The acrochordon is thus described by an intelligent modern author: “Est verruca subcutanea durior et asperior, callosa, atque plerumque teres, cute concolor, in basi tenuis, summitatis vero latioris, fabæ magnitudinem raro excedens, juniores maxime infestans.” (Mangeti Bibl. Chirurg. i, 72.) The terms thymus, myrmecia, and acrochordon, have now fallen into disuse.
SECT. XVI.—ON GANGLION.
Ganglion is a round tumour of a nerve (tendon?) arising from a blow or pressure, in many parts of the body, but particularly in those parts which are moved, such as the extremities of the hands and feet. In this case, says Archigenes, apply quick lime with the grease of geese and turpentine. But Poles uses the medicine from agate stone, and Oribasius the following: of ceruse, of pine rosin, of old oil, of each, oz. j; of ammoniac perfume, of galbanum, of each, oz. j; of wax, oz. iv; or, he says, apply a thick plate of lead, like the vertebræ, and larger than the ganglion, and bind it on; for by its weight this dissolves it in process of time. This we have used.
Commentary. See Hippocrates (De Artic. xxvi); Galen (Comment., de Med. Simpl. ix); Celsus (vii, 6); Oribasius (De Virt. simpl. ii, in voce Plumbum); Aëtius (xv, 9); Actuarius (Meth. Med. ii, 11); Avicenna (iv, 3, 2, 6); Albucasis (Chirurg. ii, 50); Rhases (ad Mansor. vii, 15: Contin. xxviii.)
Hippocrates points out the danger of opening these tumours indiscriminately. They consist, as Galen remarks, of a viscid and mucous fluid. Galen and Oribasius agree with our author in directing a piece of lead to be bound upon the ganglion. Nearly the same plan of treatment is recommended by Aëtius, who directs us to bind a piece of lead upon the tumour, and after some days to remove it, when the ganglion will be found much softened; it is then to be squeezed firmly between the thumb and the fingers, by which means it will be speedily dissolved. Albucasis approves of extirpating the tumour, unless it be seated near a joint. Rhases as usual collects the opinions of all preceding authorities. Antyllus, he says, directed the surgeon to break the sack, or to bind a heavy plate over it, or to extract it by the knife. When an operation is attempted, he recommends that the surgeon be sure that he has removed the whole sac. He relates a case in which the swelling was dissolved by an application containing mustard.
SECT. XVII.—ON PHLEGMON.
In general, we call all those swellings phlegmons which are red and painful, and accompanied with heat; some diversity of their nature arising from the cause which occasions them. For when good blood and of moderate consistence rushes abundantly to a part and from its quantity becomes seated in it, the disease is that which is properly called phlegmon; but when yellow bile is seated in a part, it is called herpes; and when blood and yellow bile together are collected in a part, erysipelas is formed; but when in this case the blood is hot and thick, it usually gives rise to carbuncle. Wherefore, we shall begin with what is properly called phlegmon, which occurs in many cases, being a swelling which is red, painful, elastic, and hot, deriving its origin, as I said, from good blood which is sometimes collected from the whole body, and sometimes is formed abundantly in the part itself, so that it cannot be contained in the vessels, but escapes from them in the form of vapour into the surrounding cavities. And this affection supervenes upon wounds, fractures, ulcers, and many other causes. When therefore a part becomes inflamed without any obvious cause preceding it, the whole body sending a defluxion to the part, we must evacuate the general system by venesection, and apply to the part embrocations and cataplasms, not such as are of a heating and moistening nature, but such as are calculated to repel the fluid, which is flowing to the part, and evacuate that which is already contained in it. Apply, therefore, a cataplasm of house-leek, and of the bark of the pomegranate tree boiled in wine, with sumach and polenta: when the pain is not violent, this or such like applications are to be used; but when there is a defluxion to the part with greater pain, then cataplasms of hot water and oil, or of polenta, must not be applied (for all these are inimical to such defluxions); but the vehemence of the pain is to be allayed by that which is composed from musk, rose-oil, and a little wax, with unwashed wool containing much grease: these things are to be prepared and applied cold in summer, but tepid if in winter, so that the parts above the affected places be covered with a sponge soaked in austere wine or cold oxycrate. But we must add to the cataplasms such herbs as are proper for the purpose required. Pellitory of the wall, therefore, is applicable to every phlegmon at the commencement, and while on the increase; and in like manner, horned poppy, orach, mallows, lettuce, and gourd, when applied on hot parts. Both kinds of caltrops (tribuli) are applicable to inflammatory defluxions, and the cabbage to such as are hard. When a change is thereby effected, and no pus falls into the part, you may accomplish the cure by means of the plaster from chalcitis, or some of those plasters of a similar nature, which apply to defluxions; but clean wool soaked in austere wine is to be put externally to the medicine. In this manner you may cure phlegmons from defluxion. But such as are occasioned by any external cause will not be injured by moistening and heating applications, and if necessity require, you may scarify them with advantage. But in phlegmons arising from defluxion, scarification, more especially at the commencement, may become the cause of much mischief to the patient.
Commentary. See Galen (ad Glauc. ii); de Different. Morb. (12); Meth. Med. (xiii, 2); Celsus (iii, 10); Oribasius (Morb. Curat. iii. 41); Aëtius (xiv. 31); Leo (vii, 4); Actuarius (Meth. Med. ii, 12); Avicenna (iv, 3, 1, 2); Serapion (v, 22); Haly Abbas (Theor. viii, 9; Pract. iii, 27); Alsaharavius (Pract. xxix, 2); Rhases (Divis. 126, and Contin. xxvii.)
Galen explains that the term phlegmone is used either to signify inflammations in general, or a red, resisting, and painful tumour in particular. It is here used in the latter acceptation. He says, when a defluxion of blood of good quality and of moderate consistence takes place to a part, and from its quantity becomes fixed in it, the person is seized with a violent pain, unless the part be very insensible; it is also accompanied with a deep-seated throbbing; it seems stretched and broken; there is a sensation of increased heat, so that the part feels as if it were burnt and desires cooling; there is a florid redness as in those who have been in the bath, or have been warmed at the fire, and by other means. This affection, he says, gets the generic appellation of phlegmone, or inflammation. He enumerates many causes of it, such as bruises, fractures, and dislocations; but even without these, he adds, it may arise from the veins being immoderately distended with humours, and the superfluity being cast off upon a part fitted to receive them at the time. Such a part, from some cause or other, happens to be weaker, or more lax, or more calculated to attract, or is more inactive than the other parts of the body. He lays it down as a general principle, that the cure of such affections is to be accomplished by evacuation. Reason and experience, he adds, teach us that the general system is to be evacuated by the suitable means, and the inflamed part by embrocations and cataplasms of a repellent nature, and such as are calculated to give tone and strength to it. Such are his general principles of treatment. His particular remedies we need not mention, as in fact our author’s are entirely borrowed from him. Oribasius, Aëtius, Actuarius, and Nonnus, in like manner, borrow from him everything which they advance upon this subject.
Celsus does not treat of phlegmon in particular, but he has given an excellent account of inflammation in general. His definition of inflammation is singularly appropriate: “Notæ inflammationis sunt quatuor, rubor, et tumor, cum calore et dolore.” Isidorus attempts the same not so successfully: “Phlegmone est fervor cum extensione et dolore; sive est inquietudo cum rubore, et dolore, et extensione, et duritie, et vastitate: quæ quum cæperit fieri, inquietudo et febris insequitur.”