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.)