SECT. XLIX.—ON THE SPLEEN.
The use of the spleen being to attract from the liver the melancholic humour, which is, as it were, the lees of the blood, if its attractive power be weakened, or the passage obstructed by which this was formerly attracted, the black jaundice is formed, blood in an unpurified state being distributed over the whole body; and if there be weight and distension about the spleen, or if there be also pain, obstruction is indicated; but if there be none of these, it is weakness of the attractive power. But vomiting of black bile taking place without fever, or any other symptom of malignity, indicates a weakness of the retentive faculty of the spleen. A weakness of the expulsive faculty will bring on anorexia, the melancholic superfluity being no longer carried to the orifice of the stomach and exciting the appetite. When the melancholic humour is infarcted in the spleen, in the first place inflammation of it occurs, indicated by heat, pain, and tightness, but afterwards it passes into scirrhus, the heat and pain having ceased, while the swelling and hardness remain. Persons thus affected have fetor of the mouth, their gums are corroded, and ulcers in their legs are difficult to heal. When the liver sympathises, dropsy takes place, as formerly mentioned; wherefore intemperaments of it are to be cured like those of the liver. But when inflammation is present, we must bleed from the left arm at the elbow, or at the extremity of the hand, in order that revulsion may take place from as great a distance as possible, and also because of some natural alliance between these parts. Then we are to apply a cataplasm of attenuants which are not manifestly caleficient, intermixing some of the astringents with them. Such is that natural substance called the flower of salt. And this is an admirable cataplasm: Of fenugreek, oz. iv; of barley-flour, of cresses, of each, oz. j; of fat figs, lb. j; of the herb vervain dried, oz. j; macerate the figs in the most acrid vinegar, and boil with the other things already bruised together, and then boil again; or apply goat’s dung boiled with raw barley-meal in oxycrate; and, if you choose, it may receive also some flower of salt. But having first used a fomentation of oil of privet with a little vinegar, use the emollient ointments; and first the more simple, such as this: Of wax, lb. iss; of the fat of bulls, lb. j; of nitre, oz. iij; of turpentine, of the fruit of the chaste-tree, of the bark of the root of capers, of each, oz. v; having boiled the soluble ingredients, sprinkle the powders above. And the malagma of Nileus is an excellent one. If the inflammation is converted into scirrhus, we must use the most powerful applications so as to stimulate the skin, such as the one from goats’ dung, and that from citrons, also that of Macherion, the barber’s, the one from bay-berries, and that from willows. This one I have found to answer upon trial: Of arsenic, oz. ij; of sandarach, oz. ij; of wax, of turpentine, of each, lib. j; of dry pitch, lb. j; of galbanum, oz. j; of opopanax, oz. j; of the bark of the root of capers, of nut ben, of each, oz. iv; of ammoniac perfume, scr. vj; of the oil of nard, and of privet, oz. v. And ammoniac, when rubbed over the spleen with vinegar, is often of great use, and also, when drunk to the amount of three or four scr. with one scr. of castor, while sitting in the hip-bath, having previously chewed dried figs and spit them out. Or of ammoniac, p. j; of castor, p. j; give one drachm of these things, and it will be of great service for scirrhus; and, in like manner, the bark of capers, triturated with vinegar and applied. The same, when drunk with vinegar or oxymel, evacuates thick and viscid humours, and sometimes blood. And the bark of the willow is rubbed in similarly. And the ashes of the brazier’s shop, when applied with raw barley-meal in oxymel, is of use; and the juice of centaury, when applied externally, and when taken in a draught; and the decoction of bitter lupines, when drunk with rue and pepper; and its flour, when applied as a poultice; and the water in which heated iron has been often extinguished, when given to the amount of three cyathi to such as have fever; and to such as are free from fever, to the amount of one cyathus with wine and vinegar; or the root of the wild dock with squills, to the amount of three oboli; or of wall germander, and of wild thyme, an acetabulum; all these may be given with oxymel; or, give two oboli of the juice of the pimpernel having a blue flower (anagallis cærulea?) with oxycrate; or vinegar of squills, or oxymel. These are compound medicines: Of the root of panacea, of ammoniac perfume, of the rind of the root of capers, of fuller’s herb, of the inner part of baked squills, equal parts; give one drachm. It is also of use in asthmatic and dropsical cases.—Another: Of the fruit of tamarisk, dr. iv; of pepper, dr. iv; of spikenard, dr. ij; of ammoniac perfume, dr. ij; triturate with vinegar of squills, and give one drachm in oxymel.
For scirrhus of the spleen. Of sow-bread, dr. xx; of bryony, dr. iij; of dittany, dr. ij; of baked squills, dr. viij; of fuller’s herb, dr. vj; of the root of capers, dr. vj. Give a trochisk to the amount of three oboli in oxymel. And the trochisk from heath is also applicable. The food should be attenuant, acrid, and dry; little drink should be taken; but exercise, friction, and sinapisms should be had recourse to, and sometimes cupping with scarifications.
Commentary. Hippocrates describes several diseases of the spleen in his work, ‘de Internis Affectionibus.’ He states that in scirrhus the spleen is sometimes larger and sometimes smaller than natural. It is an affection which continues long, but is not fatal. Sometimes, he says, it terminates in dropsy, and sometimes in suppuration, when he approves of burning the side. He also recommends diuretics and purging with hellebore. The description which he gives of the symptoms of enlarged spleen, in his work ‘On Airs, &c.,’ is very curious. Dr. Coray considers that it applies to scurvy. (See Notes, &c. 29.)
Aretæus remarks correctly that the spleen is very subject to scirrhus, but little so to suppuration. Scirrhus, he says, is removed with difficulty.
For scirrhous enlargement of the spleen, Celsus recommends unction, friction, and sudorifics. He forbids all sweet things, milk and cheese. He approves of pickled and salted things, acids, the vinegar of squills, a decoction of wormwood, and water in which a red-hot iron has been extinguished. Emollient ointments are to be applied externally.
Cælius Aurelianus says that some had directed the spleen to be cut out when it is much diseased, but he holds the proposal as mere words of course, and believes that the operation had never been performed.
Octavius Horatianus recommends as general remedies for complaints of the spleen, bleeding, purging, and fomentations with wool soaked in equal parts of oil and vinegar. When it becomes indurated he approves of vinegar of squills, friction, gestation, dropaces, salt baths, &c.
Most of our author’s remedies are taken from Galen, who treats fully and scientifically of diseases of the spleen. He states, as a general principle of treatment, that the proper medicines in cases of indurated spleen are such as are of an incisive and attenuant nature. He, therefore, approves of the mixture of bitter with austere things.