SECT. XXXV.—ON STRUMÆ, OR SCROFULOUS GLANDS.
The chœras, or scrofula, is an indurated gland, mostly forming in the neck, armpits, and groins, deriving its name either from a Greek word, signifying a species of rock, or from swine, because they are fruitful animals, or because swine have swellings of the neck. The strumæ are formed either on the anterior part of the neck, or on either side of it, or on both, and they consist of one, two, or more, all contained in their proper membranes, like the steatoma, atheroma, and meliceris. Those, therefore, which are painful to the touch, and on the application of medicine, are of a malignant nature, are to be considered as carcinomatous and it is obvious that they do not readily yield to a surgical operation. But such as are mild to the touch and the seasonable application of medicines, may be operated upon in this manner. To such as are superficial and incline towards the skin we use a simple section, and free them from the surrounding bodies, and stretching the skin with hooks we flay the lips of the incision, as we said in describing the operation of angiology, and by degrees remove them entirely. But such as are larger, having transfixed them with hooks, we raise up, and dissecting away the skin from them in like manner, we must free them entirely from the surrounding bodies, avoiding in particular the carotid arteries and recurrent nerves. If any divided vessel obscure the operation, we may include it in a ligature, or cut it asunder, if not large. And when the base of the scrofulous tumour runs out into a narrow point, we may cut it away readily, and introducing the index finger search if there be any other strumæ lying there, and remove them in the same manner. But if we suspect that a large vessel or vessels are situated at the bottom of the scrofulous tumour, we need not cut it out from the base, but include it in a ligature, so that it may fall off spontaneously in pieces without danger, when we may effect the cure by the application of lint; but if cut away at once we may unite the lips of the incisions. The incisions are to be made direct, and if there be nothing redundant we may immediately sew them up. But, if owing to the size of the scrofulous swelling there be a redundancy of skin, having cut away a part of it like a myrtle-leaf, we may have recourse to sutures, and use the applications for recent wounds.
Commentary. See all the authors referred to in [the 34th section of the Fourth Book].
Galen briefly recommends incision or septic applications. He relates an unfortunate case in which an ignorant surgeon, by cutting the recurrent nerve, occasioned loss of speech. (See Meth. Méd. xvi; and Loc. Affect. i, 6.)
Aëtius gives a long extract from Leonidas on the treatment of scrofula. His directions for dissecting out the tumours in the neck are such as experience alone could have dictated. In operating on the neck, he cautions us to avoid the jugular veins, carotid arteries, and the nerves of speech, and with this intention he recommends us rather to make the incisions longitudinal than transverse. When the tumour is small a simple incision, he says, will be sufficient; but if large, the skin is to be cut in the form of a myrtle-leaf, and the lips of the incision being stretched with hooks, the skin is to be separated from the struma with the fingers and a scalpel; but the base of the tumour is to be cut with great caution. He does not, like our author, make any mention of the ligature. When there is a discharge of blood he recommends styptics. (xv, 5.)
Celsus says nothing of the treatment by a surgical operation, (v, 28.)
Haly Abbas, Avicenna, and most of the Arabian authorities approve of excision, and describe the operation in much the same terms as our author. Albucasis directs us when there is a large vein at the bottom of the tumour to apply a ligature round its root, and allow it to drop out by putrefaction. When the contents of the tumour are fluid, he recommends us to open it, and apply an ointment to consume the corrupted flesh; after which incarnants and detergents are to be used. When scrofulous tumours resist, the ordinary treatment, he directs us to burn them with a red-hot iron.