De Medicina |
Translator: Walter George Spencer
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| 133 |
Ab his , quae extrinsecus incidunt , ad ea ueniendum est , quae interius corrupta aliqua corporum parte nascuntur . Ex quibus non aliud carbunculo peius est . Eius ha e notae sunt : rubor est , superque eum non nimium pusulae eminent , maxime nigrae , interdum subliuidae aut pallidae : in his sanies esse uidetur . Infra color niger est : ipsum corpus aridum et durius quam naturaliter oportet ; circaque quasi crusta est , eaque inflammatione cingitur : neque in eo loco leuari cutis potest , sed inferiori carni quasi adfixa est . Somnus urguet , nonnunquam horror aut febris oritur , aut utrunque . Idque uitium subteractis quasi quibusdam radicibus serpit , interdum celerius , interdum tardius : supra quoque procedens inalbescit , dein liuidum fit , circumque exiguae pustulae oriuntur ; et si circa stomachum faucesue incidit , subito spiritum saepe elidit .—Nihil melius est quam protinus adurere ; neque id graue est : nam non sentit , quoniam ea caro mortua est ; finisque adurendi est , dum ex omni parte sensus doloris est . Tum deinde uulnus sicut cetera adusta curandum est : sequitur enim sub medicamentis erodentibus crusta undique a uiua carne d iducta, quae trahit secum quicquid corruptum erat ; purusque iam sinus curari potest implentibus . At si in summa cute uitium est , possunt succurrere quaedam uel exedentia tantum uel etiam adurentia . Vis pro magnitudine adhibenda est . Quodcunque uero medicamentum impositum est , si satis proficiet , protinus a uiuo corruptam partem resoluit ; certaque esse fiducia potest f ore , ut undique uitiosa caro exc idat, qua exest . Si medicamentum malo uincitur , utique ad ustionem properandum est . Sed in eiusmodi casu abstinendum a cibo , a uino est : aquam liberaliter bibere expedit . Magisque ea seruanda sunt , si febricula quoque accessit . Non idem periculum carcinoma adfert , nisi imprudentia curantis agitatum est . Id uitium fit maxime in superioribus partibus , circa faciem , nares , aures , labra , mammas feminarum : †et in ulcere autem aut splene hoc nascitur . Circa locum aliqu a quasi puncta sentiuntur ; isque immobilis , inaequalis tumet , interdum etiam torpet . Circa eum inflatae uenae quasi recuruantur , haeque pallent aut liuent , nonnunquam etiam in quibusdam delitescunt ; tactusque is locus aliis dolorem adfert , in aliis sensum non habet . Et non nunquam sine ulcere durior aut mollior est quam esse naturaliter debet : nonnunquam isdem omnibus ulcus accedit . Interdumque nullam habet proprietatem , interdum simile is est , quae uocant Graeci condyl omata aspr itudine quadam et magnitudine ; colorque eius ruber est aut lenticulae similis . Neque tuto fer itur : nam protinus aut resolutio neruorum aut distentio insequitur . Saepe homo ictus ommutescit , atque eius anima deficit : quibusdam etiam , si id ipsum pressum est , quae circa sunt , intenduntur et intumescunt . Ob quae pessimum id genus est . Fereque primum id fit , quod cacoethes a Graecis nominatur ; deinde ex eo id carcinoma , quod sine ulcere est ; deinde ulcus , ex eo thymium . Tolli nihil nisi cacoethes potest : reliqua curationibus inritantur ; et quo maior uis adhibita est , eo magis . Quidam usi sunt medicamentis adurentibus , quidam ferro adusserunt , quidam scalpello exciderunt : neque ulla unquam medicina prof ecit , sed adusta protinus concitata sunt et increuerunt , donec occiderent . Excisa , etiam post inductam cicatricem , tamen reuerterunt et causam mortis adtulerunt : cum interim plerique nullam uim adhibendo , qua tollere id malum temptent , sed imponendo tantum lenia medicamenta , quae quasi blandiantur , quominus ad ultimam senectutem perueniant , non prohibentur . Discernere autem cacoethes , quod curationem recipit , a carcinomate , quod non recipit , nemo scire * potest sed tempore et experimento . —Ergo ubi primum id uitium notatum est , imponi debent medicamenta adurentia . Si leuatur malum , minuuntur eius indicia , procedere curatio potest et ad scalpellum et ad ustionem . Si protinus inritatum est , scire licet iam carcinoma esse , remouendaque sunt omnia acria , omnia uehementia . Sed si sine ulcere is locus durus est , imponi ficum quam pinguissimam aut rypodes emplastrum satis est . Si ulcus aequale est , ceratum ex rosa iniciendum est , adiciendusque ei puluis ex contrita testa , ex qua faber ferrarius tinguere candens ferrum solitus est . Si id nimium supercreuit , temptanda squama aeris est , quae lenissima ex adurentibus est , eatenus ne quid eminere patiatur ; sed ita , si nihil exacerbauit : si minus , eodem cerato contenti esse debebimus . Est etiam ulcus , quod ΘΗΡΙΩΜΑ Graeci uocant . Id et per se nascitur et interdum ulceri ex alia causa facto superuenit . Color est uel liuidus uel niger , odor foedus , multus et muc ci s similis umor . Ipsum ulcus neque tactum neque medicamentum sentit : prurigine tantum mouetur . At circa dolor est et inflammatio ; interdum etiam febris oritur , nonnunquam ex ulcere sanguis erumpit . Atque id quoque malum serpit . Quae omnia saepe intenduntur fitque ex his ulcus , quod phagedainam Graeci uocant , quia celeriter serpendo penetrandoque usque ossa corpus uorat . Id ulcus inaequale est , caeno simile ; inestque multus umor glutinosus ; odor intolerabilis , maiorque quam pro modo ulceris inflammatio . Vtrunque , sicut omnis cancer , fit maxime in senibus uel is , quorum corpora mali habitus sunt .—Curatio utriusque eadem est , sed in maiore malo magis necessaria . Ac primum a uictus ratione ordinandus est , ut quiescat in lectulo , ut primis diebus a cibo abstineat , aquam quam plurimam adsumat ; aluus quoque ei ducatur ; dein post inflammationem cibum boni suci capiat , uitatis omnibus acribus ; potionis quantum uolet , sic ut interdiu quidem aqua contentus sit , in cena uero etiam uini austeri aliquid bibat . Non aeque tamen fame in is , quos ΦΑΓΕΔ Α ΙΝΑ urgebit , atque is , qui therioma adhuc habebunt , utendum erit . Et uictus quidem talis necessarius est . Super ulcus uero inspergenda arida al oe * oenanthe est , et , si parum proficiet , chalcitis . Ac si quis neruus exesa carne nudatus est , contegendus ante linteolo est , ne sub eo medicamento aduratur . Si ualidioribus etiamnum remediis opus est , ad eas compositiones ueniendum est , quae uehementius adurunt . Quicquid autem inspergitur , auerso specillo infundi debet . Superdanda cum melle sunt uel lin amenta uel oleae folia ex uino decocta uel marrubium ; eaque linteolo contegenda in aqua frigida madefacto dein bene expresso ; circaque , qua tumor ex inflammatione est , imponenda quae reprimant cataplasmata . Si sub his nihil proficitur , ferro locus aduri debet , diligenter neruis , si qui apparent , ante contectis . Adustum uel medicamentis uel ferro corpus primum purgandum , deinde implendum esse apparere cuilibet ex prioribus potest . Sacer quoque ignis malis ulceribus adnumerari debet . Eius duae species sunt : alterum est subrubicundum aut mixtum rubore atque pallore exasperatumque per pusulas continuas , quarum nulla †alteri maior est , sed plurimae perexiguae : in his semper fere pus et saepe rubor cum calore est . Serpitque id nonnunquam sanescente eo , quod primum uitiatum est , nonnunquam etiam exulcerato , ubi ruptis pusulis ulcus continuatur umorque exit , qui esse inter saniem et pus uideri potest . Fit maxime in pectore aut lateribus aut eminentibus partibus , praecipueque in plantis . Alterum autem est in summae cutis exulceratione , sed sine altitudine , latum , subliuidum , inaequaliter tamen ; mediumque sanescit extremis procedentibus . Ac saepe id , quod iam sanum uidebatur , iterum exulceratur . At circa proxima cutis , quae uitium receptura est , tumidior et durior est coloremque habet ex rubro subnigrum . Atque hoc quoque malo fere corpora seniora temptantur aut quae mali habitus sunt , sed in cruribus maxime . —Omnis autem sacer ignis , ut minimum periculum habet ex is , quae serpunt , sic prope difficillime tollitur . Medicamentum eius fortuitum est uno die febris , quae umorem noxium absumat . Pus quo crassius et albidius est , eo periculi minus est . Prodest etiam infra os uulnerum * laedi , qu o plus puris exeat et id , quod ibi corruptum corpus est , extraha tur. Sed tamen si febricula accessit , abstinentia , lectulo , alui ductione opus est . In omni uero sacro igni neque lenibus et glutinosis , neque salsis et acribus utendum est , sed is , quae inter utrunque sunt , qualis est panis sine fermento , piscis , haedus , aues , exceptoque apro omnis fere uenatio . Si non est febricula , et gestatio utilis est et ambulatio et uinum austere et balneum . Atque in hoc quoque genere potio magis liberalis esse quam cibus debet . Ipsa autem ulcera si mediocriter serpunt , aqua calida , si uehementius , uino calido fouenda sunt ; deinde acu pusulae , quaecunque sunt , aperiendae ; tum imponenda ea , quae putrem carnem exedunt . Vbi inflammatio sublata ulcusque purgatum est , imponi lene medicamentum debet . In altero autem genere possunt proficere mala Coton ea in uino cocta atque contrita , potest emplastrum uel H erae uel tetr apharmacum, cui quinta pars turis adiecta sit , potest nigra hedera ex uino austero cocta ; ac , si celeriter malum serpit , non aliud magis proficit . Purgato ulcere , quod in summa cute esse proposui , satis ad sanitatem eadem lenia medicamenta proficient . Chironeum autem ulcus appellatur , quod et magnum est et habet oras duras , callosas , tumentes . Exit sanies non multa sed tenuis . Odor malus neque in ulcere neque in eius umore est ; nulla inflammatio , dolor modicus est ; nihil serpit , ideoque nullum periculum affert , sed non facile sanescit . Interdum tenuis cicatrix inducitur , deinde iterum rumpitur ulcusque renouatur . Fit maxime in pedibus et cruribus . Super id imponi debet , quod et lene aliquid et uehemens et reprimens habeat . Quale eius rei causa fit ex his : squamae aeris , plumbi eloti combusti , singulorum P . #1108 IIII ; ca dmiae, cerae , singulorum P . #1108 VIII ; rosae quantum satis est ad ceram simul cum eis molliendam . Fiunt etiam ex frigore ulcera hiberna , maxime in pueris , et praecipue pedibus digitisque eorum , nonnunquam etiam in manibus . Rubor cum inflammatione mediocri est ; interdum pusulae oriuntur , deinde exulceratio : dolor autem modicus . Prurigo maior est : nonnunquam umor exit , sed non multus , qui referre uel pus uel saniem uidetur .—In primis multa calida aqua fouendum est , in qua rapa decocta , aut si ea non sunt , aliquae uerbenae ex reprimentibus . Si n ondum adapertum ulcus , aes , quam maxime calidum quis pati potest , admouendum est . Si iam exulceratio est , imponi debet alumen aequa portione cum ture contritum uino adiecto , aut malicorium in aqua coctum deinde contrit um. Si summa detracta pellicula est , hic quoque melius lenia medicamenta proficiunt . Struma quoque est tumor , in quo subter concreta quaedam ex pure et sanguine quasi glandulae oriuntur ; quae uel praecipue fatigare medicos solent , quoniam et febres mouent nec unquam facile maturescunt ; et siue ferro siue medicamentis curantur , plerumque iterum iuxta cicatrices ipsas resurgunt multoque post medicamenta saepius ; quibus id quoque adcedit , quod longo spatio detinent . Nascuntur maxime in ceruice , sed etiam in alis et inguinibus * lateribus : in mammis quoque feminarum se reperisse Meges auctor est . —Propter haec et album ueratrum recte datur , atque etiam saepius , donec ea digerantur , et medicamenta imponuntur , quae umorem uel educant uel dissipent , quorum supra mentio facta est . Adurentibus quoque quidam utuntur , quae exedunt crustaque eum locum astringant ; tunc uero ut ulcus curant . Quaecunque autem ratio curandi est , corpus puro ulcere exercendum atque alendum est , donec ad cicatricem perueniat . Quae cum medici doceant , quorundam rusticorum experimento cognitum , quem struma male habet , si anguem edit , liberari . Furunculus uero est tuberculum acutum cum infla mmatione et dolore , maximeque ubi iam in pus uertit . Qui ubi adapertus est , et exit pus , apparet pars carnis in pus uersa , pars corrupta subalbida , subrubra , quem uentriculum quidam furunculi nominant . In eo nullum periculum est , etiam ut nulla curatio adhibeatur : maturescit enim per se atque erumpit : sed dolor efficit , ut potior medicina sit , quae maturius liberet .—Proprium eius medicamentum galbanum est : sed alia quoque quae supra comprehensa sunt . Si cetera desunt , imponi debe t primum non pingue emplastrum , ut id reprimat ; deinde , si non repressit , quodlibet puri mouendo accommodatum ; si ne id quidem est , uel resina uel fermentum . Expresso pure nulla ultra curatio necessaria est . Phyma uero nominatur tuberculum furunculo simile , sed rotundius et planius , saepe etiam maius . Nam furunculus oui dimi dii magnitudinem raro explet , nunquam excedit : phyma etiam latius patere consueuit , sed inflammatio dolorque sub eo minores sunt . Vbi diuisum est , pus eodem modo apparet ; uentriculus , ut in furunculo , non inuenitur , uerum omnis corrupta caro in pus uertitur . Id autem in pueris et saepius nascitur et facilius tollitur : in iuuenibus rarius ori tur et difficilius curatur . Vbi aetas indurauit , ne nascitur quidem . Quibus uero medicamentis discuteretur , supra propositum est . Phyget ron autem est tumor non altus , latus , in quo quiddam pusulae simile est . Dolor distentioque uehemens est , et maior quam pro magnitudine tumoris , interdum etiam febricula . Idque tarde maturescit neque magnopere in pus conuertitur . Fit maxime aut in uertice aut in alis aut inguinibus . Pan um a similitudin e figurae nostri uocant . Atque id ipsum quo medicamento tolleretur , supra demonstraui . Sed cum omnes hi nihil nisi minuti abscessus sint , generale nomen trahit latius uitium ad suppurationem spectans ; idque fere fit aut post febres aut post dolores partis alicuius maximeque eos , qui uentrem infestarunt . Saepiusque oculis expositum est , siquidem latius aliquid intumescit ad similitudinem eius , quod phyma uocari proposui , rubetque cum calore et paulo post etiam cum duritia , magisque †innocenter indolescit et sitim uigiliamque exprimit : interdum tamen nihil horum in cute deprehendi potest , maximeque ubi altius pus mouetur , sed cum siti uigiliaque sentiuntur intus aliquae punctiones . Et quod desubito durius non est , mollius est et quamuis non rubet , coloris tamen aliter mutati est . Quae signa iam pure oriente nascuntur : tumor ruborque multo ante incipiunt . Sed si locus mollis est , auertendus is materiae aditus est per cataplasmata , quae simul et reprimunt et refrigerant ; qualia et alias et paulo ante in erysipelate proposui : si iam durior est , ad ea ueniendum est , quae digerant et resoluant ; qualis est ficus arida contusa , aut faex mixta cum cerato , quod ex adipe suilla coactum sit , aut cucumeris radix , cui ex farina duae partes adiectae sint ante ex mulso decoctae . Licet etiam miscere aequis portionibus Hammoniacum , galbanum , propolim , uiscum , pondusque adicere myrrae dimidio minus quam in prioribus singulis erit . Atque emplastra quoque et malagmata idem efficiunt , quae supra explicui . Quod per haec discussum non est , necesse est maturescat ; idque quo celerius fiat , imponenda est farina hordeacia ex aqua cocta * * * recte miscetur . Eadem autem haec in minoribus quoque abscessibus , quorum nomina proprietatesque supra reddidi , recte fiunt ; eademque omnium curatio , tantum modo distat . Crudum est autem , in quo magis quasi * uenarum motus est , et grauitas et ardor et distentio et dolor et rubor et durities et , si maior abscessus est , horror aut etiam febricula permanet ; penitusque condita suppurati o est , si pro his , quae alibi cutis ostendit , punctiones sunt . Vbi ista se remiserunt , iamque is locus prurit et aut subliuidus aut subalbidus est , matura suppuratio est ; eaque ubi uel per ipsa medicamenta uel etiam ferro aperta est , pus debet emitti . Tum si qua in alis uel inguinibus sunt , sine lin amento nutrienda sunt . In ceteris quoque partibus , si una plaga exigua est , si mediocris suppuratio fuit , si non alte penetrauit , si febris non est , si ualet corpus , aeque lin amenta superuacua sunt . In reliquis , parce tamen , nec nisi * plaga est , imponi debent . Commode uero uel super lin amenta uel sine his imponitur lenticula ex melle aut malicorium ex uino coctum ; quae et per se et mixta idonea sunt . Si qua circa duriora sunt , ad ea mollienda uel malua contrita uel faeni Graeci liniue semen ex passo coctum superdandum est . Quicquid deinde impositum est , non astringi sed modice deligari debet . Illo neminem decipi decet , ut in hoc genere cerato utatur . Cetera quae pertinent ad purgandum ulcus , ad implendum , ad cicatricem inducendam , conueniuntque , in uulneribus exposita sunt . Nonnunquam autem et ex eiusmodi abscessibus et ex aliis ulcerum generibus fistulae oriuntur . Id nomen est ulceri alto , angusto , calloso . Fit in omni fere parte corporis , habetque quaedam in singulis locis propria . Prius de communibus dicam . Genera igitur plura fistularum sunt , siquidem aliae breues sunt , aliae altius penetrant ; aliae rectae intus feruntur , aliae multoque plures transuersae ; aliae simplices sunt , aliae duplices triplicesue ab uno ore intus orsae quae fiunt ; aut etiam in plures sinus diuiduntur ; aliae rectae , aliae flexae et tortuosae sunt . Aliae intra carnem desinunt , aliae ad ossa aut cartilaginem penetrant aut , ubi neutrum horum subest , ad interiora perueniunt ; aliae deinde facile , aliae cum difficultate curantur ; atque etiam quaedam insanabiles reperiuntur .—Expedita curatio in fistula simplici recenti intra carnem , adiuuatque ipsum corpus , si iuuenile , si firmum est : inimica contraria his sunt ; itemque si fistula os uel cartilaginem uel neruum uel musculos laesit ; si articulum occupauit ; si uel ad uessicam uel ad pulmonem uel ad uuluam uel ad grandes uenas arteriasue uel ad inania , ut guttur , stomachum , thoracem , penetrauit . Ad intestina quoque eam tendere semper periculosum , saepe pestiferum est . Quibus multum mali accedit , si corpus uel aegrum uel senile uel mali habitus est . Ante omnia autem demitti specillum in fistulam conuenit , ut quo tendat et quam alte perueniat , scire possimus , simul etiam protinus umida an siccior sit ; quod extracto specillo patet . Si uero os in uicino est , id quoque disci potest , iam necne eo fistula peruenerit ; * * penetrauit , quatenus nocuerit . Nam si molle est , quod ultimo specillo contingitur , intra carnem adhuc uitium est : si magis id renititur , ad os uentum est . Ibi deinde si labitur specillum , nondum caries est : si non labitur , sed aequali innititur , caries quidem , uerum adhuc leuis est : si inaequale quoque et asperum subest , uehementius os exessum est . At cartilago ubi subsit , ipsa sedes docet peruentumque esse ad eam ex renisu patet . Et ex his quidem colliguntur fistularum sedes , spatia , noxae : simplices uero eae sint , an in plures partes diducantur , cognosci potest ex modo puris ; cuius si plus fertur quam quod simplici spatio conuenit , plures sinus esse manifestum est ; cumque fere iuxta sint caro et neruos et aliqua neruosa , quales fere tunicae membranaeque sunt , genus quoque puris docebit , num plures sinus intus diuersa corporis genera perroserint . Siquidem in carne pus leue , album , copiosius fertur ; at ex neruoso loco coloris quidem eiusdem , sed tenuius et minus ; ex neruo pingue et oleo non dissimile . Denique etiam corporis inclinatio docet , num in plures partes fistulae penetrarint , quia saepe cum quis aliter decubuit aliterue membrum conlocauit , pus ferri quod iam desierat iterum incipit ; testaturque non solum alium sinum esse ex quo descendat , sed etiam in aliam corporis partem eum tendere . Sed si et in carne et recens et simplex est , ac neque rugosa neque caua sede neque in articulo , sed in eo membro , quod per se inmobile non nisi cum toto corpore mouetur , satis proficiet emplastrum , quod recentibus uulneribus inponitur , dum habeat uel sale uel alumen uel squamam aeris uel aeruginem uel ex metallicis aliquid ; exque eo collyrium fieri debet altera parte tenuius , altera parte paulo plenius ; idque ea parte , qua tenuius est , antecedente demitti oportet in fistulam , donec purus sanguis se ostendat . Quae in omnibus collyris fistularum perpetua sint . Idem deinde emplastrum in linteolo superinponendum , supraque inicienda spongia est in acetum ante demissa ; soluique quinto die satis est . Genusque uictus adhibendum est , quo carnem ali docui . Ac si longius a praecordis fistula est , ex interuallo ieiunum radiculas esse , deinde uomere necessarium est . Vetustate callosa fit fistula . Callus autem neminem fallit , quia durus est et aut albus aut pallidus . Sed tum ualidioribus medicamentis opus est ; quale est , quod habet : papaueris lacrimae P . #1108 I ; cummis P . #1108 III #1109; cadmiae P . #1108 IIII ; atramenti sutori P . #1108 VIII ; ex quibus aqua coactis collyrium fit . Aut in quo sunt : gallae P . #1108 #1109 #1110; aeruginis , sandaracae , aluminis Aegypti , singulorum P . #1114 I ; atramenti sutori conbusti P . #1114 II . Aut quod constat ex chalcitide et saxo calcis , quibus auripigmenti dimidio minus quam in singulis prioribus est adicitur ; eaque melle cocto excipiuntur . Expeditissimum autem est ex praecepto Megetis aeruginis rasae P . #1108 II conterere , deinde Hammoniaci thymiamatis P . #1114 I aceto liquare , eoque infuso aeruginem c ogere ; idque ex primis medicamentis est . Sed ut haec maximi effectus sunt , sic , cui i sta non adsunt , facile tamen est callum quibuslibet adurentibus medicamentis erodere : satisque est uel papyrum intortum uel aliquid ex penicillo in modum collyri adstrictum eo inlini . Scilla quoque cocta et mixta cum calce callum exest . Si quando uero longior sed transuersa fistula est , demisso specillo contra principium huius incidi commodissimum est , et collyrium utrinque demitti . At si duplicem esse fistulam aut multiplicem existimamus , sic tamen ut breuis intraque carnem sit , collyrio uti non debemus , quod unam partem curet , reliquas omittat ; sed eadem medicamenta arida in calamum scriptorium coicienda sunt , isque ori fistulae aptandus , inspirandumque , ut ea medicamenta intus conpellantur : aut eadem ex uino liquanda , uel , si sordidior fistula est , ex mulso , si callosior , ex aceto sunt idque intus infundendum . Quicquid inditum est , superponenda sunt , quae refrigerent et reprimant : nam fere quae circa fistulam sunt , habent aliquid inflammationis . Neque alienum est , ubi qui soluerit , antequam rursus alia medicamenta coiciat , per oricularium clysterem fistulam eluere ; si plus puris fertur , uino ; si callus durior est , aceto ; si iam purgatur , mulso uel aqua , in qua eruum coctum sit , sic ut huic quoque mellis paulum adiciatur . Fere uero fit , ut ea tunica , quae inter f or amen et integram carnem est , uicta medicamentis tota exeat , infraque ulcus purum sit ; quod ubi contigit , imponenda glutinantia sunt , praecipueque spongia melle cocto inlita . Neque ignoro multis placuisse lin amentum in modum collyri compositum tinctum melle demitti ; sed celerius id glutinat quam impletur . Neque uerendum est , ne purum corpus puro corpori iunctum non coeat : adiectis quoque medicamentis ad id efficacibus * * * cum saepe exulceratio digitorum , nisi magna cura prospeximus , sanescendo in unum eos iungat . Est etiam ulceris genus , quod a faui similitudine ΚΗΡΙΟΝ a Graecis nominatur , idque duas species habet . Alterum est subalbidum , furunculo simile , sed maius et cum dolore maiore . Quod ubi maturescit , habet foramina , per quae fertur umor glutinosus et purulentus ; neque tamen ad iustam maturitatem peruenit . Si diuisum est , multo plus intus corrupti quam in furunculo apparet altiusque descendit . Raro fit nisi in scapulis . Alterum * * * est minus super corpus eminens , durum , latum , subuiride , subpallidum , magis exulceratum : siquidem ad singulorum pilorum radices foramina sunt , per quae fertur umor glutinosus , subpallidus , crassitudinem mellis aut uisci referens , interdum olei . Si inciditur , uiridis intus caro apparet . Dolor autem et inflammatio ingens est , adeo ut acutam quoque febrem mouere consuerint .—Super id , quod minus crebris foraminibus exasperatum est , recte inponitur et ficus arida et lini semen in mulso coctum et emplastra ac malagmata materiam educentia , aut quae proprie huc pertinentia supra posui . Super alterum et eadem medicamenta , et farina ex mulso cocta , sic ut ei dimidium resinae terebenthinae misceatur ; et ficus in mulso decocta , cui paulum hysopi contriti sit adiectum ; et uuae t aminiae pars quarta fico adiecta . Quod si parum in utrolibet genere medicamenta proficiunt , totum ulcus usque ad sanam carnem excidi oportebit . Vlcere ablato super plagam medicamenta danda sunt , primum quae pus citent , deinde quae purgent , tum quae impleant . Sunt uero quaedam uerrucis similia , quorum diuersa nomina ut uitia sunt . ACROCHORDONA uocant , ubi sub cute coit aliquid durius , et interdum paulo asperius , coloris eiusdem , infra tenue , ad cutem latius ; idque modicum est , quia raro fabae magnitudinem excedit . Vix unum tantum eodem tempore nascitur , sed fere plura , maximeque in pueris ; eaque nonnumquam subito desinunt , nonnumquam mediocrem inflammationem excitant ; sub qua etiam in pus conuertuntur . At THYMION nominatur , quod super corpus quasi uerrucula eminet , ad cutem tenue , supra latius , subdurum et in summo perasperum . Idque summum colorem floris thymi repraesentat , unde ei nomen est , ibique facile finditur et cruentatur ; nonnumquam aliquantum sanguinis fundit , fere que circa magnitudinem fabae Aegyptiae est , raro maius , interdum perexiguum . Modo unum autem , modo plura nascuntur , uel in palmis uel inferioribus pedum partibus . Pessima tamen in obscenis sunt maximeque ibi sanguinem fundunt . MYRMECIA autem uocantur humili ora thym io durioraque , quae radices altius exigunt maioremque dolorem mouent : infra lata , super autem tenuia , minus sanguinis mittunt ; magnitudine uix umquam lupini modum excedunt . Nascuntur ea quoque aut in palmis , aut inferioribus pedum partibus . CLAVVS autem nonnumquam quidem alibi , sed in pedibus tamen maxime nascitur , praecipue ex contuso , quamuis interdum aliter ; dolorem , etiamsi non alias , tamen ingredienti mouet . Ex his acrochordon et thymium saepe etiam per se finiuntur , et quo minora sunt , eo magis . Myrmecia et claui sine curatione uix umquam desinunt . Acrochordon , si excissa est , nullam radiculam reli nquit, ideoque ne renascitur quidem . Thymio clauoque excissis , sub ter rotunda radicula nascitur , quae penitus descendit ad carnem , eaque relicta idem rursus exigit . Myrmecia latissimis radicibus inhaerent , ideoque ne excidi quidem sine exulceratione magna possunt . Clauum subinde radere commodissimum est : nam sine ulla ui sic mollescit ; ac si sanguinis quoque aliquid emissum est , saepe emoritur . Tollitur etiam , si quis eum circumpurgat , deinde inponit resinam , cui miscuit pulueris paulum , quem ex lapide molari contrito fecit . Cetera uero genera medicamentis adurenda sunt ; aliisque id , quod ex faece uini ; myrmecis id , quod ex alumine et sandaraca est , aptissimum . Sed ea , quae circa sunt , foliis contegi debent , ne ipsa quoque exulcerentur ; deinde postea lenticula imponi . Tollit thym ium etiam ficus in aqua cocta . At pusulae maxime uernis temporibus oriuntur . Earum plura genera sunt . Nam modo circa totum corpus partemue aspritudo quaedam fit , similis iis pusulis , quae ex urtica uel sudore nascuntur : exanthemata Graeci uocant ; eaque modo rubent , modo colorem cutis non excedunt . Nonnumquam plures similes uaris oriuntur , nonnumquam maiores pusulae liuidae aut pallidae aut nigrae , aut aliter naturali colore mutato ; subestque his umor . Vbi eae ruptae sunt , infra quasi exulcerata caro apparet : phlyctaenae Graece nominantur . Fiunt uel ex frigore uel ex igne uel ex medicamentis . Ph lyzacion autem paulo durior pusula est , subalbida , acuta , ex qua ipsa quod exprimitur umidum est . At ex pusulis uero nonnumquam etiam ulcuscula fiunt aut aridiora aut umidiora ; et modo tantum cum prurigine , modo etiam cum inflammatione aut dolore ; exitque aut pus aut sanies aut utrumque ; maximeque id euenit in aetate puerili , raro in medio corpore , saepe in eminentibus partibus . Pessima pusula est , quae epinyctis uocatur : ea colore uel subliuida uel nigra uel alba esse consueuit . Circa hanc autem uehemens inflammatio est ; et cum adaperta est , reperitur intus exulceratio muccosa , colore umori suo similis . Dolor ex ea supra magnitudinem eius est : neque enim ea faba maior est . Atque haec quoque oritur in eminentibus partibus et fere noctu ; unde nomen quoque a Graecis ei inpositum est . —In omnium uero pusularum curatione primum est multum ambulare atque exerceri ; si quid ista prohibet , gestari . Secundum est cibum minuere , abstinere ab omnibus acribus et extenuantibus ; eademque nutrices facere oportet , si lactens puer ita adfectus est . Praeter haec is , qui iam robustus est , si pusulae minutae sunt , desudare in balneo debet , simulque super eas nitrum inspergere oleoque uinum miscere et sic ungui ; tum descendere in solium . Si nihil sic proficitur , aut si maius pusularum genus occupauit , imponenda lenticula est , detractaque summa pellicula ad medicamenta lenia transeundum est . Epinyctis post lenticulam recte herba quoque sanguinali uel uiridi coriandro curatur . Vlcera ex pusulis facta tollit spuma argenti cum semine feni Graeci mixta , sic ut his inuicem rosa atque intubi sucus adiciatur , donec mellis crassitudo ei fiat . Proprie ad eas pusulas , quae infantes male habent , lapidis , quem pyriten uocant , P . #1114 VIII cum quinquaginta amaris nucibus miscetur , adiciunturque olei cyathi tres . Sed prius ungui ex cerussa pusulae debent , tum hoc inlini . Scabies uero durior : cutis rubicunda , ex qua pusulae oriuntur , quaedam umidiores , quaedam sicciores . Exit ex quibusdam sanies , fitque ex his continuata exulceratio pruriens ; serpitque in quibusdam cito . Atque in aliis quidem ex toto desinit , in aliis uero certo tempore anni reuertitur . Quo asperior est quoque prurit magis , eo difficilius tollitur : itaque eam , quae talis est , agrian Graeci appellant . —In hoc quoque uictus ratio eadem quae supra necessaria est : medicamentum autem ad incipientem hanc idoneum est , quod fit ex spodi , croci , aeruginis , singulorum P . #1114 I ; piperis albi , omphaci , singulorum P . #1108 I ; cadmiae P . #1114 VIII . At ubi iam exulceratio est , id , quod fit ex sulpuris P . #1114 I ; cerae P . #1114 IIII ; picis liquidae hemina ; olei sextaris duobus ; quae simul incocuntur , dum crassitudo mellis sit . Est etiam quod ad Protarchum auctorem refertur . Habet farinae lupinorum S. I .; nitri cyathos IIII S.; picis liquidae heminam ; resinae umidae selibram ; aceti cyathos tres . Crocum quoque , Lycium , aerugo , murra , cinis aequis portionibus recte miscentur , et ex passo cocuntur ; idque omnem pituitam ubique sustinet . Ac si nihil aliud est , amurca ad tertiam partem decocta uel sulpur pici liquidae mixtum , sicut in pecoribus proposui , hominibus quoque scabie laborantibus opitulantur . Inpetiginis uero species sunt quattuor . Minime mala est , quae similitudinem scabie repraesentat : nam et rubet et durior est et exulcerata est et roditur . Distat autem ab ea , quod magis exulcerata est et uaris similis pusulas habet ; uidenturque esse in ea quasi bullulae quaedam , ex quibus interposito tempore squamulae resoluuntur ; certioribus que hoc temporibus reuertitur . Alterum genus peius est , simile papulae fere , sed asperius rubicundiusque ; figuras uarias habet ; squamulae ex summa cute discedunt ; ros io maior est ; celerius et latius procedit certioribusque etiamnum quam prior temporibus et fit et desinit : rubrica cognominat ur. Tertia etiannum deterior est : nam et crassior est et durior et magis tumet ; in summa cute finditur et uehementius roditur . Ipsa quoque squamosa sed nigra ; proceditque et late nec tarde ; et minus errat in temporibus , quibus aut oritur aut desinit neque ex toto tollitur : nigrae cognomen est . Quartum genus est , quod curationem omnino non recipit , distans colore : nam subalbidum est et recenti cicatrici simile ; squamulasque habet pallidas , quasdam subalbidas , quasdam lenticulae similes , quibus dempti s nonnumquam profluit sanguis . Alioqui uero umor eius albidus est , cutis dura atque fissa est ; proceditque latius . Haec uero omnia genera maxime oriuntur in pedibus et manibus ; atque ungues quoque infestant . Medicamentum non aliud ualentius est quam quod ad scabiem quoque pertinere sub auctore Protarcho retuli . Sarapion autem nitri P . #1114 II , sulpuris P . #1114 IIII excipiebat resina copiosa , eaque utebatur . Papularum uero duo genera sunt . Alterum est in quo per minimas pusulas cutis exasperatur et rubet leuiterque roditur : medium habet pauxillo leuius , tarde serpit . Idque uitium maxime rotundum incipit , eademque ratione in orbem procedit . Altera autem est , quam agrian Graeci appellant ; in qua similiter quidem sed magis cutis exasperatur exulceraturque , ac uehementius et roditur et rubet et interdum etiam pilos remittit . Minus rotunda est , difficilius sanescit : nisi sublata est , in inpetiginem uertitur . Sed leuis papula etiam , si ieiuna saliua cotidie defricatur , sanescit : maior commodissime murali herba tollitur , si sub ea detrita est . Vt uero ad composita medicamenta ueniamus , idem illud Protarchi tanto ualentius in his est , quanto minus in his uiti est . Alterum ad idem Myronis : nitri rubri , turis , singulorum P . #1108 I ; cantharidum purgatarum P . #1108 II ; sulpuris ignem non experti tantundem ; resinae terebenthinae liquidae P . #1108 XX ; farinae loli S. III ; gitti cyathos III S.; picis crudae S. I . Vitligo quoque quamuis per se nullum periculum adfert , tamen et foeda est et ex malo corporis habitu fit . Eius tres species sunt . Alphos uocatur , ubi color albus est , fere subasper , et non continuus , ut quaedam quasi guttae dispersae esse uideantur . Interdum etiam latius et cum quibusdam intermissionibus serpit . Melas colore ab hoc differt , quia niger est et umbrae similis : cetera eadem sunt . Leuce habet quiddam simile alpho , sed magis albida est , et altius descendit , in eaque albi pili sunt et lanugini similes . Omnia haec serpunt , sed in aliis celerius , in aliis tardius . Alphos et melas in quibusdam uariis temporibus et oriuntur et desinunt : leuce quem occupauit , non facile dimittit . Priora curationem non difficillimam recipiunt , ultimum uix umquam sanescit ; ac si quid ei uitio demptum est , tamen non ex toto sanus color redditur . Vtrum autem aliquod horum sanabile sit , an non sit , experimento facile colligitur . Incidi enim cutis debet aut acu pungi : si sanguis exit , quod fere fit in duobus prioribus , remedio locus est ; si umor albidus , sanari non potest ; itaque ab hoc quidem abstinendum est . Super id uero , quod curationem recipit , inponenda lenticula mixta cum sulpure et ture , sic ut ea contrita ex aceto sint . Aliud ad idem , quod ad Irenaeum auctorem refertur : alcyonium , nitrum , cuminum , fici folia arida paribus portionibus contunduntur adiecto aceto . His in sole uitligo perunguitur , deinde non ita multo post , ne nimis erodatur , eluitur . Proprie quidam Myrone auctore eos , quos alphos uocari dixi , hoc medicamento perungunt : sulpuris P . #1108 #1109 #1110; aluminis scissilis P . #1108 #1109; nitri P . #1108 #1109 #1109; murti aridae contrita e acetabulum miscent ; deinde in balneo super uitliginem inspergunt farina m ex faba , tum haec inducunt . Ii uero , quos melanas uocari dixi , curantur , cum simul contrita sunt alcyoneum , tus , hordeum , faba ; eaque sine oleo in balineo ante sudorem insperguntur ; tum genus id uitliginis defricatur .
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28 From those lesions which are due to something from without we come to those which originate from within, when some bodily part has become corrupted. Of these none are worse than carbuncles, the signs of which are: redness, with a few pustules projecting a little, mostly black, sometimes livid or pallid; their contents seems to be sanies; the colour underneath is black; the actual tissue is dry, and harder than it should be naturally; and round them there is a sort of crust, and outside that an inflammatory ring; and there the skin cannot be pinched up, but is as it were fixed in the underlying flesh. The patient is somnolent; sometimes there is shivering or fever or both. And this lesion spreads, sometimes quickly, sometimes slowly, pushing out a sort of root underneath; on the surface too as it spreads the skin gets paler, then becomes livid, and a ring of small pustules arises; and if this occurs in the region of the gullet or fauces, often it suddenly stops the patient's breathing. The best thing is to apply a cautery at once; this is not a severe procedure, because the patient does not feel it, since the flesh is dead; and the cauterizing is topped when pain is felt all over the lesion. After that the wound is to be treated like other burns; for under erodent medicaments it follows that the crust becomes separated on all sides from the liv gate flesh, and takes off with it whatever has become corrupted; and the cavity when clean can be dressed with some preparation to make flesh. But when the lesion is on the surface of the skin, it is possible to cure it simply by exedents or at any rate by caustics. The strength of the remedy adopted is to be proportionate to the lesion. But whatever the medicament is, if it is sufficiently effectual, it forthwith detaches the corrupted part from the living; we may be confident that wherever the application works, the diseased flesh everywhere sloughs off. If the medicament is being mastered by the disease, certainly there must be no delay in applying the cautery. But in such a case there should be abstinence from food and from wine; it is a good thing to drink water freely. And this should be done all the more when there is feverishness as well. A carcinoma does not give rise to the same danger unless it is irritated by imprudent treatment. This disease occurs mostly in the upper parts of the body, in the region of the face, nose, ears, lips, and in the breasts of women, but it may also arise in an ulceration, or in the spleen. Around the spot is felt a sort of pricking; there is a fixed, irregular swelling, sometimes there is also numbness. Around it are dilated tortuous veins, pallid or livid in hue; sometimes in certain cases they are even hidden from view; and in some the part is painful to the touch, in others there is no feeling. And at times the part becomes harder or softer than natural, yet without ulcerating; and sometimes ulceration supervenes on all the above signs. The ulceration at times has no special characteristic; at times it resembles what the Greeks call condylomata, both in a sort of roughness and in size; its colour is either red or like that of lentils. It is not safe to give it a blow; for either paralysis or spasm of the sinews follows at once. Often from a blow on it a man loses speech and faints; in some also, if the place is pressed, the parts around become tense and swollen. Then it is the worst kind. And generally the first stage is what the Greeks call cacoethes; then from that follows a carcinoma without ulceration; then ulceration, and from that a kind of wart. It is only the cacoethes which can be removed; the other stages are irritated by treatment; and the more so the more vigorous it is. Some have used caustic medicaments, some the cautery, some excision with a scalpel; but no medicament has ever given relief; the parts cauterized are excited immediately to an increase until they cause death. After excision, even when a scar has formed, none the less the disease has returned, and caused death; while at the same time the majority of the patients, though no violent measures are applied in the attempt to remove the tumour, but only mild applications in order to soothe it, attain to a ripe old age in spite of it. No one, however, except by time and experiment, can have the skill to distinguish a cacoethes which admits of being treated from a carcinoma which does not. Therefore, as soon as the lesion is first noted, caustic medicaments should be applied. If the disease is relieved, if tis indications are lessened, the treatment can be advanced to the use of the knife and of the cautery. If it is irritated at once, we may recognize that it is already a carcinoma, and that all acrid and severe remedies are to be avoided. But if the place is hardened without ulceration, it is enough to put on a fig of the fattest sort or the plaster called rhypodes. If there is an ulceration level with the skin, the rose cerate is to be applied, to which must be added powder from a crusted earthenware pot, into which a blacksmith has been accustomed to dip red-hot iron. If there is a considerable growth upon it, copper scales, which are the mildest of the caustics, are to be tried, until they check the tendency to growth; but only so if it is in no wise made worse: when the growth is less prominent we ought to rest content with the rose cerate. There is also an ulceration which the Greeks call therioma. This may arise spontaneously, and at times it may supervene upon ulceration from another cause. It has either a livid or black colour, a foul odour, and an abundant mucus-like discharge. The ulcer itself is insensitive to touch and applications; there is just disturbance by itching. But around there is pain and inflammation; sometimes even fever is set up, occasionally blood is discharged from the ulceration. This also is a spreading disease. And all these signs often extend, and there results from them an ulcer which the Greeks call phagedaena, because it spreads rapidly and penetrates down to the bones and so devours the flesh. This ulceration is uneven, bog-like; there is a large amount of glutinous discharge; the stench is intolerable, and the inflammation is greater than accords with the extent of the ulceration. Both therioma and phagedaena, like all canker, occur for the most part in the aged or those of a bad habit of body. Both are treated in the same way, but treatment is more necessary in the severer form. Firstly, a regimen must be enforced, so that the patient rests in bed, abstains from food for the first days, drinks very freely of water; also has the bowels moved by a clyster; then, on the subsidence of the inflammation, takes digestible food, avoiding everything acrid; drinks as much as he likes, but for the time being contents himself with water, except that at dinner he may drink a little dry wine. But fasting is not to be used for patients with phagedaena to the same extent as for those with therioma. Over the ulceration too should be dusted dry lign-aloes pounded up or vine-flower, and if this does no good, copper ore; and if by erosion of flesh a sinew has become exposed, it must first be covered by lint, to prevent the medicament from burning it. If still stronger remedies are required, then recourse must be had to more active caustics. But whatever the medicament to be sprinkled on, it ought to be applied by means of the flat end of a probe. Over this should be put either lint soaked in honey or olive-leaves boiled in wine or horehound; and this is to be covered over by lint well wrung out of cold water; the inflammatory swelling around is to be covered with repressant poultices. If there is no benefit from these measures, the place should be burnt with the cautery, exposed sinews being first carefully covered over. The tissue burnt, whether by caustic or by the cautery, is first to be cleaned, then to be filled up with new flesh, as is clear to anyone from what has been stated before. Ignis sacer should be counted also among the bad ulcerations. Of this there are two kinds; one is reddish or partly red, partly pale and roughened by a chronic pustulation, the pustules all of about equal size, but mostly very small: in them there is nearly always pus and often there is redness with heat. And sometimes the disease spreads while the first part attacked is healing; sometimes even after this is ulcerated, when the pustules have ruptured and the ulcer continues and a humour is discharged which appears to be continuing between sanies and pus. It attacks chiefly the chest or flanks or extremities, particularly the soles of the feet. The second form, again, consists of a superficial ulceration, not going deep, but wide, somewhat livid, yet patchy; while it heals at the centre, it extends at the margins. And often the part which apparently had healed again ulcerates. But the skin around, which is about to be invaded by the disease, becomes more swollen and harder and of a dusky red colour. And it is the aged who are mostly afflicted by this malady too or those with a bad habit of body, but chiefly in the legs. Now all cases of erysipelas, although the least dangerous of the ulcerations which spread, are the most difficult to relieve. A chance remedy for it is a one-day fever which carries off noxious humour. The thicker and the whiter the pus, the less the danger. It is also beneficial to make incisions below the opneings of the sores, to let a larger amount of pus escape, and to extract it because the body there is corrupt. If, however, slight fever supervenes, abstinence, rest in bed and a clyster are needed. In erysipelas of all kinds, neither mild and glutinous nor salted and acrid foods should be used, but material of the middle class, such as unleavened bread, fish, kid, poultry and all kinds of game, except wild boar's meat. When there is no feverishness, both rocking and walking are of service, and dry wine and the bath. And in this class of cases drink should be taken more freely than food. gut if the ulceration spreads slowly it should be fomented with hot water; if rapidly, with hot wine; then whatever pustules there are must be opened with a needle; afterwards applications are to be made which corrode putrid flesh. When the inflammation is relieved and the ulcer cleaned, soothing ointment should be applied. But in the former kind, quinces, boiled in wine and pounded, may prove beneficial, as also a plaster, either that of Heras or the tetrapharmacum, with a fifth part of frankincense added, or black ivy boiled in dry wine; and if the disease is spreading rapidly there is nothing better. When the ulceration has been cleaned, the same soothing remedies which I prescribed above for the superficial variety are sufficient to induce healing. Again, the ulcer called chironean is large and has hard, callous, swollen margins. A sanies exudes, which is not copious, but thin. There is no bad odour, either in the ulcer or in its discharge; no inflammation; pain is moderate; it does not spread, so it brings no design, but it does not heal rapidly. At times a thin scab is produced, then in turn it is broken down and the ulceration is renewed. It occurs chiefly on the feet and legs. On it should be applied something which is at once soothing, and active and repressant, such as the following: copper scales, washed lead calcined, 16 grams each, cadmia and wax, 32 grams each, along enough rose-oil to give the wax together with the other materials a soft consistence. Ulcers are also produced in winter by the cold, mostly in children, and particularly on their feet and toes, sometimes also on the hands. There is redness with moderate inflammation; some pustules arise followed by ulceration; the pain is moderate. The itching is greater; at times humour exudes, but not much; it seems to resemble either pus or sanies. In the first place, the ulcers are to be fomented freely with a hot decoction of turnips, or, if these are not to be had, some kind of repressant vervain. If there is not yet an open ulcer, copper scales as hot as can be borne are to be applied. If there is already an ulceration, then apply equal parts of alum and frankincense pounded together with the addition of wine, or pomegranate-rind boiled in water and then pounded. If the skin has become detached, in that case also soothing medicaments do good. Struma, again, is a swelling, in which there occur underneath certain concretions of pus and blood like little glands; they are specially embarrassing to medical men, for they set up fever and yet do not quickly come to a head; and whether they are treated by incision or by medicaments, they are generally prone to recur in the neighbourhood of their scars, and this happens much more often after the application of medicaments; and in addition to all this, they are of long duration. These swellings arise particularly in the neck, but also in the armpits and groins and in the flanks. The surgeon Meges stated that he had met with them also in the breasts of women. For these white hellebore is an appropriate remedy, and this must be taken frequently until they are dispersed; and also the medicaments which have been mentioned above are applied in order to draw out or disperse the humour. Some also use caustics which eat away, and by forming a scab harden the place; after which they dress it like an ulceration. Whatever the mode of treatment, however, after the ulcer has cleaned, the patient is to have exercise and nourishment until the scar is formed. Although these are the doctrines of the physicians; it has been found out by the experience of some country folk, that anyone with a bad struma may be freed from it by eating a snake. The boil, again, is a pointed swelling attended by inflammation and pain, and especially so when it is being converted into pus. When it has opened and the pus gone out, it is seen that part of the flesh has been turned into pus, part into a greyish-reddish core which some call the sac of the boil. There is no danger in it, even although no treatment is adopted; for it ripens of itself, and bursts; but the pain renders treatment preferable in order to afford earlier relief. The special medicine for this is galbanum; but there are others also which have been mentioned above. If none of these are available a plaster that is not greasy should first be applied to disperse it; next, if this is not effective, something adapted to promote suppuration; if even that is not to be had, either raisin wine or yeast. When the pus has been squeezed out, no further treatment is needed. A phyma is a swelling which resembles a boil, but is rounder and flatter, often also larger. For a boil rarely reaches the size of half an egg, and never exceeds it; a phyma commonly extends even over a wider area, but the pain and the inflammation in it are less. When it has been opened, pus appears in the same way; no core is found as in a boil, in fact all the corrupted flesh is turned into pus. Now in children this occurs more often and is more readily relieved; in young adults it is more rare and more difficult to treat. Where age has hardened the body, the disease does not even occur. By what medicaments it should be dispersed has been stated above. Phygetron, again, is a wide swelling, not much raised up, in which there is a certain resemblance to a pustule. The pain and tension is severe, and more than would be expected from the size of the swelling; at times there is also feverishness. The ripening takes place slowly, and not much pus is formed. It occurs particularly on the top of the head, or in the armpits or groins. Our people call it panus, from its spindle-shape. And I have pointed out above by what medicament this should be relieved. But although all these diseases are really only minute abscesses, that name implies in general a more extensive lesion, tending to suppuration; and it occurs usually either after fevers or after pains in some part, and particularly after those which have attacked the abdomen. And generally it is visible, since there is some rather widespread swelling, like that which I have previously described as called phyma, and it grows red and hot and shortly afterwards hard as well, and becomes more painful as it increases and occasions both thirst and insomnia: sometimes, however, there may be none of these signs to note in the skin, and especially when pus is forming more deeply; but along with the thirst and insomnia some stabbing pains are felt internally. And it is more favourable when it does not become harder on a sudden, and although it does not redden, nevertheless changes somewhat in colour. Such are the signs which arise when pus is already forming; the swelling and redness begin long before. But if the place is soft, the gathering of the diseased matter is to be diverted by poultices which are at the same time repressant and cooling; such as I have mentioned elsewhere, and just above under erysipelas: if it has become already hard, recourse must be had to poultices for dispersing and resolving; such as a dried and crushed fig, or wine-lees mixed with cerate, made up with hog's lard, or cucumber-root to which has been added twice the weight of flour, previously boiled in honey wine. Again, we may mix equal part by weight of ammoniacum, galbanum, propolis, mistletoe-juice, and of myrrh half as much by weight as of the other ingredients. And the plasters and emollients which I have described above have the same effect. A swelling which has not been dispersed by such measures must needs mature; that it may do so more quickly, barley-meal should be put on boiled in water with which also some herb should be mixed. The same applications are appropriate also for the smaller abscesses, the names and peculiarities of which I have referred to above; treatment is the same for all, only differing in degree. Now a swelling is immature when the blood-vessels throb more as if they were bubbling and there is weight and heat and tension and pain and redness and hardening and, if the abscess is larger, shivering or even persistent feverishness; and a suppuration is completely concealed, if, instead of the signs presented by the skin in other cases, there are stabbing pains. When these signs subside, and the place begins to itch, and is either bluish or greyish, the suppuration has matured; and when it has been opened by means of these medicaments or even by the knife, the pus must be let out. Then if there are any abscesses in the armpits or groins, they must be dressed without inserting lint. In other parts also, if there is one small opening, if there has been moderate suppuration, if it has not penetrated deeply, if there is no fever, if the patient is strong, lint is equally superfluous. In other cases lint should be applied, but sparingly, and only if the opening is large. It is beneficial, whether lint is used or not, to apply lentil meal with honey, or pomegranate rind boiled in wine; these are suitable alone or mixed together. If the parts are hard, they should be softened by applying either pounded mallow or fenugreek or flax seed boiled in raisin wine. Whatever dressing is afterwards applied should not be tight but bandaged on lightly. No one should be misled into applying a cerate in this sort of case. All the other directions for cleaning the ulceration, forming flesh, and inducing a scar have been described in treating of wounds. Sometimes, again, fistulae arise, both from abscesses of this kind and from other sorts of ulceration. A fistula occurs in almost any part of the body, but in each place it has some peculiarities. I shall speak first of its general characteristics. There are many kinds of fistulae, then, and whilst some are short, others penetrate deeper; some run straight inwards, others, and by far the most numerous, crosswise; some are simple, others beginning by one opening form two or three branches inside or even divide into several passages; some go straight, others are curved and tortuous. Some end in the flesh, others penetrate to bone or to cartilage, or, when neither of these is underneath, reach to the inner parts; some, therefore, are treated easily, others with difficulty; and some are even found to be incurable. The treatment is speedy when the fistula is simple, recent and only involving the flesh, and the body itself helps, when it is youthful and sound: contrary conditions are inimical; also if the fistula has damaged bone or cartilage or sinew or muscles; if it has involved a joint; or if it has penetrated either to the bladder of lung or womb or to large veins or arteries or to hollow regions, which as the throat, gullet or thorax. When too the fistula goes towards the intestines it is always dangerous, often deadly. When the body is either sick or aged or in bad condition, the case is much worse. First of all, however, it is prisoner to pass a probe into the fistula, that we may learn both its direction and depth, and at the same time whether it is moist or rather dry. This is known when the probe is withdrawn. But if there is bone in the neighbourhood, we can also learn whether the fistula has reached and penetrated the bone or not, and how far the damage has gone. For if what is touched by the end of the probe is soft, the disease is still limited to the flesh; if it meets with more resistance, the fistula has reached bone. But when the probe slides smoothly, there is not yet decay; if it does not so slide, but meets with an even surface, there is some decay although still slight; if what underlies is uneven also and rough, the bone has become more seriously eaten away. But the position of the fistula shows where there is underlying cartilage, and resistance to the probe shows when this has been reached. And from these signs we may gather the situation, extent and harmfulness of fistulae; whether too they are simple, or have several branches, can be estimated from the amount of pus; for it there is more than one opening will account for, it is clear that there are several branches; and since generally flesh and sinew and sinewy tissue such as sheaths and membranes are near the fistula, the character of the pus also will show whether the several branches have eaten into other parts of the body. For pus derived from flesh is smooth, white and fairly plentiful; from sinewy structures it is of the same colour but thinner and less in quantity; from sinews it is fatty and not unlike oil. Further also, the bending of the body indicates whether the fistulae have penetrated in several directions, because often when a patient has changed his recumbent posture, or held a limb in a different position, pus which had previously ceased, begins to discharge again; and it then becomes evident, not only that there is another branch from which pus is being discharged, but also that it is tending into another part of the body. But if the fistula is in the flesh, and is recent and simple, and is not tortuous or in a cavity or joint, but in a part which remains still unless moved with the body generally, a sufficiently effective application is a plaster such as is applied to recent wounds, so long as it is composed of either salt or of alum or of copper scales or of verdigris or some other metallic substances; and from this a tent should be made, thinner at one end, a little thicker at the other. This should be passed into the fistula with the pointed end forwards, and be kept until pure blood shows itself. Such are the general rules for the use of all tents for fistulae. Next, the same plaster spread on lint is put over the place, and over that is applied a sponge dipped in vinegar; it is sufficient to change the dressing on the fifth day. The class of food to be used is that which I have prescribed for making flesh. And if the fistula is at some distance from the praecordia, the patient should eat radishes at intervals on an empty stomach, and then vomit. A fistula of long standing becomes callous. Now no one can mistake callus, for it is hard and either white or pallid. But there is then need for stronger medicines: such as that which has of poppy tears 4 grams, gum 12·66 grams, cadmia 16 grams, blacking 32 grams, worked up water to form a tent. Or else there is the composition containing galls 1 gram, verdigris, sandarach, Egyptian alum, 1·16 gram each, roasted blacking 2·32 grams. Or that which is compose of copper ore and limestone, with half as much orpiment as of each of the other two; and these are taken up in boiled honey. But the quickest remedy is that prescribed by meges; rub up verdigris scrapings 8 grams, then dissolve ammoniacum for incense 1·16 gram in vinegar, and work the verdigris into this infusion; and this is one of the best remedies. But whilst the above remedies are the most efficacious, when they are not at hand it is easy to eat away the callus with any of the caustic medicaments; it is enough to smear one of them on rolled papyrus, or upon a pledget of wool twisted into the shape of a tent. Squills boiled and mixed with quicklime also eat away callus. If, however, the fistula is longer but runs crosswise, it is best to insert a probe and to cut down upon its end; then a tent is passed into each opening. But if we deem the fistula to be double or multiple, yet only short and confined to flesh, we should not make use of a tent, because it treats one part and omits the rest; but the same medicaments, dry, are put into a writing-quill, and that having been placed against the orifice of the fistula is to be blown through, in order that these medicaments may be forced in; or the same materials dissolved in wine, or, if the fistula is more foul, in honey wine, or, if more callous, in vinegar, are to be poured in. Whatever is introduced, refrigerants and repressants must be put on over the wound; for generally the parts surrounding the fistula are somewhat inflamed. It is not inappropriate, when changing the dressing and again before inserting fresh medicaments, to wash out the fistula, using an ear syringe; with wine if there is much pus; with vinegar if there is hard callus; if it is already clean, with honey wine or a decoction of vetch, to which also a little honey should be added. Thus it generally happens that that covering which is between the opening and the sound flesh is destroyed by the medicaments and comes quite away, and underneath is a clean ulceration; when this has occurred, agglutinants are applied, especially a sponge steeped in boiled honey. I am not unaware that many favour the insertion of lint formed into a tent and dipped in honey; but this agglutinates more quickly than flesh is formed. There need be no fear that clean flesh in contact with clean flesh will fail to unite: we see that there is often no need to add medicaments as well to effect this, since often when there is ulceration of the fingers, unless we have taken careful precautions, they become joined together whilst healing. There is besides a class of ulceration which the Greeks call κηρίον from its resemblance to honeycomb, and of this there are two kinds. One is greyish, like a boil, but larger and more painful. As it is maturing, holes appear through which is discharged a glutinous and purulent humour; yet it does not properly mature. If it is cut into, there appears much more corruption than in a boil, and it penetrates deeper. It is rare except in the scapular region. The other kind is found only in the head; it projects less above the surface, is hard, broad, greenish or greyish-green in colour, more ulcerated; there are holes at the root of each hair, through which is discharged a glutinous greenish-white humour, in consistency like honey or mistletoe-juice, or at times like olive-oil. If it is cut into, the flesh within appears green. The pain also and inflammation are so severe that they generally cause acute fever. On a case which is only irritated by a few openings, suitable applications are a dry fig and linseed boiled in honey wine or plasters or emollients which draw out diseased matter, or the medicaments noted above for such purposes. For the other form of this, the same medicaments are good, also flour boiled in honey wine mixed with half its quantity of turpentine-resin; also a fig boiled in honey wine, to which a little pounded hyssop may be added; also black bryony berries, added to a fig, one part to three. If in either case medicaments are of little service, the whole ulceration ought to be cut away down to the sound flesh. When the ulceration is removed, medicaments are put on the wound, first to promote suppuration, next to clean it, and then to make flesh. There are also certain wart-like ulcerations, different in name and in their ill-effects. They call one acrochordon, when some material which is rather hard and at times somewhat rough, collects under the skin: its colour is that of the skin; it is thin underneath, broadening nearer the skin; of moderate size, as it is seldom larger than a bean. It is rare to find one alone, but generally there are several, and they are mostly found in children; and sometimes they go suddenly, sometimes they cause slight inflammation, and under this they even turn into pus. But that which is named thymion projects above the surface like a little wart, narrow near the skin, wider above, hardish and at the top very rough. The top in colour is like flowers of thyme, whence its name, and there it is readily split and made to bleed; at times the bleeding is considerable; it is generally about the size of an Egyptian bean, rarely larger, sometimes quite small. Sometimes one is alone, generally several grow together, either on the palms or soles of the feet. The worst, however, are situated upon the genitals, and there they bleed the most. But those called myrmecia are less prominent and harder than the thymion, their roots are more deeply fixed and they are more painful: they are broad underneath but thin above, they bleed less, and they scarcely ever exceed the size of a lupin. These also grow either on the palms or soles of the feet. The clavus, again, though occasionally found elsewhere, occurs mostly on the feet, and especially after contusions, although sometimes from other causes; it causes pain when walking, though not at other times. Of these the acrochordon and thymion often end of themselves, and the more so the smaller they are. The myrmecia and corns scarcely ever subside without treatment. The acrochordon, if cut off, leaves no trace of a root behind, and so does not sprout again. When the thymion and clavus have been cut off, a small rounded root is formed underneath, which penetrates right down into the flesh, and if this is left behind it sprouts up again. The myrmecia are held by very broad roots, and so cannot be excised without causing a large wound. A corn is best scraped down from time to time; for thus, without any violence, it softens, and if also a little blood is let out, it often dies away. It is also removed if we clean the part round it and then put on resin mixed with a little powdered millstone. All the other varieties are to be burnt away by medicaments: for some the ash of wine-lees is best; for myrmecia the application made of alum and sandarach. But the skin all round should be covered with leaves that it also may not become ulcerated; afterwards lentil meal is put on. Even a fig in boiled water removes a thymium. Pustules arise chiefly in the spring; there are many kinds. For at times a sort of roughness comes all over the body, or a part of it, resembling the pustules which are set up by nettles or by sweating; exanthemata the Greeks call them. At times they are red, at times no redder than the colour of the skin; sometimes a number occur resembling pimples, sometimes the pustules are larger, livid or pallid or black or otherwise changed from the natural colour; and there is humour underneath them. When these have burst the flesh below looks as if it were ulcerated; in Greek these are called phlyctaenae. They are produced either by cold or by heat or by medicaments. A phylacion is a somewhat harder pustule, whitish and pointed, from which moisture is squeezed out. But after pustules at times small ulcerations arise, either dry or moist, sometimes attended only by itching, sometimes also by inflammation and pain; the discharge is either pus or sanies or both; this generally occurs in children, selected on the trunk, often on the extremities. The worst kind of pustule is that called epinyctis; its colour is usually livid or black or white. And there is severe inflammation round it; and when laid open a mucous ulceration is found within, of a colour like its own humour. It gives greater pain than its size would suggest; for it is no larger than a bean. And this too grows on the extremities, and generally by night, whence also the name applied to it by the Greeks. Now in all kinds of pustules, the treatment first is much walking and exercise; and if anything prevents these, then rockings. Next food must be diminished, all things acrid and thinning avoided; and the same treatment should be applied to nursing women, if the sucking baby is so affected. Moreover, the patient who is robust, if the pustules are small, ought to go to the bath and sweat, and at the same time to dust the pustules with soda and to mix wine with oil and anoint himself, after which he goes down into the hot bath. If this does no good, or if the pustules are of the larger kind, lentil meal should be applied, and after the upper skin has been detached, we must pass on to soothing medicaments. The epinyctis, after lentil meal application, is appropriately treated by means of polygonum or green coriander. Ulcerations caused by the pustules are relieved by litharge mixed with fenugreek seeds, rose-oil and endive juice being added in turn until the mixture becomes of the consistency of honey. For the pustules which affect infants apply: pyrite stone 9·3 grams, mixed with fifty bitter almonds, and 125 cc. of oil added. But first the pustules should be anointed with white-lead, then smeared with the above. But scabies is harder: the skin is ruddy, from which the pustules grow up, some moist, some dry. From some of these sanies escapes; and from them comes a persistent itching ulceration, which in some cases rapidly spreads. And whilst in some persons it vanishes completely, in others it returns at a definite time of the year. The rougher the skin, and the more the itching, the more difficult is its relief. Hence the Greeks call such scabies, agria that is, savage. In this case also the same regimen as that given above is necessary; at the beginning a suitable application is that composed of sublimed zinc oxide, saffron, verdigris 1· 16 grams each; white pepper and omphacium 4 grams; zinc oxide ore 9· 3 grams. But when ulceration already exists that com- posed of sulphur 1·16 gram, wax 4·65 grams, liquid pitch 250 cc., oil one litre; these are heated together until they are of the consistency of honey. There is also the composition ascribed to Protarchus. It consists of half a litre of lupin meal, 190 cc. of soda, 250 cc. of liquid pitch, liquid resin 168 grams, and 125 cc. of vinegar. Also a suitable mixture is saffron, lycium, verdigris, myrrh, and charcoal in equal proportions boiled in raisin wine; this checks everywhere all discharge of phlegm. And when there is nothing else at hand, lees of olive-oil boiled down to one-third, or sulphur mixed with liquid pitch, as I have suggested for cattle is also of service for men suffering from scabies. Impetigo, again, has four species. The least bad is that which presents a semblance to scabies; for there is redness and some hardness and ulceration and erosion. But it is distinguished from scabies because there is more ulceration and there are pustules like pimples, and in it is seen an appearance as of small bubbles from which after a time little scales are detached; and this recurs at fixed seasons. The second kind is worse, almost like a pimple, but rougher and redder; it has various shapes; small scales are detached from the skin surface; there is more erosion; it spreads more rapidly and widely, and both comes and goes at fixed seasons even more markedly than the previous sort; it is called rubrica. The third kind is worse still; for it is thicker, harder and there is more swelling; there are cracks in the skin and more active erosion. This form also is scaly, but the scales are black. It spreads widely and not slowly. It varies less in the times at which it increases or subsides, and is never quite got rid of: its name is black impetigo. The fourth kind, which is quite incurable, differs in colour, for it is whitish and like a recent scar, and has small pallid or whitish scales; some are like lentils, and when these are removed there is sometimes bleeding. Otherwise its humour is white, the skin hard and chapped; it spreads widely. Now all these kinds occur generally on the hands and feet; they also attack the nails. There is no more efficacious remedy than that which I have mentioned above as prescribed by Protarchus for scabies. But Serapion used soda 2·32 grams, and sulphur 4·64 grams, taken up with plenty of resin. Of papules again there are two kinds. There is one in which the skin is roughened by very small pustules, and is reddened and slightly erodes; in the middle it is a little smoother; it spreads slowly. This disease generally has a round shape at its beginning, and in the same fashion it spreads in a circle. But the other variety is that which the Greeks call agria that is, savage; and in this there is a similar but greater roughness of the skin with ulceration, more severe erosion, and redness; sometimes it even loosens the hair. It is less round in shape, heals with more difficulty, and unless it is got rid of, turns into an impetigo. But in fact a slight papule heals if it is rubbed daily with spittle before eating; a more severe one is got rid of best by an application of pounded pellitory. But turning to compound medicaments, that same one of Protarchus is efficacious in these cases, when the disorder is less severe. An alterna- tive for the same affection is the composition of Myron containing red soda and frankincense, 4 grams each, purified cantharides 8 grams, sulphur unheated, the same amount, and turpentine resin 80 grams, darnel meal a litre and a half, cumin 145 cc., and half a litre of raw pitch. Vitiligo also, though not dangerous in itself, is still ugly and is due to a bad habit of body. There are three species. It is called alphos when it is white in colour, generally rather rough, and not continuous, so that it looks as if drops of some sort had been sprinkled about. Sometimes also it spreads still more widely with certain gaps. That called melas differs from it in being of a black colour and like a shadow; otherwise it is similar. Leuce is somewhat like alphos, but is whiter and extends deeper; there are hairs on it, white, and like down. All these spread, but more quickly in some people than in others. The alphos and melas come and go at various seasons; the leuce, once established, is not easily got rid of. The two former are not difficult to treat, the latter is scarcely ever cured, for even if the discoloration is mitigated, the colour of health does not right altogether. But whether any one of these is curable or not is easily learnt by this test. The skin should be cut into or pricked with a needle: if blood escapes, which it usually does in the first two species, there is place for a remedy; if a whitish humour, cure is impossible, and then we should even refrain from treating it. But to the species which admits of treatment we should apply lentil meal, mixed with sulphur and frankincense, pounded up together in vinegar. Another application for the same purpose, ascribed to Irenaeus, is composed of coral, soda, cumin and dried fig-leaves, in equal quantities, pounded up with vinegar added. The vitiligo is smeared with this in the sun, then it is soon washed off, lest it corrode too much. Some find it useful to anoint the species which I have said is called alphos with the following prescription ascribed to Myron: they mix sulphur 1 gram, split alum 0·66 gram, soda 1·33 grams with a cupful of dried myrtle leaves; then at the bath they dust bean-meal over the vitiligo and afterwards apply the above remedy. That which I said was termed melas is treated by pounding up together coral, frankincense, barley and bean-meal; and these are sprinkled on, using no oil in the bath before the patient sweats; then this kind of vitiligo is rubbed off. |
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Dixi de is uitiis , quae per totum corpus orientia medicamentorum auxilia desiderant : nunc ad ea ueniam , quae non nisi in SINGVLIS PARTIBVS incidere consuerunt , orsus a capite . In hoc igitur capillis fluentibus maxime quidem saepe radendo succurritur . Adicit autem uim quandam ad continendum ladanum cum oleo mixtum . Nunc de is capillis loquor , qui post morbum fere fluunt : nam quominus caput quibusdam aetate nudetur , succurri nullo modo potest .
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Book VI 1 I have spoken of those lesions which affect the whole body and require the aid of medicaments; now I come to those which customarily occur only in particular parts, beginning with the head. In the head, then, when the hair falls out, the principal remedy is frequent shaving. Ladanum mixed with oil, however, is some help in preserving it. I am now referring to the falling out of hair after illness; for no kind of remedy can be given to stop the head of some people from becoming bald through age. |
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Porrigo autem est , ubi inter pilos quaedam quasi squamulae surgunt haeque a cute resoluuntur : et interdum madent , multo saepius siccae sunt . Idque euenit modo sine ulcere , modo exulcerato loco , huic quoque modo malo odore , modo nullo accedente . Fereque id in capillo fit , rarius in barba , aliquando etiam in supercilio . Ac neque sine aliquo uitio corporis nascitur neque ex toto inutile est : nam bene integro capite non exit .—Vbi aliquod in eo uitium est , non incommodum est summam cutem potius subinde corrumpi quam id quod nocet in aliam partem magis necessariam uerti . Commodius est ergo subinde pectendo repurgare quam id ex toto prohibere . Si tamen ea res nimium offendit , quod umore sequente fieri potest , magisque si is etiam mali odoris est , caput saepe radendum est , dein id super adiuuandum aliquis ex leuiter reprimentibus , quale est nitrum cum aceto , uel ladanum cum murteo et uino , uel myrobalanum cum uino . Si parum per haec proficitur , uehementioribus uti licet , cum eo ut sciamus utique in recenti uitio id inutile esse .
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2 But the condition is called porrigo, when between the hairs something like small scales rise up and become detached from the scalp: and at times they are moist, much more often dry. Sometimes this happens without ulceration, sometimes there is a localized ulceration, and from this comes sometimes a foul odour, sometimes none. This generally occurs on the scalp, more seldom on the beard, occasionally even on the eyebrow. It does not arise only there is some general bodily lesion, so that it is not entirely without its use; for it does not exude from a thoroughly sound head. When there is present some lesion in the head, it is not disadvantageous for the surface of the scalp to become here and there corrupted, rather than for the harmful material to be diverted thence to another part of more importance. Hence it is more beneficial from time to time to clear the scalp by combing, than to repress the disorder altogether. But if this condition is too troublesome, which may happen when a discharge of humour has set in, and especially if this is malodorous, the head is to be shaved often, after which one of the mild repressants is applied, such as soda in vinegar, or ladanum in myrtle oil and wine, or bennut oil with wine. If there is little benefit from these measures it is permissible to use stronger ones, whilst bearing in mind that, at any rate when the disease is of recent origin, this is not a good thing. |
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Est etiam ulcus , quod a fici similitudine sycosis a Graecis nominatur : caro excrescit . Et id quidem generale est : sub eo uero duae species sunt : alterum ulcus durum et rotundum est , alterum umidum et inaequale . Ex duro exiguum quiddam et glutinosum exit , ex umido †sumplus et mali odoris . Fit utrumque in is partibus , quae pilis conteguntur : sed id quidem , quod callosum et rotundum est , maxime in barba , id uero , quod umidum , praecipue in capillo .—Super utrumque oportet inponere elaterium aut lini semen contritum et aqua coactum aut ficum in aqua decoctam aut emplastrum tetrapharmacum ex aceto subactum ; terra quoque Eretria ex aceto liquata recte inlinitur .
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3 There is also an ulceration, called sycosis by the Greeks from is resemblance to a fig; a sprouting up of flesh occurs. That is the general description: but there are two subordinate species; in one the ulceration is indurated and circular, in the other moist and irregular in outline. From the hard species there is a somewhat scanty and glutinous discharge; from the moist the discharge is abundant and malodorous. Both occur in those parts which are covered by hair; but the callous and circular ulceration mostly on the beard, the moist form, on the other hand, chiefly on the scalp. In both it is good to apply elaterium, or pounded linseed worked up in water, or a fig boiled in water, or the plaster tetrapharmacum moistened with vinegar; also Eretrian earth dissolved in vinegar is suitable for smearing on. |