Volume 1 / Book 3 — BOOK THIRD. (continued 2)

On the cure of epilepsy from the stomach. If the disorder is occasioned by the stomach’s being primarily affected, the patient must attend to his digestion, taking about the third hour some carefully-baked bread that has been soaked in some diluted wine, slightly astringent, and of a white colour. Give to such persons the medicine from aloes twice or thrice every year. “I once knew a boy,” says Galen, “who was never seized with epilepsy after he carried a large piece of fresh peony appended from his neck.” Agaric is beneficial to epileptics, also hartwort, the fruit and root of cow-parsnip, and the round birthwort drunk with water. Scarification of the legs frequently repeated is also of great use.

On epilepsy proceeding from some of the members. When the attack is threatened, and they feel a sensation in the part, whether the hand or foot, a tight ligature ought to be applied above it, and the cure attempted during the remissions, by applying some caustic substance to the part, such as the garden cresses (lepidium), preparations from cantharides, and the like. The Julian oxymel is also of great use to epileptics, by expelling the offending matter from the part. After those things which have been mentioned, the theriac and natural baths have place. During their whole life, they must particularly guard against indigestion, and be careful not to take food before digestion has been performed; avoid all incrassating food, too long abstinence from food, all vehement venereal impulse, much wine, and drinking, after the bath, more especially of undiluted wine, as formerly mentioned, and likewise of old and thick wines. They must avoid, also, all aromatics of an acrid smell, and such as fill the head; must abstain from looking down steadfastly from a high situation, from remaining long in the bath, and exposing the head to the heat of the sun.

Commentary. Consult Hippocrates (de Morbo Sacro); Galen (de Sympt. Diff. 3; De Loc. Affect. iii, 11; De Puero Epileptico); Oribasius (Synops. viii, 3); Aëtius (vi, 13); Aretæus (Morb. Acut. i, 5; Morb. Chron. i, 4); Pseudo-Dioscorides (Euporist. i, 21); Alexander (i, 15); Leo (6); Actuarius (Meth. Med. i, 16); Nonnus (36); Serenus Samonicus; Scribonius Largus (12); Apuleius (Apologia); Celsus (iii, 23); Octavius Horatianus (ii, 2); Isidorus (Orig. iv, 8); Pliny (H. N. xxv, 5); Avicenna (iii, i, 5, 9); Serapion (i, 23); Haly Abbas (Theor. ix, 6; Pract. v, 21); Alsaharavius (Pract. i, 2, 36); Avenzoar (i, 9); Mesue (de Ægr. Cap. 26); Rhases (Div. 7, alibique.)

Our author derives his principles of treatment, more especially with respect to regimen and diet, from Galen’s directions for the management of an epileptic boy. Part seems also to be borrowed from Oribasius.

Hippocrates with great good sense rebuts the popular belief of his own times, that the epileptic paroxysm is produced by demoniacal influence. He justly remarks, that the inferior animals, such as goats, are subject to this complaint; and that in them it is found to be occasioned by water in the brain. It is almost certain that the morbus sacer of the ancients, and the disease under which the demoniacs laboured was epilepsy. See Athenæus (Deipnos. vii, 33), with the notes of Casaubon and Schweigh.; also Coray (ad Hippocrat. de Aq. &c. 12.) Leo, in fact, says expressly, when treating of epilepsy, that the vulgar call the disease the demon and lunacy; and in like manner Aretæus mentions that some refer the disease to the moon. See further Galen (Introductio); Dietz (ad Hippocrat. de Morbo Sacro); and Greenhill (Adnot. ad Theophil. v. 30, p. 340.)

Celsus lays down his rules of treatment with his usual judgment and elegance. His practice is very similar to our author’s. He recommends bleeding; purging with black or white hellebore; shaving the head and applying cupping-instruments to it, and, in desperate cases, even the actual cautery; also friction of the extremities, and bleeding in the foot, along with attention to exercise and diet. The use of hellebore in epilepsy is mentioned by Pliny, and by Aulus Gellius (Noct. Attic. xvii, 15.)

The poet Lucretius gives a very glowing and accurate description of the symptoms and causes of epilepsy. (De Rerum Natura, iii, 485.)

Aretæus delivers separately the treatment of an acute attack and of the disease when in a chronic state. For the former he recommends the general remedies (we mean bleeding, clysters, and emetics.) Among the medicines enumerated by him for the cure of epilepsy, he mentions copper, which, he says, when given with cardamon, will act either upwards or downwards. We need scarcely say that copper has been strongly eulogised in modern practice. In the treatment of chronic cases he pays particular attention to the head, opening the veins and arteries of it, boring the bone down to the diploe, and applying the actual cautery to it. A more rational and less dangerous procedure was the application of embrocations containing cantharides and other such rubefacients to the scalp; in that case he recommends milk to be drunk beforehand, to prevent the bladder from being affected.

Aretæus and most of the authorities mention the gagate stone or jet as a test of epilepsy. The smell of it was said to bring on an attack. He exclaims in affecting terms against the abominable means often had recourse to for the cure of this disease. And so also Pliny (H. N. xxviii, 2.)

Aëtius, Oribasius, Actuarius, and Alexander treat the disease upon the same principles as our author. Alexander, although otherwise a most judicious and original writer, expresses great confidence in the use of amulets, for the preparation of which he gives very minute directions. Jasper is particularly commended as an efficacious amulet. One of his amulets is the nail taken from the arm of a malefactor who had been crucified! In his general treatment he particularly approves of giving drastic purgatives and emetics.

Isidorus thus defines epilepsy: “Epilepsia vocabulum sumpsit quod mentem apprehendens pariter etiam corpus possideat. Fit autem ex melancholico humore quoties exuberaverit, et ad cerebrum adversus fuerit.”

No ancient author has treated of epilepsy more accurately than the great Methodist Cælius; but his account is so long and minute, that it is impossible for us to do justice to it in an abridgment. The causes of the complaint which he enumerates are drinking too much wine, indigestion, compression of the brain, and frights. He says that the whole nervous system is affected, but especially the part seated in the head. When the patient is an infant, he properly directs us either to change the nurse, or to pay particular attention to her diet. Bloodletting he approves of on a first attack, unless the stomach be loaded with crudities; and if there be pain in any part of the head, he directs leeches to be applied to it. He recommends gargles, and rubbing the skin with substances which occasion an eruption of pustules. He enjoins great caution in the use of hellebore. He approves of gentle exercise, a light diet, abstinence from wine, change of scene, or a sea-voyage. With respect to the modes of treatment pursued by the other sects, he greatly disapproves of the application of fire and other hot things to the head, and of strong sinapisms to the other parts of the body. Escharotics applied to the head, he says, only increase the disorder; and the use of bull’s blood, or that of a man recently killed, and other such ridiculous remedies, he properly treats with contempt. He disapproves of diuretics, and of hellebore, scammony, and the like, when administered indiscriminately. He speaks unfavorably of chalybeates.

The Arabians follow closely the views of their Grecian masters, without suggesting any material improvement. Haly Abbas says that epilepsy is a convulsion which either comes on periodically, or at no stated times; and that it either arises from the brain itself, or from sympathy with the stomach, or with some other parts of the body. It is occasioned, he says, either by a gross humour collected in the ventricles of the brain, or from compression produced by fracture. He makes mention of the epileptic aura, and, like our author, states that the disease is distinguished by foam at the patient’s mouth. He joins Hippocrates in pronouncing such cases as occur before puberty to be not difficult to cure, but those which supervene after that age to be most intractable. When the complaint occurs in an infant, he properly directs us to attend both to the nurse’s and the infant’s diet. In cases attended with plethora he approves of general bleeding, cupping the limbs, and opening the saphena. When the disease is protracted he advises to apply cupping-instruments to the neck, and to give drastic purgatives, such as black hellebore, colocynth, &c. When it appears to proceed from the stomach he approves of emetics. He commends peony applied as an amulet. It is worthy of remark that Andreas Laurentius, in the 17th century, speaks confidently of this remedy. So inveterate is the dominion of superstition and ignorance! Alsaharavius gives a curious account of epilepsy, but mixed with some superstitious notions. He says he had had ocular proof that epileptics are possessed with demons; for that he had known many of them who had a knowledge of things which he was sure they had never learned. Like the others, he speaks of amulets; but his general treatment is sufficiently rational and scientific.

Rhases gives the theories and practice of preceding authors along with his own remarks, which, however, contain no very original opinions. One of his Arabian authorities recommends bleeding at the arm, and also by cupping and opening the occipital arteries, rubbing the head with mustard, purging with hiera, sternutatories, &c. The application of mustard to the head is approved of by most of his authorities.

Like our author, most of the ancient writers approve of Cyrenaic juice, or assafœtida, in cases of epilepsy.

SECT. XIV.—ON MELANCHOLY, MANIA, AND DEMONIACS.

Melancholy is a disorder of the intellect without fever, occasioned mostly by a melancholic humour seizing the understanding; sometimes the brain being primarily affected, and sometimes it being altered by sympathy with the rest of the body. And there is a third species called the flatulent and hypochondriac, occasioned by inflammation of the parts in the hypochondria adjoining to the stomach, by which sometimes noxious vapours or auræ are transmitted to the brain, and sometimes part of the substance of the humour. The common symptoms of them all are fear, despondency, and misanthropy; and that they fancy themselves to be, some, brute animals, and imitate their cries; and others, earthen-vessels, and are frightened lest they be broken. Some desire death, and others are afraid of dying; some laugh constantly, and others weep; and some believe themselves impelled by higher powers, and foretell what is to come, as if under divine influence; and these are, therefore, properly called demoniacs, or possessed persons. The peculiar symptoms of melancholy, from sympathy with the general system, are leanness, darkness, and shagginess; the whole appearance melancholic, either by nature, or acquired by anxiety, want of sleep, the administration of noxious food, or stoppage of the hemorrhoidal, or menstrual discharge. Melancholy, from affection of the hypochondria, is indicated by indigestion, acid eructations, heat and heaviness of them, retraction of the hypochondria, and sometimes inflammation, especially in the beginning; and then, when they increase, melancholic symptoms supervene. These are relieved by digestion, or copious discharges, or flatus, or vomiting, or eructations. When none of these symptoms, or very few of them, are present, melancholic symptoms appearing indicate that the brain is primarily affected, and for the most part from a melancholic humour. When the complaint is occasioned by yellow bile, which, by too much heat, has been turned into black, it will bring on the disease called mania, which occasions ungovernable madness, so that those affected with it will destroy persons who come near them unguardedly.

The cure of melancholy. Those who are subject to melancholy from a primary affection of the brain are to be treated with frequent baths, and a wholesome and humid diet, together with suitable exhilaration of mind, without any other remedy, unless when, from its long continuance, the offending humour is difficult to evacuate, in which case we must have recourse to more powerful and complicated plans of treatment. These cases are to be purged from the first with dodder of thyme (epithymus), or aloes; for if a small quantity of these be taken every day, it will be of the greatest service, and open the bowels gently. After purging, as we have mentioned, give wormwood, sometimes macerating and boiling the herb in water to the amount of two cyathi, and sometimes diluting the juice with water, to the amount of half a drachm, and giving it frequently. Let them drink of the most acrid vinegar before going to sleep, and dip, for the most part, their condiments in it before eating them. But it will be better if to the vinegar be added squills, poley, or the slender birthwort. When you meet with an incipient case of the complaint, from sympathy with the general system (as described above), and the body is firm, you must, by all means, begin with phlebotomy, and after phlebotomy, when the strength is recruited, purge downwards, with the wild cucumber, and the composition from the black hellebore, and promote the hemorrhoidal and menstrual discharges, if the affection be occasioned by retention of them. Diuretic remedies are likewise proper, as also evacuations by perspiration. But if the complaint arise from disorder of the hypochondria, we must attend to them, and foment them with a decoction of rue, dill, wormwood, pennyroyal, the seed of the chaste-tree, and of the fruit of the bay-tree; for these soothe the pains and diminish flatulence. They may be boiled in oil and applied; and the cataplasms of them ought to contain the remedies for flatulence, namely, parsley, or anise, or cumin; and it will not be improper to add cyperus, iris, and frankincense, to the cataplasms. These things are to be allowed to remain in general, even during the day, and whether the patient eat or fast; and, when taken away, apply some other protection, such as a broad piece of wool. Use dry-cupping for flatulence, and cupping with scarifications for pains and inflammations. While directing your attention to the cure, you must not forget mustard, and apply acrid smegmata and calefacient plasters to the back and belly. In chronic cases, the most powerful remedy is evacuation, by vomiting with hellebore. The diet for all melancholics should be wholesome, and moderately moistening; abstaining from beef, roe’s flesh, dried lentil, cabbages, snails, thick and dark-coloured wines, and, in a word, from whatever things engender black bile.

The cure of mania. Persons affected with mania are to be treated like melancholics; and, in particular, we must apply to the head rose-oil, or rose-oil with vinegar, and purge with the bitter antidote called hiera, having previously bled them; and we must use leeches to the head. But nothing is of such service as horse-fennel, either the root or seed drunk in water. A drachm of the root of bryony with water may be taken every day. If the maniacs will not be persuaded to take the purgative medicines, they must be mixed with their food, in a concealed manner, such as with mouthfuls of meat, or dried figs, or dates, or else with their drink. But, above all things, they must be secured in bed, so that they may not be able to injure themselves, or those who approach them; or swung within a wicker-basket in a small couch suspended from on high.

Commentary. Consult Hippocrates (Aphor.); Galen (Comment. in Aphor., de Morb. Vulg.); Celsus (iii, 18); Aretæus (de Morb. Chron. i, 6, and de Curat. Morb. i, 5); Aëtius (vi, 8); Nonnus (32); Oribasius (Synops. viii, 17); Alexander (i, 16); Actuarius (de Dig. Morb. ii, 34); Octavius Horatianus (ii, 2, 5); Mesue (de Ægr. Cap. 34); Serapion (i, 22); Avicenna (iii, 1, 4); Avenzoar (i, 9, 16); Haly Abbas (Theor. ix, 7; Pract. v, 23); Alsaharavius (Pract. i, 2, 27); Rhases (ad Mansor. ix, 13; Contin. 1).

Hippocrates, in his Aphorisms, points out the lower intestines as the seat of melancholy, and directs us to cure the complaint by purging. Galen, in his Commentary, agrees with his principles and practice. Galen states correctly that melancholy sometimes changes to epilepsy, and vice versa, that epilepsy is often succeeded by melancholy. (De Loc. Aff. iii, 10.) He gives a curious extract from the works of Diocles, with remarks upon the same.

Aretæus considers melancholy as an incipient mania. He gives a masterly sketch of the different modes in which mania makes its attack, and relates an interesting case of a joiner, who was perfectly sound while engaged at his work, but no sooner left the place where he was occupied than he became mad. For the cure of melancholy he advises blood to be abstracted at the commencement, according to the patient’s strength and condition. He approves then of giving black hellebore, and of applying cupping-instruments over the liver, stomach, or to the head, according as these may happen to be affected. He recommends then wormwood and aloes. When the menstrual or hemorrhoidal discharges are stopped, they are, if possible, to be restored; and for this purpose blood may be abstracted from the ancle, or even from the arm. He also approves very much of the natural hot baths.

Celsus, in cases of melancholy and mania, recommends in particular vomiting and pinging by hellebore; with the black species, if the patient is affected with grief; but with the white, if with gladness. He also approves of bleeding.

Aëtius gives an interesting account of the treatment of melancholy, principally extracted from the works of Galen, Ruffus, Posidonius, Archigenes, and Justus. The remedies which all of them seem to have reposed most confidence in are drastic purgatives combined with bitters and carminatives. They approve, however, of general bleeding and cupping, when indicated by the symptoms of the complaint, and the state of the patient. Nonnus in like manner prescribes bleeding in the forehead, purging with hiera picra, acrid clysters, and bitters, such as gentian and stæchas (lavendula stæchas.)

Alexander’s plan of treatment is very circumstantially detailed; but it differs very little from our author’s, except that he recommends Armenian bole instead of white hellebore. Like Aretæus, he strongly commends the use of the hot bath for the cure of melancholy. He speaks highly of a well-regulated diet, consisting principally of rock fishes, domestic fowls, and emollient pot-herbs, such as lettuces, mallows, and the like. He forbids cabbages, beef, the flesh of stags and of all other wild animals. Instead of hellebore, Serapion and Avicenna particularly praise the lapis lazuli. Haly Abbas gives a graphic delineation of the bizarre fancies, absurd fears, hopes, and vain imaginations of melancholics and maniacs. Like the other authorities, he attributes the disease to the prevalence of black bile. Without doubt, as has been often remarked, the alvine discharges in such cases are dark-coloured; and this, no doubt, gave rise to the ancient opinion that the disease originates in black bile. When the patient is young, and of a hot temperament, Haly abstracts blood from the arm or temples. He approves particularly of hot drastic purgatives, such as black hellebore, scammony, agaric, and the like. He also gives poppies, lettuces, &c. to compose the patient. He recommends cholagogues, such as the decoction of wormwood, and the like. But his treatment is too minutely and circumstantially detailed to admit of its being done justice to within our narrow limits. The same may be said of the account given by Alsaharavius. Rhases in certain cases approves of venesection for the cure of melancholy. When connected with dyspepsia, he recommends emetics and purgatives, especially black hellebore. He also approves of the tepid bath.

We must now mention the opinions of the Methodists. In cases of melancholy Cælius Aurelianus disapproves of aloes and wormwood, as acting too violently; and also forbids venesection and purging with hellebore. On the contrary, he recommends astringent articles of food, and astringent applications containing galls, alum, hypocistis, &c. to be laid over the stomach. Of mania he gives a fuller account, replete with much valuable matter, that does not readily admit of abridgment. He enumerates many existing causes of the complaint, such as intoxication, inordinate passions, indigestion, exposure to the sun, suppression of the hemorrhoidal and menstrual discharges, and the like. Maniacal persons, he says, are differently affected, one believing himself a cock, another a tile, another a god, another an orator, and such like ridiculous fancies. He then inculcates the important fact that the affection of the mind is always secondary, and not primary, as some had supposed. His moral and medical treatment is of the most emollient kind; and he enjoins retirement and quietude. When the patient’s strength will permit, he approves of venesection, the application of cupping-instruments to the head, and leeches to any other parts of the body which may be particularly affected. He commends strongly the bath of oil and the natural hot baths. He also approves of hellebore. He condemns the practice of the other sects in many respects. He does not approve of abstracting blood from both arms, so as to produce deliquium, nor of keeping the patient constantly in a dark place, nor of opening the temporal artery. He disapproves of applying narcotic fomentations to the head. He properly forbids all corporal punishment, although he approves of contradicting the whims of the maniac, and of reasoning him into a better train of thought.

Isidorus thus distinguishes epilepsy, melancholy, and mania: “Epilepsia autem in phantasia fit, melancholia in ratione, mania in memoria.” (Orig.)

The use of hellebore in mania and melancholy is often alluded to in the works of the Latin Classics. See, in particular, Horace (Sat. ii, 3); Perseus (Sat. iv, 16.) We are inclined to think that it was the black hellebore which was given in Anticyra. See Dioscorides (iv, 146.)

Cicero makes some pertinent remarks on the distinction between mania and melancholy. (Tusc. Disp. iii, 5.)

SECT. XV.—ON INCUBUS, OR NIGHTMARE.

Some say that this disorder is called ephialtes in Greek, from the name of a man, or from those in it fancying as if one leaped upon them. But Themison, in the tenth book of his Epistles, calls it pnigaleon, from a Greek word signifying suffocation. It attacks persons after a surfeit, and who are labouring under protracted indigestion. Persons suffering an attack experience incapability of motion, a torpid sensation in their sleep, a sense of suffocation, and oppression, as if from one pressing them down, with inability to cry out, or they utter inarticulate sounds. Some imagine often that they even hear the person who is going to press them down, that he offers lustful violence to them, but flies when they attempt to grasp him with their fingers. The evil must be guarded against at the commencement; for when it continues long, and attacks every night, it is the forerunner of some serious disease, such as apoplexy, mania, or epilepsy, when the exciting cause is determined to the head; for such as persons affected with epilepsy are, during the day, those labouring under nightmare are in their sleep. We must evacuate the patient’s general system by opening a vein and administering purgatives. Black hellebore is especially serviceable to such persons when given to the amount of a drachm, if three oboli of scammony, and some of the aromatics, such as anise, wild carrot, and Macedonian parsley, be mixed with it. The composition called hiera, from wild gourd, is also of great service; it is the hiera of Ruffus. The diet should be light, and they ought to avoid everything that is flatulent. They are benefited also by the fruit of peony: fifteen of the black grains of which may be pounded with water and drunk frequently.

Commentary. See Aëtius (vi, 12); Oribasius (Synops. viii, 2); Actuarius (i, 16); Cælius Aurelianus (Tard. Pass. i, 3); Psellus (Opus Medicum); Avicenna (iii, 1, 5, 7); Alsaharavius (Pract. i, 33); Rhases (ad Mansor. ix, 12, Contin. i.)

The other ancient authors treat the complaint, like our author, by evacuants. Bleeding (Rhases recommends this to be done at the ancle), drastic purgatives, and friction of the extremities are the common remedies. Alsaharavius says that, if not cured by bleeding, it is to be treated, as epilepsy, with hiera and the like. Even Cælius in this case nearly agrees with the others, recommending restricted diet, and, if the disorder is great, venesection. He also approves of applying cupping-instruments with scarifications on the side of the throat, and, when the disease is protracted, of emetics, and shaving the head. For the cure of incubus, Mesue and Rhases recommend bleeding and an attenuant diet. Ruffus, as quoted by the latter, recommends vomiting, purging, an attenuant diet, sternutatories, masticatories, and ointments to the head, containing castor and the like.

Psellus gives a very graphic description of incubus. (Op. Med.)

SECT. XVI.—ON LYCAON, OR LYCANTHROPIA.

Those labouring under lycanthropia go out during the night imitating wolves in all things, and lingering about sepulchres until morning. You may recognize such persons by these marks: they are pale, their vision feeble, their eyes dry, tongue very dry, and the flow of the saliva stopped; but they are thirsty, and their legs have incurable ulcerations from frequent falls. Such are the marks of the disease. You must know that lycanthropia is a species of melancholy which you may cure at the time of the attack, by opening a vein and abstracting blood to fainting, and giving the patient a diet of wholesome food. Let him use baths of sweet water, and then milk-whey for three days, and purging with the hiera from colocynth twice or thrice. After the purgings, use the theriac of vipers, and administer those things mentioned for the cure of melancholy. When the disease is already formed, use soporific embrocations, and rub the nostrils with opium when going to rest.

Commentary. See Aëtius (vi, 11); Oribasius (Synops. viii, 10); Actuarius (Meth. Med. i, 16); Anonymus (de Lycanth. ap. Phys. et Med. Min.); Psellus (Carm. de Re Med. ibid.); Avicenna (iii, i, 5, 22); Haly Abbas (Theor. ix, 7, Pract. v, 24); Alsaharavius (Pract. i, 2, 28); Rhases (Divis. 10, Cont. i.)

All the other authorities give much the same account of this species of melancholy as Paulus. If we adopt Dr. Mead’s theory respecting the dæmoniacs mentioned in Scripture, we may conclude that the man, whose state is described in Luke (viii, 27), was affected with this disease. Dr. Mead is farther of opinion that Nebuchadnezzar was seized with lycanthropia. The reader will find much curious information on this head in Burton’s ‘Anatomy of Melancholy,’ from which all Mead’s opinions are borrowed.

The Arabian term is cutubut.

Avicenna recommends the application of the actual cautery to the sinciput, when the other remedies fail. Haly Abbas describes the disease by the name of melancholia canina. He says the patient delights to wander among tombs, imitating the cries of dogs; that his colour is pale; his eyes misty (tenebricosi), dry, and hollow; his mouth parched; and that he has marks on his limbs of injuries which he has sustained from falls. He recommends the same treatment as our author: indeed he evidently merely translates this section of Paulus. Alsaharavius seems also to allude to this disease by the name of melancholia canina. Rhases’ account of it is quite similar to our author’s.

Schneider has given some interesting critical remarks upon this section of Paulus at the end of his edition of Nicander’s ‘Theriacs.’

SECT. XVII.—ON LOVE-SICK PERSONS.

It will not be out of place here to join love to the affections of the brain, since it consists of certain cares. For care is a passion of the soul occasioned by the reason’s being in a state of laborious emotion. The following symptoms attend lovers: Their eyes are hollow, and do not shed tears, but appear as if overflowing with gladness, their eyelids move rapidly; and even, when none of the other parts of the body are affected, these parts are always so affected in lovers. There is no pulse peculiar to lovers, as some have supposed, but it is the same as that of persons labouring under care. When they call to recollection the beloved object, either from seeing or hearing, and more especially if this occur suddenly, then the pulse undergoes a change from the disorder of the soul, and, therefore, it does not preserve its natural equability or order. Such persons, therefore, being desponding and sleepless, some physicians, mistaking their affection, have wasted them by prohibiting baths, and enjoining quietude, and a spare diet; but wiser ones, recognizing the lover, direct his attention to baths, the drinking of wine, gestation, spectacles, and amusing stories. Some must also be attacked with fear; for, while they think of nothing but love, the affection is difficult to remove. Wherefore, they ought also to be roused to emulation with regard to the objects of their peculiar interest in life; and, upon the whole, their understanding should be diverted to other concerns.

Commentary. See Oribasius (Synops. viii, 9); Haly Abbas (Theor. ix, 7, Pract. v, 25); Avicenna (iii, i, 5, 23); Alsaharavius (Pract. i, 2, 17); Rhases (Divis. 11.)

Although Theocritus had declared that neither ointment nor powder is of any efficacy for the cure of love, several of the ancient writers on medicine have given directions for the treatment of desponding lovers.

Rhases, with unusual brevity, merely recommends, in general terms, repeated enjoyment, fasting, walking, and frequent intoxication. Avicenna, Haly Abbas, and Alsaharavius direct nearly the same treatment; and also mention hunting and sports.

SECT. XVIII.—ON APOPLEXY, AND HEMIPLEGIA OR PARALYSIS.

When the common origin of the nerves is affected, and from it all the other parts of the body have lost their motion and sensibility, the affection is called apoplexy, by which the leading energies are impaired; but if the obstruction is in either side, it is called hemiplegia and paralysis; and if the injury is seated in any one part, it is called an affection of that part, and hence Hippocrates says, “His leg was seized with apoplexy.”

Wherefore, in apoplectics, the respiration remains small. When, then, it is greatly perverted from its natural energy, it will induce a strong affection, and when but little, a weak one. Respiration is of the worst kind when it intermits, or is performed with great exertion. The affection arises suddenly from a cold phlegm obstructing the most important cavities of the brain. Whenever the whole origin of the spinal marrow is affected, all the parts below the face become paralysed, whilst it remains unaffected, because the parts there derive sensibility and motion from the brain; but, if one half only be affected, then is there a paraplegia of these parts, that is to say, a partial paralysis. If the sense of smell is affected, this arises from the anterior cavities of the brain having contracted the intemperament, or from the pores of the ethmoid bones being obstructed. Wherefore, apoplectics lie speechless, motionless, and insensible, without fever. The precursors of this affection are sudden and acute pain of the head, distension of the jugular veins, vertigo, flashes, as it were, of light in the eyes, an inordinate coldness of the extremities, palpitation and difficult motion of the whole body, and grinding of the teeth in sleep. Their urine is in small quantity, of a verdigris-green or a black colour, and containing a branny sediment. The affection occurs in old age to those of a phlegmatic temperament, and who use a diet of this nature. If it occur in youth and in the season of summer, it indicates a strong exciting cause.

The cure of apoplexy, and hemiplegia or paralysis. Apoplexy is an affection which is never or but rarely cured, for it threatens instant death; and if it be relieved, it commonly leaves a paralysis of some part of the body. Wherefore, those persons who admit of being cured should be immediately bled, and if there be any remission of the disorder, the operation should be repeated on the same or the following day. The belly should be opened by a stimulating clyster, made by mixing salt water and honey. Then let the whole body be rubbed with plenty of sulphurated oil, but the head with the oil of chamomile, or of dill in which cow-parsnip or calamint has been boiled. Inject honied water, and apply strong-scented things, such as opopanax, sagapene, galbanum, or castor, to the nose. It may be necessary to open the mouth forcibly, and introduce a finger or feather dipped in oil to remove the matters sticking there. Anoint the anus with applications for promoting the discharge of flatus. Give honied water and oxymel to drink, and use masticatories prepared by boiling thyme, or marjoram, in vinegar. When there is a remission of the complaint, we are to have recourse to tender, diffusible, and succulent food. When loss of speech continues, if the strength permit, we are to apply to the back part of the head a cupping-instrument with scarificators, and, if admissible, it should be applied to the hypochondria also. Let them afterwards be carried about in a chair, or couch, or suspended bed, and have recourse frequently to sternutatories and masticatories. After the fourteenth day, we may bring them back to the other kinds of gestation, attend to their speech, give old apomel with pieces of bread or alica, and afterwards a small quantity of hiera. After the twenty-first day, we may lead them to the bath, give them old wine to drink; and otherwise we must promote recovery by sprinkling them with warm water, by baths, and rubbing with unguents. If possible, let them reside in places by the sea-coast.

The cure of paresis, or resolution. If there be paralysis of all or of certain members, without injury of the primary energies, we must first evacuate the offending humour, whatever it be, and then give hiera, and a certain portion of castor, beginning with half a drachm, along with some honey and warm water in which it has been dissolved, either alone, or with the addition of half a scruple of pepper; then, after an interval of four days, we may give a whole drachm, and afterwards one and a half, then two and three. After an interval of the same number of days, we may give four drachms, if the patient be able to take so much, adding one spoonful of honey. To the part we may apply some of the discutient remedies, along with rubefacients, adding to them some castor, or pepper, or pellitory, or rosemary, or euphorbium; and, in addition to these, we may have recourse to embrocations with oil of rue, or Sicyonian or old oil. The food ought to be farinaceous, taken in a slop, of easy digestion, and not excrementitious. Let cupping-instruments be applied to the affected parts separately, if there be many of them, but to one if there be few. After cupping, apply cataplasms containing pitch, rosin, or manna. A most suitable application consists of calamint, fleabane, and nitre boiled along with mugwort, and some water is to be added, which is to be evaporated during the boiling. The belly is to be again opened by means of aloes, polypody, scammony, or the colocynth pottage. Fatty inunctions are to be made with old oil in which squill has been kept for forty days in the sun; or, if it be not at hand, you may boil in oil two ounces of squill, and anoint with it; or the seed of rosemary may be prepared in like manner, but an ounce of wax must be added, that it may not be too liquid. But, if you add of galbanum, of castor, of euphorbium, of adarce, and of nitre, of each, oz. ss, it will be a more potent remedy. The herb crowfoot, boiled in the oil, and preserved in the sun, is also an excellent application. Castor to the amount of a drachm, and opopanax swallowed to the size of a bean, will make suitable potions. But sagapene taken to the size of a tare in honied water, and castor with opopanax, and the Cyrenaic juice to the size of a millet, are admirable remedies. The antidote from the three peppers is also beneficial. We may likewise use beating restoratives (acapa), and masticatories. After the fourteenth day, we may give more copious food; and, when much benefit is derived, we may lead to the bath. After the thirtieth, it will be necessary to apply a dropax, use the bath, and afterwards put on a cataplasm of mustard, taking care in those cases in which both motion and sensibility are lost, lest from want of feeling they be allowed to burn too much. Where sensibility remains, rubefacients only are to be used. After it swells, we ought to lead to the bath, and cure with simple cerates. They ought to take the emetic after a meal, and that from radishes. They should be carried about in a chair, or in a car drawn by the hand, or in one drawn with a yoke. Otherwise, let them be put into one of the natural baths. A desiccative diet, spare drink, and friction will be proper. Let them, therefore, eat dry food, and struggle against thirst as much as possible.

On paralysis with relaxation or distension. Since paralysed parts are either contracted or relaxed, and this proceeds either from plethora or emptiness, it will be necessary to attend to this, and sometimes abstract blood, and sometimes not. Again, to relaxed parts we must mix astringents with the relaxing remedies, and use intense friction; but for the contrary state we must use relaxing remedies only, along with gentle friction. For the relaxed limbs, let the oil used for friction have a little nitre and dried lees of wine pounded on it. Let hot water also be strongly poured upon them, especially sea-water, in which have been boiled bay-berries, or the shoots of the chaste-tree, or marjoram, or the like. If it is in the summer season, let them also swim in the sea. But rubefacients are particularly applicable to them, and therefore the parts may be whipped with rods, or nettle branches; but if the paralysis remain, the relaxed skin between the joints is to be drawn up, and transfixed with small and slender burning-irons. To contracted limbs it is proper to apply constantly a calefacient plaster.

On paralysis in particular parts. Paralysis occasioned by the division of a nerve is incurable; but when occasioned by an intemperament, or a certain humour, it is relieved by the common remedies already mentioned; but there are certain particular remedies applicable to each of them, which we shall describe below. Wherefore, in cynic spasms, the jaw is to be reduced to the opposite side by means of a muzzle. Detraction of blood from the vessels below the tongue will likewise be proper, as also cupping-instruments applied along the first vertebra, with masticatories, and purgatives administered by an instrument inserted into the nose. It is necessary to know that the jaw which appears to be distorted is not the one which is paralysed, but the opposite one. When the organ of deglutition is paralysed, cupping-instruments must be applied to the chin, and we must use the liniments made of castor, sagapene, and the Parthic juice. Acrid gargles are also beneficial. When the tongue is paralysed, we must open its veins, apply a cupping-instrument to the chin, and use masticatories of mustard, and exercise the tongue. When the organs of speech are paralysed, apply the remedies to the chest, enjoin retention of the breath, and have recourse to vociferation. When the eyebrows are affected, anointing of the eyelids in like manner is of great use, and, at last, the operation by suture called anarrhaphé. When the bladder is paralysed, there is either retention of urine or an involuntary discharge of it. The remedies are to be applied to the bottom of the belly and perinæum, and clysters injected by the anus, consisting of oil of rue, or Sicyonian oil, with butter and castor, galbanum, opopanax, or the juice of laserwort. And these things, if injected into the bladder by the penis, will be of great service, or prove sufficient of themselves. Clysters of centaury and colocynth, along with Sicyonian oil, are also beneficial; and diuretics may be drunk with advantage, and castor taken in like manner. But, above all things, we must have recourse to the catheter when the patients cannot make water, and get them to sit in hot baths of a relaxing nature, and use emollient cataplasms. When the urine flows involuntarily, we must treat them upon the astringent plan with tonic remedies, and make them use dry food and cold drink. During convalescence they ought to use rubefacients, and natural baths in a cold state. Cases occurring from a wound of the spine, from a fall and dislocation of a vertebra, if there be a concurrence of fatal symptoms, it is impossible to remedy. If the penis is paralysed, we must apply the remedies recommended for the bladder to the same parts, and also to the groin; and medicines which excite to erections ought also to be used. Milk, cheese, and the other cakes are improper, likewise lettuces and the other pot-herbs. When the rectum is paralysed, in which case the fæces are either discharged involuntarily, or retained, the same remedies must be used, and clysters are to be administered, sometimes of an astringent nature, such as the decoction of cypress, of rush, or of bramble; and sometimes emollient; such as the fat of swine and geese, and the oil of mallows; and sometimes stimulating, such as salt water, the decoction of colocynth, or the like. Nothing contributes so much to motion as variety of exercise with the lever. If they complain of a sense of cold, the restorative plaster of euphorbium, dissolved in oil, may be used for a clyster. But, along with the ordinary treatment, the paralysed limbs should be bent, rubbed, and stretched in the manner described; for our greatest dependence is upon friction.

On paralysis supervening upon colic disease. In our times a colic complaint has prevailed, in which convalescents are seized with complete loss of motion in their limbs, but the sense of touch remains uninjured, there being a critical translation of the disease from the internal parts. Hence, in many cases, the motion has returned spontaneously in process of time. Those of more difficult cure were remedied by using the more simple liniments formerly described. The acopa made of poplar and of the fir were found to be excellent applications; and many were greatly benefited by tonic and moderately cooling applications.

Commentary. Consult Hippocrates (Aphoris. ii, 42, de Glandulis, et alibi); Galen (Comment. de Loc. Aff. iii, 11); Aretæus (Morb. Chron. i, 7; Cur. Morb. Acut. i, 4); Aëtius (vi, 26); Oribasius (Synops. viii, 14); Theophrastus (ap. Photii Bibliothecam); Alexander (x, 2); Actuarius (Meth. Med. iv, 2); Cælius Aurelianus (Morb. Acut. iii, 5); Octavius Horatianus (ii, 7); Leo (ii, 5); Nonnus (37); Avicenna (iii, i, 5, 12); Avenzoar (i, 9, 12); Serapion (i, 24); Mesue (de Ægr. Cap. 27; de Ægr. Nerv. 2); Haly Abbas (Theor. ix, 6, Pract. v, 22); Alsaharavius (Pract. i, 2, 18); Rhases (ad Mansor. ix, 3.)

To so many excellent works on apoplexy, wherein the subject is treated of fully and correctly, it is difficult to do justice within our narrow limits. We shall give, however, a brief, though imperfect outline of their opinions.

Hippocrates pronounces a slight attack of apoplexy to be difficult to cure, and a severe one to be utterly incurable. He says that an apoplectic attack is brought on by turgidity of the veins. When a person has suddenly lost his powers Hippocrates directs that he should be bled. (Aphor.) Apoplexy, he says, occurs most frequently between the age of forty and sixty. (Ibid.) He says, in allusion to apoplexy (as his commentator Theophilus remarks), that when persons in good health are suddenly seized with pains in the head, with loss of speech, and stertorous breathing, they die in seven days, unless fever supervene. (Ibid.)

Galen states that apoplexy arises from a cold, thick, and viscid humour obstructing the ventricles of the brain. He remarks that, in severe cases, all voluntary motion is lost while respiration is performed as in persons asleep. The reason which he assigns for this is, that the nerves which are distributed upon the respiratory muscles are all derived from the brain itself, and these often escape being injured, unless the attack be of a particularly serious nature. His account of cases of partial paralysis is highly interesting. (Loc. Affect. iii, 14.)

Celsus’ brief account deserves to be given in his own words: “Attonitos quoque raro videmus, quorum et corpus et mens stupet. Fit interdum ictu fulminis, interdum morbo ἀποπληξιαν hunc Græci appellant. His sanguis mittendus est: veratro quoque albo, vel alvi ductione utendum. Tum adhibendæ frictiones, et ex mediâ materiâ minimè pingues cibi, quidam etiam acres; et a vino abstinendum.” Respecting the treatment of paralysis he delivers the following aphorism: “Si omnia membra vehementer resoluta sunt, sanguinis detractio vel occidit vel liberat: aliud curationis genus vix unquam sanitatem restituit, sæpe mortem tantum differt, vitam interdum infestat.” His other remedial measures are such as our author’s, namely gestation, the application of cupping-instruments or rubefacients to the affected part, the warm salt-water bath, and a restricted diet.

According to Theophrastus, paralysis is occasioned by a deficiency or loss of the pneuma, i. e. vital heat.

It is impossible to admire too much the brief but comprehensive account of apoplexy and paralysis given by Aretæus. He states decidedly, that there is sometimes a loss of motion alone, and sometimes of sensibility; the reason of which he supposes to be, that the sensatory and motory nerves are distinct from one another. This is the germ of the theory fully expanded afterwards by Galen. It appears, indeed, from the anatomical works of Ruffus, that the famous Erasistratus had attempted a similar classification of the nerves. Galen, however, has the merit of fully establishing the truth of the theory; and all subsequent writers on physiology stated it in nearly the same terms that he does, until ancient authority in medicine and its cognate sciences came to be despised. Aretæus states it as a general rule, that when one side of the brain is affected the opposite side of the body is paralysed; but, when the disorder is in the spinal marrow, that the affection of the spine and the paralysis are on the same side. This arises, he supposes, from the decussation of the cerebral nerves; and this explanation must be admitted even now to be tolerably correct. The causes of paralysis, as stated by him, are falls, blows, cold, indigestion, debauchery, intoxication, and violent emotions of the mind. His treatment is as follows: He inculcates, in the strongest terms, that the great remedy for apoplexy is venesection; and that the only difficulty, in general, is to determine the extent to which it is to be carried. He forbids the operation, however, when the senses are oppressed with much cold and torpor. When venesection is contra-indicated the belly is to be evacuated, in order to relieve congestion there, and to produce revulsion from the head. For this purpose acrid clysters are to be given, containing nitre, euphorbium, colocynth, turpentine-rosin, and the like. He also recommends hiera as a purgative; and if nausea be present, he advises us to encourage vomiting. He praises castor strongly as a remedy for the nervous affections. The food is to be light and of easy digestion. When the disease is protracted, cupping-instruments are to be applied to the back part of the head. When the parts concerned in deglutition, namely, the fauces and œsophagus, are paralysed, food is to be conveyed into the stomach by a suitable instrument. (By the way, Dr. Friend is mistaken in stating that Avenzoar is the only ancient author who recommends this practice. It will be remarked that our author makes mention of introducing food into the stomach by means of an instrument passed by the nostrils.) When the bladder is affected, he recommends injections, but forbids the use of the catheter, for fear of occasioning convulsions or gangrene. He approves greatly of the bath of oil in this case.

Aëtius, Oribasius, Alexander, Actuarius, and Nonnus treat of the disease in much the same terms as our author. Alexander, in particular, properly recommends moderate purging with the hiera and such like medicines. He restricts venesection to those cases in which the disease is occasioned by fulness of blood.

Cælius Aurelianus enumerates nearly the same causes of apoplexy and paralysis as Aretæus, namely, excessive heat, cold, indigestion, debauchery, and injuries of the brain. The season of winter is justly said to predispose to the disease. It is seated, he says, principally in the head. His treatment is nearly the same as that of the followers of Hippocrates and Galen, namely, emollient applications to the head and limbs, venesection, abstinence, clysters, cupping the back part of the head, and the bath of oil. Of paralysis he treats at greater length, and with much precision and judgment. He mentions nearly the same causes of it as of apoplexy; and remarks that it produces loss of sensibility, or of motion, or of both. He observes, in particular, of the tongue, that it may retain the power of deglutition although that of speech be lost. He details all the phenomena of partial paralysis with surprising accuracy; and, at the present day, we do not know a work on the subject that contains so much information. He distinctly and accurately describes paralysis of the œsophagus and fauces. His treatment is, upon the whole, not very different from our author’s; but his directions for the application of his remedies are exceedingly minute and judicious. In the first place, he approves generally of venesection, calefacient applications to the extremities, a spare diet, and afterwards of cupping with scarifications. When the tongue is affected, hot gargles of mustard and vinegar are to be given; and, when there is paralysis of the bladder, the catheter is to be used. When the disease is obstinate, he approves of hellebore as an emetic, and of calefacient plasters, depilatories, cupping with much heat, embrocations of mustard, and such things as will produce a papular eruption, namely, flour of salt, nitre, and the like. He blames Praxagoras for recommending emetics indiscriminately, and Erasistratus for omitting venesection. He finds fault with Themison for being in too great haste to apply stimulants to the affected parts, and for having recourse to cupping before the disease had begun to subside. Though he permits the occasional use of hellebore, he disapproves of purgative medicines in general. For paralysis of the œsophagus he recommends us to apply a cupping-instrument, leeches, or cataplasms to the neck.

Little additional information is to be got from the Arabians; and yet Avicenna, in particular, has treated the subject in a very masterly manner. The causes of apoplexy, he says, are either obstruction or repletion; and these are produced either by blood or a pituitous humour. We need scarcely remark that this accords with the modern division into sanguineous and serous apoplexy. Even in pituitous apoplexy he admits of venesection. He approves of vomiting when it can be produced easily. Neither Serapion nor Avenzoar makes mention of venesection. Serapion commences his treatment with an emetic. When connected with plethora, Alsaharavius recommends general bleeding, opening the temporal veins, cupping the legs, restricted diet, applications to the head, such as oil of roses and vinegar, and acrid clysters. Haly’s account is minute and judicious. He attributes the affection to obstruction within the brain occasioning a loss or diminution of the powers of sensation or of voluntary motion. It is produced, he says, by phlegm mixed with bile or blood; and sometimes arises from repletion with wine, which case generally proves fatal. He justly remarks, that one of the most common symptoms is stertorous breathing. If the face be ruddy or livid, he directs us to open the cephalic vein, or vena saphena, and abstract blood according to the patient’s strength; to apply ligatures to the extremities, vinegar and rose-oil to the head; and to give clysters. He also approves of emetics. When the disease has partly subsided, he approves of the bath. He treats separately of paralysis, describing many varieties of it. In paralysis of the face he recommends stimulant liniments, ligatures, gargles, and sternutatories. According to Rhases, apoplexy arises from congestion of blood or of viscid phlegm in the brain. He remarks correctly, that when attended with stertor it is difficult to cure. When the memory is affected, he directs us to apply a sinapism to the occiput.

The paralysis of the extremities after colic, mentioned by our author, and after him noticed by Avicenna and Haly Abbas, was, no doubt, the same disease as the palsy after colica pictonum described by modern authors. De Haen has given a masterly description of this disease. (Rat. Med.)

Rhases states decidedly that the skin of paralytics may retain its sensibility, although the muscular motion be lost. In a word, he maintains that the nerves of sensibility and motion may be affected separately. He remarks, however, that a part can scarcely retain its powers of motion when the sensibility is entirely gone. He says that he had known several cases of paralysis cured by a natural diarrhœa. His general remedies are bleeding, purging, and rubefacient applications. He, and several of the authorities referred to by him, recommend the warm salt-water bath for the cure of paralysis.

SECT. XIX.—ON CONVULSIONS, OR SPASMS.

The consideration of spasms naturally follows that of paralysis, because both are affections of the nerves; and, for the same reason, we shall next treat of tremors. When, therefore, spasms come on at the commencement of the complaint, or nearly so, and are protracted, they have their origin in plethora; but when they supervene after copious sweatings, vomitings, discharges from the bowels, hemorrhages, watchfulness, hunger, or much and violent exercise, they proceed from depletion. If they suddenly attack a person in health, they must necessarily proceed from plethora. But when from ardent fevers the nerves and whole body are dried, and then spasms come on owing to the dryness, this is one of the worst possible cases, and is almost incurable. Wherefore, we must, in the first place, bind gently the limbs which are contracted, and resist their inordinate motions, and rub them with oil of rue, Sicyonian or old oil, or the like; and the patients must take propomata of honied water. In convulsions from depletion, warm oil, or oil and water, are to be poured upon the patients, and if nothing contra-indicate, they may be put into a bath. We may use a tepid hip-bath with oil, and the gentlest friction. For food, they must take spoon-meats of chondrus and alica; and we may allow them a thin watery wine of easy diffusion if they have no fever. Then we must use the juice of ptisan and promote sleep. Spasms occasioned by plethora or inflammation, we may cure by diminishing the fulness, and removing the inflammation by suitable remedies. Spasms come on also during the agitations of violent vomitings, which cases are benefited by drinking infusions of the root of cotton-thistle, or of the white thorn, or of the Egyptian thorn; but some give the juice of the slender centaury to drink when the convulsions arise from plethora; and one should not only drink it, but rub the skin externally with castor and Sicyonian oil. If they do not cease, cupping-instruments, with scarifications, should be applied; when the legs are affected, along the ischium and the last vertebra; and when the arms are convulsed, to the back, to its first vertebra, and the one above the shoulder. When the rest of the body is not affected, but one of the lips, eyebrows, or tongue, is contracted, the symptom is to be reckoned dangerous and alarming, although the parts affected be but small in size. Wherefore you must abstract blood from the hind-head, and from over the first vertebræ.

Commentary. See Hippocrates (Aphor. v, 70); Galen (Comment.; de Loc. Aff. iii; Meth. Med. xii); Celsus (ii, 1); Cælius Aurelianus (Morb. Acut. iii, 6); Aretæus (de Morb. Acut. i, 6); Leo (ii, 17); Nonnus (38); Octavius Horatianus (ii, 10); Aëtius (vi, 38); Oribasius (Synops. viii, 16); Avicenna (iii, 2, 5, 6, 7); Serapion (i, 27); Avenzoar (ii, 3, 10, and i, 10, 3); Alsaharavius (Pract. i, 2, 21); Rhases (Divis. i, 16, and Contin. i.)

Aëtius and Oribasius treat of spasms in nearly the same terms as our author. We shall give an account of the doctrines of Aretæus and Cælius Aurelianus in the next section. The principles of our author’s treatment are mostly derived from Galen. The Arabians adopt his views without the slightest modification.

SECT. XX.—ON TETANUS AND ITS VARIETIES.

Tetanus also, being a spasm, takes place from the muscles of the body, and more particularly those about the spine, being as it were congealed by a cold humour, fixing both within and without; and hence they are incapable of bending themselves. But when the parts of the body are bent forwards, the affection is called emprosthotonos; when backwards, opisthotonos; and, when the parts are stretched equally both ways, the affection is called tetanus. Pelops says that these affections consist of a tension and contraction of the muscles and nerves about the neck, by which stooping, nodding, and turning of the head are performed; that if the affection be seated in the posterior muscles of the neck, the disease is, from this circumstance, called opisthotonos; when in the anterior, emprosthotonos; and if both are affected, tetanus. The cause, he says, is a flatus, and thick and nebulous air filling the muscles. He says that it is very cold and congealed, and that this is the cause of the difficulty of motion; and that, therefore, dry fomentations, and not moist, are most suitable to them. And these are the varieties of tetanus. “But,” he adds, “the cure of all is the same, and does not change with the varieties. Wherefore, the most potent remedy for them all is a fever supervening, when there was none at the commencement.” The symptoms are a moaning respiration, pulse rare and small, and sometimes a sardonic laugh comes on; the face is red, and their eyes appear larger than natural; their urine is either wholly suppressed, or it resembles common water, or is somewhat bloody, and contains certain bubbles; the belly is dried up; they cannot sleep; and often, from the violence of the spasms, they are in danger of falling out of their beds; they sometimes have singultus, and pains in the head, or between the shoulders and loins; and some have tremors. The disease is occasioned sometimes, though rarely, by fatigue, by lying upon the ground, lifting of weights, a fall, a wound, a burn, and a blow, or any other thing which can bring on such an injury of the nerves. The disease is to be cured like convulsions from depletion.

The cure of the varieties of tetanus. In treating tetanic spasms, we must begin with phlebotomy, and wrapping the parts in wool which has been dipped in oil, namely, the Sicyonian and castor with old oil; or a broad bladder containing hot oil may be applied to the tendons. Cupping, with scarifications, is to be applied; for dry cupping is hurtful. The neck, both sides of the spine, the muscular parts of the breast, the hypochondria, and the region of the bladder or kidneys, should be cupped. We must not be sparing of the detraction of blood, nor yet take away too much at a time, but at intervals. The sweats should be absorbed by the wool dipped in oil, lest the patient happen to catch cold. If the attack of tetanus continue long, the patient must be put into a hip-bath of oil twice a day, but not allowed to remain long in it; for, of all applications, the bath of oil is the most debilitating. Let him drink tepid hydromel boiled to the one half; and the robust may take a drachm of opopanax; or, if not so much, three oboli, or at least one obolus, if we are afraid of its proving injurious to the stomach. We must also give gum ammoniac; or the Cyrenaic juice, to the size of a tare, made up with well-boiled honey, may be swallowed. Two spoonfuls of the root of laserwort may be given in three cyathi of honied water, or in its decoction; or one drachm of myrrh, in honied water, or the decoction of hyssop. But the least dangerous and most effectual remedy is castor, to the extent of two or three spoonfuls, in divided doses. And it will do no harm, if you give it after a meal; but the drink and the other things should be taken slowly and by degrees; for if swallowed with difficulty, the drink regurgitates at the nose, the violent agitations of which bring on convulsions. The anus should be smeared with oil of rue, along with opopanax, and the same things are to be given in a clyster. The affusion of cold water being, as Hippocrates says, exceedingly hazardous, and, for that reason, I suppose, rejected by succeeding authorities, we too are disposed to condemn.

A liniment. Of nard (valerian), one sextarius; of wax, oz. ij; of malabathrum, of amomum, of storax, and of mastich, of each, oz. j; of castor, of adarce, of euphorbium, of pepper, of each, oz. j; of spikenard, of opobalsam, of each oz. j.

A potion for opisthotonos. Of the root of panacea, of white pepper, of costus, of myrrh, of poppy juice, equal parts. Give to the size of the vetch called aracus at bedtime. It is also a remedy for orthopnœa. Let the diet be attenuant, of easy diffusion, and by all means not excrementitious.

Commentary. Consult all the works referred to in the preceding Section; also, Celsus (iv, iii); Haly Abbas (Theor. ix, 10, 11, Pract. v, 31); Alexander Aphrodisiensis (Prob. i, 53.)

Hippocrates, Plato, Galen, Horatianus, and Avicenna agree in stating that a fever coming on tends to remove the tetanic affection. Cælius Aurelianus seems to question the truth of this ancient aphorism. According to Hippocrates, tetanus generally proves fatal within four days, or, if not, recovery takes place. He disapproves of the cold affusion in cases of traumatic tetanus (Aph. v, 21); Alexander Aphrodisiensis, however, speaks rather favorably of it.

Aëtius, Oribasius, and Nonnus, like our author, recommend bleeding, emollient fomentations, and the bath of oil. Archigenes (ap. Aëtium) directs the bath to be prepared by adding a fifth part of oil to the water.

The treatment recommended by Celsus is judicious and not unlike our author’s. He expresses himself hesitatingly about venesection, and forbids the early use of wine. He approves of opening the bowels.

Aretæus says that tetanus is a painful spasm, sometimes proving speedily fatal, and always difficult to cure. Like the moderns, he mentions the three varieties of it, namely, emprosthotonos, opisthotonos, and tetanus. The disease, according to his account, may arise from a variety of causes, such as a wound of a muscular or nervous part, abortion, and excessive cold. When it arises from the two causes first mentioned, it is said to be generally fatal. His description of it is given in his usual graphic manner. He advises the physician not to compromise himself by meddling with the case when the disease is fairly established. His treatment is altogether soothing and relaxant. He recommends us to lay the patient upon a soft warm bed, and, from whatever cause the complaint arise, to begin with abstracting blood from the arm. Then soft liquid food is to be given, and the whole body wrapped in wool moistened with some calefacient oil; or bladders half filled with tepid oil are to be applied to the parts most affected. He directs us to cup the back part of the neck, but cautions against exciting irritation by the application of heat. To the wound he recommends suppurative applications containing frankincense, turpentine-rosin, and the like; for he remarks (and the fact is confirmed by the experience of the late M. Larrey, who recommends a similar mode of practice) that, when tetanus supervenes, the sore becomes dry. He praises castor and assafœtida as antispasmodics; and, if these cannot be swallowed, they are to be given in an injection. He advises also hiera to be given in an injection.

Cæelius Aurelianus enumerates nearly the same causes as Aretæus, and describes all the symptoms of the disease with the greatest precision. His treatment also is nearly the same as that of Aretæus, namely, emollient applications to the neck, venesection, and oily clysters. He even enjoins the bath of oil, which has fallen into disuse in modern practice, most probably solely on account of the expense with which it would be attended. He also permits sometimes the use of the common bath, but not of cold water. He allows wine in certain cases. He condemns Hippocrates for giving both wine and emetics, and having recourse to venesection, without due discrimination. He blames him also for recommending the affusion of cold water, inasmuch as he himself had pronounced cold to be injurious to the nerves, bones, &c. Galen, however, remarks, in his Commentary upon this Aphorism of Hippocrates (sect, v, 21), that cold, in this case, is not the direct cause of the benefit derived from this remedy, but (if we understand him right) that the shock which it imparts to the system proves beneficial, by rousing the vital heat and energies of the patient. Hippocrates, however, as stated above, forbade the cold affusion in traumatic tetanus. Our author’s opinion of this practice is just such as the profession in general now entertain, after it has received another trial upon the recommendation of the late Dr. Currie. (See ‘Medical Reports,’ and Larrey’s ‘Mémoires de Chirurgie’, t. 1.)

Octavius Horatianus recommends bleeding, emollient applications, purgative clysters, the tepid bath, antispasmodics, and soporifics. The use of the last-mentioned class of remedies does not appear to have been sufficiently understood by the ancients; at all events they were less partial to them in this case than the moderns.

The Arabians enjoin nearly the same treatment as the Greeks. Avicenna and Mesue join the preceding authorities in recommending strongly the use of castor and assafœtida as antispasmodics. Avicenna, like all the others, praises the bath of oil. Serapion speaks of a bath prepared with emollient herbs. Haly Abbas describes minutely the two varieties as occasioned by repletion and inanition. For the former, he approves of purging with hot drastic purgatives, of rubbing the part affected with hot oils, and of using the warm bath with friction after it. He also approves of castor. For the other variety, he praises the affusion of plain water in which lettuces, barley, &c. have been boiled. He recommends the internal use of milk and other demulcents, and the bath of oil, and rubbing the body with oil of violets. The treatment recommended by Alsaliaravius is very similar. Rhases mentions Hippocrates’ proposal of the cold affusion; but, like our author, he rather disapproves of it. He himself recommends bleeding, when there are symptoms of repletion, emollient applications to the neck, the bath of oil, the application of leeches to the part affected, purging with aloes, &c. and the administration of antispasmodics, such as castor, assafœtida, and the like.

SECT. XXI.—ON TREMBLINGS.

Trembling is generally occasioned by a weakness of the nerves (old age is a proof of this); but there are many particular causes which occasion it; for it arises from a cold intemperament, from draughts of cold water, more especially if taken unseasonably during a fever, also from a redundance of cold and viscid humours, and from the too liberal use of wine. Those, therefore, who have tremblings from any obvious error in regimen, must abstain from the things which prove injurious to them. And, again, when the tremor remains during fevers, we must first rub the body with Sabine oil; but in the remissions of the attacks with old or Sicyonian oil. Let the extremities after being anointed, be wrapped in soft wool, and then let cupping instruments be applied along the spine, from the first vertebra to the loins; these parts, together with the hypochondria, being previously covered over with raw barley-meal. Let them also be wrapped with wool out of old or Sicyonian oil. But if the fever continue, every alternate day let them be put into a hip-bath of oil, or oil and water, and use soft frictions. But if the affection be prolonged, and cold is suspected, they should take a propoma, or sweet potion, of honied water and castor, and be carried about in warm places; and we ought to give them food of easy distribution, at first spoon-meats, and afterwards such fowls and fishes as have tender flesh. When the fever is gone, they must be washed, avoiding the cold bath and wine. But, if there be a fulness of thick and viscid humours, we must use remedies of an incisive and attenuant nature. They are these: Of the shoots of rue, of cow-parsnip, as much as can be contained in three fingers; of castor, of nitre, of each two oboli. Give every day one spoonful with oxymel, for three days while fasting; or of panacea and pepper, five grains; take in a draught of a cyathus of honied water. The following simple things in proportion relieve tremors: Castor, the brain of a hare eaten, the decoction of the root of marshmallows, of the leaves of water plantain, dr. iv, in honied water, hemp agrimony with water. When the cold prevails, we may use the liniment of Zosimus, and the restoratives, liniments, and rubefacients described above for paralysis, also exercises and frictions. Those who have tremblings from drinking wine must abstain from wine altogether, until a complete cure take place.

Commentary. See Galen (de Tremore, et alibi); Nonnus (40); Cælius Aurelianus (de Morb. Acut. iii, 7); Mesue (de Ægr. Cap. 5); Serapion (i, 3); Haly Abbas (Theor. ix, 11, Pract. v, 32); Alsaharavius (Pract. i, 2, 24); Rhases (ad Mansor. ix, 8.)

Galen, in the work referred to above, explains the rationale of this affection with his usual penetration, but at too great length to allow of our entering upon an exposition of it. The others treat of it similarly to our author. Thus Haly Abbas mentions various causes of tremors, such as old age, drinking cold water unseasonably, excessive indulgence in wine or venery, inanition, and the like. He recommends aloes and castor, the hot bath, friction with calefacient oils, and other such remedies. Serapion gives a sensible account of the nature of the affection, and recommends fetid or antispasmodic remedies internally, and friction with calefacient oils externally. When it is occasioned by exposure to cold, Rhases recommends the hot bath and insolation. We may mention here that Hippocrates has given a very accurate history of a case of delirium tremens. (Epid. iii, 5.)

SECT. XXII.—ON DISEASES OF THE EYE; AND FIRST OF PAIN, FROM GALEN.

When violent pains in the eyes take place, consider from what diathesis the eye happens to be pained in the inflammations; for they are either occasioned by the pungency of an acrid defluxion, or from the coats being over filled and stretched, or from the distension of thick humours or of flatulent spirits. When the pains proceed from pungency, they are to be cured by evacuating with purgatives, and by injecting into the eye the white of an egg. When the inflammation is concocted, if the body be free of impurities, the most befitting remedies are baths. Inflammations from plethora are to be cured by the detraction of blood, purging the belly, and applying friction to the inferior extremities. Those from distension are to be cured by first evacuating the whole body, then by occasioning a revulsion downwards of the humours, and afterwards by using topical applications of a discutient nature. The eyes must be fomented, and the decoction of fenugreek poured into them. When the vessels of the eye are distended with thick blood, while there is no plethoric diathesis in the general system, the patient must drink wine which has the power of heating, evacuating, and removing obstructions.

On disorder of the eye, and particularly of ophthalmy. Disorder of the eye is a wateriness and heat of it, with preternatural redness, not occasioned by any cause within the body, but by some external one, such as the sun, smoke, dust, or the wind; wherefore it is soon dispelled when the cause is removed. And ophthalmy is a marked disorder, which may be occasioned not only by an external cause, but also without any obvious one, and remains until the third, fourth, or fifth day. It is best cured by avoiding every external exciting cause, by spare diet, drinking water, walking, and by opening the belly.

On inflammation. When inflammation remains in the eyes after evacuation of the general system, we may use ointments for dispelling the rheum, and soothing the irritation, such as the collyrium of Nilus made from roses, the chiac, or the collyrium from nard. When the tunica adnata is inflamed, we may use the collyria called monhemera, injecting them into the eye with the white of an egg. Next day, if the inflammation be not aggravated, we may anoint them with the collyrium of nard, and use a fomentation of the decoction of melilot and fenugreek. When the humour which occasions the ophthalmy is thick, we may use medicines which are neither obstruents nor incrassants, but which, on the contrary, will dissipate, dilute, and evacuate the humours, such as the chiac collyrium. But, if the humours are impacted in the head, we may fix a cupping instrument to the hind head, or scarify, or apply leeches to the forehead, near the eye affected. We must use cataplasms of pure bread soaked in water, with a little rose-oil, or polenta boiled in the decoction of poppy-heads also with rose-oil. We may also use a more efficacious cataplasm from saffron, melilot, the fleshy parts of dates, the tender leaves of coriander, eggs, and roasted wheat and crumbs of bread dipped in a decoction with a small quantity of rose oil, in a decoction of pounded poppy heads. We mix also the seed of the poppy as an anodyne. If compelled by the severity of the pain, we must add a little opium; but, unless the pain be very violent, we must abstain from all narcotics. If the inflammation be moderate, apply aloes by itself, or rub it in with water or the white of an egg. In order that the remedy may be ready for use, take of saffron, dr. vj; of aloes, dr. xvj; of gum, dr. ix; mix with rain water, and make a collyrium. And the saffron collyria, as they are called, are proper for the commencement of ophthalmies. In those cases in which there is an œdematous and white swelling about the eyebrows and tunica adnata, without injury of the coats, the best applications are those called liquid collyria, prepared from saffron, copperas, and honey. And this one is excellent:

A liquid anodyne collyrium. Of the melanteria used by tanners, of Attic honey, of the juice of fenugreek, equal parts. Boil to the thickness of honey, and touch the two angles of the eye with it, by means of the rounded extremity of a specillum or probe.

For a copious defluxion. For a flow of humours, in the commencement abstinence from food is proper, and the drinking of water, and most especially abstinence from venery; the belly should be opened, and the face washed with a watery oxycrate, if the rheum be of a hot nature; but if otherwise, the forehead and eyebrows may be anointed with copperas and honey. Some dissolve the copperas in water, and bathe with it. In defluxions without inflammation, or with inflammation, but so that the affection is seated above the skull, we must use agglutinative applications to the forehead, either simple ones, such as green vine leaves, or the juice of the bramble, or of purslain, or of quinces with some fine polenta, or with gall levigated in wine, or with fine polenta or hemlock, or flea-wort with water, or nightshade, or snails with their shells pulverized, and applied from temple to temple, and, in a word, with things of an astringent and cooling nature, or with the following compound applications: Wheat flour, and myrrh or frankincense, with the white of an egg, may be rubbed in; or Samian earth, with myrrh and manna, in like manner, with the white of an egg; but in colder defluxions, of native sulphur, of bitumen, of pitch, of colophonian rosin, of each, dr. ij; also the trochisk of Musa, that called aster, and the like, are suitable repellents. And the theriac, dissolved in an astringent wine, and rubbed on the forehead, stops cold defluxions, and may be drunk with great advantage. Over the eye apply wool, or a small rag wet in the white of an egg; and new-made cheese, in like manner, when applied to the eye, restrains acrid defluxions in particular; also the astringent collyria, as they are called, when rubbed in or injected into the eye in a watery state, do the same thing. But if the humour be deep-seated, and below the skull, and if fixed there for a length of time, after the general evacuations use errhines and masticatories, shaving the head, and applying rubefacients to it. But to these must be joined the surgical operations for the head, namely, Angiology, Arteriotomy, Hypospathismus, and Periscyphismus, with burning at the vertex down to the bone. But cupping instruments, with scarifications applied to the hind-head, will produce a revulsion of the defluxion. The symptoms of defluxions external to the skull are distension of the vessels of the forehead and temples, forming, as it were, a band to the head, and the complaint being remedied by agglutinative applications of a desiccant nature. When these symptoms are not present, and the defluxion proves of long duration, and sometimes is exasperated by sternutatories, the humour is to be supposed seated below the skull.

On chemosis. The disease is called chemosis when both the eyelids are everted in consequence of a violent inflammation, so that the eyes are scarcely covered by them, and the white of the eye is elevated above the black, is red, and occupies a large portion of the black. We must cure it by phlebotomy, purging, the white collyrium of roses, and the spodiac, with milk, or the white of an egg, and we may anoint the eyelids, temples, and forehead with the same, and have recourse to paregoric fomentations and cataplasms. When the inflammation begins to remit, we may rub in the more acrid applications, such as the green one from roses.

On hyposphagma and emphysema. Hyposphagma is a rupture of the veins of the tunica adnata, occasioned most frequently by a blow. Bathe the eyes with the blood of the wood-pigeon, or of the common pigeon, or the warm milk of a woman in which a little frankincense has been triturated, and inject brine, more particularly that from Cappadocian salts, and use a fomentation from the decoction of hyssop. Swellings about the eyes from blows are remedied by repeated fomentations with oxycrate, or a sponge out of oxycrate may be applied to them, or a liniment may be used, consisting of equal parts of burnt lapis specularis, and pigeon’s dung, triturated with wine or vinegar. Or a cataplasm may be applied of new cheese, or of the rind of radishes, or of dried grapes without the stones. Each of these is to be mixed with oxycrate or honied water. The same remedies apply also to emphysema.

On prurient emphysema and psorophthalmia. Emphysema is an œdematous swelling of the eyelids; but psorophthalmia is a scabious eruption of the eyelids attended with pruritus, arising from a saltish and nitrous humour. They are remedied by oxycrate, the decoction of lentils, and a fomentation of roses. The following is a liquid collyrium: Of copper, dr. vj; of calcined misy, and myrrh, of each, dr. iij; of saffron, dr. iss; of pepper, dr. j; of Chian wine, and Cretan sweet wine, of each 1½ cyathus; boil to the thickness of honey. This is the collyrium of Erasistratus called panchrestos, which applies to cynanche, ulcers in the mouth, and on the privy parts, and to the earache. They are to be rubbed with oil into the patient’s eyebrows when he is going to sleep. Acid, saltish, and acrid things are to be abstained from.

On sclerophthalmia and xerophthalmia. Sclerophthalmia is a hardness of the eye with difficulty of motion, pain, and redness, without wateriness. For this the eyes are to be fomented frequently with sponges out of hot water; and at bedtime the white of an egg with rose-oil, or the fat of geese, may be applied to the eyelids. Let them avoid everything of a cooling and hardening nature; let the head be covered and anointed, and the belly kept open. Xerophthalmia is a pruriginous affection of the eyes without rheum. It is to be cured by baths, unguents, and a wholesome diet. Applications of an acrid nature are suitable to both, as they promote a flow of tears, by which the hardness will be softened, and the dryness rendered more humid. Such are the panchrestos of Erasistratus, and those called dicenteton and stratioticum.

On ectropion, or eversion of the eyelids. This complaint is an eversion of the eyelid, occasioned either by a scar or fungous flesh. When it is occasioned by fungous flesh, and is of long duration, roast scraped verdigris, pulverise it and apply, or use burned lead washed with sulphur vivum, or apply both in equal parts, namely, the verdigris and the lead. Ectropion from a cicatrix, if at all remediable, must be cured by a surgical operation.

On ægilops and anchilops. Ægilops is an aposteme between the great canthus of the eye and the nose, which breaking and being neglected, ends in a fistula that extends to the bone. Before the aposteme breaks out into an ulcer, it is called anchilops. A very good application is horned poppy and saffron, applied with the juice of perdicias (pellitory of the wall?) They must be frequently changed, and till then it will not turn to pus.—Another: Alica, boiled in vinegar and properly triturated, not only cures the disease at the commencement, but, after suppuration, it bursts the abscess and penetrates to the bone. By using it, you may cure not only ægilops but anchilops.—Another: Garden rue, levigated and boiled with protostactos and applied, answers excellently for ægilops, penetrates to the bone, proving stimulating at first, but afterwards not so; and, what is wonderful, it does not leave an ugly scar.—Another: Pulverize snails with their shells and apply them; and sometimes aloes or myrrh may be added before the ægilops is converted to pus; and after the abscess bursts it dries up the pus.

On trachoma. Trachoma is a roughness of the inner surface of the eyelid, an intense degree of which has the appearance of clefts, and is called sycosis. When it becomes chronic and callous, it is called tylosis. We must use collyria for it, namely, the one from wine, and that prepared from the two stones; or the eyelid may be rubbed with the bloodstone itself (hæmatites,) much washed in water. But the collyrium called harmation, with a little of the cycnarius, or the saffron collyrium, answer well with these, and with cases of psorophthalmia without ulceration, when rubbed upon the everted eyelid. But if the callus be hard and do not yield to these things, we must turn the eyelid out and rub it down with pumice-stone, or the shell of the cuttle-fish, or fig-leaves, or by the surgical instrument called blepharoxyston.

On chalazion. Chalazion is a concretion of an indolent humour in the eyelid, for which pound ammoniac with vinegar, and anoint along with galbanum. It likewise has a good effect when joined with cerate and turpentine.

On hordeolum, or stye. Hordeolum is a small oblong aposteme on the tarsus of the eyelid. We may foment it with white wax; or throwing away the head of a fly, we may rub the part with the rest of its body; or wash with the decoction of barley.

For lice in the eyebrows. Having first cleared away the pediculi, wash the part with tepid sea-water, and use the under-mentioned application to the tarsus: Of fissile alum, two parts; of stavesacre, one part; triturate, and use.

On madarosis, or milphosis. This affection is a falling off of the hairs of the eyelids. Wherefore, after attending to the general health, use the detergent ointments called calliblephara. Of Cannel-coal, of Celtic saffron, of ladanum, equal parts; pulverize, and use.—Another: Of antimony, calcined and cleaned, dr. j; of lead, burned and cleaned, dr. iv; of saffron, dr. iv; of Indian nard, dr. iij; pulverize, and use.—Another: Of the burnt bones of dates, dr. iij; of Celtic nard, dr. ij; pulverize, and use. This also cures scabious eyes.

That of Neopolites for milphosis and chronic affections of the eyelids. Of antimony, of cadmia, of chalcitis, of foreign misy, of each, equal parts; beat together coarsely, mix with honey; when roasted, triturate, and use.

On ptillosis. Ptillosis is a callous thickening of the eyelids, of a red colour, and often accompanied with a falling out of the hair. In addition to those already mentioned, the following is an excellent application: Rub with mice dung burnt, and triturated in honey.

For a falling off of the hairs of the eyebrows. Anointing the fingers with oil, or geese fat, rub them upon lead, and anoint with this.—Another, which also darkens the hairs: Triturate blunt Pontic walnuts with the fat of goats or of bears.—Another, which also applies to alopecia of the chin: Of henbane, dr. ij; of mice dung, dr. j; of maiden-hair, dr. j; of the ointment of iris, four spoonfuls. Pound well together, mix the ointment, and, having first fomented, anoint. If you previously shave the part, it will be the more efficacious.

For trichiasis of the eyelids. Having first torn out the hairs which irritate the eye, anoint the part immediately with the blood of a frog by itself, or with the ashes of white chameleon, or the blood of bugs; or the juice of the fumitory, which grows among barley, mixing it with gum, or the ashes of pickled limpets with cedar rosin (gum vernix?), or the ashes of the lotos; or liquid alum, called phorimum; or the blood of a tick taken from a dog. It is very efficacious.

Agglutinative medicines. The following substances agglutinate the hairs when bent inwards: Bitumen, mastich, colophonian rosin, glue, the glutinous part of snails.

On encanthis and rhyas. Encanthis is an excrescence of the natural flesh at the great canthus, but rhyas is a wasting of it. You may treat encanthis with the remedies mentioned for ectropion, and similar caustic, or septic applications; but the whole substance must not be consumed, lest rhyas be produced, for it must only be reduced to its natural size. Rhyas, when the whole flesh is consumed, either by an awkward surgical operation or medicines, is incurable. But if part of it only be lost, you may restore it by moderately astringent and incarnating applications, such as that from saffron, horned poppy, and aloes; and the saffron collyria, and henbane boiled in wine and applied, and a small quantity of alum with wine.

On ulcers. Of the ulcers in the eyes there is but one genus, but many particular species. For that in the cornea, when hollow, narrow, and clean, is called bothrion. That which is broader than the bothrion, but less deep, is called cœloma. Argemon is the name given to that which arises on the circle of the iris, but affects the surrounding parts, so that the part which is on the external side of the iris is red, but that on the internal white. Epicauma is a foul and impure ulcer with eschars, which, when cleaned away, often give vent to the humours of the eye. There are many other varieties of ulcers, all of which we shall treat of in general terms. If, therefore, the ulcer happen to be attended with inflammation, the cure must be accomplished by such things as are calculated to soothe and digest the inflammation, regard being had to the peculiar nature of the ulcer. Such are the collyria, called libanium, cycnos, and palaria, aster, and the like; and those from starch, Samian earth, and ceruse. But the most sedative collyrium which we are acquainted with is that of Nilamon; and yet we must not persevere long with it, because it is very narcotic. The best of all applications is the collyrium from decoctions not possessed of a narcotic quality. But if the ulcer be attended with a rheum, we must mix some of the collyria for it, such as that from the hydra, the chiac, the yellow cycnos, and such as possess repellent properties without being stimulant. When the ulcers are foul, we must use honied water moderately diluted, and the decoction of fenugreek, by themselves, and along with the collyria for that purpose; when they are acrid, we may use that of Severianus with the diachylon from fenugreek; when not acrid, those from myrrh and nard. When the ulcers are cleaned, they may be cicatrized by means of the collyrium called cleon, in addition to which it will render the scar of the same colour.

On procidentia. Procidentia is a projection of the coat called uva (iris?), formed by an ulceration or rupture of the cornea. When, therefore, it is small, so as to resemble the head of a fly, it is called myocephalon. When it increases more, so as to resemble a grape-stone, it is called staphyloma; when it advances far forward, so as to protrude between the eyelids, it is called melon; and if it has become callous, it is called clavus. If, therefore, the projection is small, like the head of a fly, we must use repellent and astringent applications, such as the chian, that called fuscum, the nard, and the theodotian, and those from olive leaves, and from horn. And we must bind upon them without pressure a piece of sponge which has been soaked in oxycrate, or astringent wine, or the decoction of roses, or the compress called splenium may be used. The best application for procidentia, and all ulcers of the eye, is the collyrium called olympiac or olympus, with the juice of olive, or of knot-grass, or of poley. The same things are applicable to clavus and staphyloma, before they whiten; for after they become white and callous, they are incurable.

On hypopyon. Hypopyon occurs occasionally in the cornea, being sometimes deeply seated, and sometimes more superficially, the matter assuming the shape of a nail, and hence the affection has got the name of onyx. The indication of cure is either to dispel the pus by remedies possessing this property in a moderate degree, such as honied-water, and the juice of fenugreek, and the collyria formed from it, the libyanum, and those from frankincense; or to make it burst, and cleanse the ulcer by means of the more potent remedies, such as those called diasmyrna and the hygidian. For cases of hypopyon without ulceration one may use the following liquid collyrium: Of copperas, and of saffron, of each, dr. viij; of myrrh, dr. iv; of honey, lb. j. The phlyctæna, which is an elevation of the cornea, by a certain humour corroding its fibres, yields to the same treatment as hypopyon.

The liquid collyria of Bassus for hypopyon. Of saffron, of aloes, and of myrrh, of each, oz. j; of wine, oz. iij; of the finest honey, oz. vj. The saffron is to be levigated with a small quantity of the wine, then with the aloes and myrrh; and when it thickens, add the honey, and having mixed together, lay up in a glass vessel, and use twice a day, or, if the case be urgent, three times. It at the same time cleanses the eye and proves incarnating and cicatrizing.

On cicatrices and leucomata. Superficial scars on the eye are called by some cicatrices, and by others nebulæ; but the more deeply seated are called leucomata. The proper remedies for them are those of a detergent and cleansing nature. Wherefore, nebulæ may be cleansed by the juice of anemone, and that of the small centaury, with honey; but the more chronic are reduced by cedar gum, or by copper alone levigated with water for a collyrium, and by the cleansing collyria, such as that from hartshorn, and those called rhinarian, hecatombe, and the like. Leucomata may be cleared away by nitre carefully levigated with some old oil, and properly smeared upon them, and by the shell of the cuttle-fish (sepia) burnt and pounded finely with honey. Among the collyria, the following one proves an excellent and mild detergent: Of mamira, of ammoniac perfume, of Troglodytic myrrh, of crocodile’s dung, equal parts; make a collyrium, and use. Levigate the dung of the land crocodile with water, and anoint, having formed it into a collyrium. You may also succeed well by dissolving Cappadocian salts in water, and then dissolving the collyria for leucoma in it, and injecting it.

Dyes for cicatrices. Of galls and acacia, of each dr. iv; of copperas, dr. ij; use. The following is a collyrium: Of the flowers of the pomegranate, of copperas, of acacia, of gum, of each dr. iv; of antimony and galls, of each dr. ij; triturate with water. When the flowers of the pomegranate are not at hand, you may use the internal membrane between the seeds.

On pterygium. Pterygium is a nervous (membranous?) excrescence of the tunica adnata, arising at the angle of the eye, and advancing to the corona. When it increases greatly, it covers the pupil itself. Wherefore, large and chronic pterygia can only be extirpated by a surgical operation. But the smaller and more recent ones may be worn down by the abstergent applications, such as those used for trachoma and leucoma. Among the simple remedies are burnt copper, and copperas with the gall of swine, which answer well. The following is a more potent remedy: Of copperas, p. i, of gum, p. ss.; triturate with wine, and anoint, or form into collyria. Some mix the gall of a goat with honey, and anoint with it.

For pterygium, hypopyon, and dimness of vision. (From Oribasius.) Of the magnet-stone, of scraped verdigris (xyston), of reddle, of ammoniac perfume, of each dr. iv; of saffron, dr. ij; of Attic honey half a spoonful. It also answers for leucoma.

For carbuncle and carcinoma. Carcinoma is an affection of the cornea, attended with pain, distension, redness of the tunics, and pungent agony, extending to the temples, more particularly if shaken. They loathe their food, and have the pain increased by acrid things. The affection is incurable, but may be alleviated by a milk-diet, farinaceous and otherwise wholesome food, devoid of all acrimony; and the injection of soothing collyria, such as the Spodiac, Severianum, and the like. We must previously attend that the general system be in a proper temperament. Carbuncle also is a malignant ulcer of the sloughy kind, forming sometimes in the ball of the eye, sometimes in the eyelid, as in the other parts of the body. In cases of carbuncle of the ball of the eye, we must first evacuate with a clyster, and then purge moderately with boiled milk, afterwards foment with a sponge, and apply a cataplasm of the flour of tares, or of wheat boiled in honied water, or sometimes we may add pounded iris, and wash the eye with milk. If the ulcer spread, we may apply a cataplasm of lentils with honey or boiled quinces: if it continue spreading, we may use the boiled leaves of the olive, the rind of the pomegranate boiled in wine and pounded with honey. When the ulceration stops, and the eschar falls off by the application of the medicine about to be described, and the ulcers have become clean, we may apply a cataplasm of the roasted yelks of eggs, triturated with saffron and honey, until the ulcer is healed. The medicine is this: Of spodium, dr. iv; of myrrh not much toasted, dr. iij, and oboli iij; triturate in Aminæan wine until it become dry, mix old Cretan sweet wine, and having triturated, lay up the liquid in an earthen vessel, and anoint with it. For carbuncles of the eyelids, having cut an acid pomegranate, boil it whole in vinegar, and, when softened, pound and put it into a linen cloth, and use. Change twice or thrice during the day, and once during the night.