From external injuries, we proceed to disorders which have an internal origin, when some part of the body is corrupted. Amongst these none is worse than a carbuncle. The marks of it are these. There is a redness, and above that pustules rise, not very high, mostly black, sometimes inclining to a livid colour, or pale. There seems to be sanies in them; below, the colour is black. The flesh is parched, and harder than it ought to be naturally. And about it, there is a sort of crust; which is surrounded with an inflammation. Neither can the skin be lifted up in that place, but is, as it were, bound down to the flesh below. There is a propensity to sleep. Sometimes a shuddering, or fever comes on, or both. And this disease shoots out roots, as it were, below, and spreads, sometimes quickly, sometimes more slowly. At the surface also it spreads and grows white; then becomes livid; and all round it small pustules break out. And if it happen to be near the gullet or fauces, it often stops the breath suddenly.

Nothing is better than to sear it immediately. Neither is that painful, for it has no feeling, because such flesh is mortified. And the burning should be continued, till there is a sense of pain on every side. After this, the ulcer is to be cured in the same manner, as other burns. For by eating medicines is produced an eschar, which being entirely separated from the quick flesh, draws with it whatever was corrupted; and the sinus, by this time clean, may be dressed with incarning medicines. But if the disorder be in the surface of the skin, medicines barely eating, or at most caustic, may be sufficient. The violence of the cure is to be proportioned to the malady. Whatever medicine is applied, if it has the desired effect, will immediately separate the corrupted part from the quick.

And we may generally be confident of success, if the corrupted flesh falls off, wherever such medicine eats down; if that does not happen, and the medicine is overcome by the disease, an immediate recourse must be had to the actual cautery. But in such a case, the patient must abstain from food and wine. It is also proper to drink water plentifully. And these directions are to be observed more strictly, if a febricula be added to the other complaints.

There is not so great danger of a cancer[ EZ ], unless it be irritated by the imprudence of the physician. This disease generally happens in the superior parts, about the face, the nose, ears, lips, and breasts of women. It also rises from the liver, or spleen. About the place there are pricking pains; it is immoveable, and unequally swelled; it is also sometimes insensible. Around it the veins are inflated, and tortuous; and either pale or livid; in some also, they are concealed from view. Touching the part gives pain to some, to others none. Sometimes it is harder, or softer, than it ought naturally to be, without any ulcer; at other times, all other circumstances being as above described, there is likewise an ulcer. Sometimes it has no peculiar characteristic to distinguish it; at other times it resembles those which the Greeks call condylomata[ FA ], but has an asperity and magnitude peculiar to itself. And its colour is red, or resembling that of a lentil. Neither is it safe to cut it; for immediately there follows either a palsy, or a convulsion. Often when a person receives a blow upon it, he loses his speech and faints. In some also if the tumour itself be compressed, the contiguous parts grow tense and swell. Now this is a very bad kind(79). Its general progress is this; first appears what the Greeks call a cacoethes[ FB ], then it becomes a carcinoma, without an ulcer. From that an ulcer; and from an ulcer a thymium.

None of these can be removed but the cacoethes(80); the rest are irritated by every method of cure; and the more violent the operations are, the more angry they grow. Some have made use of caustic medicines; others of the actual cautery; others cut them out with a knife. Nor was any person ever relieved by medicine; but after cauterizing, the tumours have been quickened in their progress, and increased till they proved mortal; when they have been cut out, and cicatrized, they have, notwithstanding, returned, and occasioned death. Whereas, at the same time, most people, by using no violent methods to attempt the extirpation of the disease, but only applying mild medicines, to sooth it, protract their lives, notwithstanding the disorder, to an extreme old age. But no body can pretend to distinguish a cacoethes, which is curable, from a carcinoma, which is not, otherwise than by time and experiments.

Therefore, so soon as this disease is perceived, caustic medicines ought to be applied; if the disorder is alleviated, and its symptoms grow milder, we may proceed both to incision and the actual cautery; if it is immediately irritated, we may conclude, that it is already a carcinoma; and every thing acrid and severe is to be taken away. But if the part is hard, without any ulcer, it is sufficient to apply a very mellow fig, or the plaister called rhypodes. If there is an ulcer, but not rising above the surface of the skin, the cerate of rose oil is to be put on, with the addition of a powdered shell, with smith’s forge water. If it grows fungous, copper scales (which is the gentlest caustic) must be tried, till there is no rising above the other parts; provided still that it does not exasperate; if it does, we ought to be content with the same cerate.

There is also an ulcer, which the Greeks call therioma[ FC ]. This both comes of itself, and sometimes is consequent upon an ulcer produced from another cause. The colour is either livid or black; the smell is bad; it discharges copiously a humour like mucus; it is sensible neither of the touch, nor of medicine; and is only disturbed by itching. About it there is a pain and inflammation. Sometimes also a fever comes on. Sometimes there is a haemorrhage from the ulcer, and this disorder spreads, by which all the symptoms often increase. From these proceeds the ulcer which the Greeks call herpes esthiomenos[ FD ], voracious herpes; because by spreading quickly, and penetrating even to the bones, it devours the body. The surface of this ulcer is unequal, resembling dirt; and there is in it a great quantity of glutinous humour, an intolerable smell, and an inflammation more violent, than is found in an ulcer of that size. Both of them, as indeed all the kinds of gangrenes, happen chiefly to old people, or those, who are in a bad habit of body.

The manner of curing both is the same; but the greater disease requires the sharper remedy. And the regimen must first be regulated; the patient must rest in his bed, for some days abstain from food, drink water very plentifully, and have a clyster given him. Then, when the inflammation is gone, let him take food of a good juice(81), avoiding every thing acrid; he may drink as much as he will, provided he be content in the day-time with water but at supper, he may also drink some rough wine. But the abstinence should not be equally severe in a herpes, and a therioma. This then is the regimen necessary.

Externally upon the ulcer, must be sprinkled powder of dry aloes, and if that does but little service, chalcitis. But if any nerve, by the flesh being destroyed, be laid bare, it must be covered first with linen, lest it be burnt by that medicine. If there is need of remedies still more powerful, we must make use of those compositions, that cauterize more strongly. Now when any medicine is sprinkled on, it ought to be done by the broad end of a probe(82). Over it should be applied either lint with honey, or olive leaves boiled in wine, or horehound: and these must be covered with linen dipped in cold water, and then well squeezed. And all round, where there is a tumour from the inflammation, repellent cataplasms must be applied. If by these methods it grows no better, the place ought to be cauterized with a hot iron; the nerves that are in view being first covered. By what has been said on other occasions, it will be clear enough to any body, that a part, which is burned either by medicines or the actual cautery, must first be cleansed, and then filled up.

The ignis sacer ought also to be numbered amongst bad ulcers. There are two species of it. The one is of a colour inclining to ruddy, or a mixture of red and pale, and the surface is roughened by contiguous pustules, of which no one is bigger than another, but they are very numerous, and exceeding small. In these there is almost always pus, and often a redness attended with heat; and that spreads, sometimes when the part first affected is healing, sometimes when it is ulcerated, in which case, the pustules breaking, one continued ulcer is formed, discharging a humour, which seems to be betwixt sanies and pus. It attacks chiefly the breast, or sides, or extremities, and particularly the soles of the feet. The other kind comes with an ulceration in the surface of the skin, but without going deep, broad, inclining to a livid colour, but unequal; and the middle part of it heals, while the extremities spread; and often that, which seemed to be sound, ulcerates again. But the skin round about it, which is to receive the disease, grows tumid, and hardish, and the colour of it is a blackish red. And this disease too generally attacks old people, or those, that are in a bad habit, but chiefly in their legs.

Now every ignis sacer, though it be the least dangerous of those disorders, which have the disposition to spread, yet is, I had almost said, the hardest to cure of them all. The most effectual remedy is a fever for one day, which consumes the noxious humour. The thicker and whiter the pus is, so much the less is the danger. It does good also to excoriate the part below the ulcer by scourging, that the more pus may be evacuated, and the matter drawn out, which corrupts the flesh there. But notwithstanding if a slight fever comes on, there is a necessity for abstinence, lying a-bed, and clysters. In every ignis sacer, neither mild and glutinous food, nor salt and acrid are proper; but what is betwixt these: such as unleavened bread, fish, kid, birds, and except the wild boar, almost all venison. If there is no febricula, both gestation and walking are serviceable, and rough wine, and the bath; and in this disorder, as well as that mentioned before, the drink ought to be more plentiful than the food.

As for the ulcers themselves, if their progress be moderate, they must be fomented with hot water; if more rapid, with hot wine. Next wherever there are any pustules, they must be opened with a needle. Then such applications used, as may consume the putrid flesh. When the inflammation is removed, and the ulcer cleansed, a lenient medicine ought to be applied. In the second species, quinces boiled in wine and bruised may do good; as likewise the plaister of Hera, or the tetrapharmacum, with the addition of a fifth part of frankincense; likewise black ivy boiled in a rough wine, and if the disorder spread fast, nothing is more efficacious. When the ulcer, which I observed to be in the surface of the skin, is cleansed, the same lenient medicines are sufficient to the cure.

The ulcer named Chironian(83) is large, and has hard, callous, and swelled lips. A sanies is discharged not copious, but thin; the smell is bad. There is no inflammation either in the ulcer or in the tumour about it. The pain is tolerable. It does not spread, and therefore is not dangerous; but it does not easily heal. Sometimes a thin cicatrix comes on, and then breaks again, and the ulcer is renewed. It occurs chiefly in the feet and legs.

The application to it ought to contain both something lenient, and something strong, and repellent. Such as the following composition made for the purpose: of copper scales, calcined lead washed, each p. vi. *. cadmia, wax, each p. viii. *. oil of roses a sufficient quantity to soften the wax with the other ingredients.

There is a kind of ulcer occasioned by the cold of the winter. It is most common in children, chiefly in their feet and toes, sometimes also in their hands. There is a redness with a moderate inflammation. Sometimes pustules break out, which are followed by an ulceration. The pain is not great, the itching greater. Sometimes a humour is discharged, but in small quantity, which seems to resemble either pus or sanies.

In the first place it must be fomented plentifully with a hot decoction of turnips, or if these are not to be had, some of the repellent vervains. If it is not yet ulcerated, copper, as hot as a person is able to bear it, must be applied. When it is already ulcerated, allum, powdered with an equal quantity of frankincense, ought to be put to it, with the addition of wine; or pomegranate bark boiled in water, then beat. If the surface of the skin be excoriated, in that case lenient medicines succeed best.

The scrophula is a tumour, in which there are formed some concretions of pus and blood, resembling small glands. These are extremely troublesome to physicians, because they both generate fevers, and never maturate kindly; and whether they be cured by incision or medicines, for the most part they rise again close to the cicatrices; which they are much more ready to do, after being treated with medicines; and what is more, they are of long continuance. They grow chiefly in the neck; but also in the armpits, the groin and the sides. Meges the surgeon assures us, that he has met with them in the breasts of women too.

For these reasons, it is proper to give internally white hellebore, and that even frequently, till they be discussed; and externally to apply medicines which may either draw out the humour, or discuss it; such as have been mentioned before. Some also make use of caustics, which eat down and constringe the part with an eschar; and then treat it like an ulcer. Whatever method of cure be pursued, when the ulcer is clean, the body must be exercised and nourished, till it come to a cicatrix. These are the methods prescribed by physicians(84): but the experience of some peasants has discovered, that eating a snake cures a scrophulous patient.

A furuncle is an acute tubercle, attended with inflammation and pain; and especially when it is just turning to pus. When this is opened, and the pus is discharged, part of the flesh below appears converted into pus, part corrupted, of a whitish colour, and reddish; which some call the ventricle of the furuncle. There is no danger in it, though no means be used for its cure, for it maturates of itself, and breaks. But the pain makes a medicine, that can hasten the cure, eligible.

The proper medicine for it is galbanum, but other things have also been mentioned before. If none of these can be had, the first application ought to be a plaister not greasy, to repel it; then if that has not succeeded, something to promote a suppuration. If that cannot be got, either resin or leaven(85). When the pus is squeezed out, no further cure is necessary.

The name of phyma is given to a tubercle resembling a furuncle, but rounder, and flatter in the surface, and often larger. For a furuncle seldom rises to the bulk of half an egg, and never exceeds it: a phyma is commonly of greater extent; but the inflammation and pain in it are less. When it is broken, the pus appears in the same manner; no ventricle is found here, as in the furuncle; but all the corrupted flesh is turned into pus. Now this grows more frequently in children, and is more easily cured; in young men it occurs more seldom, and is more difficult to cure: when age has given firmness to the body, it does not appear at all. The proper medicines for discussing it have been mentioned before.

A phygethlon is a low, but broad tumour, in which there is something like to a pustule. The pain and tension are violent, and greater than in proportion to the size of the tumour; sometimes also attended with a slight fever. It ripens slowly, and no great part of it is converted into pus. It is formed chiefly either in the neck, or in the armpits, or the groin. From its figure our authors call it panus(86). The proper medicine for this also we have pointed out before.

But though all the foregoing are nothing else but small abscesses, yet a larger collection, that tends entirely to suppuration, appropriates to itself the general name of abscess. And this collection happens generally after fevers or pains of some particular parts, and especially after pains in the belly. It commonly shews itself externally, for it sometimes swells to a pretty large compass, like the phyma, and is red and hot, and in a little time contracts a hardness. It is more troublesome as it advances, and occasions thirst and watchfulness. But sometimes there is none of these appearances in the skin; and more especially when the suppuration is pretty deep; but inward prickings are felt, attended with thirst and watchfulness. It is more kindly when it does not become hard of a sudden; and when, though it be ruddy, yet it is changing to a white colour. Which symptoms occur when the suppuration is beginning; for the swelling and redness comes on long before.

If the abscess be forming in any of the nobler parts, the accession of matter there must be prevented by cataplasms, which are at the same time repellent and cooling; such as I have mentioned under the erysipelas and elsewhere. If it is grown pretty hard, we must have recourse to discutients and resolvents; such as a dry fig bruised, or lees of wine mixed with cerate, made up with hog’s lard; or the root of wild cucumber, with the addition of two parts of meal, first boiled in mulse. We may also mix equal parts of ammoniacum, galbanum, propolis, viscum, adding of myrrh not half the quantity of any of the other ingredients: and the plaisters and malagmas I have mentioned before, have the same effect.

What is not discussed by these, must necessarily maturate. And to hasten this, must be applied barley meal mixed with water; to which also it will be proper to add some herbs. The same applications(87) are fit for the lesser abscesses too, whose names and properties I have recited above. The general method of cure is the same in them all; and only differs in the degree. Now that tumour is crude, in which there appears a strong pulsation of the arteries, a weight, heat, tension, pain, redness, and hardness; and if the abscess be large, a shuddering, as also a slight fever continues; and the suppuration being pretty deep and concealed, instead of the marks, which otherwise shew themselves in the skin, there are prickings. When these have abated, and the part begins to itch, and either becomes somewhat livid or whitish, the suppuration, is perfected. And when it either breaks of itself, or is opened by medicines, or by incision, the pus ought to be discharged. And if it happens in the armpits or groin, it must be dressed without lint. In other parts too, if it is narrow at the bottom, if the suppuration has been moderate, if it has not penetrated deep, if there is no fever, if the patient be strong, lint is equally needless. In other circumstances it ought to be used, sparingly however, and not unless the wound be large. It does well to spread honey upon the lint; or without it, to apply lentils with honey, or pomegranate bark boiled with wine. And these things are proper both alone and mixed.

If any parts round it should be too hard, to soften them may be applied either mallows beat, or fenugreek, or lintseed boiled in passum. And then whatever is to be applied, ought to be secured not by a tight, but an easy bandage. Every body ought to know, that in this kind of disorder cerate may be used. What else belongs to the cleansing of the ulcer, filling it up, and bringing on a cicatrix, and equally relates to wounds, has been already pointed out.

But sometimes from abscesses of this kind and other ulcers, arise fistulas. That is the name of a deep, narrow and callous ulcer. It occurs almost in every part of the body; and it has some peculiarities in each place. I shall first treat of the general properties. There are then several kinds of fistulas; for some are short, others deeper; some point inward in a straight line; others, and by far the greatest part, are transverse; some are simple, others are double, or triple, which beginning from one orifice, branch out within, into three or more sinuses; some straight, others bent and tortuous; some end in the flesh, others penetrate to bones or a cartilage; or where neither of these lies beyond them, reach to the more internal parts; some again are easily cured, others with difficulty, and some are even found incurable.

The cure of a simple and recent fistula in the flesh is easy. It is an advantage to it, if the person be young, and the constitution firm: the contrary are very unfavourable circumstances; as also if the fistula has injured a bone, or cartilage, or nerve, or muscles; if it have seized upon a joint, or has penetrated either to the bladder, or the lungs, or to the womb, or to the large veins or arteries, or to the jaw-bones, throat, stomach, or thorax. When it points towards the intestines too, it is always dangerous, and often mortal. In these cases it greatly increases the malady, if the patient be either sick, or old, or of a bad habit.

First of all, it is proper to put a probe into the fistula, that we may find its direction and depth: and at the same time whether it be altogether moist, or drier than it should be, which appears upon drawing out the probe. It may also be determined, whether the bone be affected or not; and if the fistula has penetrated there, how far it has injured it. For if that part is soft, which is touched by the end of the probe, the disorder is confined to the flesh; if it resists more, it has made way to the bone. And again, if the probe slides, there is no caries begun: if it does not slip out(88) of the point where it is placed, the caries is begun, but is slight yet: if it feels unequal also, and rough, the bone is very much corroded. The situation itself shews when there is a cartilage below; and that the fistula has reached it, appears by its resistance.

Now from these circumstances may be learnt the seats and extents of fistulas, and what parts they have damaged. From the quantity of the pus it may be known, whether they be simple, or divided into more parts. If more of that comes away, than can issue from a single cavity, it is evident there are more sinuses. And as flesh, nerves, and some nervous substances, such as the greatest part of the coats and membranes are, commonly lie together, the nature of the pus will discover whether the several sinuses have eaten through these different sorts of bodies. For from flesh a smooth and white pus is discharged pretty copiously; from a nervous place the discharge is of the same colour indeed, but thinner, and less in quantity; from a nerve fat and not unlike to oil. Lastly, the posture of the body also discovers whether the fistulas have penetrated into several parts, because often, when one lies down with his body and limb in a different position, the pus begins to flow again, which had before stopped, and shews not only that there is another sinus, from whence it descends, but also that it proceeds in a different direction.

If it be confined to the flesh, and is recent and simple, neither consisting of sinuses, nor having a large cavity: also if it be not in a joint, but in a part, which is immoveable by itself, and is never put in motion but with the whole body, a plaister for recent wounds will be sufficient, if that contain either salt, or allum, or copper scales, or verdigrease, or any of the metallic substances. And of this a collyrium(89) ought to be made, at the one end smaller, and at the other somewhat thicker. And this ought to be introduced with the small end foremost into the fistula, till pure blood begins to appear. This is universal in the application of all collyriums for fistulas. And then the same plaister is to be put over it spread upon linen; and above that must be applied a sponge first dipt in vinegar; and it is sufficient to open the dressings on the fifth day. Such diet must be used, as I have recommended for generating flesh.

But if the fistula is at a distance from the præcordia, it is necessary for the patient now and then to eat radishes fasting and then to vomit.

When the fistula by time becomes callous (and it is impossible to be mistaken in a callosity, because it is hard, and either white or pale) then there is a necessity for stronger medicines. Such as that composition, which contains of poppy tears p. i. *. gum p. iii. *. cadmia p. iv. *. copperas p. viii. *. these are incorporated with water, and made into a collyrium. Or that, which consists of galls p. i. *. verdigrease, sandarach, Egyptian allum, each p. i. *. calcined copperas p. ii. *. Or that, which is composed of chalcitis and stone-lime, to which is added of orpiment less by one half than each of the other ingredients; and these are mixed up with boiled honey. The most expeditious is the prescription of Meges: to reduce to powder of rasile verdigrease p. ii. *. then to dissolve in vinegar, of ammoniacum thymiama p. ii. *. and with this to bring the verdigrease to a consistence: and this is one of the choicest medicines. But though the foregoing compositions are the most efficacious, yet if these are not to be had, it is easy to destroy the callosity by some caustic medicines: and it is sufficient to arm with these a twisted paper reed, or some part of a penecillum, formed after the manner of a collyrium. Squills also boiled, and mixed with lime consume a callus.

If the fistula happen to be pretty long, and transverse, after introducing a probe, it is very proper to make an incision over against its origin, and to put in any collyrium you chuse.

But if we judge the fistula to have two or more sinuses, provided it be short and confined to the flesh, we ought not to make use of a collyrium, which may cure one part, and not touch the rest; but the same medicines dry are to be put into a writing reed, which being applied to the orifice, the medicines must be blown into the fistula. Or the same things may be dissolved in wine; or if the fistula be somewhat foul, in mulse; if somewhat, callous, in vinegar; and whatever is injected, must be infused in this liquid form. Coolers and repellents must be applied above; for generally the parts about a fistula are a little inflamed. Neither is it improper, when one has removed the dressings, before he make another injection, to wash the fistula by means of a syringe; if there be much matter, with wine; if the callosity be pretty hard, with vinegar; if it is already cleansing, with mulse, or a decoction of vetches in water, with a little honey added to it. It commonly happens that the membrane, which is betwixt the orifice and the sound flesh, being overcome by so many medicines, casts off, and the ulcer is clean below. Whenever this happens, agglutinants are to be applied, and especially spunge armed with boiled honey. I know it is a practice approved of by many in this case, to have lint rolled up into the form of a collyrium, and dipt in honey, introduced for incarning. But this method more quickly agglutinates, than incarns. And there is no fear, that clean flesh brought into contact with clean flesh can fail to unite, especially when medicines proper for that purpose are made use of; since often an ulceration of the fingers, unless great care is taken to prevent it, will join them together in the healing.

There is also a kind of ulcer, which from its resemblance to a honeycomb, by the Greeks is called cerium[ FE ]. And of this there are two species: the one is of a whitish colour, and like to a furuncle, but larger, and attended with great pain. When it maturates, it has openings, through which is discharged a glutinous and purulent matter; nevertheless it does not come to a due ripeness. If it be divided by incision, there appears to be a great deal more corruption within, than in a furuncle, and it reaches deeper. It seldom occurs but amongst the hair of the head.

The other is less, and eminent upon the top of the head, hard, broad, of a pale green colour, and more ulcerated; for there are openings at the roots of each of the hairs, through which issues a glutinous, palish humour, in consistence like honey, or viscum, or sometimes oil; and if an incision be made upon it, the flesh within appears green. There is a great pain and inflammation, insomuch that they often bring on an acute fever.

To that kind, which has fewer openings, it is proper to apply dry figs, and lintseed boiled in mulse, and drawing plaisters and malagmas, or the medicines, of that quality above recited.

Upon the other, the same medicines, likewise meal boiled in mulse, and half the quantity of turpentine resin added to it; and a fig boiled in mulse; to which a little powdered hyssop is added; likewise a fourth part of stavesacre added to the fig. But if medicines do but little service in either kind, the whole ulcer must be cut out to the sound flesh. When the ulcer is taken away, medicines must be applied over the wound; first such as promote pus, next detergents, then such as incarn.

There are also some resembling warts, which have different names, as they are different disorders. The Greeks call that an acrochordon[ FF ], where a substance pretty hard is collected within the skin, which sometimes is rough, and of the same colour with the adjacent parts; near the skin it is narrow, and broader above. This is small, rarely exceeding the size of a bean. They are hardly found to grow single; generally a number together, and chiefly in children. They sometimes suddenly disappear, sometimes they excite a moderate inflammation. Some are also converted into pus.

That is called acrothymium[ FG ], which rises like a small wart above the flesh, broader at the skin, smaller above, hardish and very rough upon the top, where in colour it resembles thyme, whence it has its name; and it is easily divided there, and made bloody; sometimes it discharges some blood; and is generally about the bigness of an Egyptian bean, seldom larger, sometimes very small. Sometimes only one, at other times more grow in the palms of the hands, and soles of the feet; they are worst in the private parts, and aptest to bleed there.

Those called myrmecia[ FH ] are lower and harder than an acrothymium, fix their roots deeper, and occasion a greater pain; below they are broad, and above small, and less blood comes from them: in size they scarce ever exceed a lupine. These likewise grow either in the palms of the hands, or lower parts of the feet.

The clavus grows elsewhere sometimes, but chiefly in the feet, and principally form a contusion, though sometimes from other causes; and it gives pain, if not at other times, at least when one is walking.

Of these the acrochordon, and the acrothymium often terminate of themselves, and the more readily, the less they are. Myrmecia and clavi are scarce ever removed without medicine. If the acrochordon be cut off, it leaves no root, and for reason does not grow again. When the acrothymium and clavus are cut off, a small roundish root grows, which descends deep into the flesh, and that being left, they sprout up again. The myrmecia adhere by very broad roots, and therefore cannot be taken off without a great ulceration. It is very proper to pare the clavus now and then: for thus without any violence it grows soft: but if a little blood be let out, it often dies away. It is also removed, if one cleans it round, and then applies to it resin mixed with a little of the powder of a milstone. But the other kinds are to be eaten away by medicines. For the two first, that which is made from the lees of wine; for the myrmecia the most proper is that, which consists of alum and sandarach. But the contiguous parts ought to be covered with leaves, lest they also be corroded; and after that a lentil must be applied. A fig also boiled in water destroys an acrothymium.

Pustules break out chiefly in the spring season. Of these there are several kinds. For sometimes there is a certain asperity over the whole body, or a part, resembling those pustules, which are occasioned by a nettle, or from sweat; the Greeks call them exanthemata[ FI ]. And they are sometimes red, at other times of the same colour with the skin. Sometimes a great many grow resembling vari, sometimes larger. The pustules are livid or pale, or black, or otherwise different from the natural colour; and there is a humour contained in them. When they are broke, the flesh below appears as it were ulcerated. By the Greeks they are called phlyctænæ helcodes[ FJ ]. They arise either from cold, or from fire, or from medicines.

The phlyzacium[ FK ] is a pustule somewhat harder, of a whitish colour, and sharp pointed. What is squeezed from it is moist. The pustules sometimes turn to small ulcers, either dry or moist; and sometimes attended only with an itching, at other times with an inflammation and pain: pus or sanies issues from them, or both. And this occurs in children chiefly; seldom in the trunk of the body; often in the extremities.

The worst kind of pustule is that, which is called epinyctis[ FL ]. Its colour either inclines to livid, or is a dark brown, or white. There is a violent inflammation round it; and when it is opened, a mucous ulceration is found within, in colour resembling its humour. The pain of this is greater than in proportion to its bulk; for it is not larger than a bean. And this likewise grows in the extremities, and generally in the night-time: whence the Greeks have given it the name of epinyctis.

Now in the cure of all pustules, the first thing is to walk much, and to take exercise: if that cannot be complied with, to use gestation. The second rule is, to lessen the quantity of food; to abstain from every thing acrid and extenuating. And nurses ought to observe the same rules, if their sucking child is thus affected. Besides these, one, that can bear it, if the pustules be small, ought to sweat in the bagnio; and at the same time to sprinkle nitre over them; and to anoint the part with a mixture of wine and oil; then to go into the bath. If no benefit accrues from these, or if the pustules be of a larger kind, a lentil must be applied, and when the surface of the skin is taken off, we must have recourse to lenient medicines. After the lentil, the epinyctis is to be treated with blood-herb, or green coriander.

The ulcers formed from pustules are cured by litharge mixed with fenugreek seed; and in compounding them, rose oil, or juice of endive, are used alternately, till the mixture have the consistence of honey. The proper composition for those pustules, which attack, infants, is of that stone, which the Greeks call pyrites p. viii. *. with fifty bitter almonds, and an addition of three cyathi of oil. But the pustules ought to be first rubbed with ceruss, and then anointed with this.

The scabies is a hardness of the skin, of a muddy colour, from whence pustules arise, some of them moist, others dry; from some of them issues a sanies; and in these there follows a continued itching ulceration, which in certain cases spreads very fast. In some people it goes entirely off, in others it returns at a certain season of the year; the greater its asperity, and the more it itches, the more difficult it is to cure. And therefore this species of it the Greeks call agria[ FM ], that is, cruel.

In this also the same diet is necessary, as above prescribed. The medicine proper for this in its beginning, consists of spodium, saffron, verdigrease, each p. i. *. white pepper, verjuice, each p. i. *. cadmia p. viii. *. But where there is already an ulceration, that, which is composed of sulphur p. i. *. wax p. iv. *. liquid pitch a hemina, two sextarii of oil. These must be boiled together to the consistence of honey. There is also another, which is said to have been invented by Protarchus. It contains a sextarius of lupine meal, four cyathi of nitre, a hemina of liquid pitch, half a pound of liquid resin, and three cyathi of vinegar. It is also proper to mix saffron, lycium, verdigrease, myrrh, ashes, in equal quantities, and boil them in passum. This heals every kind of scabies. And if there be nothing else at hand, lees of oil boiled to a third part, or sulphur mixed with liquid pitch, as I prescribed for cattle, relieve men also labouring under the scabies.

Of the impetigo there are four species. The least malignant is that, which resembles the scabies. For it is red, hardish, ulcerated, and corrosive. But it differs widely from that, which is more ulcerated(90), and has pustules like to vari; and there appear to be in it somewhat like air bubbles, from which, after a time, something like scales come off; and this is more certain in its returns.

The second kind is worse, and is not unlike the papula, but of greater asperity and a more ruddy colour, having various figures; scales fall off from the surface of the skin, there is a greater erosion, it spreads more quickly, and broader, and both comes and goes at more certain intervals than the former. It is called the red.

The third kind is still worse. For it is both thicker and harder, and more swelled; it causes fissures in the surface of the skin, and corrodes more vehemently. This also is scaly, but black; it spreads wide(91), and does not stay long at a time; but is less uncertain as to its periods of coming and going; and is not to be entirely removed. This has the epithet of the black.

There is a fourth kind absolutely incurable, very different from the rest in colour. For it is whitish, and resembling a recent cicatrix; it has scales of a pale colour, some whitish, others resembling a lentil; which being taken off, blood sometimes follows. Otherwise the humour of it is white, the skin is hard and chopped, and it spreads wider.

All these kinds happen chiefly in the feet and hands; and they also infest the nails. There is no medicine more efficacious than that I mentioned for the scabies, which bears the name of Protarchus. Serapion made use of the following composition, nitre p. ii. *. sulphur p. iv. *. incorporated with plenty of resin.

There are two species of the papula. One is, where the skin is made rough by very small pustules, and is both red, and gently corroded; in the midst of them is a space somewhat smoother; it spreads slowly. And this disorder is of a round form in its beginning, and proceeds in the same manner circularly.

The second, the Greeks call agria: which has a similar appearance, but the skin is more unequal and ulcerated, and it corrodes more vehemently, is redder, and sometimes also loosens the hairs.

That which is less round, heals with greater difficulty; and unless it be cured, it turns to an impetigo. But a slight papula, if it be rubbed every day with fasting spittle, will heal. The greater kind is very well cured by feverfew rubbed over it. But for the compound medicines, that same prescription abovementioned of Protarchus is so much the more powerful here, as the distemper is less. There is another of Mico’s for the same purpose; of red nitre, frankincense, each p. i. *. cantharides cleansed p. ii. *. crude sulphur a like quantity, liquid turpentine resin p. xx. *. meal of darnel three sextantes, three cyathi of git, and one sextans of crude pitch.

The vitiligo also, though of itself not dangerous, yet is both nasty, and proceeds from a bad habit of body. There are three species of it. It is called alphos[ FN ], when it is white; it is commonly a little rough, and not continued, but appears like drops dispersed here and there. Sometimes it spreads wider, leaving some, places between free. The melas[ FO ] differs from that in colour, being black, and like a shadow. In other respects it is the same. The leuce[ FP ] has some resemblance to the alphos, but is whiter, and penetrates deeper; and has white downy hairs in it. All these spread; but in some more quickly, in others slower. The alphos and melas come and go in some people without any regularity. The leuce does not easily quit a person it has once seized.

The two first are not very difficult to cure; the last scarce ever heals; and though the disorder be in some degree mitigated, yet the natural colour is never fully restored. Whether any of these be curable or not, is easily known from an experiment. For the skin should be cut, or pricked with a needle. If blood issues, which generally happens in the two former, there is room for a remedy; if a white humour starts, it will not admit of a cure. And therefore it should not he meddled with.

To the curable kinds must be applied lentils mixed with sulphur and frankincense, the lentils being bruised and dipped in vinegar. Another composition for the same purpose is that, which goes under the name of Irenæus. Bastard spunge, nitre, cummin, dry fig-leaves, of each equal parts, are bruised with the addition of vinegar. With this the part affected is anointed in the sun; and in a little time, it is washed off, lest it corrode too much. Some following the practice of Mico, anoint the alphi with the following medicine; they mix of sulphur p. ii. *. nitre p. iv. *. dry myrrh powdered an acetabulum; then in the bath sprinkle upon the vitiligo bean flour, and afterwards put the other over it. Those which I called melanes, are cured by the following things beat up together; bastard spunge, frankincense, barley, and beans; these are sprinkled upon them without oil in the bagnio, before a sweat comes on, and then that species of vitiligo comes off by rubbing.