SECT. LXXVII.—ON ISCHIATIC DISEASE.
Ischiatic disease, being of the class of arthritic complaints, is distinguished solely by the cause of it being seated in the hip-joint. The cause of it then is a thick and pituitous humour fixed in the articulation of the hip-joint. The pain in these cases extends from the parts about the buttocks and groins to the knee, and often as far as the extremity of the foot. When we see such a patient, in the beginning of the complaint, after the evacuation of the hardened fæces by a clyster, we must abstract blood from the arm at intervals; but if the disease be of some standing, we must abstract the blood from the ankle of the affected leg. During the exacerbations we must use this embrocation: Of the oil of privet, viij cyathi; of vinegar, iv cyathi; of nitre, ij cyathi; of rosemary-seeds, j cyathus; to be rubbed in hot with unwashed wool. After which a cataplasm is to be applied of the flour of bitter lupines with oxymel; or of the flour of darnel with rosin, the root of the wild cucumber, nitre, calamint, rosemary-seeds, and bay-berries. Calamint alone with oxymel, or honied water, will form a proper cataplasm. And we may rub the parts with this paregoric-plaster: Of wax, dr. x; of turpentine, dr. xxv; of verdigris, dr. vj; of myrrh, of galbanum, of iris, of each, dr. vj; of gum vernix, dr. v. But they must take the propoma containing Cyrenaic juice to the size of a bitter vetch, or a drachm of castor with three oboli of opopanax. And the rind of the root of capers in a draught, or added to the cataplasms, is of use. When the pain is great, anodynes may have place, such as the antidote of Philo and that from two peppers. This injection is to be used: Of honey, iss cyathus; of oil, iss cyathus; of water, ij cyathi; of nitre, dr. viij; of turpentine, dr. iv. These are to be injected warm, and the anus fomented, that they may be the longer retained. It evacuates mucous matters, and sometimes blood when it affords more relief. But if the complaint be prolonged, which is rare, we must repeat it frequently, instead of the water substituting the decoction of centaury. Blood is also evacuated by injecting the seed of treacle-mustard, and the juice of elaterium, and the Sicyonian oil prepared from it, or from the roots of the plant. The brine also of pickled fish, or of pickled olives, may be properly injected. Cupping-instruments may be applied to the hip with much heat and with scarifications, or sometimes leeches may be used. When the affection is protracted, we must proceed to purging either with the hiera, or giving of the medullary part of colocynth properly triturated to the amount of a drachm in two cyathi of honied water, more or less, according to the strength of the patient and the good state of his bowels. And let rue be boiled in the honied water. The pottage made with colocynth purges excellently. In some cases emetics from radishes have proved beneficial at the commencement. During the remissions we may apply dropaces to them, and use the restorative unguents (acopa) from euphorbium, and particularly the one called the complex. The natural baths also are proper; or if these be not at hand, they may bathe in the others; using the restorative ointments formerly mentioned, and the compound ones,—the Æsculapian, and that composed of equal portions of euphorbium, adarce, black hellebore, castor, pellitory, pepper, and wild grape dried. After the bath, we must sprinkle upon the skin while still warm, of dried pitch, oz. iij; and of native sulphur, oz. ij; and let the part be covered with paper. If even these things do not succeed, a remnant of the disease remaining, it will be proper to apply a cataplasm of mustard along with dried figs, or by itself. These complaints are completely removed by the Iberian herb, which some call lepidium, and some the wild cardamus (cress). And the shrub which grows among us, having leaves resembling those of the bay, but much larger, is of approved efficacy, not only in ischiatic, but in other chronic complaints; but it is by far most efficacious in summer. Or if it should not have shooted out its leaves, we must bruise the rind of the root with axunge, so as to form a plaster; and then, spreading it on a thick rag, apply to the parts affected with the pain, namely, to the whole buttocks and thighs; and allow it to remain until the part become black, or, at all events, until the cuticle become livid; then take it away, and, having washed, apply this cerate: Of opopanax, oz. iv; dissolve in ij cyathi of vinegar; and add to the cerate of privet. If they do not admit the use of such caustics, we must use the plasters called extirpative, among which is the following: Of wax, of pine-rosin, of each, dr. xij; of wild pigeon’s dung, of recent lees of burnt wine, of each, dr. vj; of galbanum, dr. iss. And the plaster called the Lioness is of the extirpative kind. Those composed from strained lye and nitre are also proper. And some have continued to drink certain potions for a whole year, among which is the one composed of four ingredients: Of wall-germander, lb. j; of gentian, oz. ix; of round birthwort, oz. ix; of the dried seed of rue, j sextarius: pound these things together, sift, and give every day a spoonful to the patient when he has an empty stomach and his digestion is good, with two cyathi of cold water; and continue this for a year, until the complaint cease. And the medicine composed of seven ingredients, and that which takes its name from Proclus, are of the same reputation. Exercise may be taken by walking, frequent bending of the body, leaping, and running. The food should be moderately attenuant and digestible. If ischiatic disease do not yield to any of the remedies now mentioned, it sometimes terminates in suppuration; and sometimes, from a relaxation of the ligaments, the thigh is dislocated at the joint. Wherefore, when the affection is protracted, we must burn the joint in three or four places (as will be described in the Surgical part of the Work), and the ulcers are to be kept open for many days.
Commentary. Consult most of the authors referred to in [the next Section].
Hippocrates gives a pretty correct account of the symptoms which attend an attack of morbus coxarius, or ischiatic disease. He says it most commonly arises owing to the fluids of the joint being dried up by exposure to the sun. It is accompanied, he justly remarks, with pain of the loins and vertebræ of the back, shooting down even to the knees. A sharp hot pain, he adds, is frequently seated in the groins. Upon any motion the most piercing cries are extorted. (De Dieb. Judic. 6.)
In ischiatic disease Galen recommends general bleeding, and most especially, emetics, which, he says, by occasioning a determination upwards, operate more beneficially than purgatives in this complaint. He disapproves of acrid embrocations, but approves of cupping. He also allows stimulant clysters of colocynth. He gives a long list of local applications from Andromachus, Asclepiades, and Democritus. He makes mention of the Iberian herb; for further information respecting which we refer the reader to Matthiolus (ad Dioscorid. i, 147), and Bernard (ad Nonni Epit. 215.) It was the Lepidium Iberis. He recommends, in certain cases, the part to be beaten with rods. (Meth. Med. xiv, 16.) See also Pseudo-Dioscorides. (Euporist. i, 240.)
Celsus says that morbus coxarius is a painful complaint and difficult to cure. He recommends warm cataplasms and fomentations, with various applications of an emollient or stimulant nature. If inflammation come on, cupping-instruments with scarifications are to be applied; diuretics are to be given; and the belly is to be opened if constipated. He also approves of friction, and even of forming issues by burning with a red-hot iron.
Various methods of performing the operation of burning are detailed by Aëtius, as will be explained in the Surgical part of this Work.
Cælius Aurelianus gives a long and interesting account of this complaint. Among the symptoms he mentions the lengthening and shortening of the limb, the wasting and paralysis of it. The periosteum, he says, is principally affected, but likewise the heads of the muscles. He correctly states that, when the complaint is protracted, collections are apt to form in the joint. He approves of the emollient treatment, the application of wool dipped in sweet oil, fomentations, and bleeding from the arm. He recommends gentle purgatives and clysters, but condemns the use of drastic cathartics, such as scammony, hellebore, and the like; because, he says, they occasion irritation. When the pains are protracted he approves of scarifications and leeching, after which the vapour of sponges squeezed out of hot water will be of service. He also makes mention of the bath of oil and various emollient ointments. He describes several methods of applying heat to the part, but condemns them in general, upon the principle that they increase the local irritation. He disapproves of diuretics as recommended by Diocles, and otherwise animadverts freely upon the practice of the other sects.
The Arabians adopt the views of Galen and his followers with little addition or alteration. Thus Serapion recommends bleeding from the arm and ankle; clysters of drastic medicines, such as colocynth, centaury, hermodactylus, &c.; soothing applications externally; quieting medicines internally; emetics consisting of radishes, vinegar of squills, or even of white hellebore. When these do not succeed, he recommends us to form an issue by burning the part with a red-hot iron. Avicenna agrees with Galen in condemning discutients and recommending emollients at the commencement, and in preferring emetics to cathartics. For this purpose he particularly mentions a solution of nitre and vinegar. When the disease is combined with inflammation, Haly Abbas directs us to begin with venesection if not otherwise contraindicated. He enjoins the necessity of abstaining from taking much food and things of difficult digestion. He directs us to pour water of a moderate temperature over the part, and to rub it with an emollient oil; but he forbids refrigerant and astringent things, as they are apt to drive the humour inwards. He joins the others in recommending particularly the hermodactylus (soureniaron), both by the mouth and in clysters. When other means fail to remove the pain, he directs us to apply a cupping-instrument with strong heat over the joint, or even to use the actual cautery. Alsaharavius recommends the same general plan of treatment. He directs the patient to abstain from the use of wine, or if he cannot observe this regimen, he recommends him to use the bath and friction with glass (pounded he probably means). He gives very excellent admonitions to guard against indigestion, and to avoid all things of a cold nature.
On the ancient cauteries for disease of the hip-joint, see [Book Sixth, Sect. LXXII].
Most of the earlier modern writers approve of the application of the actual cautery for the cure of sciatica. See Rogerius (i, 74.)