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.
eaque ubi uel per ipsa medicamenta uel etiam ferro aperta est, pus debet emitti. Tum si qua in alis uel inguinibus sunt, sine lin⟨a⟩mento 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⟨a⟩menta superuacua sunt. In reliquis, parce tamen, nec nisi * plaga est, imponi debent. Commode uero uel super lin⟨a⟩menta 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;
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.
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⟨o⟩gere; idque ex primis medicamentis est. Sed ut haec maximi effectus sunt, sic, cui i⟨s⟩ta 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⟨o⟩r⟨a⟩men 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⟨a⟩mentum 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.
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.
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 ⟨e⟩i dimidium resinae terebenthinae misceatur; et ficus in mulso decocta, cui paulum hysopi contriti sit adiectum; et uuae t⟨a⟩miniae 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⟨o⟩ra thym⟨i⟩o 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⟨n⟩quit, 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.
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.
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⟨i⟩um 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;
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.
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⟨l⟩yzacion autem paulo durior pusula est, subalbida, acuta, ex qua ipsa quod exprimitur umidum est. At ⟨ex⟩ pusulis uero nonnumquam etiam ulcuscula ⟨fi⟩unt 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.
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.
Quo asperior est quoque prurit magis, eo difficilius tollitur: itaque eam, quae talis est, agrian [id est feram] 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.
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.
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⟨i⟩o 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.
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.
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 [id est feram] 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.
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.
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.