SECT. XLIV.—ON THE OPERATION OF BURNING FOR EMPYEMA.
The most effectual remedy which has been discovered for empyema is burning. Wherefore, the parts are to be burnt by applying the root of the long birthwort soaked in oil, so as to form eschars, one of which we must make between the junction of the clavicles, having stretched the skin upwards; and two small ones a little distance from the chin and remote from the carotids; two of considerable size below the mammæ, between the third and fourth ribs; two others between the fifth and sixth, inclining a little backwards; another at the middle of the sternum, and another above the mouth of the stomach, and three behind, one at the middle of the back, and two on each side of the spine, higher up than the eschar in the back, and not very superficial. Others, as Leonidas says, having passed a knobbed cautery, heated in the fire, through the interstice between the ribs to the abscess, have carried the burning down to the pus. Some have dared to operate upon them by making a transverse incision, or one a little obliquely in the skin, between the fifth and sixth ribs, then perforating with a knife the membrane lining the ribs, and thus evacuating the pus; but they and those who burn with iron to a considerable depth either occasion immediate death, the vital spirit being evacuated with the pus, or occasion incurable fistulæ.
Commentary. Galen mentions the operation of burning the chest for phthisis. (De Morb. Vulg.)
In phthisical complaints, which do not yield to ordinary treatment, Celsus recommends the cautery to be applied in this manner: One eschar is to be burnt with a red-hot iron under the chin, another on the throat, two upon each breast, and two under the scapulæ. They are to be kept open until the cough is removed. (iii, 22.)
Aëtius directs us to burn the chest and neck much in the same manner as recommended by our author. (viii, 73.)
This operation is described by Albucasis, who gives a drawing of an instrument for performing it expeditiously. (Chirurg. i, 26.) See also Rhases (Cont. ix.)
Haly Abbas recommends such an operation as that described by Celsus and our author. He directs us to do it, not with iron, but with the root of the long birthwort smeared with oil. (Pract. ix, 74.) The use of the root of the birthwort (aristolochia) as a cautery is also mentioned by Aëtius. (xii, 3.) Cornarius, by the way, seems not to have been aware of this circumstance, which has led him into a mistake in translating the sentence where it is mentioned.
The practice of burning the chest in chronic diseases of the lungs is strongly advocated by Caillot. (Elemens de Physiologie, i.) It was tried by Dr. Mudge in his own person with great success. (See Dr. M. Good’s ‘Study of Medicine,’ ii, 786.)
Our author, it will be remarked, disapproves of paracentesis thoracis. This operation is recommended and described in one of the Hippocratic treatises. (De Morbis, i, and ii.) It is also mentioned in the ‘Isagoge’ of Galen. Rhases likewise mentions it in brief terms. (Cont. iv, 3, and x.) Rhases directs us to open the chest by a small orifice, that the matter may be slowly evacuated. He mentions that Galen recommends burning the chest, and also the operation of paracentesis in such cases.