting the general plan of treatment. Haly Abbas has correctly remarked, that the alphi are to be cured by the same sort of remedies as lepra (leuce?) only that they do not require so strong applications. The Arabians greatly commend their myrobalans with ginger, mastich, parsley, &c. Their internal applications are powerful detergents and escharotics, such as hellebore, natron, sulphur, vinegar, arsenic, copperas, &c. Celsus says nothing of internal remedies, but recommends external applications of a stimulant nature, containing sulphur, alum, nitre, frankincense, alcyonium, &c. In the ‘Isagoge’ it is said that all these complaints are to be cured by phlegmagogues, and by abstergent applications externally.

Guy of Cauliac, and the other medical authorities of that age, describe these diseases by the names of _Morphea_ alba and _M._ nigra. They recommend applications containing sulphur, alum, natron, arsenic, and the like. As usual they are the mere copyists of the Arabians.

SECT. VII.—ON STIGMATA, FROM THE WORKS OF ARCHIGENES.

You may remove stigmata by rubbing in that which sticks to a chamber-pot, along with the most acrid vinegar, or rub of quicklime, p. j; of red natron toasted, p. ss; with water, in the sun: but when it ulcerates let it be healed like an ulcer. But Crito says, for stigmata, having first scrubbed the part with nitre (soda), cover it with an application of turpentine; then having bound it, let it remain for six days, and on the seventh perforate the stigma with a needle, and having wiped away the blood with a sponge, after a little time rub with some powdered salt. Then, having applied the medicine, allow it to remain for five days. It is this: of frankincense, of natron, of the lye of quicklime, of wax, of each, dr. iv; of honey, dr. viij; having loosed it, you will find the blackness upon the application.—_Another_ ointment: Of pepper, dr. ij; of rue, dr. iv; of realgar, dr. iv; of orpiment, dr. j; of honey, q. s. Anoint with it, have previously scrubbed the part with natron, and done otherwise in like manner as for the former. Taking it away after three days, and cleaning away the blackness, anoint with it again; for, he says, it removes the complaint in twenty days, without ulceration or cicatrix.—_Another_ called Criticum: Of frankincense, dr. iv; of nitre, dr. ij; of copperas, dr. iv; of wax, dr. vj; of pepper, dr. iij; of lime, dr. iij; of thapsia, dr. iij; of orpiment, dr. iss; of realgar, dr. iij; of honey, q. s; use as the former. Oribasius says, that crowfoot (ranunculus) if applied, or the leaves of capers, take away the marks. But if they be deep seated upon only a small extent of skin, form an eschar by a cold cautery, and thus remove them.

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COMMENTARY. Consult Aëtius (viii, 12); Actuarius (Meth. Med. vi, 8); Scribonius Largus (§ 231); Avicenna (iv, 7, 2, 7); Pseudo-Dioscor. (Eupor. i, 116.)

Aëtius explains that by stigmata are meant the marks of injuries on the face or any part of the body. To eradicate them he recommends compositions containing quicklime, natron, arsenic, &c.

The Pseudo-Dioscorides recommends the ranunculus, the juice of the leaves of capers, or that of mandragora, &c.

Actuarius copies from our author.

Scribonius Largus mentions a composition containing garlic, cantharides, sulphur, chalcitis, &c.

Avicenna recommends friction with natron and the other substances mentioned by our author.

Dr. Willan defines the stigma, “a small speck on the skin, occasioning no elevation of the cuticle.” The ancient authorities, it will be perceived, apply the term in a wider sense.

SECT. VIII.—ON EXANTHEMATA.

Exanthemata are formed by thick humours impacted in the skin, and more especially if the cuticle be thick. In these cases, then, even if the humours are deep-seated, they must be first purged away; for unless you do this in the first place, before attempting to dispel them, you will only impact them the more firmly, instead of evacuating them by the skin. But if the deep-seated parts be free from crudities, you may evacuate the humours by the skin, and not produce revulsion of them to a distance, which is the case, if you attempt to evacuate them by the belly or emetics. But the cure of humours fixed in the skin, is to be accomplished by fomentations and calefacients, more especially when the exanthemata happen to be broad, for these are formed by a cold and thick humour. Wherefore, take of the tender leaves of bay, of manna, and of rue equal parts, triturate together, and dissolving frankincense in honey, anoint with it; or, having boiled and pounded tender beet, apply as a cataplasm; or, take of wax, dr. viij; of sulphur the same quantity; of salt, dr. vj; triturate them dry, and having poured on them half a cyathus of oil, boil all together, and use the plaster that is formed. But one must attentively sit by while the boiling is going on. It is a very excellent medicine.

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COMMENTARY. See Hippocrates (Epidem. et alibi); Galen (Meth. Med. v); Alexander (i, 5); Oribasius (Synops. vii, 7); Morb. Curat. (iii, 21); Aëtius (v, 129); Actuarius (Meth. Med. ii, 11; i, 23); Celsus (v, 28); Pseudo-Dioscor. (Euporist. i, 106); Haly Abbas (Theor. viii, 17; Pract. iv, 8).

As stated in another place, the Greeks used the term exanthema in a much laxer signification than it is applied in Dr. Willan’s ‘System of Cutaneous Diseases.’ Hippocrates in particular may be mentioned as applying it to various classes of these affections. Alexander describes the exanthemata of the head as superficial ulcerations, which are red and rough. Does he allude to porrigo? He recommends for the cure of them a composition of litharge, ceruse, alum, the green leaves of rue, vinegar, and myrtle oil.

Galen says that exanthemata is a term applied by some to all ulcerative and rough affections of the skin, which, according to Archigenes, stand in need of desiccative applications. In another place he mentions the exanthemata as a common symptom of the plague. Aëtius in like manner gives from Herodotus an interesting account of fevers which are accompanied with exanthemata. Both have been supposed to allude to the smallpox, but we agree with Dr. Willan, that this interpretation of their descriptions is altogether fanciful.

Our author follows Oribasius closely.

According to Actuarius exanthemata, properly speaking, are produced by thick humours either formed in the skin or in the whole body, and being detained by the density of the epidermis.

Celsus describes the exanthemata under the generic term pustulæ. His words are: “Earum plura genera sunt. Nam modo circa totum corpus partemve asperitudo quædam fit, similis iis pustulis, quæ ex urticâ, vel ex sudore nascuntur: ἐξανθήματα Græci vocant. Eæque modo rubent, modo colorem cutis non excedunt.” For pustules of all kinds he recommends exercise, restricted diet, and abstinence from all things of an acrid and attenuant nature, which regimen is likewise to be enforced upon the nurse, if the child be at the breast. If the patient be strong, he is also to be put into the hot bath, and rubbed with natron and a mixture of wine and oil. If this treatment does not succeed lentils are to be applied, especially if the pustules be large; and after the outer skin has been removed they are to be treated with gentle applications. Such is the plan of cure recommended by the great Roman authority. His directions respecting the diet are particularly important, and appear to be quite in accordance with the practice of the modern physicians, who recommend the _half-starving system_ in all such complaints.

For red exanthemata the Pseudo-Dioscorides recommends ceruse with oil of bays and sulphur, pure bark with wax, &c.

The exanthemata are described by the name of pustulæ parvæ in most of the translations of the Arabians. The exanthemata is, we think, the first species of _Serie_ described by Haly Abbas.

For the opinions of Alsaharavius and Haly Abbas about the exanthemata of infancy, see Book i, 6.

Dr. Willan thinks that the nettle-rash was comprehended under the term exanthemata. He is also of opinion that the _benat noctis_ of Avicenna is the nettle-rash. It would appear, however, that the _benat noctis_ was the same as the _sera_ or _epinyctis_. See Rhases (Cont. xxxvi, 2). The symptoms of it are said to be itching, roughness of the skin, and small eruptions attacking the patient during the night.

Thucydides, Hippocrates, and Galen mention exanthemata as a common symptom of the plague.

We may take the present occasion to mention that none of the Greek or Latin authorities has given any distinct account of _purpura_. Avicenna has briefly described it in its chronic form. (iv, 3, 1, 8).

SECT. IX.—ON EPINYCTIDES.

Epinyctides are small ulcers breaking out spontaneously on the skin, in the form of bullæ, reddish, and when broken, discharging a bloody ichor. These are not very troublesome during the day, but at night, they are more painful than the smallness of the ulcer would bespeak. Wherefore, having dissolved the juice of laserwort in water, apply it; for it is desiccative without being pungent; or, having levigated hemlock, apply it; or crude cabbage with water, or triturate parsley with polenta, and apply; or, triturate the leaves of henbane with honey, and apply; or, strychnos by itself, and with the green coriander; or, use the leaves of olives boiled with water; or, having triturated raisins deprived of their stones, and spread them upon a splenium or oblong pledget, apply; or triturate maiden-hair with honey. They must avoid all acrid, acid, and saltish things, also fomentations, baths, and insolation.

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COMMENTARY. Celsus (v, 28); Aëtius (xiv, 61); Oribasius (Morb. Curat. iii, 54); Actuarius (Meth. Med. ii, 11; vi, 8); Pollux (Onomasticon iv, 24); Avicenna (iv, 3, 1, 13); Serapion (v, 8); Haly Abbas (Theor. viii, 17); Pract. (iv, 8); Rhases (Divis. i, 122.)

Celsus describes the epinyctis as a bad species of pustule, somewhat livid or red, about the size of a bean, very painful and inflamed, and coming on principally at night, whence it derives its name. Persons of all ages, even infants at the breast, are subject to it, and in treating them he directs the regimen of the nurse to be properly attended to. In laying down the rules of treatment he puts particular stress upon the hot bath.

Aëtius, Oribasius, and Actuarius treat of it as our author. Pollux defines it to be a vesicle of a palish colour, somewhat humid and bloody, and forming about the legs and feet in the night.

The Arabians give a similar account of epinyctis, under the names of Sare, Serie, and Essere. Thus Serapion recommends bleeding if required by the general symptoms, purging with myrobalans and prunes; and external applications, containing sumach, savin, &c. Haly Abbas, who describes it as one of his serie, approves of much the same treatment. Avicenna and Rhases in like manner recommend bleeding, gentle purgatives, cooling lotions, and the tepid bath. Rhases, in his ‘Continens,’ applies the directions given in this chapter by Paulus to the treatment of the cutaneous disease, which he calls sera. This establishes their identity (xxxvi, 6.) As stated in the preceding chapter, the epinyctis is also the “benat noctis,” i. e. “filia noctis” of the Arabians. Marcus Aurelius Severinus, therefore, is mistaken in distinguishing between the epinyctis and the benat noctis. Ingrassius admits their identity.

Fracastorius gives the following account of this affection: “Si inflammata et accensa sit cholera, pustulam illam facit, quæ ἐπινυκτις vocatur, quod sæpissime noctu nascatur, Arabes Essere appellant.” (De Morb. Cont. ii, 15.) Both Lorry and Rayer confess themselves unable to determine what the epinyctis of the ancients was. It would appear to have been some peculiar species of eczema, now extinct. It must have been a more formidable disease than the nettle-rash, which certain modern authorities have taken for the _epinyctis_ of the ancients.

SECT. X.—ON PHLYCTÆNÆ OR BULLÆ.

As Bullæ when they burst spontaneously are attended with acute pain, it is proper to perforate at their under part with a sharp needle, and then to squeeze out the humour gently, suffering the skin which covers it to remain. And if the wound should close up and the bullæ fill up, it is to be evacuated again in like manner, and pressed out; and the incumbent skin is to be kept pressed down until the ulcer below be healed. Before the bullæ break, apply boiled lentils triturated with water; or, the shoots of pomegranate, having been warmed upon hot coals, are to be applied, so as to burn the parts. But if they burst and form an ulcer, having melted axunge, and mixed levigated litharge, put into a linen cloth, and apply; or, having boiled the root of lily in water, triturate it with cerate, and apply.

_For epinyctis and phlyctæna._ Having triturated equal portions of litharge and sulphur vivum with vinegar and myrtle-oil, until it become of the thickness of the sordes of baths, rub with oil and wine. For hot eruptions, warm papulæ, achores, incipient furunculus, and burns, the composition of plumbago, and that from eggs is applicable.

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COMMENTARY. See Aëtius (xiv, 63); Oribasius (Morb. Curat. iii, 23); Actuarius (Meth. Med. vi, 8); Avicenna (iii, 3, 1, 11.)

This appears to be the pompholyx of Drs. Willan and Bateman. Aëtius remarks, that the disease principally attacks women whose menses are obstructed. (Bateman says, “it seems to affect only women.”) He recommends emmenagogues, laxatives, and diuretics, and forbids all acrid things.

Our author copies the whole from Oribasius. Actuarius recommends nearly the same applications.

Celsus describes the phlyctænæ as a variety of the pustulæ. There is nothing particular in the treatment recommended by Avicenna.

Thucydides mentions small phlyctænæ and ulcers among the symptoms of the plague of Athens. (De Bello Pelopon. ii.) Hippocrates gives the name of _pemphyx_ to the cutaneous eruption, by which the plague of Athens was distinguished. (Epidem. vi.) See Galen’s Comment. (v, 453, ed. Basil.) Procopius also takes notice of black phlyctænæ among the symptoms of the great plague which raged in the reign of Justinian (Pers. ii.) See also Diodorus Siculus (Biblioth. xiv.) Some suppose, however, that by phlyctænæ were meant petechie. See Prælect. Marc. p. 301.

SECT. XI.—ON BURNS.

Burnt parts require applications which are moderately detergent, without being decidedly heating or cooling. Wherefore, Chian, Cimolian, Cretan, and every light earth, when rubbed in with vinegar not very acrid, or mixed with water, are excellent applications, and prevent blisters from forming; also a whole raw egg immediately applied upon soft wool, for it cools moderately, and dries without being stimulant. And anoint the part with black ink, or with frankincense dissolved in water, or use a cataplasm of boiled lentils, or of tares. For burning with hot water, before blisters arise, pour frequently on the part the brine of pickled olives, or apply olives themselves triturated with polenta; or, triturate stone-alum with vinegar, and rub it in; or, anoint with bull’s gall dissolved with much water; or, pour on the part strained ley with sauce of pickles, or brine; or, triturate the bulbous roots of lilies, hyacinths, or narcissi with rose-oil, and having made it of the consistence of the sordes of oil in baths, anoint with it. But Marcellus gives the following composition: having smeared a rag with honey, and wrapped it around barley, burn it, and mix of the ashes, dr. viij; of ceruse, dr. iv; of butter, dr. viij; of wax, dr. xvj; of goat’s fat, dr. xvj; of rose-oil, dr. xvj. For burnt parts already blistered, having triturated sumach and polenta with vinegar, apply it; or, mix quicklime with cerate, put it on a rag, and apply. And the medicine called Sphæria is applicable in such cases. The parts which are ulcerated, may be covered with pounded leeks; or, triturate purslain with polenta, and apply; or, put pigeon’s dung into a rag of linen, burn it, and mix the ashes with oil, and use; (this is an excellent application:) also the bark of pine and of spruce fir, or dried maiden-hair levigated, or the burnt leaves of myrtle, are to be triturated and sprinkled upon the part. Each of these things answers well, when applied with cerate. But a good application is formed by triturating together of the dried roots of the red alkanet, oz. iv; of white wax, oz. ix; of rose-oil, oz. xviij; and also that made of ceruse, with a small quantity of stag’s marrow.

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COMMENTARY. See Hippocrates (de Ulceribus.) Celsus (v, 27); Galen (de Simpl. Med. et alibi.) Aëtius (xiv, 64); Pseudo-Dioscor. (Euporist. i, 178); Actuarius (Meth. Med. vi, 6, 8); Nonnus (240); Serapion (v, 11); Avicenna (iv, 4, 2, 12); Haly Abbas (Pract. 4, 25); Alsaharavius (xxix, 2, 8); Rhases (Antid. i, 27); (ad Mansor. vii, 18); (Div. i, 136.) The author of the Hippocratic treatise referred to above, recommends various applications to burns, such as old axunge rubbed into the part, and the root of squills applied above; or a mixture of old axunge, rosin, and bitumen, spread upon a rag and heated at the fire; or the roots of the ilex boiled in white wine at a gentle fire until it be of the consistence of a liniment.

Dioscorides, Avicenna, and Galen, agree in praising Cimolian earth as an application to recent burns. Galen says that copperas, especially when dissolved in vinegar, forms an excellent application for the ulcers occasioned by burning.

Aëtius treats burns upon nearly the same principles as our author. When blisters rise he forbids an early opening to be made in them. As an application to them he recommends alum with water and the white of an egg. Some of his applications can only be supposed proper for the foul ulcers left by burning. Such is that consisting of verdigris and litharge, pounded with wine and oil. For healing ulcers he recommends a composition containing ceruse, litharge, toasted barley pounded, wax, and rose or myrtle oil.

In the ‘Euporista’ Cimolian earth, litharge and oil, and many other applications are recommended.

Actuarius recommends a composition of litharge, ceruse, wax, turpentine, and some other articles of less importance. We need scarcely mention how much the oil of turpentine has been used of late in such cases. He praises such things as are moderately astringent, such as alum dissolved in vinegar, &c.

Celsus recommends at first such things as are, “mediocriter exedentia reprimentiaque,” and afterwards articles of a soothing nature. To the former class belong the farina of lentils and honey; myrrh with urine, or the Cimolian chalk, with the bark of frankincense; and to the latter belong all fatty applications, and such things as contain the dross of lead and the yelks of eggs. He also mentions turpentine rosin, as an application to foul ulcers from burning.