SECT. XX.—ON HERPES.
When yellow bile, unmixed with any other humour is fixed in a part, the affection is called herpes: but if it is thicker and rather acrid it ulcerates the whole skin as far as the subjacent flesh, and is called herpes exedens; but if it is thin, less acrid and hot, it raises small blisters on the surface of the skin like millet-seeds, and hence has been called herpes miliaris. According to Oribasius, a mixture of phlegm, with yellow bile, produces the herpes miliaris. Wherefore we may evacuate the whole body with cholagogue medicines, and apply cooling and desiccant things to the affected part. At the commencement, therefore, we may apply cataplasms from vine shoots, bramble, and plantain; but afterwards we may add lentil to them, sometimes with honey and polenta. And the cataplasm recommended for phlegmons from defluxion may be applied without the house-leek. But ulcerated parts are to be rubbed with trochisks dissolved in must, or in a thin and austere wine, not very old, or in a watery oxycrate. Administer also horned poppy, and similar things in water; and when these do not prove effectual, vinegar may be added. But wine diluted with the juice of plantain or strychnos is of great service, or linseed bruised and boiled in wine and oil may be applied; or Cimolian earth, mixed with the juice of strychnos may be applied by anointing: and take of litharge, oz. iv; of the juice of leeks, vij cyathi, and of the juice of beet an equal quantity, triturate and anoint. But when these ulcers have become chronic, the trochisk of Musa and that of Andron will be convenient applications.—Another: For herpes phlyctænodes: having triturated the dross of lead in austere wine and anointed with it, apply above it beet leaves boiled in wine, or of wax, oz. iv; of myrtle oil, oz. xvj; of the dross of lead, oz. iv; anoint with one half of wine. When it has stopped from spreading, use the cerate from the dross; or apply boiled lentil with honey. For herpes, under the skin, mix the dross of lead with the juice of levigated rue, or myrtle cerate, instead of the rue.—Another: Of old unwashed wool wrapped round a dead pine and burnt, dr. xij ss; of wax, dr. xxv; of the dross of lead half an acetabulum; of goat’s tallow cured and washed in water, dr. xxxj; of myrtle oil, oz. v.—Another: To those which spread rapidly: of the rind of the sweet pomegranate, dr. vj; of litharge, dr. vj; of unwashed wool about a dead pine and burnt, dr. iij; of wax, dr. xij; of ceruse, dr. viij; of fissile alum, dr. j; add to wine and myrtle oil.
Commentary. The writers on phlegmon treat immediately afterwards of herpes and erysipelas. Fabricius ab Aquapendente, Dr. Bateman, and most of our modern authorities on this subject, are of opinion that the ignis sacer of Celsus and the other Latin authors was herpes. Scribonius Largus, however, distinguishes the ignis sacer from zona, which, he says, was called herpes by the Greeks. The ignis sacer of Octavius Horatianus likewise appears to be erysipelas. And Isidorus states decidedly that the ignis sacer was erysipelas:—“Erysipelas est quam Latini sacrum ignem appellant, id est, execrandum, per antiphrasin. Siquidem in superficie rubore flammeo cutes rubescunt. Tunc mutuo rubore quasi ab igne vicina invaduntur loca ita est etiam febris excitatur.” (See a learned dissertation on the ignus sacer in Burman’s edition of Serenus Samonicus, ‘Poet. Latini Minores.’ ii, 335.) Having thus stated the doubts which prevail respecting the ignis sacer of the ancients, we shall return to Celsus’s account of it, which certainly, as already mentioned, seems to apply to herpes. He describes two varieties of it. The first is reddish, or a mixture of redness and paleness, and in it the skin is covered with a great number of small pustules. The disease spreads, the part first affected either healing, or becoming ulcerated from the rupture of the pustules and discharging a humour intermediate between sanies and pus. The breast and sides are mentioned as being frequently the seat of this complaint, and hence Bateman concludes that it is the herpes zoster. The second variety is described as consisting of a superficial ulceration of the skin, broad, somewhat livid, but unequal; the middle part healing as the extremities spread, and the part about to become affected becoming swelled, hard, and of a colour compounded of black and red. It affects principally old and cachectic persons, especially their legs. We cannot understand what could have led Dr. Bateman to think that this is the same as the herpes circinatus of his arrangement. Rayer rather supposes it to be the dartre squameuse centrifuge Alibert. His general treatment consists of abstinence, opening the belly, food intermediate between the glutinous and saltish, and if there is no fever, exercise, austere wine, and the like. The ulcers (vesicles?) are to be washed with hot water, or, if they spread, with hot wine; they are then to be opened with a needle, and dressed with applications for eating away putrid flesh. When the sore is cleaned, gentle applications are to be used.
For the zona or herpes, Scribonius Largus recommends applications containing alum, galls, chalcitis, misy, quicklime, &c.
Pollux defines herpes to be inflammatory and pungent pustules, which spread most commonly about the neck, but sometimes affect also the hands and feet.
Galen gives a very full account of the nature and treatment of herpes. According to him the complaint arises from yellow bile separated from the blood and fixed in a part. When it is thickish it ulcerates the skin down to the bone, and forms the disease called by Hippocrates herpes exedens. But if thinner, it only burns as it were the surface, when it is called by the generic term of herpes. Of the other two varieties, the one, as has been said, is called exedens, and the other miliaris, because it is attended with many small bullæ (phlyctænæ) like millet-seeds. As our author’s treatment is entirely derived from him we shall not enter into any detailed exposition of his practice. We may mention, however, that he decidedly recommends purgatives for proper herpes. When the ulceration is of a malignant nature and attended with putridity it requires the most acrid medicines, and such as in power resemble fire, namely, misy, chalcitis, arsenic, quicklime, and sandarach. For, he adds, these medicines burn like fire, and often when they fail, we must have recourse to fire itself.
Aëtius gives an accurate account of herpes, but it is professedly borrowed from Galen. Like him he divides the disease into three varieties, the herpes proprius, the herpes exedens, and the herpes miliaris, the last being characterized by an eruption of vesicles (phlyctænæ). We shall here notice what Dr. Bateman says respecting this division of herpes:—“The ancient division of herpes into three varieties, miliary (κεγχρίας), vesicular (φλυκταινώδης), and eroding (ἐσθιόμενος), may be properly discarded, for there appears to be no essential difference between the first two, which differ only in respect to the size of the vesicles.” This is evidently an incorrect account of the ancient division, in which no distinction was made between the herpes miliaris and the herpes phlyctænodes.
Palladius makes mention of only two varieties of the disease, namely, the proper, and the eroding herpes. (De Febribus 2.)
Leo briefly refers to Galen’s account of the disease (vii, 3.)
Actuarius mentions only the proper herpes, and the herpes miliaris. This is, perhaps the best division of any, as the herpes exedens is evidently a disease of a very different nature from the other varieties.