Chapter IV: Appendix: To the Fifth Book (3)

Serapion, like our author, recommends applications which are moderately detergent, and neither very calefacient nor refrigerant. He gives the following directions for making a preparation from lime. Take of lime, seven times washed in sweet water and dried, oz. viij; of wax, oz. ij; of oil of roses, oz. vj: let the wax be melted along with the oil, and well mixed with lime. This is to be rubbed into the part. He also gives a prescription for preparing a mixture of lime-water and oil, exactly similar to that which is now used in cases of burns. (vii, 28.) Avicenna, with his usual accuracy, lays down very particular rules for the treatment of burns. To prevent blisters from rising he recommends cooling things; when the burning is occasioned by hot water, he directs us to apply sandals, rose-water, and camphor: or a cloth dipped in congealed water is to be kept constantly applied, and it will prevent blisters from rising. Most of the applications recommended by our author are also mentioned by him. Haly Abbas directs us to apply a cloth cooled in rose-water. He also speaks of the ointment of lime and rose-oil, mentioned above. When the burning is not severe, Alsaharavius directs us in the first place to wash the part with vinegar and salt, and then to sprinkle upon it the flour of barley or of oats. Then if blisters do not rise, but there is a sensation of burning in the part, he recommends us to apply cloths dipped in cold water, rose-water, or snow-water, which are to be changed frequently. Afterwards some emollient applications, such as the white of an egg, with gum arabic is to be used. When the burning is more severe, he recommends us to bleed and use a cooling application, such as the brain of a sheep, the white of an egg mixed with rose-oil, or an ointment made of white wax and rose-oil. He also makes mention of the application from lime. Rhases recommends an ointment containing ceruse, camphor, opium, &c. Like Avicenna, he directs us to apply at first a cloth wetted in cold water, or in rose-water, which has been cooled with snow. If the burning be extensive he recommends venesection, with a cooling and attenuant diet. When the pain is great he directs us to apply the yelks of eggs mixed with rose-oil. When a large ulcer is formed, he directs us to dress it with the ointment of lime, described above. He also approves of a white ointment, consisting of ceruse, oil of roses, and wax. In his ‘Continens,’ he relates a case of severe burning, which he treated with liniments composed of sandals, camphor, and roses; a cloth wetted in snow-water being applied externally to it. He approves of opening the blisters. To prevent them from forming, he recommends strongly an astringent collyrium of galls. Like many of the other authorities, he recommends Cimolian earth very much. The applications recommended by Haly Abbas are of a refrigerant and cooling nature, such as Armenian earth in vinegar, the white of an egg, ceruse, &c.

The earlier modern authors treat burns upon the plan laid down by the ancients, more especially the Arabians. Thus Guy, of Cauliac, recommends us in cases of extensive burning to have recourse to venesection, along with a cooling and attenuant regimen. As a local application, he recommends a cloth wetted in rose-oil congealed in snow, and afterwards cooling ointments containing ceruse, litharge, and the like. He approves of opening the blisters, of afterwards dressing the part with desiccative remedies, such as the ointment of lime, seven times slaked. (Tr. vi, Doct. C. 6.)

SECT. XII.—FOR THOSE BEATEN WITH SCOURGES.

Take of ceruse and litharge equal parts, of wax four parts, use as a plaster with the oleum susinum, or rose-oil; but on the first day use the susinum separately; or, of saffron, dr. j; of tragacanth, dr. j; unite with them a whole egg, without the shell, and use. For those who have been scourged, the skin of a sheep newly taken off, when applied while yet warm, of all remedies cures the soonest, effecting this purpose in a day and a night.

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COMMENTARY. See Aëtius (xiv, 62); Avicenna (iv, 4, 2, 7); Haly Abbas (Pract. iv, 26); Alsaharavius (Pract. xxxi, 2, 1); Rhases (Contin. xxviii.)

Aëtius gives similar directions. The following is said to be an excellent application for the stripes of a whip: mix washed lime with raw eggs, and add some rose cerate. Aëtius, Galen, Nonnus, Avicenna, Rhases, Haly Abbas, and Alsaharavius join our author in recommending the fresh skin of a newly-killed sheep as an application in such cases. Alsaharavius recommends an ointment containing white wax, rose-oil, and ceruse, when the wounds are deep; when there is any apprehension of heat and inflammation, and more especially if the patient be plethoric, he approves of venesection. When on the other hand the patient is weak, and is in danger of falling into a state of syncope, he recommends musk and wine to be administered. When there is much appearance of ecchymosis he speaks of scarifying the part after the heat is gone. Rhases recommends a composition of ceruse, litharge, wax, and rose-oil, as a general application.

Most of the applications recommended by Bertapalia contain litharge, ceruse, tutty, wax, and oil. (De Ulceribus, 16.) The other earlier medical authors of modern times likewise follow the ancients in this case.

SECT. XIII.—TO MAKE HAIRS GROW ON A PART THAT HAS BEEN BURNT.

Hairs grow on a burnt part if you apply fig leaves boiled in a pot with cerate, in the form of a plaster; or, of dried fig, dr. viij; of marjoram, dr. j; triturate with oil to the thickness of a cerate, and use; or, of gypsum, dr. _c_; of squama æris, dr. j; form trochisks with water, and keep. When going to use, mix one part with eight parts of cerate.

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COMMENTARY. The Arabians mention various things which were supposed to be possessed of the property of making hairs grow; such as turpentine, spikenard, thapsia, &c.

SECT. XIV.—FOR EXCORIATIONS.

For excoriated surfaces and superficial ulcers, at first use astringents, such as wine, or vinegar and brine, and afterwards such plasters as contain fat and promote cicatrization, and the most delicate of the white plasters. This is particularly applicable: of ceruse, p. j; of ammoniac, p. ss; of myrtle-oil, q. s; having triturated the ammoniac in water, mix the ceruse, adding the myrtle-oil, and use in an oily state: or, mix the squama æris with gypsum, and having triturated with myrtle-oil, use: or, having triturated Cimolian earth and litharge with wine, and the oleum ricini, or myrtle-oil, use.

_For excoriations, intertrigo, chronic ulcers, and old and tender skin._ Of golden-coloured litharge, dr. lx; of wax, dr. xx; of dried pitch rosin, dr. xij; of oil, iss cyathus: having boiled the litharge and the oil, add the other things, and having agitated it with a spatula, or softened it in a mortar, use. Skin which has been torn away, ought not to be cut from the sores, but it ought to be laid on, and the medicine applied; for thus they coalesce, even if it is black. When stripped of the skin, the cicatrization is difficult, the ulcer being irritated and rendered foul. Excoriated parts are preserved from inflammation by the application of red sumach, triturated with honey, or with the hair of sweet flag burnt and applied with honey.

_An anodyne for excoriations, sores from stripes, and contusions of the joints._ Of litharge, of ceruse, of each, oz. j; of wax, oz. vj; of pure oil or rose-oil, lb. iss; of starch, oz. ij. The composition called pelarium, from the dross of silver, produces the same effects, and that from eggs in like manner.

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COMMENTARY. See Oribasius (Morb. Curat. iii, 18); Aëtius (xiv, 66, 67); Scribonius Largus (88); Marcellus (De Med.); Avicenna (iv, 4, 2, 9); Haly Abbas (Pract. iv, 10); Rhases (ad Mansor. vi, 18.)

Our author copies closely from Oribasius.

Aëtius recommends as a good application for intertrigo occasioned by the friction of shoes, the warm liver of a pig or lamb, or unwashed wool. Here he follows Dioscorides (ii, 37.) He also makes mention of several cooling applications, containing ceruse, litharge, the dross of lead, &c.

Scribonius Largus recommends an ointment containing litharge, ceruse, the flour of frankincense, alum, axunge, old austere wine, roses, and sour oil.

Marcellus also recommends litharge for intertrigo.

The Arabians treat these cases similarly. Thus Avicenna agrees with Aëtius in recommending the liver, and the ointment containing ceruse, &c. For bruised parts he recommends astringents; such as galls, acacia, &c.

To relieve the heat and irritation occasioned by riding, or any such cause, Rhases directs us to apply a cloth dipped in rose-water properly cooled, he means, perhaps, with ice. After the heat and pain have been removed, an ointment of ceruse, or litharge is to be applied. Blisters produced by walking are to be opened and then washed with rose-water; and afterwards they are to be dressed with an astringent application, containing Armenian bole, galls, pomegranate flowers, or the like.

SECT. XV.—FOR MYRMECIA AND ACROCHORDON.

Each of these is a small rising of the skin, of a callous nature, and for the most part circular; but the myrmecia have a broad base, and when rubbed, convey a sensation like the bites of ants. But the acrochordon has a narrow base so as to seem to hang, resembling the extremity of a cord. Wherefore, elaterium with salts, when applied, removes these swellings; and frankincense with vinegar, green figs with vinegar, flour and natron, the juice of the fig rubbed in, and in like manner, that of the spurge, the pickled head of picarel burnt, verdigris burnt with sulphur vivum, the leaves of basil with copperas; that which flows from green vine shoots when burning, sheep’s dung with vinegar, a buck-goat’s gall when rubbed in, the fruit of the large sun-flower, when applied with wine, rue with natron and pepper, natron with the urine of a youth not come to puberty, the dung of an ox of the herd in vinegar.

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COMMENTARY. See Celsus (v, 28); Galen (Meth. Med. xiv); Aëtius (xiv, 4); Oribasius (Morb. Curat. iii, 55); Actuarius (Meth. Med. vi, 8); Pollux (Onomast. iv); Avicenna (iv, 3, 1, 6); Rhases (Divis i, 131, _et seq._; ad Mansor. vii, 15, 16.)

Celsus defines these tumours in the following terms: “Ἀκροχορδόνα Græci vocant, ubi sub cute coit aliquid durius, et interdum paulo asperius, coloris ejusdem: infra tenue, ad cutem latius: idque modicum est quia raro fabæ magnitudinem excedunt. Vix unum tantum eodem tempore nascitur; sed fere plura, maximeque in pueris; eaque nonnunquam subito desinunt; nonnunquam mediocrem inflammationem excitant; sub quâ etiam in pus convertuntur.” He then describes the θύμιον to be about the size of an Ægyptian bean, and of the colour of thyme. He adds: “Μυρμήκια autem vocantur humiliora thymio durioraque: quæ radices altius exigunt, majoremque dolorem movent: infra lata, supra autem tenuia; minus sanguinis mittunt; magnitudine vix unquam lupini modum excedunt. Nascuntur ea quoque aut in palmis aut in inferioribus partibus pedum.” The acrochordon, he says, if cut out, leaves no roots, and does not grow again. This is not the case with the myrmecia. For it he recommends an application consisting of alum and red arsenic.

Galen describes minutely the method of extracting these tumours; but that belongs more properly to the surgical part of this work.

Applications containing arsenic, chalcitis, quicklime, elaterium, sulphur, and alum are mentioned by Oribasius and Aëtius. See in like manner the ‘Euporista’ of the Pseudo-Dioscorides.

The myrmecia is generally rendered _formicaria_ by the Latin translators of the Greek medical authors, and _formica miliaris_ by those of the Arabians. Avicenna seems to confound the myrmecia with the herpes.

Pollux defines the thymus, or thymium, to be an excrescence about the pudenda, anus, fingers, or face, of a red colour, rough, bloody, and not difficult to remove. The acrochordon, he says, is white at the root, and it gets enlarged at the extremity. The myrmecia he defines to be a hard, rough excrescence of a callous nature, but bloody at its extremity.

The acrochordon is thus described by an intelligent modern author: “Est verruca subcutanea durior et asperior, callosa, atque plerumque teres, cute concolor, in basi tenuis, summitatis vero latioris, fabæ magnitudinem raro excedens, juniores maxime infestans.” (Mangeti Bibl. Chirurg. i, 72.) The terms thymus, myrmecia, and acrochordon, have now fallen into disuse.

SECT. XVI.—ON GANGLION.

Ganglion is a round tumour of a nerve (tendon?) arising from a blow or pressure, in many parts of the body, but particularly in those parts which are moved, such as the extremities of the hands and feet. In this case, says Archigenes, apply quick lime with the grease of geese and turpentine. But Poles uses the medicine from agate stone, and Oribasius the following: of ceruse, of pine rosin, of old oil, of each, oz. j; of ammoniac perfume, of galbanum, of each, oz. j; of wax, oz. iv; or, he says, apply a thick plate of lead, like the vertebræ, and larger than the ganglion, and bind it on; for by its weight this dissolves it in process of time. This we have used.

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COMMENTARY. See Hippocrates (De Artic. xxvi); Galen (Comment., de Med. Simpl. ix); Celsus (vii, 6); Oribasius (De Virt. simpl. ii, in voce Plumbum); Aëtius (xv, 9); Actuarius (Meth. Med. ii, 11); Avicenna (iv, 3, 2, 6); Albucasis (Chirurg. ii, 50); Rhases (ad Mansor. vii, 15: Contin. xxviii.)

Hippocrates points out the danger of opening these tumours indiscriminately. They consist, as Galen remarks, of a viscid and mucous fluid. Galen and Oribasius agree with our author in directing a piece of lead to be bound upon the ganglion. Nearly the same plan of treatment is recommended by Aëtius, who directs us to bind a piece of lead upon the tumour, and after some days to remove it, when the ganglion will be found much softened; it is then to be squeezed firmly between the thumb and the fingers, by which means it will be speedily dissolved. Albucasis approves of extirpating the tumour, unless it be seated near a joint. Rhases as usual collects the opinions of all preceding authorities. Antyllus, he says, directed the surgeon to break the sack, or to bind a heavy plate over it, or to extract it by the knife. When an operation is attempted, he recommends that the surgeon be sure that he has removed the whole sac. He relates a case in which the swelling was dissolved by an application containing mustard.

SECT. XVII.—ON PHLEGMON.

In general, we call all those swellings phlegmons which are red and painful, and accompanied with heat; some diversity of their nature arising from the cause which occasions them. For when good blood and of moderate consistence rushes abundantly to a part and from its quantity becomes seated in it, the disease is that which is properly called phlegmon; but when yellow bile is seated in a part, it is called herpes; and when blood and yellow bile together are collected in a part, erysipelas is formed; but when in this case the blood is hot and thick, it usually gives rise to carbuncle. Wherefore, we shall begin with what is properly called phlegmon, which occurs in many cases, being a swelling which is red, painful, elastic, and hot, deriving its origin, as I said, from good blood which is sometimes collected from the whole body, and sometimes is formed abundantly in the part itself, so that it cannot be contained in the vessels, but escapes from them in the form of vapour into the surrounding cavities. And this affection supervenes upon wounds, fractures, ulcers, and many other causes. When therefore a part becomes inflamed without any obvious cause preceding it, the whole body sending a defluxion to the part, we must evacuate the general system by venesection, and apply to the part embrocations and cataplasms, not such as are of a heating and moistening nature, but such as are calculated to repel the fluid, which is flowing to the part, and evacuate that which is already contained in it. Apply, therefore, a cataplasm of house-leek, and of the bark of the pomegranate tree boiled in wine, with sumach and polenta: when the pain is not violent, this or such like applications are to be used; but when there is a defluxion to the part with greater pain, then cataplasms of hot water and oil, or of polenta, must not be applied (for all these are inimical to such defluxions); but the vehemence of the pain is to be allayed by that which is composed from musk, rose-oil, and a little wax, with unwashed wool containing much grease: these things are to be prepared and applied cold in summer, but tepid if in winter, so that the parts above the affected places be covered with a sponge soaked in austere wine or cold oxycrate. But we must add to the cataplasms such herbs as are proper for the purpose required. Pellitory of the wall, therefore, is applicable to every phlegmon at the commencement, and while on the increase; and in like manner, horned poppy, orach, mallows, lettuce, and gourd, when applied on hot parts. Both kinds of caltrops (tribuli) are applicable to inflammatory defluxions, and the cabbage to such as are hard. When a change is thereby effected, and no pus falls into the part, you may accomplish the cure by means of the plaster from chalcitis, or some of those plasters of a similar nature, which apply to defluxions; but clean wool soaked in austere wine is to be put externally to the medicine. In this manner you may cure phlegmons from defluxion. But such as are occasioned by any external cause will not be injured by moistening and heating applications, and if necessity require, you may scarify them with advantage. But in phlegmons arising from defluxion, scarification, more especially at the commencement, may become the cause of much mischief to the patient.

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COMMENTARY. See Galen (ad Glauc. ii); de Different. Morb. (12); Meth. Med. (xiii, 2); Celsus (iii, 10); Oribasius (Morb. Curat. iii. 41); Aëtius (xiv. 31); Leo (vii, 4); Actuarius (Meth. Med. ii, 12); Avicenna (iv, 3, 1, 2); Serapion (v, 22); Haly Abbas (Theor. viii, 9; Pract. iii, 27); Alsaharavius (Pract. xxix, 2); Rhases (Divis. 126, and Contin. xxvii.)

Galen explains that the term _phlegmone_ is used either to signify inflammations in general, or a red, resisting, and painful tumour in particular. It is here used in the latter acceptation. He says, when a defluxion of blood of good quality and of moderate consistence takes place to a part, and from its quantity becomes fixed in it, the person is seized with a violent pain, unless the part be very insensible; it is also accompanied with a deep-seated throbbing; it seems stretched and broken; there is a sensation of increased heat, so that the part feels as if it were burnt and desires cooling; there is a florid redness as in those who have been in the bath, or have been warmed at the fire, and by other means. This affection, he says, gets the generic appellation of phlegmone, or inflammation. He enumerates many causes of it, such as bruises, fractures, and dislocations; but even without these, he adds, it may arise from the veins being immoderately distended with humours, and the superfluity being cast off upon a part fitted to receive them at the time. Such a part, from some cause or other, happens to be weaker, or more lax, or more calculated to attract, or is more inactive than the other parts of the body. He lays it down as a general principle, that the cure of such affections is to be accomplished by evacuation. Reason and experience, he adds, teach us that the general system is to be evacuated by the suitable means, and the inflamed part by embrocations and cataplasms of a repellent nature, and such as are calculated to give tone and strength to it. Such are his general principles of treatment. His particular remedies we need not mention, as in fact our author’s are entirely borrowed from him. Oribasius, Aëtius, Actuarius, and Nonnus, in like manner, borrow from him everything which they advance upon this subject.

Celsus does not treat of phlegmon in particular, but he has given an excellent account of inflammation in general. His definition of inflammation is singularly appropriate: “Notæ inflammationis sunt quatuor, rubor, et tumor, cum calore et dolore.” Isidorus attempts the same not so successfully: “Phlegmone est fervor cum extensione et dolore; sive est inquietudo cum rubore, et dolore, et extensione, et duritie, et vastitate: quæ quum cæperit fieri, inquietudo et febris insequitur.”

Avicenna gives a clear and comprehensive exposition of the doctrines of the Greeks, but supplies no new information. He is at pains to explain that the term phlegmon applies generally to every inflamed part; and also to a hot aposteme in particular. He joins Galen in recommending a free incision when it is apprehended that the member in which it is seated will become corrupted. Serapion’s treatment is nowise dissimilar. A phlegmon, says Haly Abbas, is a sanguineous collection, arising either from an external cause, such as a bruise, a blow, a wound, or the like, or from an internal cause, namely, a defluxion upon the part. He attributes the collection which takes place in a part to its debility, which makes it unable to cast off the load which is thrown upon it. When seated in a vascular part, phlegmon, he says, is attended with a throbbing pain. He approves of free and bold incisions. Alsaharavius treats of phlegmon at great length, but there is nothing original in his views. Rhases recommends at first bleeding, purging, and applications of a cooling and astringent nature. But when suppuration has commenced he properly forbids depletion, lest it only protract this process. He remarks that phlegmons are often occasioned by disorder of the stomach, and the use of too much food and drink. He recommends in general maturative applications, to which, if necessary, narcotics may be added.

SECT. XVIII.—ON EXTERNAL ABSCESSES.

If it appear to you impossible to prevent suppuration, boil bread in water and oil, and apply it as a cataplasm; or apply barley flour prepared in like manner; and bathe the part with an infusion of marshmallows. But when the swelling is difficult, either to convert into pus or to dissipate, you may use a cataplasm of dried figs. But sweet and fat figs are to be dissolved by boiling in water, and made like thin honey, and barley flour added to it. And if the swelling is resolved but imperfectly, you may boil with the figs hyssop or marjoram; or, if you wish to increase its strength, add salts to the decoction. But you must attend that the part be not dried too much, for thus will it be rendered hard. If you perceive any such thing, you must boil with the water the root of wild cucumber, or of marshmallows, or of bryony. But the root of the dracunculus is stronger than these and more discutient; and the medicine formed from the dracunculus itself is very discutient. Sometimes, therefore, you may apply decoctions of these things alone; but at other times you may add dried figs, and mix polenta with fat. And the oil of dill is discutient, and adapted for concocting crude humours, and unconcocted swellings. And pitch, more especially the liquid, concocts all hard and unconcocted swellings, when added to the cataplasms. A compound medicine for procuring the discharge of the concocted matter of abscesses, so that often the pus is found on the pledget; and for thoroughly discussing what is not concocted: of pyrites, of levigated ammoniac, of each, dr. xij; of the flour of beans, dr. vj; add to liquid pitch, and spread upon skin, and apply. But do not take away the pledget until it fall off spontaneously. The medicine must not be prepared long beforehand, as it soon becomes dry. When the tumour is no wise dissipated by these means, and matter falls into it, it is to be opened, and the matter evacuated, taking care not to apply to it water or oil; or, if it be necessary to clean the sore, it must be done with honied water, oxycrate, wine, and wine and honey; and if it become inflamed, the cataplasm of lentils is to be applied; but if it is not inflamed, we may use some of the plasters to such openings, more especially that from chalcitis; but apply to them sponge or wool soaked in austere wine. But to the wound itself, do not apply any of the oily ointments, such as the tetrapharmacon, for it stands much in need of being dried.

_Those things which open abscesses._ Since some persons will not endure to have abscesses opened with iron, we must endeavour to have recourse to epispastic medicines. Having triturated the root of narcissus in honied water, boil it with oil of iris, and apply; or, having triturated the tender root of calamus, and if it be hard, boil it in honied water, and apply; or, use a cataplasm of birthwort and honey. But equal parts of dry pitch and Cretan bee-glue, produce the rupture of abscesses and promote cicatrization.

_The Dionysian plaster, a wonderful epispastic application for abscesses, to the breasts and to buboes, dissipating by the insensible pores._ Of old oil, of water, of each, lb. j; having boiled the oil and water for a little time, add of aphronitrum, oz. vj; of misy, oz. j or ij; and boil until it does not stain the finger; then add of the manna of frankincense, of wax, of turpentine, of each, oz. vj.

_For abscesses of the nervous parts._ Of wax, of colophonian rosin, of butter, of each, lb. j; of dry pitch, of honey, of each, lb. ij, oz. vj; of verdigris, oz. iij; of bird lime, q. s.—_Another_, an epispastic: Of ammoniac perfume, oz. vj; of wax, of turpentine, of each, oz. iv; of sulphur vivum, oz. iij; of natron, oz. iij; and the application called smilium, and that from garlic are strongly calculated to promote the breaking of abscesses already formed. But that which consists of the juice of linseed dissipates, changes, and bursts abscesses most aptly. For the milder sorts of abscesses, those also which were mentioned for parotis will apply. These observations apply to an abscess following phlegmon. But, Galen says, that an abscess will sometimes take place without being preceded by inflammation, in which case, it has its origin from good blood. For at the commencement, he says, owing to some humour, excoriation takes place, and in process of time, the containing parts are separated from those below. And, therefore, when opened, they appear to contain within them all kinds of fluid and solid bodies. For, bodies resembling dung, urine, thrombus, a honey or mucus-like humour, bones, nails, and hairs, have been found in abscesses. And even animals have been found very like to those which derive their origin from putrefaction. Nay, they affirm that, more particularly in chronic abscesses from metastasis, bodies have been formed resembling stones, sand, shells, wood, coals, clay, the sordes of the oil of baths, the lees of oil, and the lees of wine. Wherefore, we shall now give a succinct account of abscesses, more especially such as are seated in the external parts of the body, and those which do not admit of resolution by medicines. An abscess, then, is a corruption and change of the flesh or fleshy parts, such as muscles, veins, and arteries. Of them, some are contained in a cyst, as atheroma, steatoma, and meliceris, and others are formed without a cyst, and are properly called by the generic name, and of them we have now to treat. The formation of an abscess then is most commonly preceded by inflammation, as we have stated, but sometimes it arises at once originally, as we have just now mentioned. An abscess, then, is attended with strong heat of the place, the swelling becomes greater and more red than formerly, and is hard, with a pungent pain, throbbing, and weight, so that it seems as if something were suspended from the part. And if the part be a vital one, fever supervenes with irregular rigors, and the pain and fever are greatest at night. Sometimes too a bubo is formed in the neighbouring glands. When the abscess is fairly formed, the most of these symptoms are diminished, the pungent pain becomes itchy and somewhat dull, the swelling is more sharpened into an acute point, is soft and yielding to the touch, and the skin at the top is separated; I speak with regard to those that burst externally. If therefore, it has burst spontaneously, or from medicines, it is to be cured by means of pledgets spread with ointment, the pus being evacuated by degrees; but if not, it is to be opened in the manner to be described in the surgical part of the work.

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COMMENTARY. All the writers referred to in the last Chapter may be consulted on the treatment of abscesses. See especially Aëtius. He recommends when suppuration is not taking place properly to apply barley meal, or bread boiled in the decoction of figs, to which if necessary may be added nitre, turpentine, or the like. When suppuration takes place, the abscess is to be opened where the skin is thinnest. (See