Of a carbuncle.
From external injuries, we proceed to disorders
which have an internal origin, when
some part of the body is corrupted. Amongst these
none is worse than a carbuncle. The marks of it are these.
There is a redness, and above that pustules rise, not very
high, mostly black, sometimes inclining to a livid colour,
or pale. There seems to be sanies in them; below, the
colour is black. The flesh is parched, and harder than it
ought to be naturally. And about it, there is a sort of
crust; which is surrounded with an inflammation. Neither
can the skin be lifted up in that place, but is, as it were,
bound down to the flesh below. There is a propensity to
sleep. Sometimes a shuddering, or fever comes on, or both.
And this disease shoots out roots, as it were, below, and
spreads, sometimes quickly, sometimes more slowly. At
the surface also it spreads and grows white; then becomes
livid; and all round it small pustules break out. And if it
happen to be near the gullet or fauces, it often stops the
breath suddenly.
Nothing is better than to sear it immediately. Neither
is that painful, for it has no feeling, because such flesh is
mortified. And the burning should be continued, till there
is a sense of pain on every side. After this, the ulcer is to
be cured in the same manner, as other burns. For by
eating medicines is produced an eschar, which being entirely
separated from the quick flesh, draws with it whatever
was corrupted; and the sinus, by this time clean, may
be dressed with incarning medicines. But if the disorder
be in the surface of the skin, medicines barely eating, or at
most caustic, may be sufficient. The violence of the cure
is to be proportioned to the malady. Whatever medicine
is applied, if it has the desired effect, will immediately separate
the corrupted part from the quick.
And we may generally be confident of success, if the
corrupted flesh falls off, wherever such medicine eats down;
if that does not happen, and the medicine is overcome by
the disease, an immediate recourse must be had to the actual
cautery. But in such a case, the patient must abstain
from food and wine. It is also proper to drink water plentifully.
And these directions are to be observed more
strictly, if a febricula be added to the other complaints.
Of a Cancer.
There is not so great danger of a cancer[ EZ ],
unless it be irritated by the imprudence of
the physician. This disease generally happens in the superior
parts, about the face, the nose, ears, lips, and breasts
of women. It also rises from the liver, or spleen. About
the place there are pricking pains; it is immoveable, and
unequally swelled; it is also sometimes insensible. Around
it the veins are inflated, and tortuous; and either pale or
livid; in some also, they are concealed from view. Touching
the part gives pain to some, to others none. Sometimes
it is harder, or softer, than it ought naturally to be,
without any ulcer; at other times, all other circumstances
being as above described, there is likewise an ulcer. Sometimes
it has no peculiar characteristic to distinguish it; at
other times it resembles those which the Greeks call condylomata[ FA ],
but has an asperity and magnitude peculiar to
itself. And its colour is red, or resembling that of a lentil.
Neither is it safe to cut it; for immediately there follows
either a palsy, or a convulsion. Often when a person receives
a blow upon it, he loses his speech and faints. In
some also if the tumour itself be compressed, the contiguous
parts grow tense and swell. Now this is a very bad
kind(79). Its general progress is this; first appears what the
Greeks call a cacoethes[ FB ], then it becomes a carcinoma,
without an ulcer. From that an ulcer; and from an ulcer
a thymium.
None of these can be removed but the cacoethes(80); the
rest are irritated by every method of cure; and the more
violent the operations are, the more angry they grow. Some
have made use of caustic medicines; others of the actual
cautery; others cut them out with a knife. Nor was any
person ever relieved by medicine; but after cauterizing,
the tumours have been quickened in their progress, and increased
till they proved mortal; when they have been cut
out, and cicatrized, they have, notwithstanding, returned,
and occasioned death. Whereas, at the same time, most
people, by using no violent methods to attempt the extirpation
of the disease, but only applying mild medicines, to
sooth it, protract their lives, notwithstanding the disorder,
to an extreme old age. But no body can pretend to distinguish
a cacoethes, which is curable, from a carcinoma,
which is not, otherwise than by time and experiments.
Therefore, so soon as this disease is perceived, caustic
medicines ought to be applied; if the disorder is alleviated,
and its symptoms grow milder, we may proceed both to incision
and the actual cautery; if it is immediately irritated,
we may conclude, that it is already a carcinoma; and every
thing acrid and severe is to be taken away. But if the part
is hard, without any ulcer, it is sufficient to apply a very
mellow fig, or the plaister called rhypodes. If there is an
ulcer, but not rising above the surface of the skin, the cerate
of rose oil is to be put on, with the addition of a powdered
shell, with smith’s forge water. If it grows fungous,
copper scales (which is the gentlest caustic) must be tried,
till there is no rising above the other parts; provided still
that it does not exasperate; if it does, we ought to be content
with the same cerate.
Of a therioma.
There is also an ulcer, which the Greeks
call therioma[ FC ]. This both comes of itself,
and sometimes is consequent upon an ulcer produced from
another cause. The colour is either livid or black; the
smell is bad; it discharges copiously a humour like mucus;
it is sensible neither of the touch, nor of medicine; and is
only disturbed by itching. About it there is a pain and inflammation.
Sometimes also a fever comes on. Sometimes
there is a haemorrhage from the ulcer, and this disorder
spreads, by which all the symptoms often increase.
From these proceeds the ulcer which the Greeks call herpes
esthiomenos[ FD ], voracious herpes; because by spreading
quickly, and penetrating even to the bones, it devours the
body. The surface of this ulcer is unequal, resembling
dirt; and there is in it a great quantity of glutinous humour,
an intolerable smell, and an inflammation more violent,
than is found in an ulcer of that size. Both of them,
as indeed all the kinds of gangrenes, happen chiefly to old
people, or those, who are in a bad habit of body.
The manner of curing both is the same; but the greater
disease requires the sharper remedy. And the regimen
must first be regulated; the patient must rest in his bed,
for some days abstain from food, drink water very plentifully,
and have a clyster given him. Then, when the inflammation
is gone, let him take food of a good juice(81),
avoiding every thing acrid; he may drink as much as he
will, provided he be content in the day-time with water
but at supper, he may also drink some rough wine. But
the abstinence should not be equally severe in a herpes,
and a therioma. This then is the regimen necessary.
Externally upon the ulcer, must be sprinkled powder of
dry aloes, and if that does but little service, chalcitis. But
if any nerve, by the flesh being destroyed, be laid bare,
it must be covered first with linen, lest it be burnt by that
medicine. If there is need of remedies still more powerful,
we must make use of those compositions, that cauterize
more strongly. Now when any medicine is sprinkled on,
it ought to be done by the broad end of a probe(82). Over
it should be applied either lint with honey, or olive leaves
boiled in wine, or horehound: and these must be covered
with linen dipped in cold water, and then well squeezed.
And all round, where there is a tumour from the inflammation,
repellent cataplasms must be applied. If by these
methods it grows no better, the place ought to be cauterized
with a hot iron; the nerves that are in view being
first covered. By what has been said on other occasions,
it will be clear enough to any body, that a part, which is
burned either by medicines or the actual cautery, must
first be cleansed, and then filled up.
Of the ignis sacer.
The ignis sacer ought also to be numbered
amongst bad ulcers. There are two species
of it. The one is of a colour inclining to ruddy, or a
mixture of red and pale, and the surface is roughened by
contiguous pustules, of which no one is bigger than another,
but they are very numerous, and exceeding small.
In these there is almost always pus, and often a redness
attended with heat; and that spreads, sometimes when the
part first affected is healing, sometimes when it is ulcerated,
in which case, the pustules breaking, one continued ulcer
is formed, discharging a humour, which seems to be
betwixt sanies and pus. It attacks chiefly the breast, or
sides, or extremities, and particularly the soles of the feet.
The other kind comes with an ulceration in the surface of
the skin, but without going deep, broad, inclining to a livid
colour, but unequal; and the middle part of it heals,
while the extremities spread; and often that, which seemed
to be sound, ulcerates again. But the skin round about
it, which is to receive the disease, grows tumid, and hardish,
and the colour of it is a blackish red. And this disease
too generally attacks old people, or those, that are in
a bad habit, but chiefly in their legs.
Now every ignis sacer, though it be the least dangerous
of those disorders, which have the disposition to spread,
yet is, I had almost said, the hardest to cure of them all.
The most effectual remedy is a fever for one day, which
consumes the noxious humour. The thicker and whiter
the pus is, so much the less is the danger. It does good
also to excoriate the part below the ulcer by scourging,
that the more pus may be evacuated, and the matter drawn
out, which corrupts the flesh there. But notwithstanding
if a slight fever comes on, there is a necessity for abstinence,
lying a-bed, and clysters. In every ignis sacer, neither
mild and glutinous food, nor salt and acrid are proper;
but what is betwixt these: such as unleavened bread, fish,
kid, birds, and except the wild boar, almost all venison. If
there is no febricula, both gestation and walking are serviceable,
and rough wine, and the bath; and in this disorder,
as well as that mentioned before, the drink ought to
be more plentiful than the food.
As for the ulcers themselves, if their progress be moderate,
they must be fomented with hot water; if more rapid,
with hot wine. Next wherever there are any pustules,
they must be opened with a needle. Then such applications
used, as may consume the putrid flesh. When the
inflammation is removed, and the ulcer cleansed, a lenient
medicine ought to be applied. In the second species, quinces
boiled in wine and bruised may do good; as likewise
the plaister of Hera, or the tetrapharmacum, with the addition
of a fifth part of frankincense; likewise black ivy
boiled in a rough wine, and if the disorder spread fast, nothing
is more efficacious. When the ulcer, which I observed
to be in the surface of the skin, is cleansed, the same
lenient medicines are sufficient to the cure.
Of the Chironian
ulcer.
The ulcer named Chironian(83) is large,
and has hard, callous, and swelled lips.
A sanies is discharged not copious, but
thin; the smell is bad. There is no inflammation either
in the ulcer or in the tumour about it. The pain is tolerable.
It does not spread, and therefore is not dangerous;
but it does not easily heal. Sometimes a thin cicatrix
comes on, and then breaks again, and the ulcer is renewed.
It occurs chiefly in the feet and legs.
The application to it ought to contain both something
lenient, and something strong, and repellent. Such as the
following composition made for the purpose: of copper
scales, calcined lead washed, each p. vi. *. cadmia, wax,
each p. viii. *. oil of roses a sufficient quantity to soften the
wax with the other ingredients.
Of ulcers occasioned
by
cold.
There is a kind of ulcer occasioned by the
cold of the winter. It is most common in
children, chiefly in their feet and toes, sometimes
also in their hands. There is a redness
with a moderate inflammation. Sometimes pustules
break out, which are followed by an ulceration. The pain
is not great, the itching greater. Sometimes a humour is
discharged, but in small quantity, which seems to resemble
either pus or sanies.
In the first place it must be fomented plentifully with a
hot decoction of turnips, or if these are not to be had, some
of the repellent vervains. If it is not yet ulcerated, copper,
as hot as a person is able to bear it, must be applied. When
it is already ulcerated, allum, powdered with an equal quantity
of frankincense, ought to be put to it, with the addition
of wine; or pomegranate bark boiled in water, then
beat. If the surface of the skin be excoriated, in that case
lenient medicines succeed best.
Of the scrophula.
The scrophula is a tumour, in which there
are formed some concretions of pus and
blood, resembling small glands. These are
extremely troublesome to physicians, because they both
generate fevers, and never maturate kindly; and whether
they be cured by incision or medicines, for the most part
they rise again close to the cicatrices; which they are much
more ready to do, after being treated with medicines; and
what is more, they are of long continuance. They grow
chiefly in the neck; but also in the armpits, the groin and
the sides. Meges the surgeon assures us, that he has met
with them in the breasts of women too.
For these reasons, it is proper to give internally white
hellebore, and that even frequently, till they be discussed;
and externally to apply medicines which may either draw
out the humour, or discuss it; such as have been mentioned
before. Some also make use of caustics, which eat down
and constringe the part with an eschar; and then treat it
like an ulcer. Whatever method of cure be pursued, when
the ulcer is clean, the body must be exercised and nourished,
till it come to a cicatrix. These are the methods prescribed
by physicians(84): but the experience of some peasants
has discovered, that eating a snake cures a scrophulous
patient.
Of a furuncle.
A furuncle is an acute tubercle, attended
with inflammation and pain; and especially
when it is just turning to pus. When this is opened, and
the pus is discharged, part of the flesh below appears converted
into pus, part corrupted, of a whitish colour, and
reddish; which some call the ventricle of the furuncle.
There is no danger in it, though no means be used for its
cure, for it maturates of itself, and breaks. But the pain
makes a medicine, that can hasten the cure, eligible.
The proper medicine for it is galbanum, but other things
have also been mentioned before. If none of these can be
had, the first application ought to be a plaister not greasy,
to repel it; then if that has not succeeded, something to
promote a suppuration. If that cannot be got, either resin
or leaven(85). When the pus is squeezed out, no further
cure is necessary.
Of phymata.
The name of phyma is given to a tubercle
resembling a furuncle, but rounder, and flatter
in the surface, and often larger. For a furuncle seldom
rises to the bulk of half an egg, and never exceeds it:
a phyma is commonly of greater extent; but the inflammation
and pain in it are less. When it is broken, the pus
appears in the same manner; no ventricle is found here,
as in the furuncle; but all the corrupted flesh is turned into
pus. Now this grows more frequently in children, and
is more easily cured; in young men it occurs more seldom,
and is more difficult to cure: when age has given firmness
to the body, it does not appear at all. The proper medicines
for discussing it have been mentioned before.
Of a phygethlon.
A phygethlon is a low, but broad tumour,
in which there is something like to a pustule.
The pain and tension are violent, and
greater than in proportion to the size of the tumour; sometimes
also attended with a slight fever. It ripens slowly,
and no great part of it is converted into pus. It is formed
chiefly either in the neck, or in the armpits, or the groin.
From its figure our authors call it panus(86). The proper
medicine for this also we have pointed out before.
Of abscesses.
But though all the foregoing are nothing
else but small abscesses, yet a larger collection,
that tends entirely to suppuration, appropriates to itself
the general name of abscess. And this collection happens
generally after fevers or pains of some particular parts,
and especially after pains in the belly. It commonly shews
itself externally, for it sometimes swells to a pretty large
compass, like the phyma, and is red and hot, and in a little
time contracts a hardness. It is more troublesome as it
advances, and occasions thirst and watchfulness. But sometimes
there is none of these appearances in the skin; and
more especially when the suppuration is pretty deep; but
inward prickings are felt, attended with thirst and watchfulness.
It is more kindly when it does not become hard
of a sudden; and when, though it be ruddy, yet it is changing
to a white colour. Which symptoms occur when the
suppuration is beginning; for the swelling and redness
comes on long before.
If the abscess be forming in any of the nobler parts, the
accession of matter there must be prevented by cataplasms,
which are at the same time repellent and cooling; such as
I have mentioned under the erysipelas and elsewhere. If
it is grown pretty hard, we must have recourse to discutients
and resolvents; such as a dry fig bruised, or lees of
wine mixed with cerate, made up with hog’s lard; or the
root of wild cucumber, with the addition of two parts of
meal, first boiled in mulse. We may also mix equal parts
of ammoniacum, galbanum, propolis, viscum, adding of
myrrh not half the quantity of any of the other ingredients:
and the plaisters and malagmas I have mentioned before,
have the same effect.
What is not discussed by these, must necessarily maturate.
And to hasten this, must be applied barley meal
mixed with water; to which also it will be proper to add
some herbs. The same applications(87) are fit for the lesser
abscesses too, whose names and properties I have recited
above. The general method of cure is the same in them
all; and only differs in the degree. Now that tumour is
crude, in which there appears a strong pulsation of the arteries,
a weight, heat, tension, pain, redness, and hardness;
and if the abscess be large, a shuddering, as also a slight
fever continues; and the suppuration being pretty deep
and concealed, instead of the marks, which otherwise shew
themselves in the skin, there are prickings. When these
have abated, and the part begins to itch, and either becomes
somewhat livid or whitish, the suppuration, is perfected.
And when it either breaks of itself, or is opened
by medicines, or by incision, the pus ought to be discharged.
And if it happens in the armpits or groin, it must be
dressed without lint. In other parts too, if it is narrow at
the bottom, if the suppuration has been moderate, if it has
not penetrated deep, if there is no fever, if the patient be
strong, lint is equally needless. In other circumstances it
ought to be used, sparingly however, and not unless the
wound be large. It does well to spread honey upon the
lint; or without it, to apply lentils with honey, or pomegranate
bark boiled with wine. And these things are proper
both alone and mixed.
If any parts round it should be too hard, to soften them
may be applied either mallows beat, or fenugreek, or lintseed
boiled in passum. And then whatever is to be applied,
ought to be secured not by a tight, but an easy bandage.
Every body ought to know, that in this kind of disorder
cerate may be used. What else belongs to the cleansing
of the ulcer, filling it up, and bringing on a cicatrix,
and equally relates to wounds, has been already pointed
out.
Of fistulas.
But sometimes from abscesses of this kind
and other ulcers, arise fistulas. That is the
name of a deep, narrow and callous ulcer. It occurs almost
in every part of the body; and it has some peculiarities
in each place. I shall first treat of the general properties.
There are then several kinds of fistulas; for some
are short, others deeper; some point inward in a straight
line; others, and by far the greatest part, are transverse;
some are simple, others are double, or triple, which beginning
from one orifice, branch out within, into three or more
sinuses; some straight, others bent and tortuous; some end
in the flesh, others penetrate to bones or a cartilage; or
where neither of these lies beyond them, reach to the more
internal parts; some again are easily cured, others with difficulty,
and some are even found incurable.
The cure of a simple and recent fistula in the flesh is
easy. It is an advantage to it, if the person be young,
and the constitution firm: the contrary are very unfavourable
circumstances; as also if the fistula has injured a bone,
or cartilage, or nerve, or muscles; if it have seized upon a
joint, or has penetrated either to the bladder, or the lungs,
or to the womb, or to the large veins or arteries, or to the
jaw-bones, throat, stomach, or thorax. When it points towards
the intestines too, it is always dangerous, and often
mortal. In these cases it greatly increases the malady, if
the patient be either sick, or old, or of a bad habit.
First of all, it is proper to put a probe into the fistula, that
we may find its direction and depth: and at the same time
whether it be altogether moist, or drier than it should be,
which appears upon drawing out the probe. It may also
be determined, whether the bone be affected or not; and
if the fistula has penetrated there, how far it has injured
it. For if that part is soft, which is touched by the end
of the probe, the disorder is confined to the flesh; if it resists
more, it has made way to the bone. And again, if
the probe slides, there is no caries begun: if it does not
slip out(88) of the point where it is placed, the caries is begun,
but is slight yet: if it feels unequal also, and rough,
the bone is very much corroded. The situation itself shews
when there is a cartilage below; and that the fistula has
reached it, appears by its resistance.
Now from these circumstances may be learnt the seats
and extents of fistulas, and what parts they have damaged.
From the quantity of the pus it may be known, whether
they be simple, or divided into more parts. If more of
that comes away, than can issue from a single cavity, it is
evident there are more sinuses. And as flesh, nerves, and
some nervous substances, such as the greatest part of the
coats and membranes are, commonly lie together, the
nature of the pus will discover whether the several sinuses
have eaten through these different sorts of bodies. For
from flesh a smooth and white pus is discharged pretty copiously;
from a nervous place the discharge is of the same
colour indeed, but thinner, and less in quantity; from a
nerve fat and not unlike to oil. Lastly, the posture of the
body also discovers whether the fistulas have penetrated
into several parts, because often, when one lies down with
his body and limb in a different position, the pus begins to
flow again, which had before stopped, and shews not only
that there is another sinus, from whence it descends, but
also that it proceeds in a different direction.
If it be confined to the flesh, and is recent and simple,
neither consisting of sinuses, nor having a large cavity:
also if it be not in a joint, but in a part, which is immoveable
by itself, and is never put in motion but with the whole
body, a plaister for recent wounds will be sufficient, if that
contain either salt, or allum, or copper scales, or verdigrease,
or any of the metallic substances. And of this a
collyrium(89) ought to be made, at the one end smaller, and
at the other somewhat thicker. And this ought to be introduced
with the small end foremost into the fistula, till
pure blood begins to appear. This is universal in the application
of all collyriums for fistulas. And then the same
plaister is to be put over it spread upon linen; and above
that must be applied a sponge first dipt in vinegar; and it
is sufficient to open the dressings on the fifth day. Such
diet must be used, as I have recommended for generating
flesh.
But if the fistula is at a distance from the præcordia, it
is necessary for the patient now and then to eat radishes
fasting and then to vomit.
When the fistula by time becomes callous (and it is impossible
to be mistaken in a callosity, because it is hard,
and either white or pale) then there is a necessity for
stronger medicines. Such as that composition, which
contains of poppy tears p. i. *. gum p. iii. *. cadmia p. iv. *.
copperas p. viii. *. these are incorporated with water, and
made into a collyrium. Or that, which consists of galls p.
i. *. verdigrease, sandarach, Egyptian allum, each p. i. *.
calcined copperas p. ii. *. Or that, which is composed of
chalcitis and stone-lime, to which is added of orpiment less
by one half than each of the other ingredients; and these
are mixed up with boiled honey. The most expeditious is
the prescription of Meges: to reduce to powder of rasile
verdigrease p. ii. *. then to dissolve in vinegar, of ammoniacum
thymiama p. ii. *. and with this to bring the verdigrease
to a consistence: and this is one of the choicest
medicines. But though the foregoing compositions are
the most efficacious, yet if these are not to be had, it is
easy to destroy the callosity by some caustic medicines:
and it is sufficient to arm with these a twisted paper reed,
or some part of a penecillum, formed after the manner of a
collyrium. Squills also boiled, and mixed with lime consume
a callus.
If the fistula happen to be pretty long, and transverse,
after introducing a probe, it is very proper to make an incision
over against its origin, and to put in any collyrium
you chuse.
But if we judge the fistula to have two or more sinuses,
provided it be short and confined to the flesh, we ought
not to make use of a collyrium, which may cure one part,
and not touch the rest; but the same medicines dry are to
be put into a writing reed, which being applied to the orifice,
the medicines must be blown into the fistula. Or the
same things may be dissolved in wine; or if the fistula be
somewhat foul, in mulse; if somewhat, callous, in vinegar;
and whatever is injected, must be infused in this liquid
form. Coolers and repellents must be applied above; for
generally the parts about a fistula are a little inflamed.
Neither is it improper, when one has removed the dressings,
before he make another injection, to wash the fistula by
means of a syringe; if there be much matter, with wine;
if the callosity be pretty hard, with vinegar; if it is already
cleansing, with mulse, or a decoction of vetches in water,
with a little honey added to it. It commonly happens that
the membrane, which is betwixt the orifice and the sound
flesh, being overcome by so many medicines, casts off, and
the ulcer is clean below. Whenever this happens, agglutinants
are to be applied, and especially spunge armed with
boiled honey. I know it is a practice approved of by many
in this case, to have lint rolled up into the form of a collyrium,
and dipt in honey, introduced for incarning. But
this method more quickly agglutinates, than incarns. And
there is no fear, that clean flesh brought into contact with
clean flesh can fail to unite, especially when medicines
proper for that purpose are made use of; since often an
ulceration of the fingers, unless great care is taken to prevent
it, will join them together in the healing.
Of the cerion
ulcer.
There is also a kind of ulcer, which from
its resemblance to a honeycomb, by the
Greeks is called cerium[ FE ]. And of this
there are two species: the one is of a whitish colour, and
like to a furuncle, but larger, and attended with great pain.
When it maturates, it has openings, through which is discharged
a glutinous and purulent matter; nevertheless it
does not come to a due ripeness. If it be divided by incision,
there appears to be a great deal more corruption
within, than in a furuncle, and it reaches deeper. It seldom
occurs but amongst the hair of the head.
The other is less, and eminent upon the top of the head,
hard, broad, of a pale green colour, and more ulcerated;
for there are openings at the roots of each of the hairs,
through which issues a glutinous, palish humour, in consistence
like honey, or viscum, or sometimes oil; and if an
incision be made upon it, the flesh within appears green.
There is a great pain and inflammation, insomuch that
they often bring on an acute fever.
To that kind, which has fewer openings, it is proper to
apply dry figs, and lintseed boiled in mulse, and drawing
plaisters and malagmas, or the medicines, of that quality
above recited.
Upon the other, the same medicines, likewise meal
boiled in mulse, and half the quantity of turpentine resin
added to it; and a fig boiled in mulse; to which a little
powdered hyssop is added; likewise a fourth part of stavesacre
added to the fig. But if medicines do but little
service in either kind, the whole ulcer must be cut out to
the sound flesh. When the ulcer is taken away, medicines
must be applied over the wound; first such as promote pus,
next detergents, then such as incarn.
Of the acrochordon,
acrothymium,
myrmecia,
and the clavus.
There are also some resembling warts,
which have different names, as they are
different disorders. The Greeks call that
an acrochordon[ FF ], where a substance pretty
hard is collected within the skin, which
sometimes is rough, and of the same colour
with the adjacent parts; near the skin it is narrow,
and broader above. This is small, rarely exceeding the
size of a bean. They are hardly found to grow single;
generally a number together, and chiefly in children.
They sometimes suddenly disappear, sometimes they excite
a moderate inflammation. Some are also converted into
pus.
That is called acrothymium[ FG ], which rises like a small
wart above the flesh, broader at the skin, smaller above,
hardish and very rough upon the top, where in colour it
resembles thyme, whence it has its name; and it is easily
divided there, and made bloody; sometimes it discharges
some blood; and is generally about the bigness of an
Egyptian bean, seldom larger, sometimes very small.
Sometimes only one, at other times more grow in the palms
of the hands, and soles of the feet; they are worst in the
private parts, and aptest to bleed there.
Those called myrmecia[ FH ] are lower and harder than an
acrothymium, fix their roots deeper, and occasion a greater
pain; below they are broad, and above small, and less
blood comes from them: in size they scarce ever exceed a
lupine. These likewise grow either in the palms of the
hands, or lower parts of the feet.
The clavus grows elsewhere sometimes, but chiefly in
the feet, and principally form a contusion, though sometimes
from other causes; and it gives pain, if not at other
times, at least when one is walking.
Of these the acrochordon, and the acrothymium often
terminate of themselves, and the more readily, the less
they are. Myrmecia and clavi are scarce ever removed
without medicine. If the acrochordon be cut off, it leaves
no root, and for reason does not grow again. When the
acrothymium and clavus are cut off, a small roundish root
grows, which descends deep into the flesh, and that being
left, they sprout up again. The myrmecia adhere by very
broad roots, and therefore cannot be taken off without a
great ulceration. It is very proper to pare the clavus now
and then: for thus without any violence it grows soft: but
if a little blood be let out, it often dies away. It is also
removed, if one cleans it round, and then applies to it
resin mixed with a little of the powder of a milstone. But
the other kinds are to be eaten away by medicines. For the
two first, that which is made from the lees of wine; for
the myrmecia the most proper is that, which consists of
alum and sandarach. But the contiguous parts ought to
be covered with leaves, lest they also be corroded; and
after that a lentil must be applied. A fig also boiled in
water destroys an acrothymium.
Of pustules.
Pustules break out chiefly in the spring
season. Of these there are several kinds.
For sometimes there is a certain asperity over the whole
body, or a part, resembling those pustules, which are occasioned
by a nettle, or from sweat; the Greeks call them
exanthemata[ FI ]. And they are sometimes red, at other
times of the same colour with the skin. Sometimes a
great many grow resembling vari, sometimes larger. The
pustules are livid or pale, or black, or otherwise different
from the natural colour; and there is a humour contained
in them. When they are broke, the flesh below appears
as it were ulcerated. By the Greeks they are called
phlyctænæ helcodes[ FJ ]. They arise either from cold, or
from fire, or from medicines.
The phlyzacium[ FK ] is a pustule somewhat harder, of a
whitish colour, and sharp pointed. What is squeezed from
it is moist. The pustules sometimes turn to small ulcers,
either dry or moist; and sometimes attended only with
an itching, at other times with an inflammation and
pain: pus or sanies issues from them, or both. And this
occurs in children chiefly; seldom in the trunk of the
body; often in the extremities.
The worst kind of pustule is that, which is called epinyctis[ FL ].
Its colour either inclines to livid, or is a dark
brown, or white. There is a violent inflammation round it;
and when it is opened, a mucous ulceration is found within,
in colour resembling its humour. The pain of this is
greater than in proportion to its bulk; for it is not larger
than a bean. And this likewise grows in the extremities,
and generally in the night-time: whence the Greeks have
given it the name of epinyctis.
Now in the cure of all pustules, the first thing is to walk
much, and to take exercise: if that cannot be complied
with, to use gestation. The second rule is, to lessen the
quantity of food; to abstain from every thing acrid and extenuating.
And nurses ought to observe the same rules,
if their sucking child is thus affected. Besides these, one,
that can bear it, if the pustules be small, ought to sweat in
the bagnio; and at the same time to sprinkle nitre over
them; and to anoint the part with a mixture of wine and
oil; then to go into the bath. If no benefit accrues from
these, or if the pustules be of a larger kind, a lentil must
be applied, and when the surface of the skin is taken off,
we must have recourse to lenient medicines. After the
lentil, the epinyctis is to be treated with blood-herb, or
green coriander.
The ulcers formed from pustules are cured by litharge
mixed with fenugreek seed; and in compounding them,
rose oil, or juice of endive, are used alternately, till the
mixture have the consistence of honey. The proper composition
for those pustules, which attack, infants, is of that
stone, which the Greeks call pyrites p. viii. *. with fifty bitter
almonds, and an addition of three cyathi of oil. But
the pustules ought to be first rubbed with ceruss, and then
anointed with this.
Of the scabies.
The scabies is a hardness of the skin, of
a muddy colour, from whence pustules arise,
some of them moist, others dry; from some
of them issues a sanies; and in these there follows a continued
itching ulceration, which in certain cases spreads
very fast. In some people it goes entirely off, in others it
returns at a certain season of the year; the greater its asperity,
and the more it itches, the more difficult it is to
cure. And therefore this species of it the Greeks call
agria[ FM ], that is, cruel.
In this also the same diet is necessary, as above prescribed.
The medicine proper for this in its beginning,
consists of spodium, saffron, verdigrease, each p. i. *. white
pepper, verjuice, each p. i. *. cadmia p. viii. *. But where
there is already an ulceration, that, which is composed of
sulphur p. i. *. wax p. iv. *. liquid pitch a hemina, two
sextarii of oil. These must be boiled together to the consistence
of honey. There is also another, which is said to
have been invented by Protarchus. It contains a sextarius
of lupine meal, four cyathi of nitre, a hemina of liquid
pitch, half a pound of liquid resin, and three cyathi of vinegar.
It is also proper to mix saffron, lycium, verdigrease,
myrrh, ashes, in equal quantities, and boil them in passum.
This heals every kind of scabies. And if there be nothing
else at hand, lees of oil boiled to a third part, or sulphur
mixed with liquid pitch, as I prescribed for cattle, relieve
men also labouring under the scabies.
Of the impetigo.
Of the impetigo there are four species.
The least malignant is that, which resembles
the scabies. For it is red, hardish, ulcerated,
and corrosive. But it differs widely from that, which
is more ulcerated(90), and has pustules like to vari; and
there appear to be in it somewhat like air bubbles, from
which, after a time, something like scales come off; and
this is more certain in its returns.
The second kind is worse, and is not unlike the papula,
but of greater asperity and a more ruddy colour, having
various figures; scales fall off from the surface of the skin,
there is a greater erosion, it spreads more quickly, and
broader, and both comes and goes at more certain intervals
than the former. It is called the red.
The third kind is still worse. For it is both thicker and
harder, and more swelled; it causes fissures in the surface
of the skin, and corrodes more vehemently. This also is
scaly, but black; it spreads wide(91), and does not stay long
at a time; but is less uncertain as to its periods of coming
and going; and is not to be entirely removed. This has
the epithet of the black.
There is a fourth kind absolutely incurable, very different
from the rest in colour. For it is whitish, and resembling
a recent cicatrix; it has scales of a pale colour, some
whitish, others resembling a lentil; which being taken off,
blood sometimes follows. Otherwise the humour of it is
white, the skin is hard and chopped, and it spreads wider.
All these kinds happen chiefly in the feet and hands;
and they also infest the nails. There is no medicine more
efficacious than that I mentioned for the scabies, which
bears the name of Protarchus. Serapion made use of the
following composition, nitre p. ii. *. sulphur p. iv. *. incorporated
with plenty of resin.
Of the papula.
There are two species of the papula.
One is, where the skin is made rough by
very small pustules, and is both red, and
gently corroded; in the midst of them is a space somewhat
smoother; it spreads slowly. And this disorder is of
a round form in its beginning, and proceeds in the same
manner circularly.
The second, the Greeks call agria: which has a similar
appearance, but the skin is more unequal and ulcerated,
and it corrodes more vehemently, is redder, and sometimes
also loosens the hairs.
That which is less round, heals with greater difficulty;
and unless it be cured, it turns to an impetigo. But a slight
papula, if it be rubbed every day with fasting spittle, will
heal. The greater kind is very well cured by feverfew
rubbed over it. But for the compound medicines, that
same prescription abovementioned of Protarchus is so
much the more powerful here, as the distemper is less.
There is another of Mico’s for the same purpose; of red
nitre, frankincense, each p. i. *. cantharides cleansed p.
ii. *. crude sulphur a like quantity, liquid turpentine resin
p. xx. *. meal of darnel three sextantes, three cyathi of
git, and one sextans of crude pitch.
Of the vitiligo.
The vitiligo also, though of itself not dangerous,
yet is both nasty, and proceeds from
a bad habit of body. There are three species
of it. It is called alphos[ FN ], when it is white; it is commonly
a little rough, and not continued, but appears like
drops dispersed here and there. Sometimes it spreads
wider, leaving some, places between free. The melas[ FO ]
differs from that in colour, being black, and like a shadow.
In other respects it is the same. The leuce[ FP ] has some
resemblance to the alphos, but is whiter, and penetrates
deeper; and has white downy hairs in it. All these spread;
but in some more quickly, in others slower. The alphos
and melas come and go in some people without any regularity.
The leuce does not easily quit a person it has once
seized.
The two first are not very difficult to cure; the last scarce
ever heals; and though the disorder be in some degree mitigated,
yet the natural colour is never fully restored. Whether
any of these be curable or not, is easily known from
an experiment. For the skin should be cut, or pricked
with a needle. If blood issues, which generally happens
in the two former, there is room for a remedy; if a white
humour starts, it will not admit of a cure. And therefore
it should not he meddled with.
To the curable kinds must be applied lentils mixed with
sulphur and frankincense, the lentils being bruised and
dipped in vinegar. Another composition for the same purpose
is that, which goes under the name of Irenæus. Bastard
spunge, nitre, cummin, dry fig-leaves, of each equal
parts, are bruised with the addition of vinegar. With this
the part affected is anointed in the sun; and in a little time,
it is washed off, lest it corrode too much. Some following
the practice of Mico, anoint the alphi with the following
medicine; they mix of sulphur p. ii. *. nitre p. iv. *. dry
myrrh powdered an acetabulum; then in the bath sprinkle
upon the vitiligo bean flour, and afterwards put the other
over it. Those which I called melanes, are cured by the
following things beat up together; bastard spunge, frankincense,
barley, and beans; these are sprinkled upon them
without oil in the bagnio, before a sweat comes on, and
then that species of vitiligo comes off by rubbing.
