Having stretched the skin which lies over the spleen with hooks, we burn it through by one application of a long ignited cautery so as to form two eschars; and this we do three times so that there may be six eschars formed altogether. But Marcellus by using a trident or trident-shaped cautery formed six eschars at one application.
Commentary. In cases of diseased spleen the Coan surgeons burned eschars on the side affected. (Hippocr. de Affect. intern. and de Affect. 5.)
Aëtius directs us to burn the eschar either with the actual cautery or with caustics. (x, 12.) The ancients used an issue paste, very like the modern, prepared from potass. See above ([s. 9.])
Avicenna recommends the same practice as the Greeks (iii, 15, 1); and so in like manner Haly Abbas (Pract. ix, 76); Albucasis (Chirurg. i, 32); and Rhases (Contin. xx.)
Guido de Cauliaco repeats Albucasis’s description of the process of burning the side in cases of scirrhous spleen. (ii, 2.)
SECT. XLIX.—ON BURNING OVER THE STOMACH.
In chronic defluxions of the stomach the moderns have recourse to burning,—some with knobbed cauteries, forming three eschars, one at the ensiform cartilage, and the other two below, so as to make a triangle, the depth of the burning being the thickness of the skin. Some form only one large eschar at the mouth of the stomach. But others do not burn with iron but with the substances called iscæ. The iscæ are spongy bodies forming on oaks and walnuts, being mostly in use with the barbarians. They allow the ulcers to remain for some time without cicatrizing, and rather stimulate them in order that by the great diaphoresis thereby occasioned, the mouth of the stomach may be freed from the defluxions.
Commentary. Hippocrates, Galen, and Celsus say nothing about burning over the stomach in affections of it. Aëtius’s account is similar to our author’s. He calls the iscæ the medullary part of the wood of walnuts. (vii, 91.) They are mentioned likewise by Haly Abbas, who says they are called ducanum in the Persian language. (Pract. ix, 77.) Albucasis directs us to burn with iron. (Chirurg. i, 28.)
SECT. L.—ON DROPSIES.
The formation of dropsical swellings, their varieties and causes, how they are to be distinguished from one another, and their treatment by medicine, having been explained in the [Third Book], and it having been there shown that ascites alone falls under the province of surgery, we are now going to give an account of it. Wherefore we must make the patient stand erect; or if that cannot be done, we must cause him to be seated; or if he be so weak that this cannot be done, we must abandon the operation entirely. If then the man be standing erect we give orders to the assistants standing behind to press with their hands and push downwards the swelling to the pubes. Then taking a sharp-pointed knife or lancet, if the dropsy is among the intestines, in the perpendicular line of the navel, and about three fingers’ breadth distance from it we divide the hypogastrium as far as the peritoneum. But if the liver be primarily affected we must make our incision on the left side of the navel; or if the spleen, on the right, for we must not make an incision in that part on which the patient is disposed to lie. And having dissected with the point of the instrument the skin that lies over it, we divide the peritoneum a little above the first incision until the instrument comes to an empty space. After this we introduce through the incision of the abdomen and peritoneum a copper tube, having an opening like those of writing-pens, and by this we must abstract the fluid in proportion to the strength; feeling the pulse, and then removing the tube, we stop the flow of the fluid, (for it will stop immediately from the alteration of the incision,) and, for the sake of security, we introduce a twisted tent into the incision of the abdominal parietes alone; and having placed the man in a recumbent posture and recruited him, we may next day again evacuate through the tube a small quantity of fluid proportionate to his strength; and thus, in like manner, until very little be left, avoiding, by all means, a sudden evacuation. For some ignorant persons having evacuated the vital spirit with the fluid have immediately killed the patient. Some for the sake of greater security having evacuated a small quantity of the fluid by the operation so as to relieve the powers of the system from its great load, procure the discharge of the remainder by hydragogue medicines, by burying the patient in heated sand, by insolation, abstinence from liquids, giving desiccative food; and they have recourse likewise to burning over the stomach, liver, spleen, and hypogastrium; and make five eschars about the navel, some by slender cauteries of iron, and others by those substances called iscæ, or some other such like material. And many have been rather cured by this method alone, sometimes without paracentesis having been had recourse to at all.