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

On mydriasis. When the pupil does not appear changed in colour, but much wider than natural, and when it sometimes wholly impairs the vision, and sometimes nearly so, and when every object appears smaller, the affection is called mydriasis. The cause of it is some redundant humour. We must cure it by bleeding from the arm, or purging; but, if not, by dividing the veins in the angles of the eye, and then applying a cupping instrument to the back part of the head, and bathing the face and eyes with sea-water, or, if it be not at hand, with brine or oxycrate. We must also use the remedies which are applicable to phyletænæ or blisters.

On phthisis and atrophy. Phthisis is an affection of the pupil, which is contracted, and appears duller and more rugose than usual, but objects seem larger than natural. The cause of it is condensation, mostly occasioned by dryness. Phthisis differs from atrophy in this, that phthisis renders the pupil contracted, whereas in atrophy the whole eye is smaller and more depressed. We may cure them by exercise, and rubbing carefully the head, the face, and the eyes; by bathing the face with water, and anointing the head with some healing ointment; and smearing the eyes with an attenuant and acrid composition, such as the following: Of ammoniac, dr. j; of crocomagma, dr. iv; of saffron, dr. ij; of verdigris, dr. j. Triturate in water, form and use.

For nyctalopia. In the disease called nyctalopia, the patient sees during the day, but at sunset his vision becomes dimmer, and when night comes on he does not see at all. We must effect the cure by bleeding from the arm and the angle of the eye, then purging or evacuating by a clyster, and afterwards ordering masticatories or sternutatories. Before food, we give hyssop to drink, or rue; but, if the disease do not yield, we must again administer the purgative medicine formed from scammony, and castor, anoint with clarified honey, and make the patient shut his eyelids, so as to retain the liquid application. Or of burnt alum, p. ij; of fossile salt, p. j; triturate with honey and anoint.—Another: Having roasted the liver of a goat, collect the ichor during the roasting and anoint, but give the liver itself to eat; or boil, and direct the vapours to be received with open eyes.

For glaucoma and suffusion. (From Ruffus.) The ancients considered glaucoma and suffusion as the same disease; but by their successors glaucoma has been accounted an affection of the crystalline humour, which is changed by a watery substance to a cerulean colour; but suffusion is reckoned a defluxion of humours concreted between the cornea and the crystalline lens. Glaucoma is in every case incurable. Suffusion may indeed be cured, but not always. We may try to cure suffusion before the disease is completely formed, by taking blood from the arm, by purging and acrid clysters, such as those made from the decoction of centaury, or of the bitter cucumber, and by keeping the bowels for some time in a loose state. Cupping instruments with scarifications may be applied to the hind-head; the patient must drink water during the whole regimen, take attenuant food, and, in process of time, masticatories may be used for a few days with advantage. When the vision is depraved, as, for example, gnats appearing before the eyes, which case proceeds from a cacochymy or from bilious vapours ascending to the head, we may give for a time the bitter medicine from aloes, or purge with it. To the eyes we must make applications at first simple, such as honey and oil, with the juice of fennel, and afterwards compound, such as this: Of sagapene, dr. ij; of Cyrenaic juice, of white hellebore, of each, dr. vj; triturate with eight heminæ of honey. We, says Oribasius, use the following medicine: Of the juice of wild carrots, of germander, of cresses, of each, equal parts; triturate. The following collyria are beneficial, namely, that from the juice of the fennel, that called proteus, the thalasseros and that from opobalsam. The collyria prepared from them are useful, and the decoction of fennel in the commencement answers well as a fomentation, and that from juices, opobalsam, honey, old oil, and the like.

On amaurosis and dimness of sight. Amaurosis is, for the most part, a complete impediment of the sight without any apparent affection about the eye; and dimness of sight is an imperfection of vision arising without any sensible cause. The same mode of cure as that described for suffusion applies generally in this case; but, in particular, blood may be abstracted from the corners of the eye, leeches applied to the temples, and friction of the extremities. In process of time we must have recourse to sternutatories, emetics with an empty stomach, and the application of ointments, at first with equal parts of honey and oil, and afterwards with the under-mentioned composition: Of saffron, two oboli; of the gall of the hyæna, dr. j; of common pepper, eighty-five grains; of fennel juice, dr. xvj; of ammoniac perfume, dr. j. Triturate the dry substances with the juice, add four spoonfuls of honey, prepare and lay up in a copper vessel for use. Before using, let him foment the eyes by immersing them in hot sea-water.

On strabismus, or squinting. Congenital squinting is cured by the application of a mask, so that the children are compelled to look straight forwards; for strabismus is a spasmodic affection of the muscles which move the ball of the eye. And the lamp should be placed fairly opposite, and not so as to shine obliquely. When the eye is turned to the nose, purple flocks of wool should be fastened to the outer angle of the eye, so that by looking steadily at them, the persons affected may correct the state of the eyes.

On ecpiesmus. The eyes are sometimes forced out, so as to remain prominent. When this happens from strangulation, we must let blood from the arm; but if otherwise, we must purge with black hellebore or scammony. When the eyes become prominent from the pain of labour, the complaint is often removed by the cleansing after parturition; hence we ought to promote it; and, in men, after phlebotomy, if it do not abate, we may affix a cupping instrument to the back part of the head, and apply wool smeared with honey, or flocks of it with water, and bind a compress gently above it. Cold salt water poured upon the face is likewise suitable to them, and also the juice of endive and knot-grass, rubbed in with the juice of poppy, and whatever else can repress and contract.

On synchysis, or confusion. Confusion of the sight occasioned by a blow may be cured by bleeding from the arm, and by filling the whole eye with the blood of a newly-slaughtered animal, of a turtle in particular, but, if not, of a pigeon, and then applying soft wool which has been immersed in an egg beaten up with wine and rose-oil, and binding it on the place. The same thing is to be done next day; and on the third, it is to be fomented, washed with milk, and suitable cataplasms applied; after which it is to be anointed with the remedies for old affections, such as Chiac.

For myopia. Those persons are called myopes, or near-sighted, who, from their births, see near objects, but not those at a distance. Such a state is wholly incurable, being occasioned by a weakness of the optic spirit. Old men are affected in the opposite manner to these, for they do not perceive near objects, but see those at a distance.

Commentary. See Hippocrates (Aphoris., de Visu, et alibi); Galen (de Loc. Aff. iv, de Med. Sec. Loc. iv); Aëtius (vii); Alexander (ii); Oribasius (Synops. viii); Actuarius (Meth. Med. iv, 11); Leo (iii); Psellus (Opus Medicum); Palladius (Comment. in Hippocrat. Epidem.); Scribonius Largus; Octavius Horatianus (i, 10); Nonnus (Epit. 45); Serapion (ii); Avicenna (iii, 3, 1, 2); Mesue (de Ægrit. Ocul.); Avenzoar (i, 7); Haly Abbas (Theor. ix, 13, Pract. v, 34); Alsaharavius (Pract. iv); Rhases (Divis., ad Mansor. ix, and Contin. ii); Canamusali (de Oculis, vi); Jesu Haly (Tract. de Oculis.)

On pain, disorder of the eye, ophthalmy, inflammation, and defluxion. The ancients treat of these complaints separately; but, as they are so nearly connected, we shall class them together. By disorder of the eye (taraxis), they meant an inferior degree of ophthalmy, as is remarked by Turnebus. (Bernard’s Nonnus, 45.) It is, therefore, the mild acute ophthalmy of Scarpa. The remedies enumerated by Hippocrates for pains of the eyes are thus given in the language of Celsus: “Sanguinis detractio, medicamentum, balneum, vinum.” Drinking wine might appear to us at first sight not a very likely mode of curing ophthalmies; and yet Galen, in his Commentary on this Aphorism (vi, 31), has related a case in which it effected a cure after every other remedy had failed. Even Scarpa allows the correctness of the aphorism as a rule of practice, and states that wine and the cold bath are proper when the disease is kept up by excessive irritability. Alexander recommends wine and the tepid bath when the inflammation arises from thick and pituitous blood. Philagrius, as quoted by Theophilus in his ‘Scholia on Hippocrates,’ indicates that the wine should be white, sweet, new, and if the patient’s head be delicate, diluted with water. (See further, t. ii, 501, ed. Dietz.) Mesue makes many interesting remarks upon the above-mentioned remedies of Hippocrates. For further explanation of the rationale of this practice, see Schelhammer (de Tumoribus), and Littré (Hippocrat. t. iv, 418.) Another of Hippocrates’ aphorisms is, that a spontaneous diarrhœa is a favorable occurrence in ophthalmy; upon which Galen remarks, that, in imitation of nature’s method of removing the complaint, physicians are in the practice of producing an artificial looseness by means of cathartics and clysters. Lead is an ingredient in several of Alexander’s collyria. For periodical ophthalmy, Hippocrates recommends purging the head and bowels; and in certain cases bleeding, cupping, and restricted diet. Celsus, Galen, and, in short, most of the ancient authorities make mention of narcotics, such as opium and mandragora, but do not approve of them as common remedies. Galen, however, instances ophthalmy as one of the species of inflammation in which opium is admissible. (De Optima Secta, 9.) Alexander, in like manner, cautions against the indiscriminate use of opium to lull the pain. Some of his prescriptions for collyria, however, contain opium. Galen recommends scarifications in chronic defluxions of the eye. Aëtius lays down very proper rules respecting purging, fomentations, venesection, and baths. He properly remarks regarding the use of wine, that it is only applicable when the patient is of a dry and cold intemperament. Celsus is a decided advocate for fomentations with hot water in all cases of ophthalmy.

The Arabians treat ophthalmy upon the same principles as the Greeks, without supplying much additional information. Mesue, like our author, recommends bleeding by opening the temporal artery, which operation he describes minutely. When the bleeding cannot be stopped otherwise, he directs us to secure the vessel with a silk thread. He also makes mention of leeching and the actual cautery. He is very minute in his directions about his collyria. One of his anodyne collyria consists of the juice of hyoscyamus, mandragora, and opium; and another contains camphor, saffron, hyoscyamus, and the like. The use of narcotics, however, is forbid by Jesu Haly. Rhases also rather disapproves of them. Avicenna makes mention of bleeding by the temporal arteries, the angular vein of the nose, and the frontal. When the usual remedies do not succeed, he approves of the cautery; and, in certain cases, recommends strongly the use of stimulant applications, such as æs ustum, copperas, and arsenic. Galen, in like manner, makes mention of arsenic, and also of misy, sori, and chalcitis (substances resembling our sulphate of copper) among his remedies for diseases of the eye. Having ourselves had occasion to use arsenic in certain malignant diseases of the eyelids, and not having found that it produced any serious disorder in the ball of the eye, we would call the attention of modern oculists to this medicine as one from which, when properly managed, the best results may be expected. When the ophthalmy is of a cold nature, Avicenna approves of treating it by an attenuant diet, the bath, and white wine. In certain cases he directs us to pour cold water on the head. Haly Abbas describes three varieties of ophthalmy. The first arises from manifest causes, such as the sun, dust, and the like; and is to be cured by bleeding, purging, and cooling lotions, containing rose-oil, camphor, &c. In the second, the symptoms are more severe, being attended with greater redness and pain. It also is to be cured by bleeding, cupping, and emollient collyria. The third variety is chemosis. Alsaharavius treats of the disease at great length. When it is connected with a bilious cause, he directs us to purge, use the bath, apply vapours to the eye, and soothing collyria. Serapion, like Haly, describes three varieties of the disease by the names of tarkinisis, noutelinie, and kermufil. Jesu Haly recommends general bleeding, purging, and fomentations, with the decoctions of fenugreek and fennel, for ophthalmy. It remains to be mentioned that Galen, Alexander Aphrodisiensis, and all the Arabian authorities have placed ophthalmy in the list of contagious diseases. See, in particular, Alex. Aph. (Prob. i, 35), and our brief sketch of the history of ancient opinions on contagion in the Second Book, Sect. XXXVI. The celebrated Fracastorius confidently maintains that ophthalmy is contagious. (De Morb. Contag.) And we may further mention that all the authorities of the middle ages speak of ophthalmy as being contagious.

On chemosis. By chemosis, modern oculists (as, for example, Scarpa) understand that state of ophthalmy when blood, owing to a rupture of one or more vessels, is effused into the cellular membrane which connects the conjunctiva to the anterior hemisphere of the eye. Our author’s account is mostly taken from Oribasius, who, in his turn, borrows from Demosthenes. Galen and Octavius Horatianus, without saying anything of the general treatment, merely recommend us to apply upon a clean linen cloth flies pounded with the yelk of an egg. Chemosis is Haly’s third variety of ophthalmy, for which he recommends copious and repeated bleeding, cupping, gentle laxatives, cataplasms containing poppies when the pain is violent, and other soothing collyria. Alsaharavius, in like manner, recommends depletion and emollient fomentations. Serapion, among other things, mentions soothing fomentations. In chemosis, according to Rhases, all the symptoms of ophthalmy are particularly strong and violent; the eyelids being swelled and everted, and the white of the eye appearing black. He recommends local and general bleeding, purging, and astringent applications.

On hyposphagma and emphysema. Hyposphagma is not described by any particular name in modern surgical works. Besides the local applications mentioned by our author, Aëtius properly recommends general treatment, we mean bleeding, purging, and the like. Avicenna also makes mention of venesection and arteriotomy. Haly describes the disease by the name of tumor oculi as his first variety of inflatio. Alsaharavius uses the same term. Serapion treats of it by the name of sanguis divisus in oculo, recommending treatment similar to our author’s. See also Celsus (vi, 6.)

The emphysema appears to have been a sort of œdema seated below the eyelid. Aëtius remarks that it occurs principally in old men. We have often seen it in them. He recommends fomentations by means of a sponge, rubbing the eyelid within with honey, pouring hot water on the head, using baths, drinking wine, and even bleeding at the arm. This last measure is omitted by our author, and must be unnecessary in general. It is described by Haly Abbas as his second variety of inflatio oculi. He says it is an œdematous swelling principally affecting old men in summer. He recommends collyria of a sharp penetrating nature, and various other applications.

On psorophthalmia, sclerophthalmia, and xerophthalmia. For these affections Aëtius gives various prescriptions containing calamine, burnt copper, chalcitis, and the like. Similar ones may be found in Galen (sec. loc.) Galen, like our author, recommends fomentations, by means of a sponge, with hot water or the decoction of poppies. One of Alexander’s prescriptions for psorophthalmia contains arsenic. Celsus describes the symptoms and treatment of xerophthalmia very minutely: “Neque tument, neque fluunt oculi, sed rubent tantum, et cum dolore quodam graves sunt, et noctu præ gravi pituita inhærescunt.” He gives the sum of his treatment in this short sentence: “In hoc vitio multum ambulare, multum exerceri, lavari sæpe, ibique desudare, multâque frictione uti necessarium est.” He also prescribes gargles, food of a middle quality, and various compound collyria, such as the rhinion which contained burnt copper, myrrh, Phrygian stone, &c. This affection, the dry ophthalmy, had been described by Hippocrates (Aph. iii, 12, 14.) Most probably, as Sichel suggests, it was the same as the catarrhal ophthalmy. See Littré (Hippocrat. t. iv, 418.) Celsus recommends this collyrium also for the psorophthalmia, which he describes by the name of scabri oculi. For this last-mentioned affection he recommends various stimulant applications; and, when other remedies are not at hand, directs us to apply bread pounded in wine. The psorophthalmia is the prurigo oculi of Haly Abbas, for which, among other things, he recommends a composition containing pepper, sal ammoniac, saffron, spikenard, camphor, &c. He describes sclerophthalmia by the name of durities oculi, and recommends for it bleeding, gentle purgatives, emollient collyria, &c.

On ectropion. Aëtius, in like manner, recommends compositions containing ærugo æris, misy, and chalcitis. None of the subsequent authorities supply any additional information. Alsaharavius in particular gives a very accurate account of the disease, which, when it arises from a fungous excrescence growing from the inner side of the eyelid, he directs us to burn with caustics; but, when it arises from a cicatrix, it is to be cured only by a surgical operation. This will be found described in the Sixth Book. In place of the caustics recommended by the ancients, Scarpa directs the argentum nitratum to be applied.

On ægilops and anchilops. These are different stages of the disease now known by the name of fistula lachrymalis. Galen states that at the commencement it is to be cured by applications which are repellent without being too stimulant. He gives a full account of the treatment recommended by Archigenes. The first application mentioned by him is a cataplasm consisting of tares and honey. Scarpa, by the way, speaks favorably of the practice of Ægineta, Aëtius, and Avicenna. Avicenna treats of the disease with great judgment. His first applications appear to have been intended to produce resolution; and, if these fail, suppuratives are to be applied. When the abscess bursts, the sore is to be reduced to a healthy state by escharotic powders containing alum, limatura æris, sal ammoniac, and the like. When these fail, a surgical operation must be had recourse to. This is described in the Sixth Book. Mesue also has treated of the disease at great length. Haly Abbas describes the disease very correctly. He says, “Aliquando autem ejus sanies ad nares defluit per foramen quod inter oculum est et nasum.” This passage puts it beyond a doubt that the ancients were acquainted with the lachrymal duct. The disease, he says, sometimes occasions caries of the cartilages (os unguis?). When it is recent, he recommends bleeding and laxatives; and when it gets into a fistulous state, he directs us to use applications containing arsenic, sal ammoniac, cantharides, alum, &c. Alsaharavius mentions that the abscess of the lachrymal sack may either burst outwards or into the nose. It would appear, therefore, that he also was acquainted with the natural structure of these parts. One of the applications recommended by Rhases for fistula lachrymalis contains arsenic, quicklime, and vitriol. Another is prepared from litharge, arsenic, and oil. These applications are mentioned by the earlier of the modern authorities on medicine. See Theodoricus (iii, 2.)

The protostactos mentioned by our author was a composition consisting of potass and lime. (See Book Seventh, in voce, κονία.)

On trachoma. This affection does not appear to be noticed in our late treatises on diseases of the eye, and yet in our own practice we have met with some cases of it. Rowley mentions it as an asperity of the internal superficies of the eyelid. Celsus describes it by the name of aspritudo. In severe cases, he says, some scarify the inside of the eyelid with a fig leaf, a rough probe, or a scalpel. But in ordinary cases, he rather approves of using exercises, frequent baths, fomentations with hot water, attenuant food, and escharotics, such as copperas, misy, antimony, and the like. Galen and Aëtius give prescriptions for various collyria. They consist principally of detergent and caustic substances, such as sal ammoniac, squama æris, calamine, and the like. It seems to be the disease which Haly Abbas treats of by the name of lapidositas. (Pr. v, 51.)

On chalazion. We will treat more fully of the nature of this tumour in our notes on Section XVI of the Sixth Book. It appears to be the species of encysted tumour said by Scarpa to be well described by M. Aurelius Severinus. (On Diseases of the Eye, 3.) Rowley describes it as a moveable tumour in the margin of the eyelids. Aëtius recommends us to open the tumour with a scalpel, and apply to it escharotics, such as burnt copper, chalcitis, and red arsenic. By Haly Abbas it is called grando, and the remedy mentioned by our author is recommended by him. Alsaharavius describes it as a gross humour congealed in one of the eyelids. He describes by the name of alsaanac a fatty tumour of the eyelids which we have sometimes met with and extracted. On the chalazion, see Celsus (vii, 7), and Isidorus (Orig. iv, 8.)

On hordeolum. Most of the ancient authors treat of this trifling complaint in much the same terms as our author. Scarpa evidently is mistaken in making the hordeolum and chalazion to be the same complaint. Haly Abbas describes it as being an oblong abscess resembling a grain of barley on the extremity of the eyelid. He recommends general depletion, and nearly the same remedies as our author; also a cataplasm of galbanum. Alsaharavius treats of it in a similar manner. Rhases particularly recommends melted wax as an application to it. He also speaks favorably of the diachylon plaster.

On lice in the eyebrows. Stavesacre is a very ancient remedy for pediculi on all parts of the body. Celsus lays down very minute directions for the constitutional treatment, and recommends a local application containing sandarach, or the red sulphuret of arsenic. Avicenna makes mention of sulphurous baths. Haly Abbas recommends general purging, various stimulant applications, and abstinence from figs. Our author states, in Section LXXXI of the First Book, that figs engender lice. Alsaharavius directs the eyebrows to be rubbed with sal ammoniac, alum, salts, &c. Jesu Haly recommends purging with hiera, the frequent use of the bath, and applications containing stavesacre, sulphur, alum, nitre, sal ammoniac, vinegar of squills, and the like. Rhases recommends a powder containing quicksilver.

On madarosis, or milphosis, and ptilosis. Aëtius, Actuarius, and Nonnus treat of these diseases in similar terms. The calliblephara are fully described by Galen (sec. loc. iv.) Haly Abbas seems to allude to these complaints in the following sentence: “Palpebrarum autem casus ex humiditate fit acutâ aut alopetia, et quidam fit cum palpebrarum grossite et duritie, ruboreque, et dolore.” His remedies are like our author’s. The same may be said of Alsaharavius.

On trichiasis. Our author’s treatment is mostly imitated from Galen. We shall treat more fully of the disease in the Sixth Book. Scarpa places no confidence in the operation of plucking out the hair, and yet it is favorably spoken of by most of the Greek and Arabian authorities, as, for example, Aëtius, Avicenna, Alsaharavius, and Haly Abbas; and also by Rowley, and other modern oculists. Haly, like our author, directs us to touch the part from which the hair has been plucked with the blood of a frog, or of a dog’s tick, or with the milk of a fig, or the gall of a hedgehog. Alsaharavius makes mention of the same remedies, and also of the mode of treating it by agglutinants. According to Actuarius, the disease consists in certain of the ciliary hairs being turned inwards and hurting the eyeball. (ii, 7.)

On encanthis and rhyas. Scarpa removes the encanthis by a surgical operation; but, from our own experience of the effect of septic medicines, such as arsenic, in similar complaints, we cannot doubt the propriety of the ancient practice in certain cases. Galen’s applications contain copperas, misy, sal ammoniac, and the like. Those of Aëtius are nearly the same. He remarks that seamen are particularly liable to the complaint. Haly Abbas recommends general evacuation and escharotic applications.

On ulcers. In the description of the ulcers of the eye our author follows Aëtius. He, however, evidently was much indebted to Galen (sec. loc. iv.) The Arabians copy from Galen, describing like him seven varieties of ulcer, which they treat upon general principles. See, in particular, Haly Abbas (Pract. v, 41.) Opium is one of his medicinal articles. Ceruse, starch, gum arabic, albumen, &c. also occur. See also Jesu Haly (ii, 50,) and Rhases (Cont. ii.) Celsus recommends various compound applications for ulcers of the eye, which he treats of very minutely.

The collyria mentioned in this section will be found described in the Seventh Book of this work.

On procidentia. Galen correctly describes procidentia as arising from ulceration of the cornea and protrusion of the iris. (De Diff. Morb. 13.) Aëtius has treated of it with his usual accuracy. He recommends various escharotic applications containing chalcitis, misy, and the like, which, when properly managed, may probably have answered the purpose equally well with the antimonium muriatum and argentum nitratum used by Scarpa and other modern oculists. Avicenna treats of the complaint like the Greeks. Some of his compositions contain antimony with ceruse, burnt lead, and the like. Haly Abbas describes the disease minutely in nearly the same terms, and recommends nearly the same remedies as our author, namely, such as are of a repressing nature. He properly remarks that it is one of the consequences of ulceration of the cornea. Alsaharavius gives a similar account, and recommends general depletion.

On hypopyon. Aëtius gives much more judicious directions for the treatment of this complaint than our author. He properly recommends general bloodletting at the commencement, and afterwards local, by means of leeches and cupping instruments; and then emollient, paregoric, and discutient applications to the eye. Galen (Meth. Med.) makes mention of an oculist in his time who effected wonderful cures in this complaint by shaking the patient’s head. When this does not succeed, Galen directs us to perforate the coats of the eye, and let out the matter. (See Book Sixth.) Scarpa does not approve of this practice, unless the collection of matter be considerable. However, Plempius and most of the earlier modern authorities in surgery decidedly recommend it. Haly Abbas recommends a discutient cataplasm containing opopanax, ammoniac, and fenugreek. Alsaharavius properly directs bleeding and masticatories at the commencement.

On leucoma. Aëtius directs his attention principally to the general treatment, and properly cautions against the use of strongly stimulant applications, as they only increase the evil. He allows afterwards moderately detergent ones, containing verdigris, burnt copper, squama æris, flos æris, sal ammoniac, and the like. His compositions are taken for the most part from Galen’s works (de Med. sec. loc. iv.) Aëtius disapproves of applications for changing the colour of the leucoma. Alexander recommends the detergent applications mentioned by our author. Nonnus copies from him. Haly Abbas describes it by the name of albedo oculi, and recommends nearly the same remedies as our author. He particularly praises green glass finely pulverized, which is still a popular remedy in Scotland. Alsaharavius makes mention of the juice of the lesser centaury as an useful application. Scarpa speaks favorably of this remedy, and further recommends the Sapphirian collyrium, the ingredients of which are similar to those which entered into the ancient applications. It consists of a solution of scr. ij of sal ammoniac and gr. iv of ærugo in oz. viij of aqua calcis, allowed to stand for twenty-four hours, and then filtered. Rhases recommends an ointment containing arsenic.

On pterygium. Aëtius correctly remarks that pterygium generally begins from the inner canthus, rarely from the outer, and scarce ever from above or below. He gives prescriptions for a variety of applications, which, like our author’s, contain burnt copperas, magnesian stone, sal ammoniac, and the like. Galen briefly commends the same. Nonnus, Serapion, and the others approve of this practice. Modern oculists, however, trust to nothing but the operation, which will be described in the Sixth Book. Haly Abbas describes the disease very accurately by the name of ungula; and recommends general bleeding, purging, restricted diet, and a variety of collyria. Alsaharavius gives the same account of the ungula, and when it becomes callous (nervosus), recommends an operation. Jesu Haly recommends, before attempting a surgical operation, to make trial of escharotic applications. Rhases also approves of this plan of treatment. The most active ingredients in his prescriptions are sal ammoniac, copperas, and arsenic. Some of his compositions are merely detergent.

On carbuncle and cancer. we are not aware that the parts about the eye are particularly liable to anthrax, nor do we recollect to have ever met with such a case; and yet, as Alexander and our author remark, the disease may occur there as well as in other parts of the body. Rowley describes carbuncle both of the eye and eyelids. Aëtius has given a very circumstantial account of the symptoms and treatment of anthrax. He forbids the early application of cataplasms, and seems to depend most upon constitutional treatment, by clysters, purging, and bleeding. Afterwards cooling and styptic fomentations are to be applied by means of a sponge, along with other treatment similar to our author’s. Alexander’s plan of treatment is nearly the same, and is laid down with excellent judgment. That of Oribasius is similar.

To relieve the pains of cancer, Aëtius recommends soothing applications and an anti-stimulant diet, consisting principally of milk. Avicenna, Alsaharavius, and most of the ancient authorities join in praising milk as the principal article of food in cancer of the eye. Avicenna’s applications contain ceruse, opium, and the like. Haly Abbas recommends general bleeding, if the patient’s strength permit, with emollient lotions, and collyria: the diet to consist of birds, kids, and lambs. According to Rhases, cancer of the eye is attended with excruciating pains, redness, and distension of the veins, loss of appetite, and inability to bear all applications.

On mydriasis. Aëtius treats mydriasis, or preternatural dilatation of the pupil, like our author, by general and local bleeding, clysters, an attenuant diet, and friction of the extremities. They no doubt considered that the disease arises from congestion in the brain. Avicenna refers the disease to cephalæa and injuries of the head. Scarpa quotes with approbation the account given by Celsus of mydriasis, by which he thinks was meant not only cases of dilated pupil but also of incipient amaurosis occurring suddenly. Celsus approves of opening the bowels freely. Haly Abbas describes the disease, but thinks it almost incurable. It sometimes occurs, he says, from a blow, and sometimes from abscess within the uva. Alsaharavius attributes the disease to congestion, and directs bleeding, purging, and cooling applications. He calls it dilatatio. According to Jesu Haly, it is produced by dryness of the uva, or abscess within that tunic, or pressure on the brain. The first species is to be relieved by diluents and relaxants, such as the warm bath. For the second he recommends suitable cataplasms and purgative pills. The third is to be treated by general and local bleeding, cupping, and fomentations with water, vinegar, and salt. Constriction of the pupil he directs us to treat upon the same principles as our author. His account of it is mostly taken from Aëtius. Leo describes, under the name of symptosis, constriction of the pupil; under that of paremptosis, an affection of the optic nerves; under that of platycoria, a preternatural dilatation of the pupil, for which he recommends astringents; and under that of myocephalos, procidentia of the lens, for which he recommends astringents, and even copperas.

On nyctalopia. Aëtius recommends, according to the circumstances of the case, general and local bleeding, drastic purgatives, errhines, and the like. He, Celsus, Alexander, Rhases, Avicenna, Mesue, Jesu Haly, Haly Abbas, and Alsaharavius, like our author, speak favorably of the application from the roasted liver of a goat. Instead of it Hippocrates recommends the liver of an ox. His treatment otherwise consists of bleeding, purging with elaterium, and, in desperate cases, of trepanning the head at the bregma and evacuating the water. (De Visu.) The general treatment of the Arabians is like that of the Greeks. Thus Alsaharavius recommends bleeding, purging with hiera, gargles, sternutatories, and the like. This is also the practice of Jesu Haly.

The term nyctalopia is not used by all the ancient authorities in the same sense. Thus Hippocrates applies it to that morbid state of vision in which the patient is blind during the day but sees better in the evening. Aëtius, Alexander, Paulus, and Actuarius, on the contrary, apply it to that state in which the patient sees clearly during the day but becomes blind in the evening.

On glaucoma and suffusion. Aëtius and Oribasius give nearly the same account of these complaints as Paulus, and yet that of Aëtius seems slightly different. He says that there are two kinds of glaucoma: that the first, to which the name is properly applied, arises from a dryness and concretion of the crystalline humour, which is changed to a sea-green (glaucum) colour; but that the other arises from a suffusion, the humour near the pupil having become congealed and dry. According to Leo, the affection of glaucoma arises when the crystalline humour is congealed, as it were, and having become white, obstructs vision: this occurs in old age and is incurable. Haly Abbas was aware that the disease is sometimes seated in the crystalline lens, but did not know that it always is so. Hippocrates recommends masticatories and the actual cautery. Haly Abbas and Alsaharavius approve of making trial of remedies similar to those mentioned by our author, before attempting the operation. Rhases forbids bleeding when the disease arises from the state of the eye itself. Canamusali, who flourished about the year 1258, recommends a seton in the nape of the neck for the cure of suffusion. (De Oculis, vi.) Rhases considers the case incurable when the pupil has become insensible to the stimulus of light.

On amaurosis and dimness of vision. Galen and Aëtius give a very circumstantial account of the causes and treatment of amaurosis. They state that the disease either comes on suddenly, in which case they refer its origin to obstruction and paralysis of the optic nerve, or gradually, when they believe it occasioned by a thickening of the coats of the optic nerve, or a change of the spirits, or of the humours of the eye. They enumerate various causes of it, such as injuries of the head, heat or cold, indigestion, or the like. When the disease occurs suddenly, they approve of general or local bleeding, such as cupping the back part of the head, and active purging. In the other case general depletion is not required, but the treatment is otherwise nearly the same, attention being particularly paid to the state of the bowels. They forbid emetics after food, but approve of errhines. They recommend in certain cases sinapisms to the head.

The Arabians treat the disease upon the same principles. Haly Abbas describes amaurosis among the affections of the optic nerves, and recommends for it general bleeding, purging, and the saffron collyrium. Alsaharavius remarks that it often arises from the state of the stomach, which, in that case, will require the principal attention. Avenzoar blames Galen for giving up as desperate cases of amaurosis which occur suddenly. He recommends general and local bleeding, with repellent applications to the head.

On strabismus. See Galen (de Causis Morborum); Oribasius (Synops. viii, 49.)

Avicenna properly remarks that squinting is occasioned by debility or spasm of some of the muscles of the eye. He and Rhases recommend the same treatment as our author. Avicenna also makes mention of a mask. Haly Abbas, who appears to have been intimately acquainted with anatomy, of which his work contains a valuable compendium, explains minutely the cause of the disease, which he attributes to an unequal contraction of the muscles of the eye. See also Alsaharavius and Jesu Haly. Jesu, like our author, directs us to fasten a piece of black or red cloth on the angle of the eye at the temples, when the eye inclines towards the nose. He correctly explains that the complaint arises from spasms or paralysis of some of the muscles of the eye.

On ecpiesmus, or protrusion of the eyes. This section is taken from Oribasius. (Syn. viii, 50.)

Aëtius, Avicenna, and Rhases recommend the same treatment for this complaint, which can only arise from suffocation, violent straining, or swelling of the eye.

On synchysis, or confusion of sight. Aëtius and Oribasius treat of this affection in nearly the same words.

Rowley defines synchysis to be “a solution of the vitreous humour into a fine attenuated aqueous fluid.” It does not appear to us that the ancients understood it in this sense, or that they meant anything more by it than a confusion or disorder of the eye occasioned by a blow.

On myopia. This section also is taken from Oribasius or Aëtius.

Alsaharavius treats of it by the name of alhayn. He says it sometimes arises from external causes, such as exposure to snow and cold, in which case he directs us to apply stimulant fumes to the eye and refrigerants to the head. Although the ancients were aware of the magnifying powers of specula (as appears from Seneca, ‘Quæst. Natur.’), it is doubtful if they ever thought of applying this knowledge to any useful purpose; and hence none of the Greek, Latin, or Arabian medical authors make any mention of spectacles or magnifying glasses as a remedy for this complaint, or for weakness of sight. Dutens, however, maintains that they were not unacquainted with telescopes. (p. ii, 10.) From a passage in Iamblichus it has been supposed that they also used microscopes. (Vit. Pyth. 26.)

One of the causes of myopia mentioned by Jesu Haly is enlargement of the crystalline lens, which he recommends us to endeavour to lessen by means of dissolvents. (De Oculis, iii, 6.)

SECT. XXIII.—OF DISEASES OF THE EAR; AND, FIRST, CONCERNING PAIN OF IT.

Earach may be known to be occasioned by cold from the season of the year, the preceding regimen, or from the patient’s own account, if it proceed from any external exciting cause. If the pain be deep-seated without heaviness, distension, or heat, such cases are to be cured by calefacient remedies, as hot oil of rue, or of nard, or hot oil of bays, or that of marjoram, that called foliatum, or that called spicatum, or common oil with euphorbium, or pepper, or castor, or the ointment called commagenum, or opobalsam poured into the auditory foramen; and oil in which garlic or onion has been boiled is of service when injected. Pain from a hot intemperament is judged of by a certain sensation of heat without heaviness or tension. You may cure it by the opposite remedies; by injecting the white of an egg triturated, as in affections of the eye; and woman’s milk, along with some of the anodyne collyria, or the juice of perdicias (pellitory of the wall?), with a small quantity of rose-oil, and rose-oil itself, or rose-oil and vinegar, or the juice of the nightshade, or of coriander, or of kingspear, or oil in which earthworms or millepedes have been boiled; or almond-oil, either by itself, or having three living buccinæ boiled in it, is of great natural efficacy. Pain from viscid and thick humours you may judge of from the heaviness of head, or of the ear itself, and from the previous regimen. When it is without heaviness, this state alone of hearing indicates a windy spirit that cannot get vent. In both these cases we must use remedies of a deobstruent and incisive nature, such as the aphronitrum with vinegar and honey, and sheep’s gall with common oil, or the oil of almonds, and the tepid juice of leeks and onions with honey; or triturate common marjoram with honey and a woman’s milk, and inject it. For stronger coldness inject goat’s gall with the juice of leeks; and when the pain is great and of long duration, and when difficulty of hearing is present, we must use these remedies, namely, the juice of dragon-herb, of wake-robin, and of bryony, and the like. When the pain is occasioned by a windy spirit, it may be greatly remedied by applying a cupping-instrument previously heated in hot water, and affixed near the ear. But if there be heaviness, distension, and heat, with a pulsatory pain or fever, you may be sure that the ear is inflamed; and you must, in the first place, have recourse to phlebotomy, then foment frequently with hot sweet oil by means of the ear specillum wrapped in wool. We must also inject into the ear the fat of a goose or of a fox, or the ointment basilicon, with the oil of roses, of privet, or of iris, and apply externally cataplasms of a paregoric and digestive nature; but when the pain compels us we may use those things which are moderately narcotic, for there is no little danger, owing to the nearness of the brain to the inflamed auditory nerve. The following is an excellent paregoric: Of opium, p. j; of castor, p. ij. Inject it warm with a woman’s milk, or the white of an egg, or tepid sweet wine. And the trochisk of saffron, that called aster, and the antidote of Philo is often of service to them. You must foment frequently, either with common oil or some of the hot fomentations, and apply to the ear wool steeped in it, taking care not to touch the inflamed part. When the pain continues and an abscess is about to form, use the remedy from the juice of linseed, injecting it softened with oil of roses or of chamomile. When the pain is occasioned by poisonous water which has got into the foramen of the ear, and if it be in considerable quantity it will be necessary to suck it out either with the mouth or by a reed; but if in small quantity, it may be wiped away with the ear specillum wrapped in wool; and then some of the attenuant oils may be injected, or else rose-oil, or the white of an egg, or a woman’s milk. Everything applied to the ear should be moderately warm.

For ulcers with inflammation. Triturate equal parts of lycium (catechu?) and meconium with honey, and inject.

For severe pain, pus, and difficulty of hearing. Of whitened almonds, xx in number; of aphronitrum, dr. iij; of opium, dr. iij; of frankincense, dr. iij; of saffron, dr. iv; of galbanum, dr. ij; of myrrh, dr. j; triturate with vinegar, and inject. When there is pain, dissolve it in oil of roses, and when there is a discharge of pus, in mulse or oxymel, and when there is deafness, in vinegar. Recent ulcers are cured by horned poppy dissolved in vinegar, by the collyria from it, and by those formed from roses, saffron, and myrrh, in like manner as running ulcers without pain are cured by the recrement of iron triturated with vinegar during the heat of the dog-star.

To remove the hard sordes of the ears. Dissolve nitre in vinegar, and inject with water, and having wiped it dry, inject nitre dissolved in vinegar with rose-oil.—Another for sordes: Mixing cardamom and a little nitre with dried figs freed from their stones, make collyria, which put into the ear, and remove after three days. It brings away much sordes, and gives much relief. It also applies to fungous flesh, chronic pains, and ulcers. Or of aloes, of frankincense, of myrrh, of each, dr. j; of misy, dr. iv. Make a trochisk of it with vinegar, and, when you are going to use, dissolve it in vinegar and rose-oil, and inject. In the same manner the trochisks of Andron, Heré, and that of Musa may be used.

For chronic ulcers. Mix gum juniper with honey, and anoint.—Another: Blow in misy what has been burnt and levigated. Before using those things which are injected into the ear, syringe it first with oxycrate in oxymel, or in mulse, or in a decoction of some repellent article, such as dried lentil or roses.

For bloody ears. Wash with the decoction of bog-rush, and inject the juice of knot-grass, with a little vinegar, or lycium, or lees of oil, or acacia, or the juice of leeks.

For fungous flesh. Wash nitre in hot water, and use with equal parts of flakes of copper and sandarach. Clean the eschars which are formed by it with honey.

For vermes in the ears. Wash with a decoction of wormwood, of centaury, or of leeks; inject the juice of the green leaves, or of the fruit of capers, or cedar-gum, or old human urine, or white hellebore with honey, or the juice of calamint, or scammony with vinegar, or the juice of wormwood. Oil poured into the opening of the ear, so as to make them ascend to the top, answers well. But a better application is vinegar and oil. It also applies to animalcules which fall into the ear.

For calculi and the like which have fallen into the ear. Having wrapped some wool about an ear specillum, dip it into turpentine-rosin, gum, or some glutinous substance, and thus draw it out; but if it does not yield, pour frequently warm oil into the passage; and if it do not fall out or is left behind, use the other means to be described in the Surgical part of this work.

On noises. If noises occur in fevers at their crisis, they ought not to be interfered with, for they will commonly cease of themselves; but, if they remain after the disease, having fomented with the decoction of wormwood, inject vinegar and rose-oil, or the juice of radish with rose-oil, or that of black hellebore with vinegar. For chronic noises occasioned by thick and viscid humours (which you may know from their coming on not suddenly, but gradually), syringe with vinegar, nitre, and honey.—Another: Of white hellebore, dr. ij; of castor, dr. ij; of saffron, dr. iij; of nitre, dr. xvj. Make trochisks, which triturate in vinegar, and use.

For chronic noises and hissing sounds. Triturate euphorbium with oil of privet, heat and use. When, from increased sensibility, they experience the sensation of vapours or spirits carried upwards, triturate castor and the seed of hemlock with vinegar, and inject.

On difficulty of hearing and deafness. Those cases which are congenital, or which, although not congenital, are inveterate, and attended with complete deafness, are incurable; and those which, although not complete, are inveterate, prove also incurable, or difficult to cure. Those which are formed by a bilious humour ascending upwards, you may easily cure by evacuating with cholagogue medicines; and sometimes the complaint goes off spontaneously, when bile is discharged downwards. Deafness, or difficulty of hearing, occasioned by crude and thick humours, you may cure by opening a vein, by purging freely with hiera, and by using masticatories, errhines, and natural or salt baths. It is also proper to inject into the ear those things which are recommended above for noises. But the following are particularly applicable: Inject the urine of a goat and the gall of a goat together, or the gall singly; or the juice of rue with honey; or castor with the oil of dill; or the medicine œsypum with nard ointment; or the gall of a goat with galbanum; or this: Of castor, dr. ij; of nitre and white hellebore, of each, dr. j.

For contusions of the ears. Hippocrates recommends us to apply nothing to them; but since we are often compelled by those who have sustained the injuries to do something, we may use the following: Of myrrh, of aloes, of frankincense, of acacia, equal parts; anoint with vinegar or the white of an egg. Or, pound in a mortar the inner part of warm bread with honey, and apply as a cataplasm. Or this: Of bitumen, of frankincense, of aloes, of the flesh of snails, of African bulbi, equal parts, triturate with vinegar, and apply. When there is inflammation, triturate with oily grain (sesame), or with chondrus boiled in vinegar, and apply as a cataplasm; but let the cataplasm be light, and not bandaged at all, or but slightly; and let wool dipped in oil be introduced into the passage.

On parotis. Parotis is an affection of the glands about the ears, being sometimes occasioned by humours from the head which are impacted in it, and sometimes by those collected from the rest of the body during the crisis of a fever. If it be deep-seated, and do not occasion a swelling, we may assist nature by applying attractive remedies, either by putting on a cupping-instrument or using frequent fomentations. For if the matter be determined inwardly, there is no ordinary danger; but, if it inflame and swell out to a tumour, we must, on the contrary, use soothing and digestive cataplasms, such as that from barley-flour, that from wheat, or from the flour of linseed with honied water, or boiled with the decoction of fenugreek, or of marshmallows, or of chamomile, and that from dock and axunge without salt. But if it appear that there is a fulness of blood, we must first evacuate by phlebotomy, if the strength permit: but if the swelling be not dissipated, we must use suppurative medicines, such as wheat-flour, with the decoction of dried figs and oil, and the application made from pollen and that from leaven. When the aposteme is converted into pus, we may evacuate it either by opening it, or produce its rupture by means of an acrid medicine, such as that called smilium, or that from garlic. The milder kinds of parotis are discussed by a fomentation of salt water, or the composition from Aperanus. This medicine is calculated to discuss the converted pus, and to prove very anodyne. For inveterate cases of parotis, we may apply the ashes of burnt buccinæ, or purpuræ, with honey or axunge, or figs boiled in sea water, or horehound with salts. Hard ones are softened by the composition of Mnasæus, and that of Ariobarzan; but one of the best applications is that formed from the juice of linseed. But before using these, we are to apply cataplasms of ammoniac, mixing with them liquid pitch, bull’s fat, bdellium, storax, or hart’s marrow.

Commentary. The following ancient authors treat of diseases of the ear: Hippocrates (de Affectionibus, et alibi); Galen (Sec. Loc. iii); Celsus (vi, 7); Oribasius (de Loc. Aff. iv); Aëtius (vi, 74 et seq.); Alexander (iii); Scribonius Largus; Marcellus (de Med. 9); Nonnus (74 et seq.); Cælius Aurelianus (de Tard. Pass. ii, 3); Actuarius (Meth. Med. iv, 10); Pliny (Hist. Nat. xxviii, 48); Octavius Horatianus (i, 7); Mesue (de Ægr. Aurium); Avenzoar (i, 4); Serapion (2); Avicenna (i, iii, 4); Albucasis (ii); Haly Abbas (Theor. ix, 14; Pract. v, 62); Alsaharavius (Pract. iii); Phases (ad Mansor. ix; Contin. iii.)

For relieving earach Hippocrates recommends the warm bath and fomentations; and when these do not succeed, phlegmagogues and masticatories are to be used.

Celsus gives very judicious directions for curing pain of the ears, but his treatment is little different from our author’s. When the pain is not violent he recommends abstinence alone; but if severe, venesection, purging, hot cataplasms from linseed and fenugreek, or sponges squeezed out of hot water. When the inflammation is particularly violent, poppies are to be added to the injections, which must be tepid; and when the ear is filled with them, soft wool is to be put over it to contain the injection. He mentions various compound applications, which contain poppies, castor, myrrh, alum, saffron, and the like.

Our author copies from Galen. He recommends the following simple application: Having scooped out the heart of an onion, fill it with oil, and having heated it in ashes, put it into the ear. He gives prescriptions for various injections and other compositions, which are similar to those of our author and Celsus.

Aëtius on this head is more brief and less distinct than our author.

Alexander, Actuarius, and Octavius Horatianus treat of these complaints very properly, but not differently from Celsus and our author. Alexander states correctly that inflammation within the ear sometimes spreads to the brain, and proves fatal. He enjoins caution in using opiate applications to the ear, as he has seen dangerous effects from them by their inducing stupor. He particularly approves of introducing steam into the ear, by means of a tube connected with a vessel containing some boiling decoction.

Marcellus gives a long list of empirical applications, from which, perhaps, something valuable might be extracted. He recommends, like some of the other authorities, a solution of alum in hot vinegar, with some honey. We shall see in the twenty-sixth Section that alum was much used for allaying the pains of toothach. Among the ingredients in his injections we remark tepid milk, opium, castor, spikenard, saffron, opobalsam, millepedes, &c.

The treatment directed by the Methodist Cælius Aurelianus is little different from that of the other sects. He approves of putting tepid oil into the ear; of stuffing it with wool; of using fomentations, cataplasms, leeches, and scarifications; and when the disease becomes chronic, of shaving the head, and applying acopa, dropaces, malagmata, and so forth.

Serapion and Rhases treat the complaint exactly like our author.

Avenzoar relates a case of inflammation seated in the meatus, which he cured by filling it with oil of eggs. He further recommends bleeding and the other remedies already mentioned. Avicenna treats of diseases of the ear most minutely and scientifically, but at too great length for us to do justice to his account of them. For pains from a hot cause he recommends camphor-oil, or oil of violets with camphor. Mesue also treats of these complaints very minutely. When the pain is violent, he recommends injections containing poppies, henbane, mandrake, nightshade, and the like. Haly Abbas, in such cases, also approves of rose-oil, with opium, the juice of mandrake, &c. Alsaharavius varies his treatment according to the nature of the exciting cause. When it is caused by congestion of blood in the organ, he recommends bleeding, abstinence from wine, a restricted diet, and pouring warm oil into the ear. When it arises from a cold cause he approves of oil of costus, of spikenard, &c., and of applying to the ear a cataplasm of hot flour.

On ulcers of the ears. Aëtius and Alexander give various prescriptions for these cases. The fullest account, however, is contained in Galen (sec. loc.) When there is a discharge of pus, attended with pain, Octavius recommends alum, mixed with honey and oil. When ulcers of the ears are recent, Mesue recommends injections of honied water, wine and honey, vinegar and honey, or the like, by a syringe. They are to be dried by means of olibanum, or sarcocolla dissolved in wine. He also praises myrrh, aloes, alum, and red arsenic, as ingredients in the applications to ulcers of the ears. When the ulcers are chronic, they are first to be cleansed by such applications as the decoction of wormwood in wine, or oxymel of squills, with a small quantity of the flowers of copper; then they are to be dressed with the usual incarnants; and, lastly, they are to be dried or cicatrized by compositions containing aloes, myrrh, and frankincense. When the ulcers are foul, he and Serapion recommend escharotics, such as the scoria æris. Haly’s applications are quite similar. For sanious discharge he recommends us to wipe the ear with a piece of cloth wrapped round a probe, and dipped in an astringent solution. He directs us to remove fungous flesh by an operation, or with the ointment of flos æris. In this case Celsus recommends applications, consisting of verdigris and honey, or frankincense, or squama aris triturated with red arsenic. These powerful ingredients enter into some of the compositions recommended by Rhases.

For vermes in the ear. All the ancient authorities in this case recommend acrid and bitter injections. Wormwood, hellebore, nitre, calamint, birthwort, and sulphur are the common ingredients in the compositions recommended by Galen, Alexander, Aëtius, Oribasius, Celsus, Mesue, Serapion, Haly Abbas, Alsaharavius, and Rhases.

On calculi and the like which have fallen into the ear. Alexander, Aëtius, and Haly Abbas recommend similar means, and also direct us to compress the patient’s nose and mouth, and to make him sneeze. Galen, copying from Archigenes, gives similar directions. This subject is more fully treated of in the Sixth Book.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Scribonius gives prescriptions similar to those of Galen.

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

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

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

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

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

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

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

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

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

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

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

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

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

SECT. XXV.—ON AFFECTIONS OF THE FACE.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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