Scribonius Largus recommends sulphur with common oil for lepra, “et quam elephantiam dicunt,” but he gives no description of the latter.
It is greatly to be lamented that Cælius Aurelianus’ account of elephantiasis has come down to us in an imperfect state. His description is entirely lost, and his detail of the treatment is in a mutilated state. It appears, however, that his views were similar to those of Celsus, and that he considered it to be a malignant disease, affecting principally the skin. He approves of rubbing stimulant ointments into the skin, and of using medicinal baths, especially the aluminous and chalybeate. When the applications produce ulceration of the skin, he directs us to treat it upon general principles. He makes mention of vomiting by radishes, and latterly by means of the white hellebore. He approves of a sea voyage and change of scene. He says the first author who described elephantiasis was Themison, the same person that is damned to everlasting fame in one of the lines of Juvenal: “Quot Themison agros autumno occiderit uno.” (Sat. x, 221.) If this statement be correct, it is clear that Celsus cannot be of so early a date as is generally believed, that is to say, the Augustan age, for Themison flourished towards the end of the first century, P. C. He was the founder of the Methodical sect. Cælius also blames Themison for recommending bleeding and vomiting unseasonably, and disapproves of his directions respecting the applications to the skin. It appears that he also disapproved of the theriac of vipers, and of giving to drink water in which red-hot iron had been extinguished. There can be no doubt, from the circumstances which he mentions, that the disease was thought contagious in his time.
Octavius Horatianus, who lived under the emperor Valentinian, gives a pretty full detail of the treatment, but his description of the symptoms is defective. He makes mention, however, of maculæ, which affect principally the face; he contends that the whole system is attacked with the disease, and that the flesh is corrupted. His remedies are much the same as those recommended by the other authorities, namely, bleeding, purging, vomiting, the theriac of vipers, and rubbing with the usual applications for scabies. He also speaks favorably of the natural and the sea-water baths.
Marcellus the Emperic, who is supposed to have flourished in the reign of Theodosius, recommends, like Serenus, mint, juniper, and mezereon, for elephantiasis. He describes it as being attended with hard excrescences of the extremities, eruptions on the face, and disease of the bones. He speaks of its being endemic in Ægypt.
The disease, elephantiasis, according to Isidorus, is so called from its resemblance to the elephant. The skin in it is hard and rough, from which it gets its appellation, because the surface of the patient’s body resembles that of an elephant; or because it is a mighty affection, as the elephant is one of the largest of animals.
Vegetius, the great ancient authority on veterinary surgery, describes elephantiasis as it affects cattle. The symptoms are hardness and roughness of the skin, squamæ, eruptions on the feet and head, and a fetid discharge from the nose. He approves of bleeding, and the other means recommended by the regular surgeons.
We shall next give the descriptions of the Greek authorities.
Aretæus gives a most elaborate but surely somewhat overstrained description of elephas, which he paints in colours the most hideous and disgusting. We shall endeavour to convey to the reader an idea of his sketch, stripping his picture of its flowery ornaments, and contracting its bulk. The disease is called elephas, he says, from its magnitude, leontium or morbus leoninus, from the supposed resemblance of the eyebrows to those of the lion; and satyriasis, from the venereal desires with which it is attended. The disease is described as escaping notice at first, being deep-seated and preying upon the vitals, but afterwards it is determined to the superficies, commencing sometimes with the face, and at other times with the extremities. The belly is dry, because, as he ingeniously remarks, the distribution of the food is performed regularly, and the vitiated parts strongly attract the chyle to them as a pabulum to the disease. There are large callous eminences on the skin, and the veins appear enlarged, owing to a thickening of the vessels and not to a plethora of blood. The hairs of the head, pubes, and other parts of the body, drop off. The face in particular is affected with callous tubercles or warts, and it is not uncommon for the tongue, and most parts of the body, to be also covered with them. The eyebrows are thickened, stripped of their hair, and hang down like those of the lion. The general appearance of the skin, covered as it is with hard tubercles, and intersected with deep fissures, is said to bear some resemblance to that of the elephant. Sometimes particular members, such as the nose, feet, fingers, the whole hand, or the pudenda, will die and drop off; and it is not uncommon for incurable ulcers to break forth on different parts of the body. Dyspnœa, and a sense of suffocation, are occasionally present. He says, it is dangerous to have any intercourse with persons labouring under the disease, no less so than in the case of the plague, as both are readily communicated by respiration. He directs us, at the commencement, to abstract blood freely, because blood is the pabulum morbi. He recommends us to purge with hiera, and to procure vomiting by radishes, but more particularly by the white hellebore, upon which he bestows a glowing and eloquent eulogy. Like our author, he approves of the theriac of vipers. He makes mention of many external applications of a detergent nature, and in particular praises a soap used by the Celts for cleaning their clothes. He also commends natron, alcyonium, sulphur, alum, ammoniac with vinegar, and the like, for the same purpose. When the flesh is livid, he directs us previously to make deep incisions in it. The diet is to be plain and digestible; sulphureous baths are to be used: the patient is to swim frequently in sea-water, to take a sea voyage, and otherwise not neglect suitable exercise.
Plutarch informs us that it was disputed in his time whether or not elephantiasis was a new complaint.
Galen, as far as we can recollect, has nowhere treated very particularly of elephantiasis, but in his work ‘De Causis Morborum’ he has briefly mentioned that in this disease the nose becomes flattened, the lips thick, and the ears extenuated, the whole appearance resembling that of a satyr: and in his work entitled ‘De Curatione ad Glauconem’ he ranks elephantiasis with cancerous swellings, and says that the disease is common about Alexandria, owing to the heat of the place and the food of the inhabitants, which consists principally of lentils, snails, pickles, the flesh of asses, and the like, all which things have a tendency to engender the melancholic humour. The temperature of the place likewise, he shrewdly remarks, determines the superfluities of the system to the skin. He recommends the treatment which we have already had occasion to mention, namely, bleeding, purging, and the theriac of vipers. In the ‘Isagoge,’ the black and white hellebores are particularly commended. Galen elsewhere calls it contagious. (Lib. ii, Simpl. de carne viperæ.)