SECT. XIX.—ON RESTORATIVE OINTMENTS (ACOPA), LINIMENTS, CALEFACIENT PLASTERS (DROPACES), AND SINAPISMS.
The acopa are so named for having been first invented for the feeling of lassitude, as a tensive, ulcerative, and osseous lassitude; but they agree with many other complaints. Some, then, are calefacient, some emollient, and some stimulant. The calefacient are prepared from pepper, pellitory, the seed of rosemary, and the like. They agree with affections of the nerves, and strong frigidity which cannot be readily restored to heat. The emollient agree with induration, scirrhus, and infarction of the joints; and the materials of which they are formed have been pointed out by us when treating of plasters. The stimulant being composed of lemnestis, the seed of rosemary, euphorbium, the granum cnidium, and the like, are to be used in chronic affections, and such as are difficult to dislodge, namely, in such cases as sinapisms are applicable. The consistence of all the acopa is to be intermediate between the cerates and plasters. The liniments resemble the acopa, but have a more liquid consistence. The dropax has a two-fold composition, the one being like a plaster, and the other like a malagma. Some rub them into the part warm. Their materials are like those of the acopa and plasters. It serves the purpose of a cataplasm, agreeing with the same chronic affections in which sinapisms are applicable. A dropax (“calefacient plaster”) is applied before a sinapism, in order to prepare the body for the mustard; and after the sinapism, in order to remove the residue of the complaint. The sinapism is not composed of many ingredients, but is a most powerful application, agreeing particularly with chronic affections after all other remedies have been tried in vain. It is more especially applicable in cephalæa, hemicrania, epilepsy, vertigo, and mania, when applied to the head; and in asthma, orthopnœa, and chronic cough when applied to the chest; and in chronic catarrh, a sinapism may be applied both to the head and chest; and to the stomach and belly in chronic affections of them. It is a suitable remedy in all ischiatic and podagric cases, to any part which has lost its tone, or is in a cold state, and cannot easily be warmed. The limits of the action of the medicine are, when violent pain has been produced, and the flesh becomes more livid and swelled up, and so that after the bath it may become blistered in a mild manner. But if the sensibility has been lost, care must be taken lest the burning proceed too far without being perceived, and therefore the part is to be often uncovered and examined. Of acute diseases, lethargy, cataphora, and catochus admit of sinapisms, which, if at the commencement, are to be applied to the legs, but if the matter has fixed in the part, to the head. Those which are in a cold state and cannot be warmed but with difficulty, must have sinapisms applied to the legs and arms. Sinapisms are to be entirely proscribed when there is continued fever or an ulcer; also in affections of cartilaginous parts, and such as have no flesh. For the parts which are devoid of flesh are sometimes burnt black when sinapisms are applied to them.
The acopon called Bromion. Of wax, of Colophonian rosin, of common rosin, of each, lb. j; of hog’s lard, oz. iv; of butter, oz. vj; of marshmallows, of fenugreek, of linseed, of each, lb. ij; of oil, lb. j; of galbanum, oz. iiss. Having boiled the juice with the oil until the most of the juice be consumed, add the other things with wax and galbanum.
The complex acopon. Of the juice of marshmallows, of fenugreek, of linseed, of rue, and of cumin, of each, lb. ij; of stag’s marrow, lb. j; of old oil, lb. j; of the fat of geese, of opobalsam, or nard, of each, lb. j; of wax, of Colophonian rosin, of common rosin, of each, lb. iss; of euphorbium, of turpentine, of opoponax, of each, oz. vj; of castor, oz. iij; of the herbs from which the juice is formed, of each, lb. j, is to be taken and boiled like the former.
The acopon of Azanites. Of hog’s lard, lb. ij; of the fat of bulls, of rosin, of Colophonian rosin, of the medicine œsypum, of wax; of each, lb. j; of galbanum, oz. iij.
The acopon of Basilius. Of marshmallows, of chamomile, of melilot, of linseed, of fenugreek, of each, oz. iss; of amomum, oz. iij. These things are macerated in sext. viij of the wine of Ascalon or the Cilician for three days, and boiled to a milky consistence. Then lb. v of the juice, with lb. ivss of old oil are boiled until a moderate quantity of the juice remain; and then there are added to it of butter, oz. vj; of turpentine, oz. iv; of the fat of geese, oz. xv; of stag’s marrow, triturated with a little oil, oz. v; of white wax, lb. iij.
The acopon Lysiponium. Of pepper, of castor, of storax, of mastich, of aloes, of elecampane, of iris, of each, oz. iv; of euphorbium, of costus, of ammoniac perfume, of myrrh, of marjoram (sampsuchum), of frankincense, of cyperus, of cassia fistula, of the seed of rosemary, of each, oz. iij; of adarce, of amomum, of bdellium, of xylobalsam, of each, oz. ij; of Indian leaf, of spikenard, of pellitory, of saffron, of each, oz. j; of opobalsam, lb. j; of the ointment of nard, of the ointment of privet, of gleucinum, of each, lb. ij; of wax, lb. j.
A fetid acopon from Galen’s work, secundum genera. Of wax, of turpentine, of each, dr. xxiv; of galbanum, of ammoniac perfume, of each, dr. vj; of old oil, hemin. ij; of stag’s marrow, dr. viij. Use both undiluted and diluted.
Another fetid acopon. Of turpentine, dr. lvj; of wax, dr. xxviij; of œsypum, of honey, of each, dr. vj; of stag’s marrow, dr. vj; of ammoniac perfume, of galbanum, of aphronitrum, of bay berries, of each, dr. vj; of old oil, sext. j; of wine, cyath, ij. Some add also of castor, dr. iij.
The barbaric acopon from euphorbium, for ischiatic diseases, and many other purposes. Of opoponax, oz. j; of Tuscan wax, lb. j; of turpentine, lb. iiss; of galbanum, oz. j; of ammoniac perfume, oz. ij; of euphorbium, of castor, of white pepper, of each, oz. ij; of stag’s marrow, oz. iv; of œsypum, oz. iv; of lemnestis, (a saline concretion), it is the same as adarce, oz. ss; of the oils of storax, of bay, of iris, and of sweet marjoram, of each, oz vj; of old oil, lb. ij; of hedychroum, oz. vj.
The acopon called Pyxis. Of Colophonian rosin, lb. iss; of turpentine, oz. viij; of ammoniac perfume, oz. iij; of frankincense, oz. ix; of old oil, lb. ij; of the juice of linseed, lb. j; of cow’s milk, lb. j; of the fat of geese, oz. vj; of butter, oz. viij; the whites of xxiv eggs. Having prepared it, lay it up in a vessel of box wood.
The acopon from the fir, of Galen. Of the ripe seed of the fir tree, j Italian modius, i. e. sext. xvj; of oil, lb. xv; of wax, lb. iv; of rosin, of pine-nut, or of turpentine, of each, oz. iv. Having bruised the seed of the fir, add it to the oil, and allowing it to remain forty days, filtrate and throw away; and having mixed the other things, use for spontaneous lassitude, paralysis, and coldness of the joints. But if the necessity for using it be urgent, we must boil the seed of the fir with the oil, mixing with them, sext. iv of water, to prevent them from being burnt. They are used in podagric and arthritic affections.
The same otherwise. Of oil, hemin. xxv, i. e. sext. xiiss; of the fruit of the fir, mod. j, i. e. sext. xvj; of the rosin of ash, lb. iij; of the rosin of pine-nut or of turpentine, lb. iij; of wax, lb. j.
The acopon from the black poplar, for the same affections. Instead of the fruit of the fir, adding an equal quantity of the fruit of the black poplar, prepare the other things in like manner.
The liniment of Zosimus, celebrated for tremblings. Of pine rosin, oz. xvj; of wax, oz. iv; of old oil, lb. j; of opoponax, oz. ij; of adarce, oz. j; of euphorbium, oz. j; of natron, oz. iv; of tender aphronitrum, oz. iv. Triturate the natron, euphorbium, and adarce with wine, then add the opoponax, and triturate together. Melt the soluble substances separately with alkanet, that they may acquire colour, and having cooled, mix.
The dropax, or calefacient plaster Gallus. Of Oribasius. Of the Colophonian rosin which is redolent of frankincense, of pine rosin, and of that which is called the woody, being found only in Italy, of the pitch of ships, of dried pitch, of each, lb. iv; of wax. lb. iv; of roasted rosin, oz. xv; of Brutian pitch, lb. ij; of natron, lb. j; of bitumen, of galbanum, of adarce, of pellitory, of each, oz. vj; of opoponax, of euphorbium, of white hellebore, of pepper, of each, oz. iv; of sulphur vivum, oz. iij; of castor, of ammoniac, of the wild grape dried, of each, oz. ij; of Sicyonian oil, lb. j; of opobalsam, oz. vj.
Otherwise, a simple dropax. Of wax, lb. j; of dried pitch, lb. iss; of Brutian pitch, lb. j; of pine pitch, lb. iss; of roasted rosin, lb. j, oz. iij. Having first prepared the part with natron, apply.
The preparation of a sinapism. On the preceding day, dried figs are to be macerated in tepid water, and next day they are to be properly filtrated and strongly pounded. Then some acrid mustard, such as the Syriac and Egyptian, is to be triturated separately, pouring on it a little of the infusion, and mixing and forming into a mass; if we wish to form a strong sinapism, joining two parts of mustard to one of dried figs, but if weak, in the inverse proportion; and if a moderate one, mixing equal parts. If the mustard before it is triturated, be allowed to macerate in vinegar, as some do, it becomes weaker. After the mustard has been cleared away, and the bath used, if the pain continue violent, or if redness and blisters supervene, we are to wet a cloth in the juice of mallows, or of fenugreek, with oil of roses, and apply. Then we may use the rose cerate with ceruse. But in cases of paralysis, when the sensibility is impaired, care must be taken, and the part frequently uncovered and examined, for often they are burnt immoderately without being sensible of it. And goat’s dung, applied with vinegar, is more efficacious than mustard, especially in diseases of the hip-joint.
The liniment from writing-ink acting as a rubefacient, especially in cases of hemicrania. From the works of Alexander. Of euphorbium, of writing-ink, of each, dr. iv; of troglodytic myrrh, of crocomagma, of white pepper, of each, oz. iij; of saffron, dr. ij; of vinegar, q. s., so that these things may be properly triturated, and become of the consistence of the sordes in baths; and then anoint with it, beginning from the middle of the eyebrow to the whole temple, especially if it be bare of hairs; and after it cools, anoint again, and when the remedy acts properly, let the man be put into a bath.
Commentary. Le Clerc says of the Acopa: “On les appelloit acopa comme qui diroit, Unguens qui ôtent les douleurs, ou la lassitude, parcequ’on s’en servoit principalement pour le délasser, ou pour apaiser les douleurs qu’on sent après le travail et la fatigue.” (Hist. de la Méd.) Galen explains that although this class of ointments derived their name from their being originally used as soothing applications to parts which were pained from severe exertion, they came afterwards to be applied for various other purposes, as for removing all deep-seated pains, indurations, contractions, and the like. Their consistence, he says, is nearly the same as that of the liquid cerates or the ointments made from wax and oil. According to their qualities, he adds, they have the epithets of emollient, calefacient, anodyne, relaxant, or alterative, applied to them. He describes, in prose and verse, the composition of an almost countless variety of these preparations. (De med. sec. gen. vii.) Celsus says of the acopa: “Acopa quoque utilia nervis sunt.” He gives formulæ only for two acopa, which consist of aromatic and stimulant medicines mixed with oil or some fragrant ointment. (v, 25.) Oribasius divides them into three kinds, the emollient, the calefacient, and the scarifacient; the last being a near approach to sinapisms. On the acopa see further Scribonius and Actuarius.
The liniments of the ancients seem to have been very much the same as those of the moderns. Celsus says of them: “Ἔγχριστα autem Græci vocant liquida qui illinuntur.” (v, 243.) In consistence and qualities they nearly resembled the acopa, being composed of a large proportion of oil with a small quantity of wax or honey. Myrepsus gives prescriptions for a considerable number of them.
The dropax is thus described by Le Clerc: “On étendoit une certaine quantité de cette emplâtre sur la toile, ou la peau; on appliquoit cela sur quelque partie du corps, on le levoit, ou on l’arrachoit, et on l’appliquoit derechef, reitérant souvent la même chose, pour faire rougir la partie, dans le dessein d’attirer en dehors les humeurs, ou les sucs qui servent à la nourriture des parties, ou dans la vue d’ouvrir les pores. Pour rendre cette emplâtre plus efficace on y ajoutoit quelquefois des poudres acres, comme du pyréthre, du poivre, du sel, du soufre. On emploit aussi le dropax pour faire tomber, ou pour arracher le poil de quelque partie.” (Hist. de la Méd.) Hesychius appears to have confounded the dropax with the psilothron or depilatory. The former was merely a sort of calefacient plaster, and was applied to parts not covered with hairs. Oribasius says of it that it is prepared like the malagma. When it is desired to make it calefacient, he directs us to add to it pellitory, the seed of rosemary, and bitumen; when desiccative, the sulphur vivum, salts, and the ashes of vegetables; and when it is wished to make it of such a nature as to scarify the parts, he directs us to add to it limnesium (adarce) and spurge. The part to which it is to be applied, he says, if weak, should be shaven, but in the more robust, and when a stronger application is required, it need not be shaven, unless it is to be applied to the head, chin, or pubes. Myrepsus commends the following dropax: “Take of bitumen, oz. ij; of wax, oz. j, sext. j; of dried pitch, dr. j; of pine-rosin, of natron, of each, oz. j; of sulphur vivum, of pellitory, of white hellebore, of adarce, of each, sext. j; of stavesacre, of spurge, of each, dr. ⅛; of oil, q. s.” Certain forms of the dropax seem to have been allied to the blistering plasters of the moderns. On this subject we cannot do better than copy the remarks of Dr. Clinch, in his Preface to Ruffus Ephesius: “Quantum usus cantharidum, ex quibus hodierna vesicantia ubique fere componuntur, veteribus innotuit, vir Doctissimus Johannes Freind luculenter satis explicuit. Nequeo autem hic silentio transire, quam graviter erratum sit a Georgio Baglivi, qui Oribasii meminit, utpote primi ex Arabibus, qui de usu vesicantium scripsit, quum eundem et Græcum fuisse, et Græcorum idiomate scripsisse, nemo non noverit. Is profecto aliquid suggerit de eo vesicantium genere, quæ dropaces et sinapismi dicuntur, qui ex sinapi, pipere, pyrethro et ejusmodi acribus medicamentis conficiebantur, et semel quidem cantharidum mentionem facit, neutiquam vero, quod scio, de his loquitur tanquam de medicina, quâ ad vesicas in cute excitandas utebantur. Ætius quidem dropacis formam exhibuit, quæ tres cantharidum drachmas recipit, unde dropax exulcerans vulgo audit.”
Oribasius gives, from Antyllus, a most interesting and judicious account of the sinapism. He says that it does not suit with acute diseases, or, at least, only when the patient is of an inert constitution, and the sensibility is obtuse. It is applicable, however, he says, in almost all chronic diseases when other remedies have failed, except in the case of an ulcer in the lungs or liver, or when the disease is seated in a cartilaginous part. He recommends it in all cases of diminished sensibility. The only acute diseases in which he represents it as applicable are lethargy, catochus, carus, or fevers attended with loss of heat and diminished sensibility. Like our author, he directs us to prepare the sinapism with dried figs and mustard. Aëtius, upon the authority of Archigenes, details its medicinal properties in nearly the same terms. Both Aëtius and Oribasius represent goat’s dung, pounded with vinegar, as being equally efficacious as the sinapism, and applying particularly to ischiatic diseases. Myrepsus’s account agrees exactly with that of our author. He mentions that some macerate the figs in vinegar instead of water, but says that it renders the preparation weaker. The Arabians prepared the sinapism exactly as the Greeks, and applied it in similar cases. See Mesue (De Unguentis, i.)