SECT. III.—ON LICHEN.
Lichen is formed by the mixture of a thin and acrid ichor with other gross humours, and passes readily into leprosy and psora; wherefore it requires to be treated by the most desiccative applications. After general depletion, if necessary, the following simple medicines will be proper: chick-peas, hellebore, the urchin which dwells among rocks, pitch mixed with cerate and rosin, the dung of the land crocodile, that of starlings fed solely upon rice. And many have cured the complaint when occurring on the chin, or other parts of the body, by this application alone: take several grains of wheat and place upon a stithy red-hot, and taking the fluid which flows from them while yet warm, anoint the part affected with lichen. The lichen of children is to be rubbed frequently with human saliva. The gum of the plum tree, when rubbed in, is beneficial in these cases. When the complaint is protracted, the leaves of the chaste tree, triturated with vinegar, are to be applied, or the leaves of capers in like manner. The following are compound applications: Dissolve sulphur with rosemary in vinegar, or with ammoniac, and anoint. A trochisk for lichen: Of artificers’ glue, dr. iv; of frankincense, dr. iij; of vinegar half a cyathus; dissolve in vinegar, and anoint.—Another: Of chalcitis, of gum, of each, dr. viij; of sulphur vivum, of misy, of each, dr. vj; of the flakes of copper, of acacia, of each, dr. ij; anoint with vinegar.—Another: Of sulphur vivum, of spuma nitri, of each, dr. iv; of the seeds of rosemary, lx; triturate with vinegar, and anoint only the part which is affected, not touching the sound skin. When dry, wash it away with cold water.—Another: Of white hellebore, dr. viij; of the flour of lupines, of burnt shell-fishes called buccina, of natron, of each, one chœnix; rub with it dry. They call that variety of lichen agrius which is nowise remedied by moderately desiccative applications, and is exacerbated by more acrid ones. These cases are therefore to be treated by applications which are sufficiently strong, without being pungent, such as this: of horned poppy, of frankincense, of alcyonium, of bitumen, of sulphur, of gum, of each, oz. j; anoint with vinegar. Boil African pitch with vinegar, and, when dissolved, anoint.—Another, for lichen and prurigo: Of copperas, of sulphur vivum, of natron, of frankincense, equal parts; use for lichen with vinegar, and for prurigo with wine.—Another, for lichen: Of ammoniac perfume, of the flour of bitter vetch, of the flour of lupines, equal parts; add to vinegar.
Commentary. See Hippocrates (de Humor., de Affect.); Galen. (Isagoge, de Med. sec. loc. v); Oribasius (Morb. Curat. iii, 59); Aëtius (viii, 16); Actuarius (Meth. Med. ii, 11); Marcellus (19); Nonnus (236); Celsus (v, 28); Pliny (H. N. xxvi, 2); Serapion (v, 2); Avicenna (iv, 7, 3, 3); Alsaharavius (Pract. xxxi, 7); Rhases (Divis. 117); Haly Abbas (Pract. iv, 10.)
Dr. Bateman states, that the exact acceptation of the term lichen cannot well be ascertained from the writings of Hippocrates; but Dr. Willan affirms that he restricted it to a papular eruption on the skin.
In the ‘Isagoge,’ usually ascribed to Galen, two varieties are described, the lichen mitis, and the lichen agrius, in both of which scales are formed upon the skin, which appear almost ulcerated when they are removed. They are to be cured by cholagogues internally, and liniments externally.
Galen remarks the tendency of the disease to pass into lepra and scabies. To prevent this, he directs desiccative and detergent applications, for the preparation of which he gives various prescriptions. One of these, which bears the name of Pamphilus, is a powerful escharotic, composed of orpiment, realgar, burnt copper, and cantharides. (Med. sec. loc. v.) He says it affects principally the chin, but is apt to spread over the face.
Oribasius, Aëtius, Actuarius, and Nonnus, treat of the complaint in nearly the same terms as our author. Their translators improperly render it by impetigo. Leo ascribes the origin of the disease to hot and corrupted blood.
Celsus describes the lichen of the Greeks by the name of papula, of which he mentions two varieties. In the first, he says, the skin is merely roughened by small pustules, is reddened and slightly corroded; the middle is somewhat smoother, and it spreads slowly, generally in a round shape. This description would seem to apply to the lichen circumscriptus of Drs. Bateman and Willan, although the latter author thinks that it possessed a wider signification. The second variety, he says, is called ἀγρία by the Greeks, and in it the skin is more rough, red, and corroded. The more it departs from the circular form the less tractable is it, and, unless removed, it is said to pass into impetigo. From this account it is clear that the lichen of the Greeks, in its original form, was different from impetigo. Celsus recommends friction with the saliva of a fasting person, and also mentions a composition containing natron, frankincense, sulphur, &c.
The translator of Serapion improperly renders the name of this affection by the term impetigo. His remedies are nearly the same as our author’s, namely, the saliva of a person fasting, compositions containing hellebore, natron, the ashes of starlings, &c.
In the translation of Avicenna it is likewise described by the name of impetigo. It is called a species of dry achor, by which is no doubt meant papula. It is stated that it has a tendency to pass into lepra or psora. The remedies which are recommended are human saliva, the chaste tree, capers, leeches (which are not mentioned by the Greeks), likewise gum arabic dissolved in vinegar, mustard and vinegar, salt water, the roots of king’s spear, &c. Haly Abbas recommends stimulant liniments of a similar kind.
Rhases briefly recommends lotions of vinegar and ammoniac, and, when it becomes inveterate, leeches, strong friction, &c. His translator also misapplies the term impetigo to it.
The lichen appears to be the cutaneous complaint which Alsaharavius describes by the name of alcoab. He represents it as a superficial ulceration, and mentions four species of it.
Dr. Willan confirms the statement of the ancient authorities, that the disease has a tendency to pass into lepra and psora. The species called lichen tropicus by Dr. Willan, seems to be the hidroa of Hippocrates (Aph. iii, 21); the sudamen of Pliny (xxiii, 45); one of the essere of Haly Abbas (Theor. viii, 17); one of the alsara of Alsaharavius (Pract. xxx, 8); and the hasef of Avicenna (iv, 7, 3, 8). See also Galen’s ‘Commentary’ (v, 261); ed. Basil. Galen says it is attended with pruritus, asperity, and ulceration. Avicenna and Rhases particularly commend bleeding, cleansing the skin, and the cold bath. Most of Rhases’ authorities in his ‘Continens,’ recommend for the asaf, or sudamen, cooling and astringent applications, containing roses, myrtles, galls, sandals, camphor, and the like. They attribute the complaint to profuse perspiration. In certain cases, Rhases directs us to allay the pruritus or tingling, with hot water and the flesh of melons. He also approves of purging with tamarinds and myrobalans. (Cont. xxxvi.) See also ad Mansor. (v, 30). Mercurialis is of opinion that Virgil alludes to the sudamina in the following lines:
“Verum etiam invisos si quis tentarat amictus,
Ardentes papulæ atque immundus olentia sudor
Membra sequebatur.”
(Georg. iii, 565.)
We shall briefly notice in this place the singular disease of the face which prevailed in the Roman empire during the reign of Tiberius, called mentagra by Pliny, in his curious description of it, but which he says was named lichenes by some. He represents it as a contagious disease, which was readily propagated by kissing. It attacked principally the higher class, the lower and middle ranks and women having generally escaped it. The seat of it was commonly the chin, but it sometimes spread over the whole face, and affected even the neck, breast, and hands. The only means of cure was burning with caustics down to the bone. (H. N. xxxvii; see also Marcellus, 19.) We are inclined to think that it must have been some variety of elephantiasis. Modern authorities have ranked it under sycosis, but it would appear to have been a much more intractable disease. The sycosis is distinctly described by Celsus, among the diseases of the hairy parts. He recommends for it elaterium, linseed, or figs boiled in water, &c. (vi, 3.)