The Canon of Medicine

which are called by the proper name of synochi a type of continuous fever. But neither on account of the intolerable pains (for these are not absent in this disease) is such a great subtraction of blood to be made; or if they were even present, a distinction should perhaps be made, as Galen says in his exposition of the Aphorism: "Those things which are excreted, one ought not to consider the multitude, whether they should be settled by phlebotomy or rather by purging." He insinuates nothing else from these words except that where another humor than blood causes pain by its quality or quantity, purging is to be preferred. We see that the same Galen observed this everywhere in the cure of all diseases, especially choleric ones, so much so that in his commentaries on the second book on humors, he condemns phlebotomy even in pleurisy, although it is from choleric humor, which nevertheless he seems to approve more in this than in any other disease. For it appears that he himself, just as Avicenna, avoids the excessive inflammation of choleric humors everywhere, although Avicenna did not avoid it in this cure of the Persian fire, teaching that one should sometimes evacuate blood until syncope.

Doubt XI: Concerning incision in pruna or ignis persicus.

A decorative drop cap 'A' is shown with floral patterns and a bird. Avicenna prohibits deep incision in pruna or ignis persicus when the matter is inclined toward bile—for he uses these words—and yet in the chapter where he deals with the formica literally "ant," used for herpes or small spreading ulcers, he had advised, by the counsel of Galen, to extirpate the formica with something that is like a probe, the extremity of which is almost pointed, or with another thing whose extremity is sharp, with which it is possible to swallow up the formica. And yet this extirpation of the formica, if we look diligently, is much more violent than an incision. So if Avicenna fears this when the matter is inclined toward bile, he should have much more dreaded doing such a thing in a disease created from matter not inclined to bile, but from pure bile, as he himself opines. For my part, I think that Avicenna—if it be permitted to speak thus while saving the reverence due to such a great man—confuses diseases that are distant in nature and their cures, or, to use the words which he himself is accustomed to use sometimes in the reprehension of others, he "puts chapter into chapter." This confusion, indeed, he seems to have particularly made in the three consecutive chapters on erysipelas, on formica, and on ignis persicus.

Doubt XII: Concerning the three chapters, namely erysipelas, formica, and Persian fire, poorly ordered by Avicenna.

A decorative drop cap 'A' is shown with foliate scrollwork. In the chapter where he deals with herisipila, Avicenna puts this among the other marks of this disease: that it burns and blisters by its virulence. This blistering, however (if I may say so), is more proper to another disease, with which he deals in the following chapter, which he himself calls formica miliaris. But Paul and Galen call it herpes cenchrias—that is, miliaris—for the reason that it creeps and excites on the skin blisters or pustules similar to millet. But also the medicines themselves which Avicenna applies to

herisipila existing on the skin are those which are written by Paul for formica miliaris or (to use his words) for herpes vesicosus blistering herpes, or pustular. For these are the words of Paul: "For blistering herpes, take dross of lead ground in strong wine and applied immediately; apply a cataplasm made from beet leaves boiled in wine on top." Avicenna, however, wrote thus in imitation (as it seems) of Paul: "And if there is herisipila on the skin, it should be cured with dross of lead with sour wine, with leaves of beet boiled with wine." The mode of speaking of Avicenna can cause no small doubt for those looking diligently. For when he says, "if there is herisipila on the skin," he seems to insinuate by these words that it is possible for herisipila to exist otherwise than on the skin. And yet Avicenna, making a difference between inflammation and herisipila above, had written thus: "And the abscess of herisipila is only in that which appears on the skin." Therefore, unless this doubt is solved, no small suspicion remains that the medicines which Avicenna writes for herisipila in this place are more appropriate for another disease, that is, formica miliaris. But the following words of Avicenna show this very thing most openly, for he immediately infers: "And let it be cured with that in which there is resolution and strong drying with cooling." No one is ignorant—unless he is ignorant of that trite principle in medicine that "contraries are cured by contraries"—that strongly drying things are not appropriate for the hot and dry disease of herisipila. Noting this, Fulginas Gentilis Gentile da Foligno, 14th-century Italian physician says that Avicenna here intends in a twofold way that he places medicines absolutely which are appropriate in the second stage, because here he placed medicines which are appropriate in ulcerated herisipila, which are of too strong a drying nature. We, however, have this confessed from this very answer, which we were striving to prove against Avicenna: that the medicines which are placed here by him are not appropriate for herisipila, which he discusses in this chapter, but rather for the other disease which he treats in the following, namely formica, whether miliaris or corrosive. For ulcerated herisipila is nothing other than herpes excedens eating or spreading herpes according to Galen, as the same Galen testifies in the thirteenth book of the Curative Art. But herpes comedens eating herpes is formica corrosiva or ulcerated according to Avicenna. That herpes comedens, which Galen discusses, does not differ from the formica corrosiva, about which Avicenna writes, one can see from the fact that both prescribe the same things for the cure of herpes comedens and formica corrosiva. For these are the words of Avicenna: "The way by which formica is cured is that the part of it which is corrosive should be alienated, for humectation is not appropriate in ulcers." Galen, also, from whom Avicenna took this, writes in almost the same sentiment in the second book of the Curative Art to Glaucon, in this sentiment: "Herpes, indeed, should be treated at the time for the cure of the whole body in a similar way to that in which it is necessary to cure erysipelas. But at the affected place itself, not all in a similar way. For those which are eaten desire to be cooled..."