SECT. II.—ON LEPROSY AND PSORA.
Both these affections consist of an asperity of the skin, with pruritus or wasting of the body, having their origin from a melancholic humour. But leprosy spreads over the skin more deeply in a circular form, throwing out scales which resemble those of fishes. But psora is more superficial and variously figured, and throws out furfuraceous bodies. In these cases we must premise venesection when the body appears more than usually plethoric; but, if not, we must by all means purge with those things which evacuate black bile. Externally we may use in common either of the hellebores; and have washed lime dried, and, when going to use it, we may dilute it in water until it attain the thickness of the wrestler’s sordes, and anoint.—Another: Of sage, of the tears of Æthiopian olive, of each, dr. viij; of the bark of capper’s root, of gum, of each, dr. xiij; anoint with vinegar, in the sun. Anemone, when applied, and the root of the white vine particularly, remove psora. But the following are compound remedies: Of the flour of darnel, one chœnix; of the white cardamom, dr. iv; of the scum of natron, dr. j; of copperas, dr. viij; of the middle roots of asphodel, dr. iv; having triturated them in vinegar, and made of the thickness of a cerate, anoint, having first applied nitre to the part; and having removed it, (which do about the third day,) and washed with cold water, again anoint.—Another: Of the juice of kings’ spears’ roots, oz. vj; of sulphur vivum, of manna, of each, dr. x; of natron, dr. viij; anoint, mixing with vinegar. The following simple remedies are particularly applicable for psora: Stavesacre, bitter lupins, cardamom with vinegar, the root of lily with honey, turpentine rosin, sulphur, chick peas, goat’s dung; and these compound ones—mix equal parts of chalcitis and misy with wine, and anoint the more humid kinds of psora.—Another: Boil the tender leaves of rose-bay in a sextarius of oil until they are dried, and, throwing away the leaves, add to the oil oz. iij of white wax, and, after it is dissolved, cool and sprinkle upon it oz. j of sulphur vivum, and anoint in the sun or in the bath. Some boil also squills with the rose-bay.—Another: Of diachylon, oz. ij; of wax, oz. ij; of oil of roses, oz. j; of litharge, oz. iij; of ceruse, oz. iij; of liquid pitch, oz. vj; of the dross of silver, oz. ij; of siricum, oz. ij; of vinegar, what will be sufficient for the trituration of the dry things.—Another: Of ceruse, oz. ss; of starch, oz. ss; of lead, oz. j; of red lotuses, or of alkanet, oz. ij; of wax, oz. vj; of oil of roses, oz. ix; boil the alkanet properly with the oil of roses, and then add the other things.—Another: Take ten eggs, or as many as are required, and having macerated in the most acrid vinegar until their shell become tender; boil in the vinegar the yelks of them; having triturated with rose-oil and what remains of the vinegar a moderate quantity of litharge, anoint, when of the consistence of the sordes of oil in baths.—Another: Three yelks of eggs out of vinegar; of rose-oil, oz. vj; of sulphur vivum, oz. iij; having triturated the yelks of the eggs and the sulphur with the vinegar, add the cerate. And litharge triturated with vinegar and rose oil, until it be of the consistence of a plaster, cleanses the most acrid kinds of psora; and the detergent ointments from dock, and the most of those for elephantiasis, answer well in general with leprosy and psora.
Commentary. See Hippocrates (de Usu Humidorum, Epidem. ii); Galen. (Meth. Med. xiv; de Causis Sympt. iii, 6; et alibi); Oribasius (Morb. Curat, iii, 58); Aëtius (xiii, 134); Actuarius (Meth. Med. ii, 11); Nonnus (Epit. 234); Pseudo-Dioscor. (Euporist. i, 128); Leo (vii, 15, 18); Pollux (Onomasticon, iv, 9); Æschylus (Choeph. 274); Alexander Aphrodisiensis (Prob. i, 146, and ii, 42); Celsus (v, 28); Scribonius Largus; Octavius Horatianus (i, 31); Serenus Samonicus; Marcellus (de Med. xix); Isidorus (Orig. iv, 8); Psellus (op. Medicum); Vegetius (Mulom. iii, 71); Geopon. (xviii, 15); Serapion (v, 2); Avicenna (iv, 7, 2, 9); Avenzoar (ii, 7, 4); Haly Abbas (Theor. viii, 16; Pract. iv, 4); Alsaharavius (xxxi, 1, 2, 3, 4); Rhases (ad Mansor. v, 31 et seq.; Divis. 117, et seq.); Contin. (xxxvi.)
As in the preceding chapter, we shall here give a separate account of the views of the Greeks, Latins, and Arabians, beginning, in this instance, with the Greeks.
Hippocrates makes only casual mention of these diseases, and has nowhere marked their distinguishing characters. In one place he calls leprosy a blemish rather than a disease; and in another he remarks that some varieties of it itch before rain. He speaks of vinegar, and of lime and water as remedies for it. It is proper to apprize the reader that the two works quoted above from the Hippocratic Collection are, most probably, not genuine.
Galen also is very deficient on the subject of lepra, having nowhere given a complete description of it, although he notices it incidentally in many parts of his works. In one place he calls elephas, leuce, and alphos cognate affections. Alphos, he says, is much more superficial than leuce. In another, he attributes these complaints to the melancholic humour which becomes fixed in the skin. In the ‘Isagogue,’ which, however, seems not to be a genuine work of his, it is said that lepra is an affection of the skin, which becomes whiter and rougher than natural, the roughness resembling that from prominent psydracia. Psora is said to partake more of the nature of ulceration. Both are represented as arising from a saltish phlegm, and as being cured by phlegmagogues, and ointments rubbed into the skin. It is also stated that leuce is distinguished from lepra by there being no roughness of the skin in the former disease. In another place he mentions psora as a disease most inveterate to cure. (Facult. Natur. i, 13.)
Oribasius thus distinguishes leuce, alphos, melas, lepra, and psora from one another. Leuce is occasioned by a pituitous and viscid blood, which, in process of time, renders the colour white. Alphos arises in like manner, but the superficial skin only is affected, and not the whole flesh. When a pituitous humour is the cause of the complaint, it puts on the appearance of alphos, and when the melancholic, of melas. Lepra affects mostly the deep-seated parts, and psora the superficial. For all these complaints he recommends a mixture of lime and water and some other such things.
In the ‘Euporista,’ generally ascribed to Dioscorides, there is given a long list of medicinal articles for lepra, such as the flour of darnel with sulphur, hellebore with vinegar, verdigris, cantharides, &c.
Aëtius, copying from Archigenes, thus marks the difference between lepra and its cognate diseases. Lepra differs from leuce and alphos, inasmuch as lepra is distinguished by roughness and a sense of itching, and yet the skin only is affected, and when it is removed, the flesh below is discovered to be sound; but in leuce, the flesh below assumes an unnatural degree of whiteness, while the surface of the part is very smooth, and when rubbed it soon becomes red, especially in those who are readily cured; and alphos is altogether superficial, having the appearance of a scale fastened to the skin. Lepra differs from psora, inasmuch as in psora the substances which appear on the skin are of a furfuraceous nature, while in lepra they resemble the scales of a large fish. He omits the constitutional treatment so judiciously stated by our author, but his local applications are little different. They contain hellebore, sulphur, misy, verdigris, liquid pitch, cantharides, natron, copperas, myrrh, galls, vinegar, &c., mixed in various proportions.
Actuarius states that lepra is next to elephantia in malignity, and that it is distinguished from psora by spreading deeper and having scales of a circular shape like those of fishes; whereas, psora is more superficial, and its scales are furfuraceous and of no determinate shape. Both are attended with asperity of the skin, and itching. Leuce holds the same place to alphos that lepra does to psora, that is to say, leuce is more deep-seated, and affects the colour of the hair, while alphos is more superficial, and the hair is in general unchanged. For all these affections he recommends an application containing copperas, black hellebore, arsenic, and cantharides, mixed with oil, cedar resin, or rose oil.
Psellus states correctly that the scales in leprosy assume a circular shape.
Nonnus marks the distinction between these diseases very accurately. Lepra arises from a corroding humour, and hence scales fall from the surface of the skin, and it is attended with pruritus. But lepra is more deep-seated, and affects the skin circularly; whereas psora is more superficial and variously figured. Leuce and alphos albus and niger, he says, are allied; but leuce is deeper seated, so as to change the colour of the hairs, whereas the alphi are more superficial affections.
Pollux, like most of the others, states that in leuce, when the skin is pricked, it does not bleed, and that the disease is difficult to cure. Alphos and melas, he says, are easily cured.
Although Myrepsus has not described these diseases, he gives prescriptions for various compositions to remove them. The most active ingredients in them are hellebore, natron, sulphur, quicksilver, sal ammoniac, quicklime, bay-berries, &c.
Alexander Aphrodisiensis mentions psora among the contagious diseases, but says that lepra and leuce are not contagious.
Chrysostom alludes to the common opinion that psora is a contagious disease. The poet Æschylus gives a short description of leprosy in his ‘Chöepheræ’ by the name of lichenes. (l. 277.)
Celsus nowhere uses the terms lepra and psora, and therefore there is considerable difficulty in comparing his account of these cutaneous affections with the descriptions of the Greeks. Alphos, melas, and leuce, he describes very intelligibly, connecting them together by the generic term of vitiligo. We shall give his own characteristic description of these diseases:—“Ἄλφος vocatur ubi color albus est, fere subasper, et non continuus, et quædam quasi guttæ dispersæ esse videantur: interdum etiam latius, et cum quibusdum intermissionibus serpit. Μέλας colore ab hoc differt quia niger est et umbræ similis: cætera eadem sunt. Leuce habet quiddam simile alpho, sed magis albida est et altius descendit; in eâque albi pili sunt, et lanugini similes. Priora curationem non deficillimam recipiunt: ultimum vix unquam sanescit.” Another class of cutaneous affections he connects by the generic term of impetigo, and it is to be remarked that they are all squamous diseases, and not pustular, like the complaints to which Drs. Willan and Bateman have applied the term. His second species of impetigo (as Bateman remarks) appears to be the psora of the Greeks:—“Alterum genus pejus est, simile papulæ feræ, sed asperius rubicandiusque, figuras varias habens: squamulæ ex summâ cute discedunt, rosio major est, celerius et latius procedit, certioribusque etiam quam prior temporibus et fit et desinit. Rubra cognominatur.” His third species bears some resemblance to the lepra nigricans of Willan and Bateman:—“Tertia etiamnum deterior est: nam et crassior est et durior, et magis tumet, in summâ cute finditur, et vehementius rodit, ipsa quoque squamosa sed nigra, &c. Nigræ cognomen est.” His account of the fourth species seems to refer to the lepra vulgaris:—“Quartum genus est quod curationem omnino non recipit distans colore: nam sub-albidum est et recenti cicatrici simile: squamulas habet pallidas, quasdam subalbidas, quasdam lenticulæ similes: quibus demptis nonunquam profluit sanguis.” For all these diseases he recommends a composition containing sulphur, natron, and rosin.
Scribonius Largus describes several compositions, “ad lepram, quæ quasi impetigo est cum prurigine cutis,” and for scabies. They contain sulphur, Æthiopian cumin, vinegar, frankincense.
Serenus Samonicus makes mention of a few popular remedies for scabies, prurigo, and papulæ, but he gives no description of these complaints.
Octavius Horatianus recommends for scabies (meaning, we suppose, the psora of the Greeks,) bleeding, purging, frequent baths, and external applications containing natron, frankincense, and sulphur. He does not mention lepra by name, nor does he seem to allude to it at all.
Marcellus recommends for lepra a composition containing equal parts of natron, frankincense, litharge, and sulphur pounded with vinegar.
Vegetius says that the scabies of cattle “contagiosa est et transit in plures.” Probably Virgil alludes to the scab of sheep in this line: “Nec mala vicini pecoris contagia lædant.” (Ecl. i.) He mentions, as remedies for it, sulphur, litharge, pitch, hellebore, &c. (Georg. iii, 449.) See also Geopon. (xvi, 18, xviii, 15); Columella (viii, 5); and Gratius (Cyneget. 412).
Isidorus gives the following definitions of the complaints we have been treating of: “Lepra vero cutis asperitas squammosa lepidi similis unde nomen accepit: cujus color nunc in nigridinem vertitur, nunc in alborem, nunc in ruborem. Scabies tenuis asperitas et squammata est. Impetigo est sicca scabies; prominens a corpore cum asperitate et rotunditate formæ. Hanc vulgus sarnam appellat.”
Justin applies the terms vitiligo and scabies to the diseases treated of in this chapter. See Hist. (xxxvi, 2.) We now turn to the Arabians.
In the Latin translation of Serapion, lepra and psora are described under the generic term of “impetigines in quibus excoriatur et scinditur cutis;” but they are further distinguished from one another by the specific titles of albaras nigra and pruritus. The former is characterized as arising from the melancholic humour, and as casting off round scales. The latter is said to consist of pustules, which appear on different parts of the body, are variously figured, and cast off furfuraceous scales. The leuce is described by the name of baras, as arising from viscid, pituitous blood, and being produced by a defect of the assimilative faculty. In it the flesh itself is said to be changed to a white colour. If, when pricked with the head of a needle it bleeds, there is a probability of cure; but if it does not bleed, it is incurable. The two alphi are described by the names of morphea alba and nigra. The morphea alba resembles the white albaras (leuce) only that in the latter the affection of the skin is more deep-seated, and the hairs in it are turned to a white colour; but in morphea the only change is in the external appearance of the skin. The morphea nigra (melas?) is said to resemble the albaras nigra (lepra nigricans?) only that it is more superficial.
In the Latin translation of Avicenna by Bullonensis, alphos albus and niger are distinguished by the names of morphea alba (or alguada), and morphea nigra; leuce by that of albaras; and lepra by those of albaras nigra and impetigo excorticativa. The specific differences between them are stated with great precision. The morpheæ are superficial affections of the skin, but the albaras affects also the flesh, penetrating sometimes down to the bone. All these diseases are said to arise from a weakness of the assimilative faculty. In the albaras nigra, or leprosy, the skin is said to be covered with scales, like those of a fish. Like the authorities formerly quoted, Avicenna states that in alguada (alphos albus) the hairs do not change their colour, but that they do so in albaras. The puncture of a needle likewise extracts blood from the guada, but not from the baras.
Avenzoar makes mention of the morphea alba and nigra, but has not described them particularly. These authors seem to have treated lepra and psora like the Greeks, by bleeding, melanogogues, and abstergent applications to the skin, such as the two hellebores, lime, lupines, &c.
In the translation of Haly Abbas, leuce is correctly described by the name of lepra. It is represented as a whiteness sometimes affecting the whole body, and it is said to be occasioned by debility of the assimilative faculty. When the hairs are white, and the skin does not bleed when pricked with a lancet or needle, the disease is incurable. Alphos albus is described by the name of morphea alba, and is distinguished from the former by the whiteness being more superficial, and the colour of the hairs remaining unchanged. In the morphea nigra, that is to say the alphos niger, the colour is said to be black, owing to the prevalence of black bile, and if rubbed a furfuraceous scale falls off, and it becomes red. The lepra nigricans is described by the names of impetigo and sarpedo, as an asperity of the skin, inclining to blackness or redness, and terminating in round scales, like those of fishes. For the cure of lepra, he directs us to abstain from all articles of food which engender phlegm, to take hiera of colocynth, with pepper, &c., and also the theriac of vipers, and various other internal medicines. He recommends various external applications, containing sulphur, arsenic, hellebore, spurge, &c.
Alsaharavius describes three varieties of morphea. 1st. The morphea terrestris, which is attended with furfuraceous scales on the skin, and tingling. This is evidently the psora of the Greeks. 2d. The morphea alba, which consists of a more superficial whiteness of the skin than the albaras (leuce): this is the alphos albus. 3d. The morphea nigra, is like the former, only that the colour is black. This must be the alphos niger. All these affections he treats upon much the same principles as the Greeks, namely, by evacuants, and stimulant applications to the skin, such as sulphur, hellebore, &c. Albaras he describes as a deep-seated whiteness of the skin, and directs us to prick the skin with a needle, and if it does not bleed the disease is to be set down as incurable. This, of course, is the leuce of the Greeks. He treats it upon much the same principles as the morpheæ. He appears not to make any distinction between the leuce and the lepra.
Rhases describes the lepra of the Greeks by the term impetigo; alphos albus by that of morphea alba; alphos niger by that of morphea nigra; and leuce by that of albaras. There is nothing very particular in his treatment of leprosy. It may be worth while to mention, however, that he strongly recommends leeches to the affected part, at the commencement. Scabies, he says, is formed by a salt diet, old wine, and neglect of the bath. For the cure of it, he recommends bleeding, purging, and various external applications, some of which contain quicksilver, nitre, vinegar, and the like. In his ‘Continens’ he gives a full account of these diseases, upon the authority of preceding writers. He gives the names of baras to lepra, and morphea alba to alphos. He recommends stimulant applications containing cantharides, nitre, with vinegar, &c. He says that he had found a mixture of sal ammoniac and oil of eggs an excellent application.
It will be remarked that the leuce of the Greeks, the leuce and fourth species of impetigo of Celsus, and the albaras of most of the Arabians, are the same as the lepra vulgaris of Drs. Willan and Bateman; that the alphos of most of the Greek authorities and of Celsus, and the morphea alba of most of the Arabians, correspond to the lepra alphoides of our English nosologists; that the melas, alphos niger, and common lepra of the Greeks, Celsus’ third species of impetigo and his melas, and the morphea nigra and impetigo of most of the Arabian translators, apply to the lepra nigricans of our modern arrangement; and that the psora of the Greeks, Celsus’ second species of impetigo, and the scabies of Octavius Horatianus, and of most of the Arabian translators, comprehend both the psoriasis and scabies of Willan and Bateman.
Since many of the ancient authorities speak of scabies as being infectious, they must have applied the term to the true itch, with which it is not likely, as Rayer maintains, that they were wholly unacquainted.
The earlier modern writers, such as those of the Schola Salernitana, Platearius, Guy of Cauliac, and Lanfrancus, jumble together the Latin and Arabian names, so as to produce no ordinary degree of confusion. Guy of Cauliac, indeed, maintains that there is little necessity for distinguishing lepra, alphos, melas, impetigo, gutta rosacea, and such like cutaneous complaints from one another, as they are all varieties of the same disease. Lanfrancus, however, is of a different opinion. (i, 3, 6.)