SECT. XXII.—ON PHYMA, BUBO, AND PHYGETHLON.
According to Galen, phyma, bubo, and phygethlon, are affections of the glands: bubo being an inflammation of a gland; phygethlon, an inflammatory erysipelas, or an erysipelatous inflammation of a gland; and phyma, an inflammation of a gland passing rapidly into suppuration. But, according to others, all tumours of the nature of apostemes, which arise in any part of the body, are called phymata. For Hippocrates says, “Those in whose urethra phymata form are relieved when they suppurate and burst.” Wherefore those buboes which are occasioned by accidents, either ulcers or pains, are not dangerous; but those which occur in fevers, more especially in the pestilential, are of a very bad description, whether they are formed in the groins, the armpits, or neck. But those of the first kind, as is the case in every other inflammation, we must endeavour to put back with cooling and astringent applications, either applying a sponge out of oxycrate, or wool out of wine and raw oil, or oil of roses, or oil of apples, or oil of lentisk, or oil of myrtles; and then we are to apply diaphoretics. But if the whole body is plethoric, it is to be evacuated. If free from superfluities, we must manage the ulcer arising from it in the manner to be described when treating of ulcers. When the gland is in a state of inflammation, it is to be mitigated by wool soaked in some of the emollient oils, and the whole limb is to be wrapped therewith. When the tumour has suppurated, we must not be in haste to open it, but endeavour to dissipate it by the medicines in the form of cerates, such as that prepared from apyranon, and that from herbs called botanica. When resolution is not thereby accomplished, we must forward the rupture as in the other abscesses, and cure it in like manner as them. In those buboes which arise in fevers or from a collection of humours, we must abstain from all repellents, lest the matter should be repelled and regurgitate to the deep-seated parts; but we must begin at once with discutients. When nothing prohibits, such as the age or strength of the patient, venesection from the arm is to be had recourse to, and fomentations applied to the part, either from the decoction of camomile, or of dill, or of some such; but the materials of the other applications may be transferred from our account, in the [Third Book], concerning parotis, and from what has been lately delivered, more especially respecting phlegmons. And in like manner the cure of phygethlon may be learned from what has been stated respecting them and erysipelas. But the herb aster atticus, which, on this account, they call bubonium, not only in the form of a cataplasm, but also when bound round the part as an amulet, is believed to be of use for buboes. Phymata may be discussed by the following applications in particular: maiden-hair; orache; pellitory of the wall; the root of marsh-mallows, boiled in wine; ammoniac, softened with honey, and applied; birdlime, with the rosin cerate. But bee-glue, bitter lupins applied with vinegar, the root of the wild cucumber added to turpentine, and in like manner root of capers, and nitre with leaven, or figs, promote the rupture of these tumours.
Commentary. The account here given of these glandular inflammations is taken from Galen (ad Glauc. ii.) See also ‘de Tumoribus’ and ‘Comment. in Hippocrat. Epid.’ vi.
Celsus describes phyma as resembling furunculus, but as being larger, and turning to pus. According to Rayer, his description of phyma applies better to the boil than his account of anthrax. (Malad. de la Peau, p. 229.) The phygethlon, he says, is a tumour not high, but broad, and containing something resembling a pustule. It occurs mostly in the armpits, neck, or groins. He proposes applications of a repellent and refrigerant nature; but if the swelling is hard, digestives must be had recourse to, such as dried figs bruised, &c. He also recommends a composition of sal ammoniac, galbanum, bee-glue, and mistletoe, with a small proportion of myrrh. His treatment is considerably different from our author’s. When matter is formed, he directs us to let it out by medicines or the lancet, but he decidedly forbids the use of cerates. In another place, however, he recommends an application containing lime, spuma nitri, round pepper, galbanum, and salt mixed with rose cerate.
Scribonius Largus recommends a malagma containing pitch, aphronitum, pine-rosin, wax, bay-berries, axunge, ammoniac, Illyrian iris, galbanum, and white pepper, for discussing phygethlon.
Oribasius and Actuarius mark the distinction between these affections in the same terms as Galen, and direct us to treat them with emollient, concoctive, and discutient applications. For concocting phymata, the Pseudo-Dioscorides recommends southernwood, boiled with raw barley flour; figs, boiled with yeast, &c.; and for breaking them, the juice of thapsia, with sulphur; cantharides, mixed with turpentine, &c. (Euporist, i, 156.)
Nonnus’ account is mostly abridged from our author’s. Thus, he recommends at first venesection, and sponges squeezed out of oxycrate and the like; then digestives are to be applied; and afterwards cataplasms and such things as will favour the rupture of the abscess, namely, compositions containing bee-glue, bitter lupins, vinegar, nitre, yeast, or figs and pitch.
Avicenna describes these affections by the name of althaum. It is remarked by his translator that the Arabian recommends the same medicines as Paulus, but neglects the distinction which the latter properly makes between the bubo when attended with pestilential fever and when without it.
The phyma seems to have been merely an acute inflammation of a gland, terminating in suppuration. The phygethlon was an erysipelatous inflammation of a gland. These complaints are well defined and described by Fabricius ab Aquapendente (1, i, 23.) Dr. Willan uses the term phyma in a different sense from that of our author. The term occurs in Marcus Antoninus (ii, 16), where see the note of Gataker.