Having treated of swellings formed by hot humours, we shall now treat of those from the opposite, beginning with the œdema. For as erysipelas is formed by a bilious humour, so is œdema by a pituitous, being a loose swelling devoid of pain. We are aware also, that œdematous swellings occur in the feet, in dropsical affections, in phthisis, and in cachexia, but in them the œdema is a symptom of the complaint under which the person is labouring, and requires no very particular treatment; for it will be sufficient in general to rub the limbs sometimes with vinegar and rose-oil, and sometimes with oil and salts, or the salts may be added to the vinegar and rose-oil. When the œdema is occasioned by a pituitous humour being determined to the part, a sponge soaked in oxycrate may be properly applied with a bandage loosely put on, beginning below and terminating above. The sponge ought to be new, but if such a one is not at hand, that which is may be cleaned with natron, or more especially with what is called strained lye. If the swelling do not thereby subside, we may mix some alum. And a very convenient application is a tender wick of a lamp, soaked in such a fluid, and applied. A good remedy also is horned poppy. When the œdema has become chronic, having first anointed the part with oil, and then applied a sponge out of lye, bind it firmly, and you will effect a cure. Every kind of earth discusses and represses œdematous swellings, more especially the Ægyptian, and also the matured woad.
Commentary. See Galen (ad Glauc. ii; de Tumoribus); Aëtius (xv, 1); Oribasius (Morb. Curat. iii, 51); Leo. (vii, 5); Actuarius (Meth. Med. iv, 16); Nonnus (251); Serapion (v, 23); Avicenna (iv, 3, 2); Haly Abbas (Theor. viii, 11; Pract. iii, 30); Alsaharavius (xxix, 13); Rhases (ad Mansor. vii, 12.)
Our author’s account of this disease is taken from Galen, Oribasius, Aëtius, and, in fact, all the Greek, Latin, and Arabian authorities adopt his views, without any material alteration. They all concur in recommending cooling and astringent applications, with suitable bandages; and, in certain cases, friction. Rhases recommends that the limb should be buried in heated sand. He also approves of various cooling and astringent applications with bandages. In the translation of Alsaharavius, the œdema is described by the name of apostema flegmaticum; in those of Avicenna, Haly Abbas, and Serapion, by that of undemia. The celebrated Paracelsus used the term undemia for œdema. In some late works we have seen it stated that the undemia was a species of erysipelas, but this is evidently a mistake.
SECT. XXVIII.—ON EMPHYSEMA.
Emphysema is formed by a flatulent spirit, collected sometimes under the skin, sometimes under the periosteum, or the membranes which surround the muscles. And it is also sometimes collected in the stomach and intestines, or between them and the peritoneum, in those kinds of dropsy which are called tympanitic; and it differs from œdema in this, that the parts do not pit upon pressure like it, and that it sounds like a drum. The density of the body co-operates in preventing the flatus from being dissipated, at the same time that the flatus also is of a thick nature. Wherefore, the indication of cure is to rarefy the body, and attenuate the thick air; which is to be accomplished by means of attenuant and heating remedies. When the complaint is seated in the stomach and intestines, this is to be brought about by a fine oil, having rue, cumin, or parsley seed boiled in it. And sometimes a large cupping instrument without scarificators, applied two or three times to the navel, will discuss it. When the muscles from contusion are inflated, so as to sound like an emphysema, the parts will not bear very heating and acrid applications. Wherefore, at the commencement, we must use paregorics liberally, and, when the disease is on the decline, discutients. Thus we may use sodden must with a small quantity of oil, applying them warm upon unwashed wool, or mixing the cerate of unwashed wool. And we must take care that the heat be preserved, for it is not expedient that the part be cooled. When the patient has been soothed, we are to mix vinegar and nitre or aphronitrum, and afterwards some lye; and lastly, we may use discutient plasters, for the removal of the complaint such as the following: having boiled the sordes of the oil used in baths, strain it first, so that it may become pure, and again throw it into the pot, and having triturated slaked lime like flour, sprinkle until it become of the consistence of clay, and use. A still more effectual application is the compound medicine from sycomores.
Commentary. See Galen (Meth. Med. xiv); (Therap. ad Glauc. ii); Aëtius (xv, 2); Oribasius (Synop. vii); Actuarius (Meth. Med. ii, 12); Nonnus (252); Scribonius Largus (§ 119); Avicenna (iv, 3, 2, 20); Serapion (v, 23); Alsaharavius (Pract. xxix, § 1, 14); Rhases (Divis. 127, Cont. xxvii.)
Our author has copied closely from Galen. The great indications of cure, as laid down by him and acknowledged by all subsequent authorities, are to rarefy the containing parts and attenuate the spirit. By spirit, as we stated in another place, the ancients meant a thick air or gas. The indications which we have mentioned are best fulfilled by friction with oils, in which calefacient medicines, such as cumin, parsley, anise, and the like, have been boiled. When, however, any inflammation is suspected, he properly forbids us to use acrid or heating medicines. When the pain of the bowels is violent in cases of tympanites, he allows medicines containing opium, which are to be given by the mouth if the small intestines be affected, but are to be administered in a clyster if the large intestines be the seat of the disease. When the disease is in a muscular part, he directs us to use a combination of attenuants and emollients. In certain cases he recommends dry-cupping. Oribasius, Aëtius, Actuarius, and Nonnus, adopt the views of Galen, without any alteration.
For tympanites, Scribonius recommends cumin internally.
Avicenna, like our author, in ordinary cases recommends combinations of attenuants and calefacients, dry-cupping and the like, for dispelling the spirit; but when the disease arises from contusion of the muscles, he directs us to use resolvents and paregorics. Serapion approves of similar treatment. Alsaharavius recommends attenuant and calefacient remedies externally and internally. In the translation of his works, the disease is called inflatio. Rhases recommends friction with calefacient oils; he remarks that the disease occurs most commonly in the stomach and intestines. He calls it by the name of apostema inflatum.