SECT. XVII.—ON PHLEGMON.
In general, we call all those swellings phlegmons which are red and painful, and accompanied with heat; some diversity of their nature arising from the cause which occasions them. For when good blood and of moderate consistence rushes abundantly to a part and from its quantity becomes seated in it, the disease is that which is properly called phlegmon; but when yellow bile is seated in a part, it is called herpes; and when blood and yellow bile together are collected in a part, erysipelas is formed; but when in this case the blood is hot and thick, it usually gives rise to carbuncle. Wherefore, we shall begin with what is properly called phlegmon, which occurs in many cases, being a swelling which is red, painful, elastic, and hot, deriving its origin, as I said, from good blood which is sometimes collected from the whole body, and sometimes is formed abundantly in the part itself, so that it cannot be contained in the vessels, but escapes from them in the form of vapour into the surrounding cavities. And this affection supervenes upon wounds, fractures, ulcers, and many other causes. When therefore a part becomes inflamed without any obvious cause preceding it, the whole body sending a defluxion to the part, we must evacuate the general system by venesection, and apply to the part embrocations and cataplasms, not such as are of a heating and moistening nature, but such as are calculated to repel the fluid, which is flowing to the part, and evacuate that which is already contained in it. Apply, therefore, a cataplasm of house-leek, and of the bark of the pomegranate tree boiled in wine, with sumach and polenta: when the pain is not violent, this or such like applications are to be used; but when there is a defluxion to the part with greater pain, then cataplasms of hot water and oil, or of polenta, must not be applied (for all these are inimical to such defluxions); but the vehemence of the pain is to be allayed by that which is composed from musk, rose-oil, and a little wax, with unwashed wool containing much grease: these things are to be prepared and applied cold in summer, but tepid if in winter, so that the parts above the affected places be covered with a sponge soaked in austere wine or cold oxycrate. But we must add to the cataplasms such herbs as are proper for the purpose required. Pellitory of the wall, therefore, is applicable to every phlegmon at the commencement, and while on the increase; and in like manner, horned poppy, orach, mallows, lettuce, and gourd, when applied on hot parts. Both kinds of caltrops (tribuli) are applicable to inflammatory defluxions, and the cabbage to such as are hard. When a change is thereby effected, and no pus falls into the part, you may accomplish the cure by means of the plaster from chalcitis, or some of those plasters of a similar nature, which apply to defluxions; but clean wool soaked in austere wine is to be put externally to the medicine. In this manner you may cure phlegmons from defluxion. But such as are occasioned by any external cause will not be injured by moistening and heating applications, and if necessity require, you may scarify them with advantage. But in phlegmons arising from defluxion, scarification, more especially at the commencement, may become the cause of much mischief to the patient.
Commentary. See Galen (ad Glauc. ii); de Different. Morb. (12); Meth. Med. (xiii, 2); Celsus (iii, 10); Oribasius (Morb. Curat. iii. 41); Aëtius (xiv. 31); Leo (vii, 4); Actuarius (Meth. Med. ii, 12); Avicenna (iv, 3, 1, 2); Serapion (v, 22); Haly Abbas (Theor. viii, 9; Pract. iii, 27); Alsaharavius (Pract. xxix, 2); Rhases (Divis. 126, and Contin. xxvii.)
Galen explains that the term phlegmone is used either to signify inflammations in general, or a red, resisting, and painful tumour in particular. It is here used in the latter acceptation. He says, when a defluxion of blood of good quality and of moderate consistence takes place to a part, and from its quantity becomes fixed in it, the person is seized with a violent pain, unless the part be very insensible; it is also accompanied with a deep-seated throbbing; it seems stretched and broken; there is a sensation of increased heat, so that the part feels as if it were burnt and desires cooling; there is a florid redness as in those who have been in the bath, or have been warmed at the fire, and by other means. This affection, he says, gets the generic appellation of phlegmone, or inflammation. He enumerates many causes of it, such as bruises, fractures, and dislocations; but even without these, he adds, it may arise from the veins being immoderately distended with humours, and the superfluity being cast off upon a part fitted to receive them at the time. Such a part, from some cause or other, happens to be weaker, or more lax, or more calculated to attract, or is more inactive than the other parts of the body. He lays it down as a general principle, that the cure of such affections is to be accomplished by evacuation. Reason and experience, he adds, teach us that the general system is to be evacuated by the suitable means, and the inflamed part by embrocations and cataplasms of a repellent nature, and such as are calculated to give tone and strength to it. Such are his general principles of treatment. His particular remedies we need not mention, as in fact our author’s are entirely borrowed from him. Oribasius, Aëtius, Actuarius, and Nonnus, in like manner, borrow from him everything which they advance upon this subject.
Celsus does not treat of phlegmon in particular, but he has given an excellent account of inflammation in general. His definition of inflammation is singularly appropriate: “Notæ inflammationis sunt quatuor, rubor, et tumor, cum calore et dolore.” Isidorus attempts the same not so successfully: “Phlegmone est fervor cum extensione et dolore; sive est inquietudo cum rubore, et dolore, et extensione, et duritie, et vastitate: quæ quum cæperit fieri, inquietudo et febris insequitur.”
Avicenna gives a clear and comprehensive exposition of the doctrines of the Greeks, but supplies no new information. He is at pains to explain that the term phlegmon applies generally to every inflamed part; and also to a hot aposteme in particular. He joins Galen in recommending a free incision when it is apprehended that the member in which it is seated will become corrupted. Serapion’s treatment is nowise dissimilar. A phlegmon, says Haly Abbas, is a sanguineous collection, arising either from an external cause, such as a bruise, a blow, a wound, or the like, or from an internal cause, namely, a defluxion upon the part. He attributes the collection which takes place in a part to its debility, which makes it unable to cast off the load which is thrown upon it. When seated in a vascular part, phlegmon, he says, is attended with a throbbing pain. He approves of free and bold incisions. Alsaharavius treats of phlegmon at great length, but there is nothing original in his views. Rhases recommends at first bleeding, purging, and applications of a cooling and astringent nature. But when suppuration has commenced he properly forbids depletion, lest it only protract this process. He remarks that phlegmons are often occasioned by disorder of the stomach, and the use of too much food and drink. He recommends in general maturative applications, to which, if necessary, narcotics may be added.