SECT. III.—ON PITYRIASIS.
Pityriasis is an eruption of small furfuraceous substances on the skin of the head, or the rest of the body, without ulceration. It is occasioned, either by depraved humours which have been determined to the head, or by a saltish phlegm, or by bilious or melancholic blood. After the general system has been evacuated, as formerly described, we must use some of the under-mentioned remedies. Having first macerated Cimolian earth in water, mix with the juice of beet, and anoint it, allowing it to remain until dry, then wash it away, and, having pounded frankincense with wine and oil, anoint with them. Next day, rub in stavesacre with oil.—Another: Of nitre, of the burnt lees of wine, of ben-nut, of each, lb. j; of stavesacre, lb. iss. Dissolve in wine, and rub the head; or, if the rest of the body be affected with tingling, it may be used dry. When the pityriasis is more humid, wash with brine or the decoction of lupines. Of this remedy I have had ample experience.
On psydracia and exanthemata of the head. The psydracia are small protuberances, like blisters, elevated above the skin. The exanthemata are superficial ulcerations, somewhat red and rough. Both are to be cured by the under-mentioned remedies: Of litharge, dr. ij; of ceruse, dr. iv; of alum dr. ij: of the green leaves of rue, dr. ij; pound with vinegar and myrtle-oil, and anoint.—Another: Pounding rue and alum with honey, anoint with this the head, after having first shaved it. If the head is excoriated, apply olive leaves boiled with honey.—Another: Of litharge and ceruse, of each, dr. xij; of native sulphur, dr. viij; mix with myrtle cerate.
For the thick and red ulcers of the head, resembling papulæ, or small nipples, from which ichor is discharged. Having first shaved the head and scrubbed it with water and nitre, use native sulphur livigated with human urine; or anoint with melanteria and vinegar.
For achores and favi. The complaint called achor is one of those which affect the skin of the head, corroding the skin by very small perforations, from which a discharge of viscid humour takes place. The complaint called favus is nearly allied to it in appearance, since it consists of larger perforations resembling the combs of bees, containing a honey-like fluid. They are occasioned by a nitrous and saltish phlegm. In such cases, the diet should consist of wholesome food; and everything that is acrid and saltish should be avoided, more particularly if the attack be inflammatory. After the proper evacuation of the prevailing humour, having shaved the hairs, foment twice, thrice, or oftener, with warm water, in which has been boiled myrtle, bramble, or lentil, or bitter lupines, or the root of asparagus. When the ichorous discharge is greater, apply a cataplasm of the leaves of willow, with water, or of lentil. The ointments used should consist of Cimolian, Cretan, or Samian earth, or pompholyx, or spodium, or litharge, or cadmia, or burnt paper, or the powder from pepper. All these are to be applied with vinegar. We may use the following smegma: Of sulphur, of the herb perdicias, and soap, of each equal parts. The following are compound applications: Of litharge, dr. xvj; of the leaves of rue, dr. viij; of the stavesacre, dr. iv; of copperas, dr. ij; with vinegar and myrtle oil; make to the consistence of bath-sordes, and anoint with it.—Another: Of sandyx (calcined ceruse?), dr. iv; of myrrh, dr. iv; of native sulphur, dr. ij; of manna, dr. iv; rub into the part with old oil.
For achores. When they discharge ichor, triturate the dross of silver, or yellow ore of lead (molybdœna), and sprinkle upon them.—Another, for achores and humid psora: Of the roses of the rhododaphne, oz. iv; of native sulphur, oz. iv; of liquid pitch, oz. iij; of dry pitch, oz. iij; of wax, oz. vj; of myrtle oil, q. s. For children, dissolve in milk, and anoint.
For fici. We give the name of fici to ulcerous excrescences which are round, somewhat hard, red, and accompanied with pain. They arise for the most part on the head, but also sometimes on the other parts of the body. The best application for this complaint consists of fissile alum, of the calcined flowers of copper, of taurocolla, of each equal parts, with double the quantity of the flakes of copper; triturate with vinegar, and anoint. A proper application is also prepared from the burnt heads of the cackrel fish, the bulbi boiled, and their ashes mixed with vinegar.
A dry application for ficose eruptions of the head and chin. Of misy, dr. iss; of chalcitis, dr. iiss; of squama æris, dr. j; of fissile alum, dr. j. Having washed, apply this powder in a dry state unsparingly, and allow it to remain. Next day, having again washed, wipe the part with a sponge, and apply it again. A thick scab will then fall from the ulcer. Repeat the same application the following days. The cure will be effected in a few days without leaving a cicatrix; but this medicine operates strongly.
For lice in the head. Direct the head to be scrubbed with the decoction of lupines; or pound together stavesacre and sandarach, and rub them in along with oil or vinegar; or a small quantity of pepper may be added to old oil, so as not to occasion ulceration; or the juice of ivy with honey may be used; or mustard and vinegar; or the gum vernix, or liquid pitch with alum; or the expressed juice of the bay berries; or oil of radishes. I have always succeeded by pounding stavesacre with vinegar and oil, and anointing with this.
Commentary. Drs. Willan and Bateman agree with all the best medical writers of antiquity in describing, by the name of pityriasis, a disease consisting of slight, scaly, and branny exfoliations without ulceration. See Galen (Sec. Loc. i); Alexander (i, 3); Oribasius (Synops. vi, 25); Aëtius (vi, 66); Actuarius (de Sig. Morb. ii, 5); Nonnus (4.) Actuarius, who gives a very distinct account of the disease, states in strong terms the danger of repressing the cutaneous eruption. (l. c.)
It is the porrigo sicca of Celsus (vi, 2), who recommends for it shaving the head, and using slightly repressing applications, “quale est nitrum cum aceto, vel ladanum cum myrteo et vino, vel myrobalanum cum vino.” Marcellus distinguishes the pityriasis from porrigo. (De Med. 4.)
The Arabians, especially Serapion, direct very active general treatment, such as venesection, masticatories, cathartics, and the like. (i, 4.) It is described under the name of furfures capitis by the translator of Haly Abbas. (Theor. viii, 18.) Like the Greeks, he represents it as consisting of small furfuraceous scales without ulceration. Alsaharavius uses the same name, and recommends bleeding, cupping, purging, and external applications of a detergent nature, such as flour of vetches, with vinegar and the like. Avenzoar recommends pills of drastic purgatives, and the ordinary lotions. (i, 1, 10.) See also Avicenna (iv, 7, 1, 24); and Rhases (ad Mansor. v, 1; Contin. xxxvi.) In the ‘Continens,’ the disease is described by the names of furfures and impetigo, for which Rhases recommends liniments containing nitre, sulphur, hellebore, vinegar, &c.
Willan and Bateman describe the psydracia as being small pustules irregularly circumscribed and terminating in a laminated scab. Most of the above-mentioned writers treat of them in the same terms as our author. They seem to be the balchie of Avicenna (iv, 7, 6, 1) who calls them a malignant species of achor. See Galen (l. c.)
Galen, Alexander, Aëtius, and our author describe the exanthemata as being small superficial ulcerations. Drs. Willan and Bateman use it as a generic term for rashes. The exanthemata seem to be the alraba or pustulæ dulces of Alsaharavius (i, 10.) See [Book First, Sect. VI], and [Book Fourth, Sect. VIII], of this Work.
Willan and Bateman apply the terms achor and favus in the same sense as Paulus and the other ancient authors. Octavius Horatianus uses the terms acora and cerio. He says, “Acoræ et ceriones distant, quod ceriones plures cavernas egestionis habent et humorem multo pinguiorem emittunt; acora autem unam cavernam habet, et humorem egerit aquatiorem.” (i, 5.) Galen has treated of these complaints very fully, and his applications are similar to those of our author. See also most of the authorities on pityriasis. The favus is the first species of tinea described by Haly Abbas. It consists, he says, of cells, and discharges a fluid-like honey. The achor is his amada, or third species of tinea, consisting of smaller cells than the former. Alsaharavius describes the favus by the name of alsahara. It contains, he says, a viscid fluid like honey. He recommends for it purgatives, and detergent applications containing nitre, lees of wine, &c. (Pract. i, 9.) The achor is called alsahafa by him. The description which Actuarius gives of papulæ, favus, and ficus is sufficiently distinct, but not different from our author’s. (De Diagnos. ii, 5.)
The other authorities gives the same account of ficus as Paulus. It is Haly Abbas’ second species of tinea, and is described by him as consisting of hard round protuberances. Haly’s fourth species of tinea consists of small ulcers of a mammiform appearance. They are mentioned by our author. Fabricius ab Aquapendente defines the ficus thus: “Tumeur qui est rouge, ronde, quelque peu dure, et de laquelle (etant ulcérée et pressée) sort une matière sanieuse, semblable aux grains de figues.” (Œuv. Chir. i, 1, 13.) He says that Hippocrates and Galen give a different account of it from our author’s; but we can see very little difference between them. Most of the ancient authors recommend the same remedies for ficus as Paulus. The most active of these are stavesacre, and sandarach or red sulphuret of arsenic. They do not appear to have apprehended danger from the free use of arsenic in this way. Galen recommends equal parts of white hellebore, stavesacre, and nitre with oil. (De Med. Sec. Loc. i.) Octavius Horatianus mentions equal parts of pellitory and galls. The same medicines are recommended by Serapion, (i, 5.) See also Oribasius (de Loc. Affect. iv, 11); Celsus (xi, 3); Cælius Aurelianus (de Morb. Tard. iv, 2.) Haly’s remedies consist of galls, litharge, mercury killed (sublimed?), sulphur, and so forth. Among those of Rhases we remark squills, assafœtida, quicklime, mercury, &c. However, he prefers excision. (Continens. xxxvi).
For pediculi in the head, the Arabians recommend nearly the same compositions as our author. They contain arsenic, stavesacre, hellebore, nitre, and the like. See Alsaharavius (Pract. i, 16), and Phases (Cont. xxxvi, 6.) Among the ingredients mentioned by the latter, we remark quicksilver, sulphur, red arsenic, mustard, stavesacre, the oil of oleander, vinegar, &c. These medicines form the ingredients in the compositions recommended by modern writers on this complaint. See Plempius (de Morbis Pilorum), and Amatus Lusitanus (Curat. 58.)