Preternatural fingers are formed in the hand sometimes near the thumbs, and sometimes near the little finger, but rarely beside any of the others. Of preternatural fingers, some are wholly fleshy, and others have bones in them, and sometimes they have likewise nails. Of those having bones, some derive their origin from a joint, having a common articulation with some other finger; and some arise from the phalanx, and these have no motion. The others sometimes have motion. Now the excision of those which are fleshy is easy, for we cut with a scalpel the preternatural finger all through. But on those which have their origin from a joint the attempt is more difficult. Of those which arise from the phalanx we must first cut away the flesh all around to the bone, and as to the bone itself we either chop it through with a chisel, or remove it by sawing; and in the treatment we scrape and cicatrize them as mentioned by us with regard to the wounds of bones.
Commentary. Galen (de Diff. Morb. 4,) and Avicenna (Cant. i, 2,) allude to the preternatural growth of fingers.
Haly Abbas describes the operation in the same terms as our author. (Pract. ix, 39.) Rhases repeats our author’s description of the method of treatment, and also mentions that of Antyllus, which, however, is little or nothing different from our author’s. Thus, he directs us first to make an incision of the soft parts down to the bone, which is to be sawn across; the skin is then to be united, and the part treated with agglutinants. When the supernumerary finger grows from a joint he directs us to make the separation cautiously; and if it grows between two fingers, or contains a bone, he forbids it to be amputated. (Cont. xxiv.)
Albucasis’s account of preternatural fingers is evidently taken from our author. (Chirurg. ii, 91.) When there is a preternatural adhesion of two fingers to one another, he directs us to divide it with a scalpel, and introduce a pledget wetted in the oil of roses, or a thin plate of lead between them, until the parts heal. (Ibid.)
SECT. XLIV.—ON THE OPERATION OF BURNING FOR EMPYEMA.
The most effectual remedy which has been discovered for empyema is burning. Wherefore, the parts are to be burnt by applying the root of the long birthwort soaked in oil, so as to form eschars, one of which we must make between the junction of the clavicles, having stretched the skin upwards; and two small ones a little distance from the chin and remote from the carotids; two of considerable size below the mammæ, between the third and fourth ribs; two others between the fifth and sixth, inclining a little backwards; another at the middle of the sternum, and another above the mouth of the stomach, and three behind, one at the middle of the back, and two on each side of the spine, higher up than the eschar in the back, and not very superficial. Others, as Leonidas says, having passed a knobbed cautery, heated in the fire, through the interstice between the ribs to the abscess, have carried the burning down to the pus. Some have dared to operate upon them by making a transverse incision, or one a little obliquely in the skin, between the fifth and sixth ribs, then perforating with a knife the membrane lining the ribs, and thus evacuating the pus; but they and those who burn with iron to a considerable depth either occasion immediate death, the vital spirit being evacuated with the pus, or occasion incurable fistulæ.
Commentary. Galen mentions the operation of burning the chest for phthisis. (De Morb. Vulg.)
In phthisical complaints, which do not yield to ordinary treatment, Celsus recommends the cautery to be applied in this manner: One eschar is to be burnt with a red-hot iron under the chin, another on the throat, two upon each breast, and two under the scapulæ. They are to be kept open until the cough is removed. (iii, 22.)
Aëtius directs us to burn the chest and neck much in the same manner as recommended by our author. (viii, 73.)
This operation is described by Albucasis, who gives a drawing of an instrument for performing it expeditiously. (Chirurg. i, 26.) See also Rhases (Cont. ix.)