SECT. XXXIII.—ON STRUMA OR SCROFULA.
Strumæ are indurated glands forming principally in the neck, armpits, and groins. Their general treatment therefore is the same as that for scirrhus, but in particular the flour of bitter lupines is to be boiled in oxymel and applied (this also answers with phyma;) or apply cows’ dung boiled in vinegar. This discusses all indurated swellings. But strumæ may be properly discussed by means of quicklime mixed with honey, the sordes of baths, oil, or axunge; or, equal parts of quicklime and natron, and four times the quantity of cardamom and fenugreek may be boiled with honey for an emollient ointment and applied. This one discusses hard strumæ, and produces the rupture of suppurated swellings; the flour of darnel boiled with pigeon’s dung, or linseed and wine: or, green olives, either wild or cultivated; or, the white cardamus triturated with liquid pitch and made into an emollient ointment may be applied; or, the ashes of the dried root of the wild cucumber, and the burnt dried leaves of the bay, may be mixed with turpentine and applied; or, equal parts of stavesacre and of natron, with double the quantity of rocket may be applied, with rosin; or, goats’ or cows’ dung boiled in vinegar; or, the flour of bitter vetches soaked in the urine of a young person not come to manhood, and added to melted pitch, wax and oil; or, a dead snake may be thrown into a pot, and being covered over with gypsum, it is to be put into a furnace, the ashes of it mixed with equal parts of fenugreek, and then added to honey and used. And the composition from asps is an admirable one, also that from fullers’ herb, that from the wild cucumber and that from cedar rosin. The following one produces suppuration, or resolution of strumæ: Of myrrh, dr. x; of ammoniac perfume, dr. ij; of the mistletoe of oaks, dr. viij; of galbanum, dr. iv; of bee-glue, dr. j; pound in a mortar.
For strumæ and hardness of the breasts. Of wrought birdlime, of dry rosin, of wax, of each lb. j; of galbanum, oz. iij.
For strumæ ulcerated and not ulcerated. Of wax, of pine rosin, of axunge not salted, of horehound, of scraped birdlime, of each oz. vj.
An application for strumæ. Of old oil, lb. ij; of wax, lb. j; of colophonian rosin, oz. iv; of natron, oz. iv; the heads of garlic xij. Take away the cloves (nuclei) of the garlic, macerate in oil for three days, then having boiled until they are softened, throw them away, and melt in the oil those ingredients which are soluble, and after they are taken off the fire sprinkle on it levigated natron. It also breaks apostemes.—Another: Of the ashes of figs, oz. ij; of fissile alum, oz. j; of aphronitrum, oz. j; of liquid pitch, oz. vij.
A septic application for scrofula. Of fissile alum, of realgar, of each, dr. iv; of the flakes of copper, dr. j; of orpiment, dr. j; sprinkle the strumæ with it in a dry state; but if they are of a cancerous nature, mix with rose oil and use twice a day.
Commentary. See Hippocrates (De Glandulis); Galen (Meth. Med. xiv, 11); Oribasius (Synops. vii, 29); Aëtius (xv, 5); Actuarius (Meth. Med. iv, 16); Nonnus (Epit. 124); Celsus (v, 18); Scribonius Largus (153); Myrepsus (56); Marcellus (36); Serapion (v, 25); Avicenna (iv, 3, 2, 10); Albucasis (Chirurg. ii, 42); Alsaharavius (Pract. xxix, 1, 23); Haly Abbas (Pract. iii, 33); Rhases (ad Mansor. vii. 8; Cont. xxvii); Avenzoar (i, 10, 10.)
Hippocrates mentions struma as being one of the worst diseases of the neck, originating in inflammation, and being produced by a pituitous and indolent defluxion.
Galen directs us when scrofulous glands are not situated near large vessels to extract them with the knife, or consume them with septic applications. In another place he relates a case in which an imprudent surgeon, while removing a scrofulous gland of the neck, cut the recurrent nerves, and thereby occasioned loss of speech. (De Loc. Aff. i, 6.) For an account of the operation see the [Sixth Book].
Part only of our author’s applications are derived from Oribasius.
A very minute account of these complaints is given by Aëtius. He divides strumæ into the mild and the malignant. The mild are without inflammation or pain, and are attended with a moderate degree of hardness; the malignant are accompanied with inflammation, and a throbbing pain, feel unequal, have enlarged veins, and are exacerbated by handling or medicines. The latter are said to be incurable. He mentions, upon the authority of Leonidas, the accident related by Galen. He approves, however, of the operation in general. Incipient strumæ, he states, may be discussed like scirrhi, by a combination of emollients with discutients. He gives a long list of prescriptions for removing scrofulous tumours. One of them contains arsenic mixed with the fat of a goat or ox. With regard to the general treatment, he recommends laxatives, restricted diet, emetics, and the theriac.
Actuarius and Nonnus, as usual, borrow from our author.
Celsus remarks that strumæ occur most frequently in the neck, armpits, groins, sides, and the female breasts. He represents them as indolent affections of the glands, which come slowly to maturity and prove very troublesome to the physician. Some, he says, give white hellebore in these cases, and use applications for bringing them forward or for discussing them. Others have recourse to caustics, and when the eschar is removed, they heal the ulcer upon general principles. When the sore becomes clean he recommends exercise and a nourishing diet.
Scribonius Largus, Marcellus, and Myrepsus give nearly the same prescriptions as our author. Arsenic is an ingredient in the septic applications of Myrepsus.
Avicenna recommends emetics, phlegmagogues, bleeding in the arm, attenuant food, and avoiding all gross things and repletion. As a discutient he and Serapion commend the diachylon plaster. Haly Abbas likewise mentions this application, and also directs the swellings to be burnt with caustics. Alsaharavius briefly recommends excision or burning. Serapion evidently copies from our author. Avenzoar gives a very full account of scrofulous swellings, which, he says, are formed in general of a gross and viscid phlegm. Except in very particular cases he disapproves of bleeding. He approves in general of discutient applications; but when the swelling tends to suppuration, he directs us to promote it; and when pus is fairly formed he recommends us to let it out, but cautions the surgeon not to attempt this operation unless he has a practical acquaintance with anatomy, lest he wound any of the veins, arteries, or nerves.
Rhases forbids the knife when the scrofula is in the neck or deep seated. In certain cases he approves of destroying the tunic with septic applications.
Brunus, and the other surgical writers of that age, in imitation of the Arabian authorities, direct scrofulous tumours to be treated with discutients, excision, or septics. A discutient ointment recommended by Brunus consists of litharge, common oil, and the juice of melons and fenugreek. His septic medicine is a mixture of arsenic and quicklime, which is to be applied with honey. (Chirurg. Minor. 19.)