Part only of our author’s applications are derived from Oribasius.
A very minute account of these complaints is given by Aëtius. He divides strumæ into the mild and the malignant. The mild are without inflammation or pain, and are attended with a moderate degree of hardness; the malignant are accompanied with inflammation, and a throbbing pain, feel unequal, have enlarged veins, and are exacerbated by handling or medicines. The latter are said to be incurable. He mentions, upon the authority of Leonidas, the accident related by Galen. He approves, however, of the operation in general. Incipient strumæ, he states, may be discussed like scirrhi, by a combination of emollients with discutients. He gives a long list of prescriptions for removing scrofulous tumours. One of them contains arsenic mixed with the fat of a goat or ox. With regard to the general treatment, he recommends laxatives, restricted diet, emetics, and the theriac.
Actuarius and Nonnus, as usual, borrow from our author.
Celsus remarks that strumæ occur most frequently in the neck, armpits, groins, sides, and the female breasts. He represents them as indolent affections of the glands, which come slowly to maturity and prove very troublesome to the physician. Some, he says, give white hellebore in these cases, and use applications for bringing them forward or for discussing them. Others have recourse to caustics, and when the eschar is removed, they heal the ulcer upon general principles. When the sore becomes clean he recommends exercise and a nourishing diet.
Scribonius Largus, Marcellus, and Myrepsus give nearly the same prescriptions as our author. Arsenic is an ingredient in the septic applications of Myrepsus.
Avicenna recommends emetics, phlegmagogues, bleeding in the arm, attenuant food, and avoiding all gross things and repletion. As a discutient he and Serapion commend the diachylon plaster. Haly Abbas likewise mentions this application, and also directs the swellings to be burnt with caustics. Alsaharavius briefly recommends excision or burning. Serapion evidently copies from our author. Avenzoar gives a very full account of scrofulous swellings, which, he says, are formed in general of a gross and viscid phlegm. Except in very particular cases he disapproves of bleeding. He approves in general of discutient applications; but when the swelling tends to suppuration, he directs us to promote it; and when pus is fairly formed he recommends us to let it out, but cautions the surgeon not to attempt this operation unless he has a practical acquaintance with anatomy, lest he wound any of the veins, arteries, or nerves.
Rhases forbids the knife when the scrofula is in the neck or deep seated. In certain cases he approves of destroying the tunic with septic applications.
Brunus, and the other surgical writers of that age, in imitation of the Arabian authorities, direct scrofulous tumours to be treated with discutients, excision, or septics. A discutient ointment recommended by Brunus consists of litharge, common oil, and the juice of melons and fenugreek. His septic medicine is a mixture of arsenic and quicklime, which is to be applied with honey. (Chirurg. Minor. 19.)
SECT. XXXIV.—ON STEATOMA, ATHEROMA, AND MELICERIS.
These things belong to the class of apostemes, as we said when treating of them, and each receives its peculiar appellation from the substance contained in the tumour. Thus one of them is like fat, another like honey, and the third like pap. The indication of cure in them all is to discuss the contents, produce the putrefaction of them, or to cut them out. Some tumours fall under all these three indications of cure, namely, those which contain a thin fluid, as the meliceris; others come under two of them only, as the atheroma, for it can only be cured by excision or putrefaction. But the steotoma admits of no cure except by a surgical operation, for it can neither be discussed nor made to putrefy. The diagnosis of each of these may be found in the Surgical part of the work, while the materials of which the discutients are formed are mentioned under the head of scrofula. This application is peculiarly adapted for discussing meliceris: Twenty raisins without their stones; of squama æris, dr. iij; having first fomented, apply.—Another: Of Cretan cistus, of bdellium, of galbanum, of ammoniæ perfume, of bee-glue, of turpentine, equal parts; to be pounded together in a mortar. It applies to scrofula, parotis, furunculus, and phyma. But Archigenes applies to meliceris aphronitrum, and double the quantity of hellebore, with hard cerate. But septics cannot be applied while the skin remains entire; we must therefore in the first place lay bare the meliceris, atheroma, or strumæ, with caustic medicines, of which the most simple is that consisting of quicklime (calx viva,) soap, and strained lye. The following one is more complex, and admits of being kept: Of calx viva, dr. iv; of red natron toasted, of burnt lees of wine, of each, dr. ij; of vermilion, dr. j; triturate in lye; and having made it of the consistence of liquid honey, boil three times, until it is of the proper thickness, and lay it up in a leaden vessel, pouring in some lye, so that it may not quickly become dry. It applies to acrochordon, myrmecia, pterygium, clavus, callus, and excrescences of the gums. The lees of wine should not be older than two months. Anoint the skin with this, and when it begins to dry clean it away with a sponge, and anoint again; and when the skin becomes black, wash away again, and use escharotics. When the eschars fall off, apply the septic medicines. A septic application which is not irritating: Of squama æris, dr. iv; of realgar, dr. ij; of black hellebore, dr. ij; use with rose oil.—Another: Of squama æris, of realgar, of nettle seeds toasted, equal parts; use with rose oil.—Another: Of burnt sea-urchins, of the shell of the cuttle fish, of arsenic, equal parts; use with rose oil, but rub all the parts around with cerate and oil. This also is a good application: Of quicklime, p. ij; of chalcitis, p. j; of arsenic, p. j.