The Canon of Medicine

malignant necessity: the other, which is made of poisonous matter at the time of the present pestilence. In the beginning of a bubo, Paul Paul of Aegina, 7th-century Byzantine physician uses refrigerating and astringent medicines, such as a sponge soaked in vinegar, wool with wine, or bitter, rose, or honeyed oil—that is, oil of apple or very mild or myrrh-based oil. For no danger threatens from these in such a bubo, as anyone skilled in the medical art understands. Avicenna, however, applies these same remedies without any distinction, just as he applies them from experiments in the beginning of altoim a type of pestilential bubo, than which nothing could be more dangerous in this malady. Nor does it satisfy me that some, doubting about this type of treatment, say in excuse of Avicenna that Avicenna did not wish to apply them upon the altoim itself, but rather upon the parts adjacent to it, so that the corruption might not traverse them, and that these medicines are applied to repel it. For in this type of disease, I always believe it is better to evoke the pestilential rot not only from the affected place, but also from the parts nearest to it, if possible. For if it is repelled from the surrounding places, it is then driven away from external parts—that is, from the ignoble ones—and is pushed toward the internal and often lethal ones. Since it has also been observed in pestilence that the more the parts of the outer skin are affected as the whole mass comes out, the less danger there is beneath, just as when a carbuncle has occupied only one location, the patient’s health is almost despaired of. Avicenna, even if he does not agree in the method of curing, at least agrees with Paul in that, just as the latter separated buboes from the anthrax, he separated altoim from the pruna a severe, coal-like skin lesion or boil. Yet it is not equally clear in Avicenna from what matter the pruna or ignis persicus Persian fire, an inflammatory skin condition arises, since sometimes Avicenna seems to dissent not only from Paul and Galen, but even from himself when writing about these diseases.

Doubt VIII: Concerning the anthrax and the Persian fire.

Galen, whom Paul of Aegina follows, holds that the anthrax is generated from burning melancholic blood, and therefore sometimes begins from a pustule and sometimes without one; then a certain pustule is raised, and when it is broken, a crusty ulcer is similarly formed. Avicenna writes almost the same thing about the pruna or ignis persicus in a certain place in the fourth book, among the beginnings of the third chapter on abscesses and pustules, in this manner: "But truly, species of evil eruptions are made from thick, bad blood; for if its malice becomes vehement and it burns, herisipila erysipelas will arise, and there will result burning, and a crust, and the ignis persicus is worse." In this place, Avicenna seems to agree with Galen concerning the Persian fire, since the Persian fire enters the same genus as the anthrax, which Galen discusses in the fourteenth book of the Curative Art, as is evident from Avicenna himself, who in the fourth book, in the chapter on ulcers, calls the Persian fire a corrosive ulcer, as is also evident from many translations that interpret the anthrax as holy fire or Persian fire.

Doubt IX: Concerning erysipelas and corrosive pustules.

Regarding herisipila, Avicenna openly disagrees with Galen, who maintains that herisipila is not generated from thick blood, such as melancholic, but rather from the very thinnest, as is evident from his words in the second book of the Curative Art to Glaucon, written regarding erysipelas. But afterwards, when Avicenna treats the pruna and ignis persicus in that chapter of the fourth book, although he writes almost the same signs for the pruna and ignis persicus that Paul and Galen write for the anthrax or coal—that they form corrosive pustules and cause an eschara a dry, crusty scab formed by burns or cautery, such as burning and a cautery cause—he nevertheless intends that both the pruna and ignis persicus are generated from yellow bile, which, if we attend to his words, has its origin from choleric blood. Therefore, the words of Avicenna himself (as we recently said) indicate that the matter of the pruna or ignis persicus is yellow bile generated from choleric blood, which are as follows: "And each of both, namely both pruna and ignis persicus, is of yellow bile burning mixed with melancholy."

Doubt X: Concerning phlebotomy until syncope in the cure of erysipelas, Persian fire, and pruna.

In the cure of ignis persicus, pruna, and herisipila, Avicenna orders phlebotomy to be performed, sometimes until syncope fainting or loss of consciousness, so that the choleric blood may be evacuated. I do not know how much this mode of cure agrees with reason or even with Avicenna himself, who everywhere insinuates that blood is the bridle of bile and admonishes in the first book that we must be careful not to lead the patient to the boiling over of choleric humors through an excessive mission of blood. Therefore, if we follow his doctrine in other places, phlebotomy is not appropriate in a disease from overflowing bile or blood turned choleric, or at least not so much that it leads to syncope. For even Galen himself, who assents to such a bold remedy, draws blood until the failure of spirit syncope only in three dispositions: namely, in the greatest inflammations, or most burning fevers, or most vehement pains. None of these is present in the disease of which we are discoursing. For if the choleric blood is superabundant, which Avicenna hints is the case in ignis persicus, it will not make inflammations, but rather even exquisite herisipilas, as Galen says in the second book of the Curative Art to Glaucon, where he places a difference between inflammation and herisipilas. The cure for true herisipilatis is not other than drinking cold water. Thus, whatever other fevers are generated from bile, either by itself or mixed with blood, have no more immediate remedy than the drinking of cold water. Whence Avicenna, even in the cure of herisipila and causon burning or inflammatory fever, seemed to doubt whether it was necessary to let blood in them, let alone ordering it to be drained until syncope. For this remedy is appropriate only in those fevers which are generated from much blood, either boiling or putrefying, such as those...