The treatment of abscesses is fully explained by Galen. (Therap. ad Glauc. ii.) He directs us, when an abscess is slow of ripening, to make superficial scarifications in it, and afterwards to apply a cataplasm of barley-meal.
Aëtius’s directions are, upon the whole, similar to our author’s, but not quite so minute and precise. Like our author, he directs us to make the incision long and narrow, like a myrtle-leaf. The ancients were well aware that circular sores are slow of healing; and the causes of this fact are fully explained by Cassius and Alexander Aphrodisiensis.
Little additional information is to be obtained from the other authorities. Albucasis directs us, when the abscess is large, not to evacuate all its contents at once, lest it produce dangerous prostration, especially if the patient be weak; for, he remarks, the animal spirits will escape along with the pus. Like our author, he forbids us to open abscesses until they are ripe, unless seated near the anus, or some vital part. (Chirurg. ii, 40.)
Haly Abbas justly remarks that if an abscess be opened prematurely, the lips of it remain in an indurated state, and prevent the sore from healing. But when seated near nerves or ligaments, he advises not to wait until it is ripe. His treatment upon the whole does not differ from our author’s. (Pract. ix, 8.)
The method of opening abscesses, by means of caustic applications, is described in the [Fourth Book, 18].
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.)