Having explained the virtues of medicines, I shall next consider five different kinds of disorders, to which the body is incident. When it is hurt externally, as in wounds. When any part is corrupted internally, as in a gangrene. When any thing grows within some part, as the stone in the bladder. When any part is preternaturally enlarged, as a vein, which swelling is called a varix. Lastly, when somewhat is deficient, or maimed. In some of these medicines, in others manual operations are most useful. Deferring the consideration of the disorders, which chiefly require manual operations, I shall now treat of such, as stand mostly in need of medicines. And I shall divide this part of medicine in the same manner as the former, and first speak of those, which may happen in any part of the body; next of these, which attack certain parts. I shall begin with wounds.

Now a physician should above all things know, what are incurable, what difficult to cure, and what more easy. For it is the part of a prudent man first, not to undertake one, whose case is desperate, lest he appear to have killed him, whom his own destiny has destroyed. Next, in a case of great danger, but not quite desperate, to discover to the friends of the patient, that it is a matter of difficulty: that if the malady should prevail against the art, he may neither seem to have been ignorant himself, nor to have deceived them. But as this is the proper conduct for a prudent person, so on the contrary it is the part of a quack to exaggerate a small matter, that he may appear to have performed the greater cure. Where a case is easy, it is reasonable that the physician by a free declaration of its easiness be obliged to the greater diligence and circumspection; that what is in itself small may not by his negligence become more considerable.

A person cannot be preserved, when the basis of the brain, or the heart, or the gullet, or the portæ of the liver, or the spinal marrow is wounded; or when the middle of the lungs, or the jejunum, or smaller intestine, or stomach, or kidneys are wounded; or when the large veins or arteries about the throat are cut through.

The cure is difficult in such as are wounded either in any part of the lungs, or the thick part of the liver, or the membrane that contains the brain, or in the spleen, or womb, or bladder, or any intestine, or the diaphragm. Such also are in a very dangerous situation, in whom the point of a weapon has penetrated as far as the large blood vessels, that lie deep in the arm-pits and hams. And all wounds are dangerous, wherever there are large blood-vessels, because they may exhaust a person by the profusion of blood. And this happens not only in the arm-pits and hams, but likewise in the veins, which go to the anus and testicles. Besides these, any wound in the arm-pits, or the inside of the thighs, or in any cavity, or between the fingers(15) is bad. Also by which a muscle, or nerve, or artery, or membrane, or bone, or cartilage, is hurt.

A wound in the flesh is safest of all, and these again from their situation are either worse or better. But a wound when large is dangerous from its size.

The nature of the wound also and its figure make some difference; for when a part is both cut and bruised, it is worse than when it is only cut asunder; so that it is better to be wounded by a sharp weapon, than a blunt one. And that wound is worse, out of which any substance is cut, or where the flesh is carried off on one part, and hangs on the other. In general, those wounds are the worst, that are crooked: and those safest that are of a straight direction. And then, the nearer the wound approaches to the first or second of these forms, it is more or less dangerous.

Moreover the age, constitution, the way of life of the patient, and the season of the year, are of some importance: for a boy or a youth recovers more easily than one that is older; the strong than the infirm; one, that is neither too slender nor too plethoric, than one, that is on either of these extremes; one of a sound than one of a corrupt habit; one, that takes exercise, than an indolent person; the sober and temperate than one given to wine and venery. Again, the most convenient season of the year for curing a wound is the spring; or at least when it is neither hot nor cold: for both excessive heat and intense cold are prejudicial to wounds; but most of all an alternate change of these: and for that reason the autumn is very hurtful.

Most wounds are exposed to our view: but there are some, of which we judge from the situation of the parts, which we explained elsewhere, when we demonstrated the position of the internal parts. Nevertheless, because some of these lie superficial, and it makes a difference, whether a wound be in the surface, or has penetrated deeper; it is necessary to mention the appearances, by which we may know what is hurt within; and from which we are either to hope or despair.

When the heart is wounded, there is a great effusion of blood, the pulse is languid, the skin very pale, cold sweats with a bad smell come on, the same as in sickness: the extremities grow cold, and death quickly follows.

When the lungs are wounded, there is a difficulty of breathing; frothy blood is discharged from the mouth, and red blood from the wound; also along with the latter the air issues with a noise; the patient has an inclination to lie upon the wound; some start up without any reason. Many when they are lying upon the wound, are able to speak: if upon another part, they lose that faculty.

The symptoms of a wounded liver are these: there is a great effusion of blood under the right side of the præcordia; the præcordia are drawn backward towards the spine; there is a pleasure in lying upon the belly; there are prickings and pains reaching as far as the clavicle and the broad bone of the shoulder, that is joined to it; to these there is sometimes added also a bilious vomiting.

When the kidneys are wounded, the pain reaches to the groin and testicles; the urine is made with difficulty; and it is either bloody, or grumous blood is voided.

But when the spleen is wounded, black blood issues out from the left side; the præcordia and stomach on the same side grow hard; a great thirst ensues; and a pain strikes up to the clavicle, as when the liver is wounded.

But when the womb is wounded, there is a pain in the groin, and hips, and inside of the thighs; the blood is partly discharged by the wound, partly by the vagina; and a bilious vomiting follows. Some women lose their speech; some are delirious; others sensible, but complain, that they are tormented with a pain of their nerves and eyes: and when dying, have the same symptoms, as attend a wounded heart.

If the brain or its membrane has received a wound, blood is discharged by the nose, in some also by the ears and generally a bilious vomiting follows. The senses of some are impaired, and they do not perceive when they are called upon: the countenance of others is fierce; and their eyes roll different ways, as in a palsy; and commonly on the third or fifth day a delirium comes on. Many are likewise convulsed. Before death most of them tear the bandages, with which their head is bound up, and expose the naked wound to the cold.

When the gullet is wounded, a hiccough and bilious vomiting follow; if any meat or drink has been taken, it is quickly returned; the pulse grows languid; thin sweats come on, in which the extremities grow cold.

The signs of a wound in the jejunum and stomach are the same; for the food and drink pass through the wound: the præcordia grow hard; sometimes bile is vomited. Only it must be observed, that the jejunum is situated lower than the stomach. When the other intestines are wounded, they emit either excrement, or its smell.

When the spinal marrow is cut through, there follows either a palsy or convulsions; the patient becomes insensible; and after some time, the lower parts discharge involuntarily either seed, or urine, or excrement.

But if the diaphragm is wounded, the præcordia are drawn upward; there is a pain in the spine, an oppression of the breath, and a discharge of frothy blood.

When the bladder is wounded, the groin is pained, there is a tension of the parts immediately above the pubes; instead of urine comes blood; and the urine is discharged at the wound; the stomach is affected, so that the patients either vomit bile, or have a hiccough; a coldness seizes them, and after that death.

These things being known, there still remain some other particulars to be observed relating to the wounds and ulcers, which we are to treat of. From wounds then and ulcers are discharged blood, sanies, and pus. Blood is known to every one. Sanies is thinner than blood, unequally thick, glutinous, and coloured. Pus is very thick and white, also more glutinous than either blood or sanies. Now blood is discharged from a recent wound, or one that is just healing: sanies appears betwixt these times: pus in an ulcer beginning to heal. Further, both sanies and pus are distinguished into several species by Greek names; for there is one kind of sanies, which is called ichor[ EO ], another melicera[ EP ]. There is also a species of pus called elæodes[ EQ ]. Ichor.Ichor is thin, of a whitish colour, and proceeds from a bad ulcer, and especially where a nerve has been hurt, and an inflammation has followed. Melicera is thicker, more glutinous, whitish,Melicera. and somewhat resembling white honey: this also is discharged from malignant ulcers, where the nerves about the joints are hurt; and amongst the joints principally from the knees. Elæodes is thin, whitish, somewhatElæodes. unctuous, in colour and fatness not unlike to white oil; and appears in large ulcers, that are healing. Now blood is bad that is either too thin or too thick, in colour either livid or black; or mixed with phlegm, or of various colours: the best is warm, red, moderately thick, and not glutinous. Therefore from the first the cure of a wound, which has yielded good blood, is more easy and quick: and afterwards there is more hope of those, from which the several discharges have been of the best kind. Sanies then is bad, where it is in great quantity, over thin, livid, or pale, or black, or glutinous, or fetid, or such as corrodes the ulcer itself and the adjacent skin. It is better, when the quantity is small, indifferently thick, of a reddish colour, or inclining to white. Ichor again is the worst, that is plentiful, thick, inclining to a livid or pale colour, glutinous, black, hot, fetid. It is more tolerable, if inclining to white, and when in all other respects it is the reverse of the former. But melicera is bad, when it is in great quantity, and very thick; better, when thinner, and less in quantity. Pus is the best amongst these. But even that too is bad, when it is copious, thin, diluted; and the more so, if it be such from the beginning; also if in colour it resemble serum, if it be pale, or livid, or feculent; moreover if it be fetid; unless the smell arises from the nature of the particular part, where the ulcer is. The less there is of it, and the thicker, and whiter, so much the better; and also if it be smooth, if it have no smell, if it be homogeneous. In quantity, however, it ought to correspond both with the size and age of the wound: for a greater quantity is discharged naturally from a larger one; and more before the inflammation is removed, than afterwards. Elæodes also when plentiful, and containing but little fat, is bad: but the less there is of it, and the more oily so much the better.

These things being considered, when any person is wounded, that can be cured, two things are immediately to be regarded: that he do not perish either by a hæmorrhage, or an inflammation. If we are afraid of a hæmorrhage (which may be known from the situation of the wound and its largeness, and from the force of the stream of blood) the wound is to be filled with dry lint, and over it a sponge squeezed out of cold water must be applied, and pressed down with the hand. If this does not stop the blood, the lint is to be frequently changed: and if it have not strength enough dry, it must be moistened with vinegar. This is very powerful in stopping blood: and therefore some people pour it into the wound. But here again it is to be feared, that the matter being too forcibly retained there, may afterwards raise a great inflammation. Which is the reason why neither corroding medicines, nor such as are caustic, and therefore forming a slough, are to be used, although most of these stop blood: but if recourse is ever had to them, such ought rather to be employed, as are the mildest in their operation. But if even these do not prevail against the hæmorrhage, the vessels, which discharge the blood are to be taken hold of, and tied in two places about the wounded part, and cut through, that they may both unite together, and nevertheless have their orifices closed. When the circumstances do not even allow of this measure, they may be cauterized with a hot iron. And in this case too, when there is a considerable hæmorrhage from a part, where there is neither nerve, nor muscle, in the forehead for instance, or upper part of the head, it is very proper to apply a cupping vessel to the opposite part, that the current of blood may be diverted thither.

These then are the remedies against a haemorrhage: but for an inflammation the flux of blood itself is the cure. This may be apprehended, when either a bone has been hurt, or a nerve, or a cartilage, or a muscle, or when the haemorrhage has been too small in proportion to the size of the wound. Therefore when any thing of this kind happens, it will not be proper to stop the blood quickly, but to suffer it to flow as long as it is safe; insomuch that if the discharge has appeared small, it ought also to be taken from the arm; especially if the patient be young and robust, and used to exercise; much more, if he was intoxicated before he received the wound. And if a muscle shall appear to be wounded, it must be cut through: for when it is only divided in part, it is mortal; cut quite through it admits of a cure.

The blood then being either stopped, when the haemorrhage is excessive, or more taken away by phlebotomy when too small, it is far the best method to agglutinate the wound. Now this may be done, either when it is in the skin, or even in the flesh, if nothing else is hurt. It may be done, where the flesh is hanging down in one part, and adhering in another; provided however it be still sound, and nourished by its continuity with the body.

In wounds to be agglutinated there is a double method of cure. For if the wound be in a soft place, it ought to be sewed: and especially, if the extremity of the ear, or the lower part of the nose be cut, or the forehead, or the cheek, or the eye-brow, or the lip, or the skin about the throat, or the belly. But if the wound is in the flesh, and gapes, and its lips cannot be easily brought together, a suture is improper: and in this case fibulæ(64) are to be put on (the Greeks call them ancteres[ ER ]) to draw the lips a little closer; that the cicatrix may be the less broad after the cure.

Hence now it may be collected, whether a wound, in which the flesh is in one part depending, and in another adhering, if it is not yet corrupted, requires a suture, or a fibula. But neither of them ought to be applied before the wound be cleansed within, lest any concreted blood be left there. For that turns to pus, raises an inflammation, and prevents the wound from being agglutinated. Even the lint, that is put into it to stop the bleeding, must not be left there; for that also inflames.

It will be necessary to take up with the needle, or the fibula, not only the skin, but also some of the flesh below it, that it may adhere the more strongly, and not break away the skin. Both of them are best done with soft thread(65), not too much twisted, that it may be the less uneasy to the part. Neither of them are to be applied at too great distances, nor too frequently: if at too great distances they will not hold; if too frequently they are very hurtful; because the oftener the needle has passed, and the more places are gauled by the fibula, so much the greater will the inflammation be; and especially in the summer-time. Neither of them requires any force; but the operation is only so far useful, as the skin follows the hand as it were of its own accord. Now the fibula commonly allows a wound to be broader: a suture joins its lips, but these should not touch one another in every part; that if any humour be collected within, there may be a passage for it to escape. But if a wound admits of neither of these, it ought nevertheless to be cleansed.

In the next place, upon every wound should be applied first a sponge squeezed out of vinegar: if any patient is not able to bear the strength of vinegar, wine must be made use of: a slight wound is helped by laying on a sponge squeezed even out of cold water. But in whatever way it is put on, it does good no longer than it is moist: therefore it must not be suffered to dry. A wound may be cured without foreign, scarce, and compound medicines. But if one has not confidence in that method, he ought to apply a medicine, that is composed, without suet, of those things, which I mentioned to be proper for bloody wounds; and particularly if it be in the flesh, the barbarum: if it be a nerve, or cartilage, or any of the prominent parts, as the ears, or lips, the sphragis of Polybus. The green Alexandrian also is fit for the nerves; and for the prominent parts that, which the Greeks call rhuptousa[ ES ].

It is common also, where there is a contusion, for the skin to be a little broken. When this happens, it is not improper to make a larger opening with a knife; unless there be muscles and nerves near to it, which it is not fit to cut. When it is sufficiently opened, a medicine must be applied. But if the bruised part cannot admit the opening, though too small, to be enlarged, upon account of nerves or muscles, such applications are to be used, as may draw out the humour gently; and of that kind the fittest for the present purpose is the composition, which I said was called rhypodes. It is not improper also, wherever there is a severe wound, after applying(66) what is agreeable to it; to cover the whole with sordid wool moistened with vinegar and oil; or if the part be soft, a mild restringent cataplasm; if nervous, or muscular, an emollient.

For binding up a wound a linen roller is most convenient: and this ought to be bandages for so broad, that a single application of it may not only cover the wound, but take in a little on each side of it. If the flesh has shrunk away more on one side, it is better to begin the rolling from thence; if equally on both sides, it ought to lay hold of the lips transversely; or if the nature of the wound does not admit of that, the middle of it is first put on, that it may be drawn afterwards both ways. Now it is to be bound on in such a manner, that it may both hold, and not be over tight. When it does not hold, it slides off; and that, which is over tight, hazards a gangrene. In the winter-time the roller ought to be carried round oftener; in the summer, no more than necessity requires. Then the extremity of it is to be sewed to the lower part of the bandage. For a knot hurts a wound, unless it be at a distance from it.

Moreover every person ought to know, that the viscera, which I mentioned before, require a particular method of cure. For the external wound is to be cured either by a suture, or some other method. In the bowels nothing is to be touched, unless some bit in the extremity of the liver, or spleen, or lungs be hanging out, which may be cut away. Otherwise the internal wound is to be cured by the diet and medicines, which I mentioned in the former book as agreeable to each viscus.

These steps being taken on the first day, the patient must be put to bed: and if the wound be severe, he ought to abstain from food, as much as his strength will permit, before the inflammation comes on; to satisfy his thirst with warm water, or if it be in summer, and he have neither fever nor pain, the water may be cold. However no rule is so constant, but that a regard must always be had to the strength of the patient; so that his weakness may render it necessary to take food immediately, but such as is thin, and in small quantity, just sufficient to support him. And many sinking under a hæmorrhage, before any thing else be done, are even to be refreshed with wine; which is otherwise very prejudicial to a wound.

It is dangerous for a wound to swell too much: not to swell at all is extremely dangerous. The first is a sign of a violent inflammation; the other of a mortification. If the patient be sensible, and no fever has come on, we may at once conclude, that the wound will be soon healed: and even a fever ought not to alarm us, if in a large wound it continue, while the inflammation subsists; it is bad, when it either supervenes to a slight wound, or lasts longer than the inflammation, or brings on a delirium; or if it does not remove a tetanus, or convulsion, that arose from the wound. Also an involuntary bilious vomiting coming on either immediately after the wound is received, or while the inflammation continues, is a bad symptom in those only, whose nerves, or nervous parts are wounded. However to take a vomit is not hurtful; especially in those, who have been accustomed to it; but neither immediately after meat, nor when the inflammation has begun, nor when the wound is in the superior parts.

The wound being kept thus for two days, on third it must be opened, and the sanies must be wiped off with cold water, and the same kind of dressings put on. On the fifth day it will be easy to judge to what height the inflammation is to rise. On which day the wound must be uncovered again, and its colour observed. And if it be livid, or pale, or variegated, or black, we may be sure it is a bad wound: and whensoever this appearance is observed, it may alarm us. It is best for a wound to be white, or ruddy. Also a hard, thick, and painful skin denotes danger. It is a good sign, when this is free from pain, thin and soft. But if the wound is closed, or there be a slight swelling, the same application must be used as at first.

If the inflammation is violent, with no hopes of an agglutination, and does not yield, the use of warm water too is necessary, that it may dissipate the matter, and soften the hardness, and promote a suppuration. It must be of such a degree of warmth, as to be agreeable to the hand; and be continued so long, till it appear to have diminished in some measure the swelling, and restored a more natural heat to the ulcer. After this fomentation, if the wound does not gape much, a plaister should be applied immediately, and if it be a large wound, the tetrapharmacum would be best; in the joints, fingers, or cartilaginous parts, the rhypodes. But if it gapes pretty much, that same plaister must be softened with ointment of iris, and lint spread with it must be laid over the wound; then the plaister applied above, and over that sordid wool; and the rollers must be also less tight than at first.

But there are some peculiarities to be attended to in the joints. If the nerves, which secure them, are cut through, a weakness of that part follows. If that is uncertain, and the wound is from a sharp weapon, and that in a transverse direction, it is more easy to cure: and if it be from a blunt and heavy one, the figure of it makes no difference: but it must be observed whether the pus comes from above or below the joint. If it come from under it, and continue a long time white and thick, it is probable that a nerve is cut through, and the more so, the greater the pains and inflammations are, and the sooner they began. But although the nerve be not cut through, yet if a hard tumour continue round it long, the ulcer of necessity must be tedious, and even when that is healed, the tumour will remain; and it will be a considerable time before that limb recover its power either of extension or contraction. And it is longer before it can be extended, when the cure has been conducted with the joint bent, than it is before one can be bent, which we have kept straight. The limb, that is wounded, ought to be placed also in a certain position: if it is to be agglutinated, it must be laid high; if it is inflamed, so as to incline to neither side; if the pus has begun to flow, it must be kept in a depending posture.

Rest too is an excellent remedy. Motion and walking are prejudicial, except to people in health: however, less dangerous to such as are wounded in the head or arms, than those, that are wounded in the lower parts. And walking is least of all proper, when the hurt is in the thigh, or the leg, or the foot. The place, where the patient lies, ought to be warm. Bathing also, while the wound is not clean, is extremely bad: for that renders it both tumid and foul; from whence the transition to a gangrene is common. Gentle friction is good; but in those parts, that are at a great distance from the wound.

After the inflammation is gone, the wound must be deterged. That end is best obtained by lint dipt in honey; and over that must be applied either the tetrapharmacum plaister, or the enneapharmacum. Now that ulcer is clean, which appears red, and is neither too dry nor too moist. But any ulcer that is deprived of its sensibility, or whose feeling is unnaturally exquisite, or that is either too dry or too moist, or that is either whitish or livid, or black, that ulcer is not clean.

After a wound is deterged, it must next be incarned; and for that purpose warm water is so far necessary, as to remove the sanies. The use of sordid wool is improper; it is better to cover it with such as has been washed. And there are also some medicines, which conduce to the filling up of the wound; therefore it is not amiss to make use of them: such as butter with oil of roses, and a small proportion of honey; or the plaister tetrapharmacum with the same proportion of honey, or with the oil of roses; or lint dipped in oil of roses. But the bath used sparingly is more efficacious; and food of a good juice, avoiding every thing acrid. When they are almost filled up, birds and venison and boiled pork may be given. Wine is always hurtful, while there is a fever or inflammation; and indeed, till it be cicatrized, if either nerves or muscles are wounded; or even the flesh, if it be deep. But if the wound is of the safer kind, and only superficial, wine not very old, given in moderate quantities however, may promote the incarnation. If any thing is to be softened, which is necessary in nervous and muscular parts, cerate must also be laid upon the wound. But if fungous flesh has grown upon it, dry lint restrains it gently; copper scales more powerfully. If the quantity to be taken away be more considerable, things still stronger must be applied to eat down the flesh. After these a cicatrix is very well formed by lycium diluted in passum or milk; or dry lint laid on alone is still more efficacious.

This then is the process of a successful cure. But at times things will happen to take a dangerous turn. For sometimes the ulcer grows ancient, a callosity comes over it, and its lips are thick, and of a livid colour: after which, whatever medicine is applied, does little good; and this generally happens to an ulcer negligently treated.

Sometimes from an excessive inflammation, or violent heats, or excessive cold, or too tight bandages, or the old age or bad habit of the patient, a gangrene seizes upon it. This kind of disorder by the Greeks is divided into several species, for which we have no terms in our language. Now every gangrene not only corrupts that, which it has seized upon, but also spreads. But then the distinction is to be made between the species by different symptoms. For sometimes beyond the inflammation a redness surrounds the ulcer, and spreads with pain; the Greeks call it erysipelas[ ET ].; sometimes the ulcer is black, because the flesh of it is corrupted, and the blackness is greatly increased as the putrefaction goes on, when the wound is moist, and from the black ulcer is discharged a pale fetid liquor, and the flesh within is corrupted(67): sometimes also the nerves and membranes are dissolved, and a probe put in descends either laterally or downwards; sometimes the bone is affected with that disorder: and sometimes there follows what the Greeks call gangræna[ EU ].

The former kinds happen in any part of the body: the last mentioned about the extremities, that is, the nails, the armpits, or groin; and generally in old people, or in such as are in a bad habit of body. The flesh of such an ulcer is either black or livid, but dry and withered, and the contiguous skin is for the most part covered with pustules of a dark brown colour; then the next to that is either pale or livid, and commonly of an æruginous colour, and void of sensation; the skin a little farther off(68) is inflamed. And all these spread at once; the ulcer into the pustulous part; the pustules to the part that is pale or livid; the paleness or livor to that which is inflamed; and the inflammation proceeds to that which is sound. In the mean time an acute fever comes on, and a vehement thirst; some are also delirious; others, though they be sensible, stammer, and with great difficulty can make their meaning understood; the stomach begins to be affected; the breath itself acquires a fetid smell. Now this disorder in the beginning admits of a cure; but when it is thoroughly rooted, it is incurable; and most of them die with a cold sweat.

These are the dangers, to which wounds are liable. But when the ulcer is old, it must be cut round with a knife, and its lips cut off, and whatever beyond them is livid, must likewise be scarified. If there be a small varix within, which prevents its healing, that also must be cut out. Afterwards when blood has been discharged, and a new face thus given to the wound, the same method of cure must be pursued, which has been directed for recent wounds. If any person does not chuse to make use of a knife, the plaister, which is composed of labdanum, may incarn it, and when the ulcer has been eaten down by that, a plaister, which brings on a cicatrix.

Now that, which I said has the name of an erysipelas, is not only consequent upon a wound, but often happens without it, and is sometimes very dangerous; especially if its seat be about the neck or head.

It is proper, if the strength will admit, to bleed; then to apply at once repellents and coolers, and particularly cerus with the juice of nightshade, or cimolian chalk with rain water; or meal made into a paste with the same water, with the addition of cypress, or if it be in a tender part, with lentils. Whatever is applied, must be covered with a beet leaf, and upon that must be laid a linen cloth dipped in cold water. If coolers alone do little service, the following mixture must be made; of sulphur p. i. *. ceruss, saffron, each p. x. *. and these to be rubbed down with wine, and spread over the part: or if the place is not tender, leaves of nightshade powdered must be mixed with hog’s lard, and applied spread upon linen.

But if there be a blackness, which does not yet spread, such applications must be used, as will gently eat away the putrid flesh; and the ulcer being thus cleansed, must be dressed in the same manner as others. If it be more putrid, and already begins to advance and spread, there is a necessity for stronger corrosives. If even these do not overcome it, the part must be cauterized, till no moisture flow from it; for whatever is sound, is dry when it is burnt. After the burning of a putrid ulcer, such applications must be used, as may separate the sloughs from the quick part; the Greeks call them apescharotica[ EV ]. When they have fallen off, the ulcer must be cleansed, particularly with honey and resin; but it may be cleansed also by those things with which purulent ulcers are dressed, and healed up by the like methods.

It is not very difficult to cure a gangrene, if it has not got full possession, but is only beginning, especially in a young person: and easier still, if the muscles are sound; or if the nerves are either untouched, or but slightly affected; and no large joint laid bare; or there be but little flesh in that part, and consequently not much to putrify, and if the disorder is confined to one place, which chiefly happens in a finger. In such a case the first thing to be done, if the strength will allow, is to let blood: after that, to cut through to the sound flesh, whatever is dry, which by a kind of tension is uneasy to the contiguous parts.

While the disorder is spreading, no suppurating medicines are to be applied; and for that reason not so much as warm water. Ponderous medicines also, although they be repellent, are hurtful; but the lightest of that nature are required; and over the parts, which are inflamed, coolers must be applied. If the disease is not stopped by these, so much as is betwixt the sound and corrupted parts, ought to be cauterized.

And in this case particularly help must be sought not from medicines alone, but from a due regimen: for this disease never appears but in a corrupt and vitiated habit. Wherefore in the first place, unless weakness forbid, the patient must live abstemiously: and then for food and drink must be given what will bind the belly, and consequently the body also; but these must be of a light nature. Afterwards if the disorder stop, the same applications must be used as have been prescribed in a putrid ulcer. And then also a fuller diet may be allowed of the middle class: only such however as tends to dry the belly and the whole body; and the drink must be cold rain water. The bath, unless we are confident of a cure, is hurtful; for the ulcer softened by that means is quickly affected again with the same disorder. But sometimes it happens, that all these remedies do no service, and notwithstanding all their force, the gangrene spreads. In which case the miserable but sole remedy is to cut off that limb, which is perishing by degrees, to save the rest of the body.

This then is the method of treating the most severe wounds. But even such are not to be neglected, where the skin is entire, but the flesh within(69) is bruised; or where any thing is razed or rubbed off the surface; or when a splinter is fixed into the flesh; or when a wound, though small, has penetrated deep.

In the first case it is a very proper remedy to boil pomegranate bark in wine, and bruising the inner part of it, to mix it with a cerate of the oil of roses, which is to be laid upon the part; then where the skin is razed, to cover it with a mild medicine, such as the lipara[ EW ].

Upon the part, that has its surface razed and rubbed off, the tetrapharmacum plaister must be applied, and the quantity of food diminished, and wine denied. Nor should such a hurt be looked upon as contemptible, because the wound is not deep: for from such accidents gangrenes often arise. But if it be slight and of small extent, the mild medicine abovementioned may be sufficient for the cure.

A splinter, if possible, must be extracted either by the hand or by an instrument: if it has either broke or penetrated deeper than to admit of this, it must be drawn out by a medicine. Now the best application for that purpose is the root of a reed; which if tender, must be immediately bruised; if grown hard, it may be first boiled in mulse: to this honey must always be added; or birthwort with honey must be applied. The worst splinter is that of a reed, on account of its asperity: the fern is also equally hurtful: but it has been found by experience, that each of these bruised and applied is a cure for the other. Every medicine, that has the faculty of drawing, has the same effect in all splinters. The same kind of medicine is also finest for deep and small wounds: the plaister of Philocrates is best adapted to the former, that of Hecatæus to the latter case.

In any wound, when we are to form the cicatrix (which is necessary after the ulcers are thoroughly cleansed and incarned) in the first place lint dipped in cold water must be applied, while the growth of flesh is encouraged; afterwards when that is to be restrained, it must be put on dry, till a cicatrix be formed; then white lead ought to be bound over it, which both compresses the cicatrix, and gives it a colour resembling the sound part of the body. The root of wild cucumber has the same effect. Also the composition, which contains of elaterium p. i. *. litharge p. ii. *. myrobalans p. iv. *. to which is added turpentine resin, till the whole be brought to the consistence of a plaister. But black cicatrices are gently cleansed by a mixture of equal parts of verdigrease, and washed lead, and the same resin boiled, whether the cicatrix be anointed with this, which may be practised in the face, or it be applied like a plaister, which is more convenient in other parts of the body.

But if the cicatrix is either protuberant or hollow, it is ridiculous, merely in regard to the appearance to submit a second time to the pain and trouble of a cure; otherwise both cases might be remedied. For either of these cicatrices may be converted into a wound by the knife. If one rather chuses a medicine, the same purpose is answered by those compositions, which eat down flesh. When the skin is taken off, upon the prominent one must be applied eating medicines, upon the hollow one such as tend to fill up, till both these kinds of ulcers be brought to the level of the sound skin, and then they may be cicatrized.