Serapion treats of the disease very accurately by the name of al massire, but in nearly the same terms as Galen. He approves decidedly of cooling and repellent applications at the commencement. Serapion and Avicenna notice the eruption of bullæ in erysipelas.
Haly Abbas directs us, when erysipelas is not attended with swelling, to use cooling and repellent applications to the part, and to administer gentle cholagogues, such as myrobalans, tamarinds, and prunes. But if swelling be present, and if there is nothing to contra-indicate venesection, he recommends us to bleed and apply cataplasms.
Alsaharavius describes three varieties of erysipelas; namely, the erysipelas properly so called, the ignis Persicus, and the erysipelas inflativa. The first variety, he says, is attended solely with redness of the cuticle. It is to be treated by bleeding, purging, and local applications of a cooling and humid nature. In the ignis Persicus, the heat and redness are strong, and black blisters rise on the part. It is to be treated by bleeding at the commencement, and scarifications. The erysipelas inflativa arises with a sudden swelling, and blisters, like those produced by fire. It is to be treated by bleeding and cooling applications, containing ceruse, litharge, &c. The ignis Persicus would appear to have been some variety of anthrax, or the malignant pustule.
None of the ancient authorities express themselves so decidedly favorable to bleeding as Rhases. Like the others, he attributes it to heated bile. He, and most of the authors quoted by him in his ‘Continens,’ approve of cooling applications, but he cautions against carrying this practice too far. He remarks that vesicles like those from burning often arise on the part.
Fabricius ab Aquapendente is a strong advocate for the ancient theory, of which he gives a full explanation. The system, he says, being loaded with vitiated bile, the more important organs cast it off: it is, therefore, sent outwardly, and is detained by the cuticle when its pores are obstructed. He attempts to reconcile the contrary opinions of the ancients with regard to venesection. He himself approves decidedly of bleeding when the disease is seated in the head or neck.
None of the ancient authorities seem to have entertained the same apprehensions as most of the moderns do against liquid applications in cases of erysipelas. When this prejudice became general we do not exactly know. Heister mentions that, in his days, some surgeons disapproved of liquid applications, but, as he thought, without any good reason. He himself recommends camphorated spirit of wine. The earlier modern surgeons, as, for example, Brunus and Theodoricus, decidedly recommend cold applications at the commencement. When the disease is not thereby resolved, they direct us to have recourse to leeches and scarifications. They approve much of cholagogue purgatives, but do not recommend bleeding unless inflammatory symptoms run high.
SECT. XXII.—ON PHYMA, BUBO, AND PHYGETHLON.
According to Galen, phyma, bubo, and phygethlon, are affections of the glands: bubo being an inflammation of a gland; phygethlon, an inflammatory erysipelas, or an erysipelatous inflammation of a gland; and phyma, an inflammation of a gland passing rapidly into suppuration. But, according to others, all tumours of the nature of apostemes, which arise in any part of the body, are called phymata. For Hippocrates says, “Those in whose urethra phymata form are relieved when they suppurate and burst.” Wherefore those buboes which are occasioned by accidents, either ulcers or pains, are not dangerous; but those which occur in fevers, more especially in the pestilential, are of a very bad description, whether they are formed in the groins, the armpits, or neck. But those of the first kind, as is the case in every other inflammation, we must endeavour to put back with cooling and astringent applications, either applying a sponge out of oxycrate, or wool out of wine and raw oil, or oil of roses, or oil of apples, or oil of lentisk, or oil of myrtles; and then we are to apply diaphoretics. But if the whole body is plethoric, it is to be evacuated. If free from superfluities, we must manage the ulcer arising from it in the manner to be described when treating of ulcers. When the gland is in a state of inflammation, it is to be mitigated by wool soaked in some of the emollient oils, and the whole limb is to be wrapped therewith. When the tumour has suppurated, we must not be in haste to open it, but endeavour to dissipate it by the medicines in the form of cerates, such as that prepared from apyranon, and that from herbs called botanica. When resolution is not thereby accomplished, we must forward the rupture as in the other abscesses, and cure it in like manner as them. In those buboes which arise in fevers or from a collection of humours, we must abstain from all repellents, lest the matter should be repelled and regurgitate to the deep-seated parts; but we must begin at once with discutients. When nothing prohibits, such as the age or strength of the patient, venesection from the arm is to be had recourse to, and fomentations applied to the part, either from the decoction of camomile, or of dill, or of some such; but the materials of the other applications may be transferred from our account, in the [Third Book], concerning parotis, and from what has been lately delivered, more especially respecting phlegmons. And in like manner the cure of phygethlon may be learned from what has been stated respecting them and erysipelas. But the herb aster atticus, which, on this account, they call bubonium, not only in the form of a cataplasm, but also when bound round the part as an amulet, is believed to be of use for buboes. Phymata may be discussed by the following applications in particular: maiden-hair; orache; pellitory of the wall; the root of marsh-mallows, boiled in wine; ammoniac, softened with honey, and applied; birdlime, with the rosin cerate. But bee-glue, bitter lupins applied with vinegar, the root of the wild cucumber added to turpentine, and in like manner root of capers, and nitre with leaven, or figs, promote the rupture of these tumours.
Commentary. The account here given of these glandular inflammations is taken from Galen (ad Glauc. ii.) See also ‘de Tumoribus’ and ‘Comment. in Hippocrat. Epid.’ vi.