SECT. XXXVI.—ON STEATOMA, ATHEROMA, AND MELICERIS.
These also belong to the class of abscesses, but differ from them in this respect, that those which are properly called abscesses are of an inflammatory nature, painful, and contain an acrid and corroding fluid; neither are they surrounded by a proper membrane or tunic. They differ from one another, in as much as that which is contained in the steatoma is, as its name implies, like suet; that which is in the atheroma is like pap made from corn; while the fluid in the meliceris is like honey. You may distinguish them from one another thus. The steatoma is harder than the others, is unyielding to the touch, and has a narrower base. The meliceris conveys to the touch the sensation of a soft body, is slowly diffused, and soon returns again to its shape. We operate upon them as upon scrofulous tumours, by incision, dissection, sutures, and the rest of the treatment, only avoiding to wound the membrane, lest its fluid contents be poured out and obstruct the operation, and lest a part of it should be left behind, which often occasions a renewal of the complaint at the wrists, ankles, and the moveable parts about joints, as a scrofulous tumour does in like manner, if the whole or a part of it be left behind. If any such thing be left it will be better not to sew up the wound, but to consume the remainder with septic applications.
Commentary. We have given an explanation of the nature of these tumours in the [Fourth Book].
Galen states that the indications of cure in all these cases are to discuss their contents, produce putrefaction of them, or to cut them out. The steatoma, he remarks, being of a solid nature, can be remedied only by an operation. (Meth. Méd. xiv.)
Celsus directs us, in extirpating steatomatous tumours, to open the cyst and evacuate its contents; but recommends not to wound the cyst of the others. Should the whole or part of the cyst be unavoidably left behind, he directs suppurative applications to be used. After the operation he directs us to unite the lips of the wound by a clasp (fibula) and an agglutinative medicine. (vii, 6.)
The surgical treatment of these tumours is very fully laid down by Aëtius, in an extract from Leonidas; but his description is so long that we cannot do justice to it within our narrow limits. Like Celsus, he directs us to avoid wounding the tunics which surround the atheroma and meliceris; but states that this may be done in the case of the steatoma. He judiciously directs the skin to be cut in the form of a myrtle-leaf. (xv, 7, 8.)
Albucasis directs us, in the first place, to prick the tumour, in order to ascertain the nature of its contents. When they are found to be fatty, he recommends us to cut it out by making a crucial incision, and removing it with its cyst if possible. When the cyst is wounded he directs us to dissect it out in pieces, and to endeavour to leave no part of it behind. He gives drawings of various instruments, namely, scalpels, tenacula, and perforators, for dissecting out these tumours. (ii, 45, 46.)
Rhases and Avicenna give very judicious directions for the treatment of these tumours, but they scarcely differ at all from those of Aëtius and our author. They recommend us to avoid opening the cysts of the atheroma and meliceris, if possible; but if any part remain they direct us to destroy it by septics. (Contin. xxvii.)