For myopia. Those persons are called myopes, or near-sighted, who, from their births, see near objects, but not those at a distance. Such a state is wholly incurable, being occasioned by a weakness of the optic spirit. Old men are affected in the opposite manner to these, for they do not perceive near objects, but see those at a distance.
Commentary. See Hippocrates (Aphoris., de Visu, et alibi); Galen (de Loc. Aff. iv, de Med. Sec. Loc. iv); Aëtius (vii); Alexander (ii); Oribasius (Synops. viii); Actuarius (Meth. Med. iv, 11); Leo (iii); Psellus (Opus Medicum); Palladius (Comment. in Hippocrat. Epidem.); Scribonius Largus; Octavius Horatianus (i, 10); Nonnus (Epit. 45); Serapion (ii); Avicenna (iii, 3, 1, 2); Mesue (de Ægrit. Ocul.); Avenzoar (i, 7); Haly Abbas (Theor. ix, 13, Pract. v, 34); Alsaharavius (Pract. iv); Rhases (Divis., ad Mansor. ix, and Contin. ii); Canamusali (de Oculis, vi); Jesu Haly (Tract. de Oculis.)
On pain, disorder of the eye, ophthalmy, inflammation, and defluxion. The ancients treat of these complaints separately; but, as they are so nearly connected, we shall class them together. By disorder of the eye (taraxis), they meant an inferior degree of ophthalmy, as is remarked by Turnebus. (Bernard’s Nonnus, 45.) It is, therefore, the mild acute ophthalmy of Scarpa. The remedies enumerated by Hippocrates for pains of the eyes are thus given in the language of Celsus: “Sanguinis detractio, medicamentum, balneum, vinum.” Drinking wine might appear to us at first sight not a very likely mode of curing ophthalmies; and yet Galen, in his Commentary on this Aphorism (vi, 31), has related a case in which it effected a cure after every other remedy had failed. Even Scarpa allows the correctness of the aphorism as a rule of practice, and states that wine and the cold bath are proper when the disease is kept up by excessive irritability. Alexander recommends wine and the tepid bath when the inflammation arises from thick and pituitous blood. Philagrius, as quoted by Theophilus in his ‘Scholia on Hippocrates,’ indicates that the wine should be white, sweet, new, and if the patient’s head be delicate, diluted with water. (See further, t. ii, 501, ed. Dietz.) Mesue makes many interesting remarks upon the above-mentioned remedies of Hippocrates. For further explanation of the rationale of this practice, see Schelhammer (de Tumoribus), and Littré (Hippocrat. t. iv, 418.) Another of Hippocrates’ aphorisms is, that a spontaneous diarrhœa is a favorable occurrence in ophthalmy; upon which Galen remarks, that, in imitation of nature’s method of removing the complaint, physicians are in the practice of producing an artificial looseness by means of cathartics and clysters. Lead is an ingredient in several of Alexander’s collyria. For periodical ophthalmy, Hippocrates recommends purging the head and bowels; and in certain cases bleeding, cupping, and restricted diet. Celsus, Galen, and, in short, most of the ancient authorities make mention of narcotics, such as opium and mandragora, but do not approve of them as common remedies. Galen, however, instances ophthalmy as one of the species of inflammation in which opium is admissible. (De Optima Secta, 9.) Alexander, in like manner, cautions against the indiscriminate use of opium to lull the pain. Some of his prescriptions for collyria, however, contain opium. Galen recommends scarifications in chronic defluxions of the eye. Aëtius lays down very proper rules respecting purging, fomentations, venesection, and baths. He properly remarks regarding the use of wine, that it is only applicable when the patient is of a dry and cold intemperament. Celsus is a decided advocate for fomentations with hot water in all cases of ophthalmy.
The Arabians treat ophthalmy upon the same principles as the Greeks, without supplying much additional information. Mesue, like our author, recommends bleeding by opening the temporal artery, which operation he describes minutely. When the bleeding cannot be stopped otherwise, he directs us to secure the vessel with a silk thread. He also makes mention of leeching and the actual cautery. He is very minute in his directions about his collyria. One of his anodyne collyria consists of the juice of hyoscyamus, mandragora, and opium; and another contains camphor, saffron, hyoscyamus, and the like. The use of narcotics, however, is forbid by Jesu Haly. Rhases also rather disapproves of them. Avicenna makes mention of bleeding by the temporal arteries, the angular vein of the nose, and the frontal. When the usual remedies do not succeed, he approves of the cautery; and, in certain cases, recommends strongly the use of stimulant applications, such as æs ustum, copperas, and arsenic. Galen, in like manner, makes mention of arsenic, and also of misy, sori, and chalcitis (substances resembling our sulphate of copper) among his remedies for diseases of the eye. Having ourselves had occasion to use arsenic in certain malignant diseases of the eyelids, and not having found that it produced any serious disorder in the ball of the eye, we would call the attention of modern oculists to this medicine as one from which, when properly managed, the best results may be expected. When the ophthalmy is of a cold nature, Avicenna approves of treating it by an attenuant diet, the bath, and white wine. In certain cases he directs us to pour cold water on the head. Haly Abbas describes three varieties of ophthalmy. The first arises from manifest causes, such as the sun, dust, and the like; and is to be cured by bleeding, purging, and cooling lotions, containing rose-oil, camphor, &c. In the second, the symptoms are more severe, being attended with greater redness and pain. It also is to be cured by bleeding, cupping, and emollient collyria. The third variety is chemosis. Alsaharavius treats of the disease at great length. When it is connected with a bilious cause, he directs us to purge, use the bath, apply vapours to the eye, and soothing collyria. Serapion, like Haly, describes three varieties of the disease by the names of tarkinisis, noutelinie, and kermufil. Jesu Haly recommends general bleeding, purging, and fomentations, with the decoctions of fenugreek and fennel, for ophthalmy. It remains to be mentioned that Galen, Alexander Aphrodisiensis, and all the Arabian authorities have placed ophthalmy in the list of contagious diseases. See, in particular, Alex. Aph. (Prob. i, 35), and our brief sketch of the history of ancient opinions on contagion in the [Second Book, Sect. XXXVI]. The celebrated Fracastorius confidently maintains that ophthalmy is contagious. (De Morb. Contag.) And we may further mention that all the authorities of the middle ages speak of ophthalmy as being contagious.
On chemosis. By chemosis, modern oculists (as, for example, Scarpa) understand that state of ophthalmy when blood, owing to a rupture of one or more vessels, is effused into the cellular membrane which connects the conjunctiva to the anterior hemisphere of the eye. Our author’s account is mostly taken from Oribasius, who, in his turn, borrows from Demosthenes. Galen and Octavius Horatianus, without saying anything of the general treatment, merely recommend us to apply upon a clean linen cloth flies pounded with the yelk of an egg. Chemosis is Haly’s third variety of ophthalmy, for which he recommends copious and repeated bleeding, cupping, gentle laxatives, cataplasms containing poppies when the pain is violent, and other soothing collyria. Alsaharavius, in like manner, recommends depletion and emollient fomentations. Serapion, among other things, mentions soothing fomentations. In chemosis, according to Rhases, all the symptoms of ophthalmy are particularly strong and violent; the eyelids being swelled and everted, and the white of the eye appearing black. He recommends local and general bleeding, purging, and astringent applications.
On hyposphagma and emphysema. Hyposphagma is not described by any particular name in modern surgical works. Besides the local applications mentioned by our author, Aëtius properly recommends general treatment, we mean bleeding, purging, and the like. Avicenna also makes mention of venesection and arteriotomy. Haly describes the disease by the name of tumor oculi as his first variety of inflatio. Alsaharavius uses the same term. Serapion treats of it by the name of sanguis divisus in oculo, recommending treatment similar to our author’s. See also Celsus (vi, 6.)
The emphysema appears to have been a sort of œdema seated below the eyelid. Aëtius remarks that it occurs principally in old men. We have often seen it in them. He recommends fomentations by means of a sponge, rubbing the eyelid within with honey, pouring hot water on the head, using baths, drinking wine, and even bleeding at the arm. This last measure is omitted by our author, and must be unnecessary in general. It is described by Haly Abbas as his second variety of inflatio oculi. He says it is an œdematous swelling principally affecting old men in summer. He recommends collyria of a sharp penetrating nature, and various other applications.
On psorophthalmia, sclerophthalmia, and xerophthalmia. For these affections Aëtius gives various prescriptions containing calamine, burnt copper, chalcitis, and the like. Similar ones may be found in Galen (sec. loc.) Galen, like our author, recommends fomentations, by means of a sponge, with hot water or the decoction of poppies. One of Alexander’s prescriptions for psorophthalmia contains arsenic. Celsus describes the symptoms and treatment of xerophthalmia very minutely: “Neque tument, neque fluunt oculi, sed rubent tantum, et cum dolore quodam graves sunt, et noctu præ gravi pituita inhærescunt.” He gives the sum of his treatment in this short sentence: “In hoc vitio multum ambulare, multum exerceri, lavari sæpe, ibique desudare, multâque frictione uti necessarium est.” He also prescribes gargles, food of a middle quality, and various compound collyria, such as the rhinion which contained burnt copper, myrrh, Phrygian stone, &c. This affection, the dry ophthalmy, had been described by Hippocrates (Aph. iii, 12, 14.) Most probably, as Sichel suggests, it was the same as the catarrhal ophthalmy. See Littré (Hippocrat. t. iv, 418.) Celsus recommends this collyrium also for the psorophthalmia, which he describes by the name of scabri oculi. For this last-mentioned affection he recommends various stimulant applications; and, when other remedies are not at hand, directs us to apply bread pounded in wine. The psorophthalmia is the prurigo oculi of Haly Abbas, for which, among other things, he recommends a composition containing pepper, sal ammoniac, saffron, spikenard, camphor, &c. He describes sclerophthalmia by the name of durities oculi, and recommends for it bleeding, gentle purgatives, emollient collyria, &c.
On ectropion. Aëtius, in like manner, recommends compositions containing ærugo æris, misy, and chalcitis. None of the subsequent authorities supply any additional information. Alsaharavius in particular gives a very accurate account of the disease, which, when it arises from a fungous excrescence growing from the inner side of the eyelid, he directs us to burn with caustics; but, when it arises from a cicatrix, it is to be cured only by a surgical operation. This will be found described in the [Sixth Book]. In place of the caustics recommended by the ancients, Scarpa directs the argentum nitratum to be applied.
On ægilops and anchilops. These are different stages of the disease now known by the name of fistula lachrymalis. Galen states that at the commencement it is to be cured by applications which are repellent without being too stimulant. He gives a full account of the treatment recommended by Archigenes. The first application mentioned by him is a cataplasm consisting of tares and honey. Scarpa, by the way, speaks favorably of the practice of Ægineta, Aëtius, and Avicenna. Avicenna treats of the disease with great judgment. His first applications appear to have been intended to produce resolution; and, if these fail, suppuratives are to be applied. When the abscess bursts, the sore is to be reduced to a healthy state by escharotic powders containing alum, limatura æris, sal ammoniac, and the like. When these fail, a surgical operation must be had recourse to. This is described in the [Sixth Book]. Mesue also has treated of the disease at great length. Haly Abbas describes the disease very correctly. He says, “Aliquando autem ejus sanies ad nares defluit per foramen quod inter oculum est et nasum.” This passage puts it beyond a doubt that the ancients were acquainted with the lachrymal duct. The disease, he says, sometimes occasions caries of the cartilages (os unguis?). When it is recent, he recommends bleeding and laxatives; and when it gets into a fistulous state, he directs us to use applications containing arsenic, sal ammoniac, cantharides, alum, &c. Alsaharavius mentions that the abscess of the lachrymal sack may either burst outwards or into the nose. It would appear, therefore, that he also was acquainted with the natural structure of these parts. One of the applications recommended by Rhases for fistula lachrymalis contains arsenic, quicklime, and vitriol. Another is prepared from litharge, arsenic, and oil. These applications are mentioned by the earlier of the modern authorities on medicine. See Theodoricus (iii, 2.)