A tumor is caused by a disruption in the body’s natural balance stemming from one of three types of ailments:
These conditions interfere with normal bodily operations. A tumor is initiated by a humor or other substance that, depending on its proportion, can reduce, weaken, or distort the functionality of the affected body part.
Typically, tumors are differentiated based on five criteria: the quantity of the humor, its composition, accompanying symptoms, the nature of the body part involved, and the fundamental causes of the condition.
An impostume, commonly so called, is an affect against nature, composed and made of three kinds of diseases:
A humor, or any other matter, answering in proportion to a humor, abolishing, weakening, or depraving of the office or function of that part or body in which it resides, causes it.
The differences of impostumes are commonly drawn from five things; quantity, matter, accidents, the nature of the part, which they affect or possess; and lastly, their efficient causes. I have thought good for the better understanding of them, to describe them in this following scheme.
A Table of the differences of tumors.
The differences of impostumes are drawn principally from five things, that is,
from their quantity, by reason whereof impostumes are called:
Great, which are comprehended under the general name of Phlegmons, which happen in the fleshy parts, by Galen, Lib de tumor contra naauram, & lib. 2, ad Glauconem.
Indifferent, or of the middle sort, as Fellons.
Small, as those which Avicenne calls Bothores, i. Pushes and Pustules, all kind of Scabs and Leprosies, and lastly, all small breakings out.
from their accidents, as:
Color, from whence impostumes are named white, red, pale, yellow, blue, or black, and so of any other color.
Pain, hardness, softness, and such like, from whence they are said to be painful, not painful, hard, soft, and so of the rest.
from the matter, of which they are caused and made, which is either:
Natural
Hot, and either
Sanguine, from whence a true Phlegmon.
Choleric, from whence a true Erysipelas.
Cold & either
Phlegmatic, from whence a true Oedema.
Melancolic from whence a perfect Scyrrhus.
Not natural, which has exceeded the limits of its natural goodness, from whence illegitimate tumors, therefore
of a sanguine humor,
of a choleric humor,
Carbuncles, Gangrenes, eating ulcers, Sphaceles are caused.
Of the grosser, the eating Herpes, of the subtler, the Herpes miliaris is made.
Watery and flatulent impostumes, the King’s-evil, knots & all phlegmatic swellings, & excrescences.
The exquisite or perfect Scyrrhus, hardnesses and all sorts of cancerous Tumors.
of a phlegmatic humor,
of a melancholic humor,
From the condition and nature of the parts which they possess, from whence the Ophthalmia, is a Phlegmon of the eyes. Parotis a tumor near the ears. Paronychia or a whitlow at the roots of the nails; and so of the rest.
From the efficient causes, or rather the manner of doing. For some impostumes are said to be made by defluxions, others by congestion, those are commonly hot, & the other commonly cold, as it shall more manifestly appear by the following chapter.
These terms refer to medical conditions involving the accumulation of fluids or substances in the body, often leading to swelling or inflammation.
Tumors (abscesses or swellings filled with pus), fluxion, and congestion can generally be attributed to two sources: one that expels problematic fluids and another that accumulates undesirable conditions, both influenced by the body’s structure and functioning.
There are three common causes that lead to an increase of heat within the body:
There are four causes of pain:
Before we begin discussing the treatment of tumors, it is crucial to understand their various types and differences based on specific signs. The primary signs of tumors originate from the characteristics of the affected body part, so we must first familiarize ourselves with these parts and then examine their essence and composition.
Our understanding is informed by anatomical knowledge and the observation of impaired function, particularly when the affected area is concealed within the body. We can identify an external tumor by comparing it to its healthy counterpart. By assessing sound tissue against diseased tissue, we can determine whether swelling is present.
Variations among tumors arise from the nature and condition of the substances that flow into and form them. Tumors can be identified by characteristics such as color, heat, hardness, softness, pain, tension, and resistance.
Pain, heat, redness, and tension suggest a sanguine humor. Coldness, softness, and minimal pain indicate phlegm. Hardness, a livid color, and intermittent pricking pain are associated with melancholy. A yellowish or pale color with biting pain without hardness points to choler.
Abscesses also exhibit distinct periods and exacerbations that correspond to the nature and movement of the humors from which they arise. Understanding these fluctuations aids in identifying the type of humor involved. For instance, in spring and morning, the blood is in motion; in summer and midday, choler is prevalent; in autumn and evening, melancholy predominates; and in winter and nighttime, exacerbations of phlegm are most common. Diseases follow seasonal cycles, reflecting the variations in the excess and movement of humors throughout the year and the four quarters of each day.
Curable abscesses progress through four stages: onset, increase, stable state, and decline, necessitating adjustments in treatment based on these phases. The onset is marked by initial swelling. The increase occurs when swelling, pain, and other symptoms become more pronounced. The stable state is reached when these symptoms plateau unless the tumor’s substance degenerates and transforms into another type of humor. The decline is characterized by a reduction in swelling, pain, fever, and restlessness. From these observations, the surgeon can predict the potential outcomes of the tumor, which typically resolve in one of four ways, provided that the movement of the underlying humors is not interrupted.
The four possible outcomes are:
Resolution is the most favorable outcome, while corruption is the least desirable. Suppuration and induration fall in between, with suppuration being preferable to induration. Signs suggesting an abscess may resolve include a decrease in swelling, pain, pulsation, tension, and heat, along with an unusual liveliness and itching in the area. Hot abscesses often resolve more readily due to the subtle nature of the hot humor.
Signs of suppuration include increased pain, heat, swelling, pulsation, and fever. Pain and fever are typically more intense during the process of suppuration than afterward. The surgeon must be vigilant in recognizing when suppuration begins, as purulent matter can sometimes be obscured by the surrounding tissue.
Signs that an abscess is evolving into a scirrhus include a reduction in size while hardness persists. This hardness may result from a weakened constitution, the density and toughness of the humor, or the inexperience of the surgeon, who may have overly relied on resolving treatments.
An abscess may progress to gangrene if symptoms of heat, redness, pulsation, and tension intensify beyond typical levels; if pain suddenly ceases without apparent reason; or if the tissue becomes livid or black. A sudden decrease in tumor size without a clear cause may indicate that the matter has receded and re-entered the body, potentially triggered by excessive use of refrigerants.
This reversal of humor into the body can lead to fevers and severe symptoms, such as fainting and convulsions, resulting from the translation of the matter to vital areas.
There are three factors to consider when curing abscesses:
To effectively address health issues, you must consider the flow of humors, the condition of the humor affecting the part, and the management of symptoms. Treatments should begin with repercussives tailored to the tumor’s nature, while being mindful of six specific conditions that may complicate treatment:
For a body that is overloaded or plethoric, it is crucial to make dietary adjustments, engage in purging, and consider bloodletting, alongside therapies such as massage and bathing. Poor humors can often be improved through careful dietary choices and purging methods. If a weakened area leads to fluid accumulation, it’s important to strengthen that region. For issues in the lower body, elevating the affected area can be beneficial.
When fluid buildup is associated with pain, soothing treatments should be prioritized. Conversely, if the fluids are thin or light, they may need to be thickened through appropriate food and medicinal remedies.
To eliminate any unnatural matter present in a specific area, one can use remedies such as cataplasms, ointments, or cupping. More invasive techniques like scarification or drainage may also be necessary. Finally, for accompanying symptoms like fever and pain, the focus should be on alleviating discomfort with soothing and softening medications, which I will discuss in more detail shortly.
A phlegmon is a general term for all abscesses caused by an excess of inflamed blood. A true phlegmon is characterized by healthy blood that is simply present in too large a quantity. In contrast, a bastard phlegmon, or phlegmonous abscess, has its own specific names, such as carbuncle, felon, gangrene, and other malignant pustules.
When various humors converge into a single tumor, different types of phlegmonous abscesses emerge, named according to the predominant humor. For instance, if a small amount of phlegm mixes with more blood, it is termed edematous phlegmon; conversely, if phlegm is in greater quantity, it is called phlegmonous edema. The tumor is always named based on the most dominant humor.
Phlegmon can arise from three main types of causes: primitive, antecedent, and conjunct.
Primitive causes include falls, bruises, strains, excessive labor, vigorous massages, the use of irritating ointments, burns, prolonged exposure to heat, and poor dietary choices that generate excess blood. Antecedent causes refer to an excessive amount of blood flowing through the veins, while conjunct causes involve the accumulation of stagnant blood in a specific area.
The signs of a phlegmon include swelling, tension, resistance, fever, pain, throbbing (especially during suppuration), and redness, all indicating an excess of blood in the affected region.
A small phlegmon may resolve on its own, while a larger one often leads to suppuration. In some cases, it can develop into a scirrhus or a scirrhous-like tumor, and in more severe instances, it may result in gangrene when the local tissue’s vitality is overwhelmed by the influx of blood.
Surgeons must carefully consider these factors to determine the appropriate treatments tailored to the patient’s condition and the specifics of the affected area.
Since a phlegmon is a hot condition that induces fever, the patient’s diet should consist of cooling and moistening foods. Recommended foods include light broths seasoned with herbs like borage, lettuce, sorrel, and succory, while avoiding spicy, fatty, or sweet foods that can generate excess blood. Small amounts of diluted wine are acceptable, and if the fever is severe, soothing drinks made from licorice, barley, or sweet almonds are preferable. The patient’s age and habits should influence these choices. Rest is essential, as movement can increase body heat, especially avoiding activity in the area affected by phlegmon. Sleep should be moderate, with daytime sleeping discouraged after meals. Regular bowel movements are important, which can be aided by enemas if necessary. The patient should also avoid strong emotions and refrain from sexual activity. The patient should breathe clean, cool air—not too humid—to avoid exacerbating the condition.
This can be achieved through purging or bloodletting if the patient’s condition allows. If the affected area is weak, it should be strengthened with astringent substances while using cupping, massage, or ligatures to draw out the excessive humors. Pain management is also vital to prevent further complications.
Address the conjunct cause; assess the tumor’s progression—its onset, growth, stability, and decline—to tailor the treatment accordingly. Initially, the use of repercussive methods can help redirect the phlegmon’s material, utilizing remedies like egg whites, oxicrate, and various herbal infusions (e.g., houseleek, plantain, roses). Cataplasms made from henbane, pomegranate, and other soothing agents may also be employed.
Prescription:
Make a poultice out of these ingredients.
Prescription:
Boil the plantain, henbane, horse chestnut, burdock, and cintinodia perfectly in oxymel. Pound them and strain them. Add the myrtle, cypress, red rose, bean flour, rose oil and quince oil. Mix to create a cataplasm in the form of a liquid poultice. You can use this liniment by soaking linen cloths in it and applying them to the affected area.
Prescription:
Combine these ingredients to create a liniment.
You can also use rose ointment and white ointment with camphor. Rasis (medicinal preparations) are suitable to apply, similar to how the Emplastor Diacalcitheos is dissolved in vinegar and rose oil. You may also use populeon.
When increasing the treatment, pay close attention to the humor that is flowing downward, as well as any that has already settled in the affected area. Therefore, repercussive treatments (those that redirect the flow of bodily humors) should be carefully balanced and mixed with discussing medicines, ensuring that the repercussives remain the primary focus of the treatment.
Prescription:
Boil the mallow leaves, wormwood and plantain in a mixture of sour wine (oxicrate).
Crush and strain.
Add bean and barley flour.
Add powdered red rose, wormwood, rose oil and chamomile oil.
Mix to create a poultice that has a sufficiently liquid consistency.
Prescription:
Boil the barley flour, flaxseed flour and fenugreek in common water.
Towards the end of cooking, add the blueberries, rose petals, and chamomile.
Then add goose fat and rose oil.
Mix everything to create a poultice.
Prescription:
Mix everything to create a poultice.
Prescription:
Mix together to create a poultice that is sufficiently liquid; good for pain.
When the intensity of pain and other symptoms have eased, it is likely that the inflammation (phlegmon) has reached a stage of resolution. Therefore, at this point, we must use more potent and stronger discussing treatments, starting with gentler ones to avoid dissolving the finer parts of the bodily humor too quickly, which could leave the coarser parts behind and cause them to harden.
Prescription:
Boil the bismalva, then add barley flour, honey, chamomile and melilot.
Mix everything to make a poultice.
Prescription:
Boil cucumber, briony, chamomile, and clove flowers in hydromel.
Add flaxseed flour and fenugreek. Then add anise, goose and duck fat.
Mix together to make a poultice.
Prescription for plaster:
Dissolve all these ingredients together to make a medicinal plaster for your use.
Prescription for plaster:
Mix together to make a soft plaster.
The surgeon must work diligently to alleviate this pain, as it not only weakens the patient but also disrupts bodily functions and can cause further complications by drawing blood and energy to the affected area.
Prescription:
Soak the bread in the milk, add egg yolks, rose oil and saffron to make a poultice.
Prescription:
Mix to make a liquid poultice.
Prescription:
Mix together using enough flaxseed flour to form a soft poultice.
If the pain does not improve with these remedies, stronger treatments may be necessary, including narcotics or sedatives, but with caution to avoid numbing or damaging the affected area.
Prescription:
Boil the henpane and poppy under ashes.
Mix in the lard, rose oil and saffron to create a poultice.
Another Strong Treatment:
Boil the hemlock and nightshade under ashes, strain, and add the poplar ointment and rose oil, along with enough fenugreek flour to form a sufficiently liquid poultice.
Sometimes, the body’s humor becomes so trapped in a certain area that it cannot be released, and it becomes so thick that it cannot drain. You can identify this condition by the intense heat and swelling in the area, the sharp, bitter pain, the presence of fever, and a heavy feeling.
In such cases, since it’s no longer possible to drain the humor, we must shift our focus to creating suppuratives (medicines that promote the formation of pus). Galen recommends applying warm water or oil to the swollen area, or a combination of both, followed by a specific poultice.
Prescription for a Poultice:
Another Poultice Prescription:
Boil these in hydromel (honeyed water) and after straining, add
Create a poultice
Alternative Poultice Prescription:
You can also use large diachylon plasters or basilicon ointment for the same purpose.
Once the heat, pain, fever, and other symptoms start to lessen, and if the swelling develops a sharp point, and you can feel the fluid moving back and forth when you press on it, this indicates that the tumor is ready to be opened. It is crucial to open the tumor without delay to prevent the trapped material from damaging the surrounding tissues and causing a more complicated ulcer. This is particularly important if the material is toxic or if the swelling is near a joint or in a moist area of the body. According to Hippocrates, we should proactively open such tumors as they mature.
Methods for Opening the Tumor:
You can open it with a surgical knife or a cauterizing tool, whether it is a direct or indirect method. If the patient is fearful or unwilling to tolerate any instruments, you can use a potential cautery to create an opening.
A Clever Technique:
If your patient is frightened, you may need to use this trick. Take a sharp knife or lancet and push it through a brass plate so it stays secure. Cover it carefully with a poultice so that neither the patient nor bystanders notice the trick. When you position the plate over the tumor, guide it with your fingers to create an impression that is sufficient for allowing the trapped fluid to escape.
I have described three different types of instruments that you can use, whether larger, smaller, or medium-sized, depending on the situation.
[image]
Tokens with the points of knives or lances put through them.
[image]
Other instruments for opening abscesses.
Rings in which little knives lie hidden, suitable to open abscesses.
The delineation of a trunk or hollow instrument going with a spring.
There are seven important considerations to keep in mind when opening any type of abscess.
However, it is common for some of the swelling to remain after such an incision, as not all of the pus may have been drained. In this case, the surgeon should recognize this as a lingering issue, indicating both a tumor and an ulcer. The treatment should focus on removing the tumor before addressing the ulcer, as the ulcer cannot heal until the area has returned to its normal state. Therefore, the previously recommended treatments should be applied, and the ulcer should be dressed with a specific medication for two or three days.
Prescription:
Create a medicinal preparation. Following this, you should cleanse the area using the following medicine:
Prescription:
Create a medicinal preparation for use.
For this purpose, there is a special cleansing agent made from celery (smallage), described as follows:
Prescription:
Cook the honey with the juices until consumed, then add the flours and powders, mixing everything until it forms an ointment.
If you wish to cleanse the area more effectively, you may use either the Apostolic Ointment or a mixture of Golden Ointment and Egyptian Ointment, depending on the intended purpose. Once the ulcer appears sufficiently cleansed, it should be filled with flesh and allowed to heal, as we will explain in the appropriate section on the treatment of ulcers.
Among the symptoms that most commonly accompany phlegmons and affect the entire body of the patient, fevers are the most significant. These fevers are characterized as hot and dry disturbances ignited in the heart, which then spread throughout the body via the arteries. The fevers that typically follow this type of swelling are classified as ephemeral, meaning they last for a day, or as non-putrid or putrid synochi.
The causes of this fever include fatigue, hunger, drunkenness, anger, rage, sorrow, sleeplessness, extreme cold, burns, baths, and a lifestyle that tends to be hotter than usual, as well as the use or consumption of acrid medicines, poisons, or hot foods and drinks. In summary, all the causes that are common to all fevers apply here, except for putrefaction, which is specifically associated with putrid fevers.
A bubo, which is a phlegmon of the glands, can also cause a daily fever, as Hippocrates indicates. All fevers that arise from glandular swelling are considered harmful, except for the ephemeral ones.
The common signs of a daily fever include a moderate and vaporous heat that feels gentle to the touch, a pulse that is swift and frequent, sometimes strong and forceful—especially when the fever is caused by anger; at other times, it may be weak if the fever arises from sorrow, hunger, cold, or indigestion, but in all other respects, it remains normal and typical.
The most certain signs occur when the fever strikes suddenly rather than gradually, and is triggered by some external and evident cause. There should be no loss of appetite, no unexplained fatigue, no deep sleep, yawning, significant pain, restlessness, shivering, or cold preceding the fever, and finally, no other troubling symptoms beforehand. We do not discuss the urine here, as it most often resembles that of healthy individuals; in the short duration of daily fevers, there cannot be enough disturbance in the blood to produce noticeable signs in the urine.
A daily fever concludes in one episode, which, by the nature of this fever, lasts only one day, although it can occasionally extend to three or four days. If this happens, it can easily turn into a putrid fever, especially if there is an error on the part of the patient, the physician, or the caregivers, or if external factors are not properly managed.
This fever resolves either through insensible perspiration, moisture of the skin, or by a natural, gentle sweat that is not foul-smelling. To this category, we can include the non-putrid synochus, which arises from blood that is heated but not putrid. Typically, there is a significant heat throughout the body due to the excessively heated blood; this causes the veins to become more swollen, the face to appear flushed, the eyes to be red and burning, and the breath to be hot. In conclusion, the entire body appears fuller due to the boiling of the blood and the dispersion of the vapors that arise throughout the body. Hence, this type of synochus can be referred to as a vaporous fever. Children and all sanguine individuals who do not have any bad humors are particularly susceptible to this.
The treatment for this fever and the daily fever is the same, as there seems to be little difference between them, other than the possibility of the daily fever lasting three or four days. Therefore, whatever we say about treating the daily fever can also be applied to the synochus, except for bloodletting, which is very necessary in a non-putrid synochus.
The treatment for a daily fever involves the appropriate use of remedies that counteract the cause of the illness. Therefore, warm baths with natural water are very beneficial, provided that the patient is not plethoric (overloaded with blood), constipated, or prone to catarrh (excess mucus production) and discharges. This is important because catarrh can be easily triggered and worsened by the humors that are spread and dissolved by the heat of a bath. In this situation, we should avoid massage and the application of warm oil, even though these methods are often considered very helpful for these types of fevers, especially when they originate from extreme exertion, skin constriction, or a bubo (a swollen lymph node).
As a general rule, for every cause of the fever, you should apply a remedy that is contrary to it: for labor, provide rest; for wakefulness, ensure sleep; for anger and sorrow, seek the pleasant company of friends and activities filled with good cheer; and for a bubo, administer the appropriate treatment for that condition.
Wine, when mixed moderately with water according to the preference of the sick patient, is beneficial for all causes of this fever, except in cases where the patient has a headache or if the fever originates from anger or a bubo (swollen lymph node). In the latter case, the patient must completely avoid wine until the inflammation subsides and begins to improve.
This type of fever often affects infants. In such cases, you should prescribe medications to their nurses as if they were ill themselves, so that the milk can become medicinal. It is also advisable to place the infant in a bath of warm, natural water and then anoint the spine and chest with violet oil after the bath.
However, if a phlegmon affects any internal part, or if it is severe or located near a major organ, it can continuously release either putrid matter or vapor to the heart. This can lead to a putrid synochus, especially if the blood becomes contaminated and putrefied in the larger vessels, consisting of an equal mixture of the four humors. This fever lasts longer than twenty-four hours and does not conclude with vomiting, sweating, moisture, or gradual insensible transpiration, as seen in intermittent fevers or agues. Instead, it remains constant until it completely leaves the patient. It typically occurs in individuals with a good temperament and complexion, who have an abundance of blood balanced by an equal mixture of the four humors.
The treatment for this fever, as I have learned from many learned physicians, mainly involves bloodletting. By letting blood, the fullness is reduced, which helps remove obstructions and ultimately addresses putrefaction. In this type of fever, there is not only an issue with the matter due to the putrefaction of the blood, but also a problem with the temperament caused by excess heat. Thus, phlebotomy aids not only in reducing putrefaction but also in alleviating the hot temperament. When blood, which contains all the body’s heat, is removed, the acrid and foul excretions that contribute to the feverish heat are expelled along with it.
Moreover, to avoid emptiness—which nature abhors—the veins are filled with cool air instead of the hot blood that was drawn out, leading to a cooling effect on the entire body. Many individuals have experienced relief from abdominal issues and sweating through bloodletting, both of which are beneficial in this type of fever.
This led ancient physicians to recommend drawing blood in this illness, even to the point of fainting the patient. However, since this has caused some to lose their lives along with their blood, it is safer and wiser to space out the bloodletting, taking as much blood as the severity of the disease requires and as the patient’s strength can tolerate.
After drawing blood, it is essential to administer a soothing and cooling enema to prevent the emptied veins from drawing impurities from the intestines. However, be cautious with cooling enemas, as those that are too cooling can cause constipation rather than relief. The following day, the harmful matter should be partially evacuated with a gentle purge, such as a dose of cassia cinnamon or a cathartic.
Then, you should prescribe syrups that not only have cooling properties but also combat putrefaction, such as syrups made from lemons, barberries, citrons, pomegranates, sorrel, and vinegar. The patient’s diet should be cooling, moistening, and light, as the natural heat significantly weakened by the blood loss cannot handle a rich diet. Therefore, it will suffice to feed the patient with broths made from chicken and veal, prepared with cooling herbs like sorrel, lettuce, and purslane.
For drinks, provide barley water or syrup of violets mixed with a good amount of boiled water, and Alexandrian julep, especially if the patient is experiencing diarrhea or loose stools. The physician must pay particular attention to the fourth day; if any signs of digestion appear in the excrement, a crisis should be anticipated on the seventh day, manifesting as either diarrhea, increased urination, vomiting, sweating, or bleeding. Therefore, at that point, we should do nothing but leave the entire matter to nature.
Regarding the drinking of cold water, which Galen highly recommends for this type of fever, it should not be allowed until signs of digestion appear. Furthermore, in the later stages of the illness, the use of wine can be beneficial to promote sweating.
We will now address the tumors that recognize bile (choler) as their material cause, due to the connection between bile and blood. The tumors caused by natural bile are called erysipelas or inflammations; they contain significant heat, primarily affecting the skin and sometimes the underlying flesh. These tumors are produced by very thin and subtle blood, which can easily become choleric during inflammation, or by blood and bile that are hotter than necessary, and sometimes by bile mixed with an acrid watery humor.
Although erysipelas can occur in any part of the body, it primarily affects the face due to the thinness of the skin in that area and the tendency of the choleric humor to rise. It is problematic when erysipelas develops over a wound or ulcer; even if it leads to suppuration, this is not favorable, as it indicates an obstruction caused by a thick humor, which poses a risk of erosion in the tissue just beneath the skin.
It is beneficial when erysipelas spreads from the inside out; however, it is harmful when it retreats inward from the outside. If erysipelas affects the womb, it is deadly, and similarly, if it spreads too extensively across the face, it poses a danger due to the connection with the membranes of the brain.
To treat erysipelas, we need to achieve two main objectives: evacuation and cooling. However, since cooling is more crucial than in the case of phlegmon, our primary focus should be on refrigeration. Once this is accomplished, we must remove and evacuate the contained matter using moderately resolving medicines. To achieve these goals, we must undertake four actions.
First, we must establish an appropriate diet by considering the six non-natural factors. This means we should focus on thickening, cooling, and moistening the body as much as the nature of the disease and the patient will allow, significantly more than in cases of phlegmon. Next, we will evacuate the underlying matter by performing venesection (bloodletting) and administering medicines that purge bile. This involves cutting the cephalic vein if there is blood mixed with bile and if the erysipelas is affecting the face and has spread extensively.
If it affects another part of the body, bloodletting may not be as necessary, even if it stems from pure bile. Removing blood, which acts as a restraint on the bile, could potentially worsen the condition. However, if the body is plethoric (overabundant in blood), it would be wise to let blood, as Galen teaches that this is often a cause of erysipelas.
It is also advisable to administer a clyster (enema) containing cooling and moistening ingredients before performing venesection. A knowledgeable and prudent physician should be responsible for prescribing medicines that purge bile.
The third consideration involves topical or local treatments, which should be cold and moist at the onset and during the progression of the condition. They should not be dry or astringent, as using astringent substances could push more acrid matter inward, leading to ulceration and irritation of the surrounding tissues.
Prescription:
Mix to make an oxycrate.
Use this to wet linen cloths and apply them to the affected area and surrounding regions, renewing them frequently.
Or
Prescription:
Mix all these ingredients together.
If the erysipelas is on the face, you should use the following preparation:
Prescription:
Mix these together to create a liniment.
If the heat and pain are unbearable, we must resort to narcotic medicines, such as:
Prescription:
Combine these ingredients to make a liniment, adding enough cooling ointment and camphor as needed.
However, we must not use such medicines for too long, as they may cause a loss of the body’s natural heat and lead to tissue death in the affected area. Therefore, narcotic medicines should be used with caution, considering the location, duration, and other circumstances.
Thus, we can understand in three ways when to stop using narcotic or stupefying medicines. The first indication to stop using narcotic medicines is when the patient feels less heat, tingling, and pain in the affected area than before. The second indication is when the area feels softer to the touch than it did previously. The third is when the fiery and pale color begins to gradually turn livid and black; at this point, we must refrain from narcotics and instead use resolving and strengthening treatments to revive and restore the natural heat of the affected area.
Prescription:
Cook the barley flour, orobium, flaxseed flour in hydromel or vinegar, then add powdered rose, chamomile and aethiops and chamomile to create a poultice.
Alternatively, you can use the following fomentation:
Prescription:
These should be boiled in equal parts of wine and water, and then used as a wash with a sponge.
After the fomentation, you may apply a plaster of Diachylon or Diapalma dissolved in chamomile and melilot oil, or similar preparations.
Herpes is a type of tumor caused by pure bile that has separated from the other bodily humors. Due to its natural lightness and thinness, it travels to the outer skin and spreads across its surface. Galen identifies three types of this tumor. If the bile is of a pure and moderate consistency (not too thick), it produces simple herpes, which is named after its genus. If the humor is not as thin and is mixed with a small amount of phlegm, it will create small blisters on the skin resembling the seeds of a miller (a grain). This is why the Ancients referred to this type of tumor as herpes miltaris. However, if there is any mixture of melancholy (black bile), it will result in an erosive herpes (herpes exedens), which is severe due to its ability to erode the skin and underlying muscles.
There are three primary approaches to treatment. The first is to prescribe a diet similar to that discussed for the treatment of erysipelas. The second is to eliminate the underlying cause by using medicines that purge the harmful humor. Often, enemas are sufficient for this purpose, especially if the patient has a naturally easy constitution and if the urine flows as desired, as this can help carry a significant portion of the humor into the bladder. The third approach is to address the immediate cause with local medicines aimed at reducing the swelling and treating the ulcer. Therefore, the surgeon must focus on two aspects: resolving the tumor and drying up the ulcer, as every ulcer requires drying, which cannot be achieved unless the swelling is reduced. Since the primary concern is to eliminate the tumor, which is essential for healing the ulcer, he should apply a medicine that dissolves and dries, such as:
Prescription:
Or
Prescription:
Cook the barley flour and lentils in a decoction of pomegranate bark and plantain, adding powdered red rose and wormwood, then myrtle oil and common honey, to make an ointment as is customary.
For herpes miltaris, the following should be primarily used:
Prescription:
Mix to make an ointment for use.
I have often found that unguentum enulatum with mercury is very effective, as it destroys the pustules and partially reduces the humor contained within them. However, if the ulcer does not yield and continues to spread further each day, you should treat the edges and lips of the ulcer with a caustic medicine, such as Aqua fortis or oil of vitriol, or something similar. This type of remedy has often allowed me to heal stubborn ulcers that seemed completely incurable.
The primary causes are generally vigorous exercise, especially in hot weather, the consumption of heating and drying foods or medicines, significant abstinence combined with intense labor, and emotional stress such as worry or sorrow. The antecedent causes include an excess of bile in the body, and a hot and dry imbalance either throughout the body or specifically in the liver. The conjunct cause is the putrefaction of the choleric humor, which is abundant in certain areas outside the larger vessels within the body.
Signs of these fevers include shivering or shaking, similar to the sensation of having urinated on a cold winter morning, along with a significant prickling, stretching, or stiffness throughout the body, as if pins were being thrust into the skin. This is due to the acridity of the choleric humor that spreads erratically and violently throughout the body, affecting the sensitive membranes and nervous tissues at the onset of the fever. The heat then becomes intense, and the fever ignites like a fire in dry straw. The pulse is strong, rapid, and regular; the tongue is dry; and the urine appears yellowish, red, and thin.
Symptoms include restlessness, thirst, nonsensical talking, irritability, and an inability to stay still at the slightest noise. These fevers typically resolve with significant sweating. They are common in choleric young men, particularly those who are lean, and tend to occur in the summer. Following the fever, there may be choleric vomiting and yellowish stools. After the episode, there is a complete intermission, with no remnants of the fever until the next episode, because the choleric material is easily expelled from the body due to its natural lightness and fluidity. In contrast, quotidian fevers leave a lingering sense of discomfort due to the stubbornness of phlegm, which resists motion. Each episode usually lasts 4, 5, or 6 hours, although it can extend to 8 or 10 hours. This fever generally concludes after seven episodes and is usually not dangerous unless errors are made by the physician, the patient, or caregivers. Tertian fevers are shorter in summer and longer in winter.
The onset of the episode is often marked by stiffness or stretching, while the state of the fever is characterized by sweating. If the nose, lips, or mouth develop pimples or scabs, it is a sign of the fever’s conclusion and indicates the body’s ability to expel the underlying cause of the illness from the center to the surface. However, these pimples do not appear in all declining tertians, but only when the choleric humor causing the fever resides in the stomach or is drawn there from another part of the liver. The finer portion of this humor can travel through the internal membranes to the mouth and nose, where its acridity can easily cause pimples in those areas. Treatment involves both dietary measures and pharmacological intervention.
The diet should be designed to counteract the six non-natural factors, promoting cooling and moistening as much as the digestive ability allows. Suitable foods include lettuce, sorrel, gourds, cucumbers, mallows, barley creams, and well-diluted wine (thin and small quantities), and it should be consumed sparingly, avoiding food until signs of digestion appear in the urine. At the onset of the fever, the patient should refrain from eating for three hours prior to an expected episode, to prevent the heat from corrupting any undigested food, which could worsen the fever. However, the strictness of this rule can be adjusted based on the patient’s strength; weaker patients may need to eat before or during the episode, but only in small amounts to avoid excessive depletion of strength.
Frequent use of soothing enemas made with decoctions of prunes, jujubes, violets, bran, and barley can be very beneficial. If the patient experiences delirium or nonsensical talking due to the heat and dryness affecting the head, particularly from an excess of choleric humor, the head should be cooled by applying oils of violets, roses, or breast milk to the temples and forehead, and oil should be placed in the nostrils. The feet and legs should be soaked in warm water, and the soles of the feet should be anointed with violet oil or similar substances.
In the later stages, a bath made from vine branches, willow leaves, lettuce, and other cooling ingredients boiled in clean water can be beneficial if taken three hours after a light meal. It is important to understand that this bathing should not occur at the onset of the disease but rather during the decline, allowing the already processed humors to be more easily expelled to the skin due to the warmth of the bath. Initiating a bath too early may cause a blockage in the skin and body by drawing thick and dense humors without prior evacuation.
After general purgations, it is advisable to induce sweating by drinking well-diluted white wine. Urination can be promoted using decoctions of smallage and dill. Sweating is highly beneficial in any putrid fever as it helps eliminate the underlying cause of the disease, especially in tertians, due to the inherent lightness of bile. For sweating to be effective, it should occur on a critical day and be preceded by signs of digestion that align with the nature of the disease. Slower sweats can be encouraged through both internal and external applications; internally, by consuming white wine or decoctions of figs, stoned raisins, grass roots, and other laxative ingredients; and externally, by applying sponges soaked in hot herbal decoctions (such as rosemary, thyme, lavender, marjoram, etc.) to the groin, armpits, and back.
To further promote sweating, two pig bladders or stone bottles filled with the same decoction can be placed on the feet, sides, and between the thighs. The endpoint of sweating should be determined when the patient begins to feel cold, meaning the sweat has turned from hot to cold.
It is widely agreed that bloodletting should not occur after the third episode, but rather at the onset of the fever, in accordance with Galen’s guidance. Since this fever typically resolves after seven episodes, waiting until after the third episode would mean the fever has reached its peak. Hippocrates advises against any interventions during this state, as it may distract nature from its process of resolving the illness.
There are only two types of cold tumors: edema and scirrhus. Although Hippocrates and the Ancients used the term “edema” broadly to refer to all kinds of tumors, Galen and later physicians refined this definition to refer specifically to a particular type of tumor.
An edema is a soft, loose, and painless tumor caused by the accumulation of phlegmatic humor. The Ancients identified eight variations of tumors resulting from phlegm. The first type they called a true and legitimate edema, which arises from natural phlegm. They recognized that unnatural phlegm, due to the mixture with another humor, could lead to three types of tumors: for example, an edema caused by blood was termed an “edema phlegmonodes,” and similar distinctions were made for other mixtures.
Additionally, when they observed unnatural phlegm either inflated with gas or overly watery, they categorized some as flatulent edemas and others as watery edemas. They also noted that when this same phlegm often transformed into a plaster-like substance, it led to another type of edema, which they referred to at different times as “atheroma,” “steatoma,” or “melicerides.” Lastly, they called the type of edema caused by putrid and corrupt phlegm “scrofulae.” It is important to note that phlegm can sometimes be natural and merely excessive, leading to true edema. Other times, it is unnatural, which can occur due to the mixture with foreign substances like blood, bile, or melancholy, leading to the three types of edemas mentioned earlier. It can also become unnatural through the putrefaction and corruption of its own substance, resulting in struma and scrofulae, or through solidification, leading to kernels and various types of wens, ganglia, and knots, or through resolution, resulting in flatulent and watery tumors such as hydrocele, pneumatocele, and all forms of dropsy.
The causes of all edemas are either the flow of phlegmatic or flatulent humor into a specific area or the gradual accumulation of the same in any part due to its weakness in processing nourishment and expelling waste.
The signs of edema include a whitish color similar to the skin, a soft tumor that is rare and lax due to the abundant moisture it contains, and a lack of pain since this humor does not produce a sense of heat or noticeable cold. When you press it with your finger, the imprint remains because of the density of the humor and its sluggish movement. Edemas are more likely to develop in winter than in summer, as winter is more conducive to the accumulation of phlegm. They primarily affect the nervous and glandular parts of the body, as these areas are devoid of blood, cold, and more receptive to the influx due to their looseness. For the same reason, individuals with poor humors, the elderly, and those who are sedentary are particularly susceptible to this type of tumor.
An edema can resolve sometimes through resolution, but more often through solidification, and rarely through suppuration due to the low amount of heat in that humor.
A symptomatic edema, such as that which occurs following dropsy or consumption, cannot be treated unless the underlying disease is addressed first.
The general cure consists of two main aspects: the evacuation of the accumulated matter and the prevention of its recurrence. We achieve both primarily through four methods.
The first method involves establishing a suitable lifestyle and recommending moderation in the use of the six non-natural factors. Therefore, we must choose air that is hot, dry, and subtle; recommend wine of moderate quality for drinking; ensure the bread is well-baked; select meats that can generate good blood, preferably roasted rather than boiled. All fruits, broths, and dairy products should be avoided; instead, the patient should eat fish caught in rocky rivers. The patient should practice moderation in eating, but especially in drinking, to avoid excess moisture. After meals, they should use digestive powders or common digestive aids; if the patient does not naturally have loose bowels, they should be made so artificially.
The patient should engage in exercise before meals to gradually reduce this humor and restore natural heat. They should sleep little, as excessive sleep generates cold humors, and avoid grief and sadness. If the patient is weak, they should abstain from sexual activity to prevent further weakening that could lead to an incurable coldness, which would increase the severity of the accumulated moisture. Conversely, if the body is strong and robust, moderate exercise and sexual activity can help to dry and heat the body.
This aligns with Hippocrates’ assertion that sexual activity can be beneficial for phlegmatic diseases, as Galen mentions in his writings. The physician can further address the issue by focusing on the area from which the phlegmatic humor originates. If the problem arises from the stomach or another specific area, that area must be strengthened. If the issue is systemic, then medications that are attenuating, penetrating, and opening should be prescribed.
The third approach involves evacuating the accumulated humor in the affected area using localized treatments tailored to the different stages of the tumor. Galen advises using a fomentation of oxycratum with a sponge at the beginning and during the increase of the condition. If the edema is on the arm or leg, a repelling roller applied from below upwards is very effective.
The following remedies are also suitable for this purpose:
Prescription:
Mix all together and make a decoction in which wet sponges can be soaked and then applied to the area.
Additionally, you may use the following poultice:
Prescription:
Mix to create a poultice.
During the later stages and decline of the condition, drying and resolving medicines should be employed, such as:
Prescription:
Boil with lye; foment with a sponge, then immediately apply the following poultice:
Prescription:
Boil in honey-water, mash, strain, and add 1 ounce each of crushed red rose, chamomile, and sweet clover to create a poultice.
Finally, you can successfully use resolving plasters and ointments after first heating or stimulating the area with either moist or dry massage or fomentations; otherwise, the plasters may not work effectively due to the coldness of the area, which can hinder the absorption of nourishment and the expulsion of excess and unhelpful humor.
A fomentation can be made with white wine, boiled with sage, rosemary, thyme, lavender, chamomile, and sweet clover flowers, as well as orris roots, staecha, and similar herbs, with a small amount of vinegar added. Soak hot bricks in this decoction and apply them wrapped in linen cloths to the affected area, allowing vapor to be released that has attenuating, penetrating, resolving, and strengthening properties. Alternatively, you can use hog or ox bladders filled halfway with the same hot decoction. Massage should be performed with hot linen cloths to help restore the natural heat along with blood and spirits to the area, resolving the stagnant humors trapped beneath the skin and partially restoring the strength of the area.
I have previously stated that the term edema encompasses not only flatulent and watery tumors but also those formed from congealed phlegm, such as Atheromata, Steatomata, and Melicerides. Flatulent or windy tumors are caused by vapor and gas that are trapped either beneath the skin or within membranes, such as the periosteum and pericranium. This leads to severe pain due to the distention of these areas, which are highly sensitive. Sometimes, the internal organs, like the stomach and intestines, become swollen and stretched from gas, as seen in tympanites (abdominal distention).
These tumors differ from true and legitimate edema in that when you press on them with your finger and then remove it, there is no residual mark left, because they are distended by vapor rather than fluid. The vapor, when pressed, quickly returns to its original state, similar to balls or bladders filled with air.
The cause of such tumors is the weakness of the body’s natural heat, which struggles to dissolve and eliminate the phlegm that leads to the formation of these windy tumors. This is akin to how the morning sun (which somewhat resembles our natural heat) cannot dissipate the mists in the air, but can easily convert them into clear air by noon. In a similar way, our weaker internal heat can stir up vapors from phlegm it cannot dissolve, and these vapors become the material for swellings or tumors. However, even if the natural heat is sufficiently strong, if the humor is situated deep within or trapped by the thickness of a membrane, tendon, or ligament, the vapor cannot escape. Consequently, as it gradually accumulates, it produces a tumor.
The signs of such a tumor include a certain resistance felt when pressing it with your finger, and sometimes a sound like striking a drum, especially if there is a significant amount of gas trapped inside, as often occurs in the hollow of the abdomen and in the spaces between larger muscles. The tumor is neither red nor hot, but rather cold and white, resembling edema. It often affects the joints, particularly the knees, and is very difficult to resolve. If such flatulence accumulates in the intestines, it can lead to wind colic, where the distention may become so severe that it results in death due to the tearing of the intestinal walls.
We will primarily treat flatulent and watery tumors through three main methods. First, by the same diet that we prescribed for edema; second, by strengthening the organs responsible for digestion, particularly the stomach and liver, mainly through the moderate use of aromatic substances such as Diacuminum, Diacalamenthae, Aromaticum caryophyllatum, and Aromaticum Rosatum, which should be prescribed according to the physician’s discretion; lastly, by eliminating the accumulated matter using hot, drying, and attenuating medicines known as carminatives, so that the affected area becomes less dense, allowing the humor and gas contained within to disperse and dissipate. However, these remedies should be adjusted based on the specific area affected; for some treatments are suitable for the stomach, others for the intestines, others for the joints, and others for fleshy areas. For colic, carminative enemas should be administered, resolving bags or pouches should be applied, and cupping glasses should be attached to the navel. If an external area is affected, we use fomentations and liniments, especially if pain is present; we may also use poultices and plasters, such as:
Prescription:
Boil these in lye, adding a little vinegar for a fomentation to be used with sponges.
Galen recommends fomenting the area with rose vinegar and a little salt added, and suggests that a sponge dipped in this mixture should be left on the affected area for some time.
Prescription:
Mix everything together to make a liniment, which should be used to anoint the area after fomentation.
Prescription:
Cook the flour in a decoction of the other ingredients.
Prescription:
Cook the flour of broad beans and peas in common lye. Add the rest of the ingredients.
This will create a plaster for the aforementioned use.
The Vigo plaster with mercury, both with and without it, is also very effective for this purpose. It is important to note that such medicines should be applied to the area while it is still warm, and that heat should be maintained and renewed by surrounding it with linen cloths, hot bricks, bottles, and similar warm objects.
Once the humor and gas that was trapped in the area have been resolved, it is essential to strengthen the area to prevent the recurrence of similar issues. This can be achieved through the following fomentation and poultice:
Prescription:
Boil everything in equal parts of bean water and sour wine, and use this as a fomentation in bags, or apply the decoction with a sponge.
Prescription:
Use as much of the aforementioned decoction as needed to create a sufficiently liquid poultice, and apply it hot to the affected area after using the fomentation.
The signs of a watery tumor are similar to those of a flatulent tumor; however, it appears shiny, and when pressed with your fingers, you can hear a hard noise or murmur as if it were a bladder partially filled with water.
Therefore, if the watery tumor does not respond to the aforementioned resolving medicines, an incision must be made to open it, similar to the method we discussed for treating a phlegmon. Often, this type of remedy is necessary, not only due to the stubbornness of the humor that resists resolving treatments but also because it is contained within its own cyst or bag, the thickness of which prevents the resolving medicines from penetrating effectively. I learned this through experience several years ago with a seven-year-old girl who suffered from a hydrocele (a fluid-filled sac). When I hastily applied various resolving treatments, I ultimately had to open it with my knife—not only to evacuate the fluid but also to remove the bag itself, as failing to excise it completely would result in a relapse. John Altine, a doctor of medicine, called me to assist with this case, and James Guilemeau, the King’s surgeon, oversaw the treatment.
Although these tumors might be considered part of the same category as other edematous tumors, they differ in that their contents are enclosed in a sac or pouch, as if contained in a unique cell. However, they also differ from one another: the substance of the Steatoma, as the name suggests, resembles tallow, but it is often found filled with various hard substances, such as stones, bones, or callous materials resembling the claws of a hen. Philoxenus reports that he sometimes saw flies in a Steatoma at its opening, along with other foreign bodies that are entirely different from the typical matter found in tumors. The material contained in an Atheroma is similar to the porridge that is fed to small children. A Meliceris contains a substance that resembles honey in both color and consistency; these tumors appear and develop without any preceding inflammation.
You can identify these tumors as follows: a Steatoma is harder than the other two and does not yield to finger pressure; however, once it does yield, it does not quickly return to its original shape due to the denser matter it contains. It has the same color as the skin, is painless, and has an elongated shape. The Meliceris, on the other hand, yields to touch, being a loose and soft body, and as it is easily displaced, it quickly returns to its original form. It differs from the Atheroma in both shape and substance, being more rounded and composed of a subtler, shinier matter; it also occupies a larger space and is more pliable to touch, and like the others, it is painless.
Regarding the surgeon’s manual operation for treating these tumors, it seems that the specific type of substance—whether it resembles tallow, honey, or porridge—is not of great importance, as there is one straightforward method of operation: you simply remove the contained fluid and the sac in which it is held. However, it is essential to note that some tumors may appear to hang loosely on the skin’s surface and can be easily moved in different directions, while others are deeply embedded and firmly adhere to surrounding tissues, requiring a skilled hand and careful technique to avoid excessive bleeding or the risk of cutting a vein, which could lead to convulsions.
There are many other types of tumors, such as the Testudo (or Mole), Nata, Glandula, Nodus, Botium, and Lupia, which, in terms of their composition (as they are all made up of thick, sticky, and viscous phlegmatic humor), also share similarities with Atheroma, Steatoma, and Meliceris. Furthermore, when these tumors are opened, you may often find various substances that differ significantly from the typical tumor matter, including stones, chalk, sand, coal, snails, straw, corn husks, hay, horn, hair, hard and spongy flesh, cartilage, bones, and even entire creatures, both living and dead.
The generation of such substances (due to the corruption and alteration of humors) should not surprise us if we consider that, just as nature has made man a microcosm—a small version of the larger world—so too does it allow for all kinds of motions and actions to manifest within him, as long as the material for generation is present. However, since there is little, or rather no, mention of these tumors in ancient texts, we will briefly outline the opinions of later writers regarding them.
Now, they say the Testudo is an abnormal growth that is soft, diffuse, or vaulted, resembling a tortoise; sometimes it appears on the head in the form of a mole, and is then referred to as a mole.
The Nata is a large, fleshy tumor, somewhat resembling a melon or the flesh of a man’s buttocks, which may explain its name, as it tends to occur more frequently in that area than elsewhere on the body.
The Glandula derives its name from the acorn (called “glans” in Latin), as it somewhat resembles an acorn in shape and size; it most commonly develops in the glands or ducts of the human body.
The Nodus, or knot, is a round, hard, and immovable tumor, named after a knot tied in a rope. Guido Cauliacensis asserts that knots typically grow in nervous tissues, but they are now more commonly found on the bones of individuals suffering from the French disease.
A Wen, or Ganglion, is a tumor that can be hard or soft, but is always round, typically forming in dry, hard, and nervous tissues. Some tumors mentioned in the previous chapter are immovable because they are not enclosed in a cyst or sac; others can be moved up and down when touched because they are enclosed in a bag or bladder. Generally, Wens have their own bladder to contain them, which is why we find it appropriate to discuss their treatment more freely and in detail, as they are often more difficult to cure, especially when they are old and longstanding.
The primary causes of these tumors are blunt trauma, falls from heights, strains, and similar incidents. The associated and contributing causes are the same as those for Atheroma, Meliceris, and Steatoma.
The description given earlier will help you recognize when they are present; they typically grow slowly from very small beginnings to a considerable size over six or seven years. Some of them yield significantly to touch, and almost all are painless.
To prevent the growth of those that are just beginning, you can rub them strongly and frequently with your fingers. This will cause the bladder and skin to thin, and the contained fluid will become hot, thin, and resolve. However, if this does not work, you should apply your entire hand or a flat, heavy piece of wood until the cyst or bag is broken by pressure. Afterward, apply and tightly bind a plate of lead, coated with mercury, as I have found through experience that it has a remarkable ability to dissolve and reduce the contained fluid. If the Wen is in a location where strong pressure cannot be applied, such as the face, chest, abdomen, or throat, you should use a plaster with resolving properties, such as the following:
Prescription:
Liquefy the ammoniac gum, bdellium and galbanum in vinegar and strain through a fine cloth. Add the lily oil, laurel oil, a little aqua vitae, and orris powder, ammonium salt, live sulfur, and Roman vitriol.
Mix them all together to create a plaster according to the art.
If the tumor cannot be resolved in this way, it must be opened with a knife or cautery. After the eschar is removed and the bag is treated with Egyptian ointment, mercury, or similar substances, the ulcer must be cleaned, filled with healthy tissue, and allowed to heal.
Sometimes Wens grow to such a size that they cannot be treated with the remedies described, and must be removed entirely by hand and instrument, provided there is no danger due to their size, and that they do not adhere too closely to surrounding tissues or major veins and arteries; in such cases, it is better to leave them alone.
To remove them, make a small incision down to the bag, and insert a probe about the thickness of a finger, hollowed in the middle and rounded at the end, as long as necessary. Then, move it around between the skin and the bag to the root of the Wen, so as to divide the skin lengthwise. Next, make another incision crosswise, so that the cuts intersect like a cross. Then, carefully pull the skin away from the bag from the corners of the Wen towards the root, using your finger covered with a fine linen cloth, or a razor if necessary.
You must be aware that a Wen always contains certain vessels that start small but can increase significantly over time as the Wen grows, acting like roots. Therefore, if any hemorrhage occurs, it is important to stop it by binding the vessels at their heads and roots, or by making a ligature at the roots of the Wen using a piece of whipcord or a doubled thread, leaving the ends hanging until they fall off on their own.
It is not enough to simply remove the tumor; you should also excise a portion of the skin covering the tumor, leaving just enough to cover the area, and then stitch the edges of the incision together. In the meantime, place tents in the bottom of the ulcer until it is completely cleaned, and perform the remainder of the treatment properly, including the healing process.
The surgeon Collo and I used this method, in the presence of Master Dr. Violanius, the King’s physician, to remove a Wen from Martial Colard, the Mayor of Bourbon. It hung from his neck, as large as a man’s head, and weighed eight pounds, making it so troublesome and burdensome that he had to carry it wrapped in a towel, like a satchel.
Indeed, if these types of tumors have a slender root and a broad top, they must be tightly tied and then cut off. However, it is very difficult and fraught with danger to remove Wens located in the neck, near the jugular veins, under the arms, in the groin, or behind the knees due to the potentially deadly consequences that may arise from such procedures. We can only speculate about the nature of the material contained within them, and we can only ascertain its type when it is revealed to us through incision.
In cases where the Wen is very hard and resists touch, it is often found that the material inside resembles small stones or pebbles.
Once, when called to perform an autopsy on a great lady, I discovered a mass in one of her breasts that was about the size of a hen’s egg, hard and compact like a rough pebble. While she lived, both physicians and surgeons believed it to be cancer, because the hardness caused her significant pain even with gentle pressure.
A few years ago, I was called to treat a very respectable woman suffering from a similar ailment, who strongly resisted the physicians and surgeons’ claims that it was cancer. The tumor had not taken deep root, the tissue color remained unchanged, the veins around it were not swollen, and there were no other convincing signs of cancer. This woman had regular menstrual cycles, was in good health, had a good complexion, and experienced no pain except when the affected area was pressed. Moreover, the tumor did not grow any further, and she experienced no other adverse effects; indeed, she lives happily and well, both physically and mentally.
There are also certain small tumors similar to Wens, known as Ganglions, which grow on various parts of the body, but most commonly on the wrists and ankles. These tumors appear on the surface of the skin and do not lie deep within. The cause of these ganglions is usually the weakness of a nerve or tendon, resulting from twisting, stretching, a blow, labor, or other similar causes. As a result, the nourishing fluid that flows to these areas cannot be properly processed or assimilated into the surrounding tissue, and instead, it transforms into a cold and thick humor. Over time, this fluid accumulates gradually around the fibers and the very substance of the tendon, eventually solidifying into a tumor.
It is not advisable to use any metal instruments on these ganglions that affect the tendons and joints. Instead, apply a mixture of ammoniac gum and galbanum dissolved in vinegar and aqua vitae. The recipe is as follows:
Prescription:
Dissolve ammoniac gum and sagapen in aqua vitae. Boil over warm ashes to form a plaster, and at the end, add powdered live sulfur to make a plaster for use.
Additionally, Vigo’s plaster with double mercury would also be effective for the same purpose.
Once the tumor has been softened by these remedies, it should be manipulated, rubbed, or pressed until the bladder or sac breaks under your fingers, which I have done several times. After this, it is advisable to immediately apply and bind a lead plate rubbed with mercury over the area, which will help to break down the remaining tumor.
Sometimes ganglions appear to hang by a small root, resembling a string. In these cases, they should be tied at the root with a string and gradually pulled tighter each day until they fall off. The rest of the treatment can then be carried out according to the common rules of medical practice.
Scrophulae are swollen tumors that arise in glandular areas, such as the breasts, armpits, groins, and primarily in the glands of the neck. They can appear as single or multiple tumors, depending on the amount of matter from which they originate, typically contained within their own cyst or sac, similar to Atheromas, Steatomas, and Melicerides.
These tumors consist of a thick, cold, viscous, and phlegmatic substance, with some mixture of melancholy. They differ from other glandular tumors primarily in their number; scrophulae often appear in clusters, stemming from a deeper root than typical glandular tumors. Some scrophulae are movable, while others are intertwined with nearby nerves and remain fixed.
Ganglions usually appear in smaller numbers and are painless, whereas scrophulae can often be painful, especially when they become inflamed due to putrefaction, occasionally degenerating into cancerous ulcers that should not be treated with instruments or harsh medicines.
Individuals who are phlegmatic, melancholic, gluttonous, or who consume cold and moist foods, such as fish and cold water, and lead a sedentary lifestyle are more prone to developing scrophulae. Treatment involves a very light diet, as this allows the body’s natural heat to focus on the material cause of the tumors, gradually reducing them.
They can also be treated by purging excess humors and applying emollient, resolving, and suppurative topical medicines, prepared as follows:
Prescription:
Mix together to form a plaster, using enough wax as necessary
The ointment for the French disease and the Emplaster of Vigo with mercury are excellent for this purpose, especially if treatment continues until the patient experiences salivation, as this allows Nature to rid itself of the humor causing the scrophulae, which I have sometimes successfully observed.
Prescription:
However, if the scrophulae cannot be resolved through these means and tend towards suppuration, you must use suppurative treatments, such as:
Prescription:
Boil the marshmallow and lily in common water, then strain and add the lily oil, goose fat and duck fat, along with enough flaxseed meal to form a poultice.
It’s important to advise the surgeon not to open the scrophulae until all the contained humor has fully transformed into pus. Otherwise, the remaining humor will remain unripe and may take a long time to mature. This principle should be particularly followed with scrophulae and sometimes with other abscesses that have reached suppuration. We should not hasten to open the abscess as soon as any portion of the contained humor appears to have turned into pus. The portion that has already suppurated helps the remaining humor to convert into pus, which can be observed in inanimate bodies. For example, fruits that begin to rot will cause the rest to spoil quickly unless we immediately remove the decaying part.
Another reason is that the body’s natural heat is the effective cause of suppuration; if the sore is opened prematurely, this heat will diminish due to the escape of vital spirits along with the humor, making it difficult for the remaining humor to suppurate. However, if the swollen part is prone to corruption and putrefaction, or if the contained matter is malignant or critical, it may be better to hasten the opening.
There is also another method of treating scrophulae that involves surgical intervention. For those located in the neck and lacking deep roots, incisions can be made through the skin to pull and cut them away from the surrounding tissues. Special care must be taken not to damage the jugular veins, carotid arteries, or recurrent nerves. If there is any risk of significant blood loss, after removing the tumors, they should be tied at their roots using a needle and thread, binding the thread securely on both sides so that the tumors can detach themselves gradually and safely. The remaining treatment can proceed according to standard medical practices.
A quotidian fever recurs daily, lasting for about eighteen hours, followed by a noticeable intermission for the remainder of the day. The primary causes of this fever include the coldness and humidity of the surrounding air, prolonged consumption of cold foods and drinks, as well as items that are prone to spoilage, such as summer fruits, raw fish, and the neglect of regular physical activity.
The antecedent causes consist of a significant accumulation of tumors, particularly phlegmatic ones. The conjunct cause is the putrefaction of phlegm within the body and its primary regions outside the major veins.
The signs of this fever can be categorized into three groups. First, those related to natural factors: this fever or ague primarily affects individuals with a cold and moist constitution, such as the elderly, women, children, and eunuchs, who tend to have an abundance of phlegm. It particularly targets the elderly due to their diminished natural heat, which prevents them from converting food into healthy blood and bodily substance. In children, the fever occurs more by chance; although they are naturally hot and moist, their voracious appetites and excessive, unrestrained activity after eating lead to the accumulation of crude humors, making them susceptible to this fever. Consequently, overweight children often suffer from this type of fever because their bodily passages may be constricted or blocked, or they may be affected by worms, leading to pain from the corruption of their food, which in turn causes a hot disturbance from putrefaction and the release of putrid vapors, ultimately irritating the heart and making it vulnerable to this fever.
From the perspective of unnatural factors, the signs of this fever are observed primarily in winter and spring, particularly in cold and moist regions, among those who lead a sedentary lifestyle, and through the consumption of foods that are not only cold and moist but also hot and dry, if consumed in excessive quantities that overwhelm the body’s natural heat.
For example, although wine is inherently hot and dry, drinking it excessively can lead to the accumulation of phlegmatic humors and cause cold-related illnesses. Thus, drunkenness, gluttony, the consumption of raw foods, and physical exertion immediately after eating can introduce crude substances into the body and bloodstream. In conclusion, any factors that significantly increase phlegm in the body may lead to a quotidian fever. Additionally, due to its tendency to follow cold diseases, this fever often arises when the body’s center, circumference, and overall condition are chilled.
Symptoms of this fever include pain in the stomach area, where phlegm is typically concentrated, often resulting in vomiting or expulsion of phlegm. The face appears pale, and the mouth remains moist without thirst, often during the fever itself because the stomach, filled with phlegm, causes the watery and thinner portions to continuously rise into the mouth and tongue through the continuity of the stomach lining shared with the esophagus and mouth.
The individual experiences coldness in the extremities, a small and weak pulse, which, despite the vigor of the fit, may become stronger, larger, fuller, and quicker. Similarly, the heat of this fever initially feels mild, gentle, moist, and vaporous, but eventually becomes more acrid—much like a fire kindled in green wood, which starts small, weak, and smoky but eventually burns brightly as the moisture is overcome.
Patients are often relieved from their fits through minimal sweating, which initially occurs sparingly but becomes more abundant as the crisis approaches. Initially, the urine is pale and thick, sometimes thin when there is an obstruction. However, once the matter is processed, it turns red. If the patient vomits a considerable amount of phlegm at the onset of the fit, followed by substantial sweating, this indicates that the fever will not last long, suggesting the body’s strength and the expulsion of the underlying cause of the fever.
Treatment involves two approaches: diet and medication. The diet should be light and reducing; the patient should breathe in moderately warm and dry air. Recommended foods include well-baked bread, chicken or hen broths with boiled roots such as parsley and sorrel. Occasionally, the use of hot foods, especially spiced and salted items, can be beneficial, particularly for those whose stomachs and livers are significantly cooled. Suitable foods include chicken, mutton, partridge, small birds, and river fish that are either fried or broiled, as well as raw eggs and similar items. Fruits such as raisins, stewed prunes, almonds, and dates are also good choices. The patient should drink small amounts of white wine mixed with boiled water. Moderate exercise and full-body massages are helpful, as is sleep taken at appropriate times, ensuring that sleep does not coincide with the fever’s onset, as this can exacerbate the condition by drawing heat inward and intensifying the fever.
For mental well-being, it is important for the patient to remain cheerful and hopeful about recovery. Some recommend immersing the feet and legs in hot water infused with chamomile, dill, melilot, marjoram, sage, and rosemary at the onset of the fever.
Medicinal treatments should include digestive and aperitive syrups. Laxatives should be prepared as potions or administered in the form of a bolus with sugar, depending on the physician’s judgment regarding the patient’s condition.
Regarding the state of the illness, it is crucial to care for the stomach, particularly the mouth, as it is the primary site of phlegm accumulation. Therefore, it is advisable to anoint the mouth every other day with chamomile oil mixed with a little white wine, and to expel phlegm through vomiting induced by radish juice and copious amounts of oxymel or a decoction of asarum seeds and chamomile. A syrup made from vinegar is particularly beneficial at the beginning of the fit when nature and the humors begin to stir. For a chronic quotidian fever, if no other remedy is effective, a dram of old treacle taken with sugar in the form of a bolus or dissolved in aqua vitae is thought to be particularly helpful.
These tumors include hardness, resistance to pressure, a dark color, and the dilation of the veins in the affected area, which may also appear dark due to the abundance of thick humor. The illegitimate or bastard scirrhus, which is entirely painless and insensible, as well as the cancerous type, do not respond to treatment, and the true legitimate scirrhus only rarely yields to any form of remedy. Those that progress to suppuration can easily transform into cancers and fistulas; although these tumors may initially appear small, they tend to grow significantly over time.
First, the physician should prescribe an appropriate diet that is sober and moderate, focusing on moisture and a neutral level of heat. The patient’s lifestyle should be calm and free from disturbances such as anger, grief, and sadness, and they should avoid sexual activity.
The second approach involves the evacuation of the underlying matter, which may require bloodletting if necessary, as well as purging. This can be done by encouraging hemorrhoids in men and menstrual flow in women. Prescriptions for purgatives may include Discatholicon, Hyera, diasenna, polypody, and Epythymum, according to the physician’s expertise.
The third approach consists of the appropriate use of topical medicines, which should be emollient at first and then immediately followed by resolving agents, or a combination of both emollient and resolving properties, as Galen teaches. Using only emollient substances carries the risk of putrefaction and cancer, while using only resolving agents may lead to the resolution of the finer parts while the coarser parts settle.
The emollient preparation can be as follows:
Prescription:
Boil the marshmallow and lily roots in common water. Strain. Add Chamomile, lily oil, moist oesp, plaster and enough white wax to create a suitable ointment.
Prescription
Combine 2 ounces of the oesp plaster as described by Philagrus.
Melt everything together, adding enough wax to create a sufficiently soft ointment.
After adequately using emollient substances, fumigate the tumor with strong vinegar and aqua vitae poured over a heated piece of millstone, flint, or brick. This will help to rarefy, thin, and resolve the softened humor. After some time, reapply your emollients and then again use your resolving agents to eliminate what remains, as it may not be possible to address everything at once. This method is how Galen cured a scirrhus in Cercilius, his son. Goat dung is also very effective in treating scirrhous tumors, but the Vigo plaster with double the amount of mercury is particularly effective, as it both softens, resolves, and eliminates all tumors of this type.
A cancer is a hard tumor that is rough and uneven, round in shape, immovable, and has an ash or livid color. It is horrifying due to the veins that surround it, swollen with dark blood, and it spreads out resembling the stretched legs and claws of a crab.
This type of tumor is difficult to identify at first, as it may be no larger than a chickpea. However, after a short time, it can grow to the size of a hazelnut, unless it is provoked to grow suddenly larger by overly harsh treatments. As it increases in size, the patient experiences tormenting pricking pains and a sharp heat, as the thick blood in the veins becomes heated, causing a sensation similar to being pricked by needles, although the patient may sometimes find some relief.
Because this type of tumor has veins that extend and spread around it like claws and feet, and because it is of a livid and ash color, accompanied by rough skin and a thick consistency, it resembles the clawed appendages of a crab. Therefore, I thought it appropriate to include an illustration of a crab here, so that the reasoning behind both the name and the characteristics of the condition might be clearer.
Here we recognize two primary causes of cancer: the antecedent and the conjunct. The antecedent cause arises from an irregular diet, which leads to the generation and accumulation of thick, unhealthy blood; it is influenced by a morbid condition of the liver that predisposes it to produce such blood; it is also affected by the weakness of the spleen in its ability to attract and cleanse the blood; and it may result from the suppression of menstrual cycles, hemorrhoids, or any other usual bodily evacuations.
The conjunct cause refers to the thick and melancholic humor that becomes trapped in the affected area, much like being stuck in a narrow passage. This melancholic blood, which is less malignant and milder, can lead to a non-ulcerated form of cancer when it is heated slightly. However, when the humor is more malignant and acrid, it can lead to an ulcerated form. For instance, the humor responsible for carbuncles can, when heated and corrupted, corrode and ulcerate the tissue it affects.
Cancer can be exacerbated by foods that inflame the blood, as well as by emotional disturbances such as anger and stress. Additionally, the use of overly acrid, oily, and inappropriate medicinal applications can worsen the condition.
When it comes to the types of cancers, two main categories stand out: ulcerated (or manifest) cancers and non-ulcerated (or occult) cancers. Some cancers affect internal organs like the intestines, uterus, and rectum, while others impact external areas such as the breasts. There are also newly formed cancers and those that have become chronic. They can vary in size, with some being small and others large; some are aggressive and malignant, while others are milder in nature.
Cancer is generally regarded as nearly incurable, or at the very least, very difficult to treat, as it is a wholly malignant disease, often compared to a specific form of leprosy. Aëtius notes that cancer is not easily contained until it has completely consumed the area it occupies. It tends to affect women more than men, particularly in areas that are soft, rarefied, fungous, and glandular; thus, they are more prone to accumulating thick humor, such as in the breasts and other delicate regions.
When cancer affects the breasts, it can lead to inflammation in the armpits and swelling in the nearby glands. Patients often report sharp pain that can radiate to the heart, collarbones, and even the inner sides of the shoulder blades. If the condition worsens and spreads to critical areas, surgery may be the only viable option for treatment. However, in weakened individuals whose strength has diminished, especially in cases of chronic cancer, aggressive treatments such as surgical intervention, cauterization, or harsh medications should be avoided. Instead, the focus should be on preventing the condition from worsening and spreading further, employing gentle remedies and palliative care.
Many individuals suffering from cancer have lived to a ripe old age by adopting such an approach. Hippocrates advises that it is often better not to treat occult or hidden cancers; he suggests that patients who undergo treatment for these tend to die quickly, whereas those who are left untreated may live longer.
One should avoid thick and muddy wines, vinegar, dark bread, cold herbs, aged cheese, and preserved meats such as beef, venison, goat, and hare. Foods like garlic, onions, mustard, and all acrid, sour, or salty items that could thicken the blood and inflame the humors should also be excluded. Instead, a cooling and moistening diet should be prescribed. Fasting, sleeplessness, excessive labor, sorrow, anxiety, and mourning should be avoided.
The diet should include light broths made with ingredients such as mallows, spinach, lettuce, sorrel, purslane, chicory, hops, violets, borage, and the four cooling seeds. The patient may eat mutton, veal, kid, capon, young hares, partridges, fish from rocky rivers, and fresh eggs. White wine may be consumed moderately.
The affected area should be treated gently, avoiding heavy or overly solid applications. Instead, soothing and mitigating remedies should be used, applying substances that counteract venom or poison, such as treacle and mithridate, at appropriate times. Ass’s milk is particularly effective in alleviating the acrimony of the cancerous humor; it should be taken both internally and applied externally as a poultice to the affected area.
An ulcerated cancer exhibits many characteristics similar to its non-ulcerated counterpart, including the rounded shape of the tumor, its uneven and rough texture, and the pain associated with it. To the eye, the tumor may seem soft, yet it feels hard when touched. The ulcer itself is quite foul, with thick, swollen, and knotted edges that protrude outward, creating a ghastly appearance. It discharges a repugnant, ichorous fluid that resembles rotting flesh, sometimes black, at other times mixed with putrid debris, and occasionally accompanied by a significant amount of blood. This type of ulcer is malignant, resistant to treatment, and tends to worsen with harsh remedies. The pain, fever, and other symptoms escalate, leading to a decline in the patient’s strength, resulting in wasting and ultimately, death.
If the cancer is small and located in a part of the body that can be amputated, and if the patient’s condition allows, it is wise to first cleanse the body and draw blood. Following this, surgical intervention should be employed to remove all diseased tissue, even down to the quick, ensuring that no traces of contagion remain. After the amputation, it is important not to immediately stop the bleeding; rather, allow it to flow freely for a while to drain the veins filled with dark, melancholic blood. Once a sufficient amount of blood has been drawn, the area should be treated with actual cautery. This will help strengthen the affected area, draw out any toxins, and stop any further discharge. Afterward, soothing remedies should be applied to promote the separation of the eschar.
In conclusion, we can determine that all cancerous tissue has been successfully removed and the malignancy eradicated when the ulcer begins to discharge healthy fluid and new, healthy flesh starts to grow, resembling the seeds of a pomegranate, with alleviation of the sharp pain and other symptoms. The treatment of an ulcerated cancer affecting the lips can be conducted more gently and effectively, without the need for caustic agents after excision, leading to minimal deformity during the healing process. This innovative method, which I believe has not been previously documented, was developed and applied to a fifty-year-old man in the presence of Doctor John Altine, a highly esteemed physician, alongside James Guillemeau, Master Eustachius, the King’s surgeons, and John Le Jeune, the respected surgeon of the Duke of Guise.
The method is as follows: the cancer must be pierced through the lips on both sides, above and below, using a needle and thread. This allows you to control the cancer with your left hand using the thread, preventing any part from escaping during the excision. Then, with scissors in your right hand, cut it off in one swift motion; however, care must be taken to leave some tissue from the inner part of the lip, adjacent to the teeth, if the cancer has not fully penetrated. This remaining tissue will serve as a foundation for new flesh to fill the void. Once sufficient bleeding has occurred, the edges of the wound should be scarified on both the right and left sides, both internally and externally, with a somewhat deep scarification. This will make the flesh more pliable and suitable for stitching, similar to the technique used for repairing a hare-lip. The remainder of the treatment should proceed in the same manner as we would treat hare-lips, which we will discuss further.
Initially, we employ repercussive medicines such as the juices of nightshade, plantain, henbane, lettuce, sorrel, houseleek, water lentil (or duckweed), knotgrass, pomegranates, and similar herbs. Additionally, we use rose oil, powders of sumac, barberry, litharge, ceruse, burnt lead, tutia, quicksilver, and the like. These can be combined to create fomentations, liniments, ointments, cataplasms, and plasters. The diacalcitheos plaster, dissolved with nightshade juice and rose oil, is particularly suitable for non-ulcerated cancers. Pompholix or tutia, washed in nightshade or plantain juice, works well for ulcerated cancers. The following preparation is also highly regarded:
Take equal parts of litharge and ceruse (1 ounce each), grind them in a mortar with rose oil until they reach the consistency of a liniment or ointment.
A resolving and repercussive ointment can be made with the following ingredients:
– 1.5 ounces of washed burnt lead,
– 1.5 ounces of pompholix,
– 1 ounce of pontic wormwood,
– 3 ounces of rose oil,
– 6 drachms of wax,
– Sufficient juice of solanum to achieve the desired thickness for an ointment.
Theodorick’s emplaister is highly praised for alleviating the pain associated with ulcerated cancers:
– 1.5 ounces of rose oil,
– 1.5 ounces of pomegranate and solanum juice,
– 1 ounce of washed ceruse,
– 0.5 ounces of washed burnt lead and prepared tutia,
– 2 drachms of frankincense and mastic.
Combine these to create a soft emplaister.
I have often successfully used the following ointment:
– 1 ounce of old theriac,
– 0.5 ounces of crab juice,
– 0.5 ounces each of lettuce and rose oil,
– 2 cooked egg yolks,
– 1 drachm of camphor.
Grind all ingredients in a mortar to create an ointment.
Combine 0.5 pounds of fresh lard with 0.5 pounds of good oil and 3 cooked egg yolks to make an ointment. Store for use, and when needed, mix it with a little rose ointment. I have also found relief from severe pain by applying leeches to a non-ulcerated cancer, particularly at the site of most intense discomfort, thereby alleviating some of the malign humor. Similarly, I have used young puppies, kittens, pigeons, or chickens cut lengthwise and applied to the ulcer, changing them as soon as they lose their warmth, along with other applications for their natural heat in soothing or mitigating medicines.
John Baptista Theodofius, in his writings, claims that a cataplasm made from crushed erysimum (or candock) is excellent for non-ulcerated cancer. For ulcerated cancers, he recommends boiling the same herb in honey water and using it for injections and washes to cleanse the ulcer and reduce pain.
When the cancer affects the womb, patients may experience sharp pain in the groin and kidneys, often accompanied by difficulty urinating. If ulcerated, it may discharge a foul, putrid matter in large quantities, the noxious vapors of which can lead to fainting spells. To alleviate pain in such cases, the following remedies are beneficial:
– Fomentation: Use mucilage from flaxseed and fenugreek, extracted in rose and plantain water, while warm.
– Cataplasm: Boil 0.5 pounds of althea root in honey water, strain, and add a little rose oil.
You may also prepare various pessaries to address different types of pain, as well as injections made from a mixture of plantain, knotgrass, lettuce, and purslane juice, ground in a lead mortar with rose oil. This type of remedy is recommended by galen for all forms of ulcerated cancer.
Another effective remedy is:
– 4 pounds of cow dung,
– 1 pound each of robert’s herb, plantain, live forever, henbane, purslane, lettuce, and endive.
Crush all together and distill in a lead alembic, saving the liquid for use in injections or, if possible, washing the cancerous ulcers with it. Wet lint pledgets soaked in this liquid can be applied and frequently changed, as it helps to reduce inflammation and alleviate pain.
Galen recommended using powdered burnt river crabs mixed with rose ointment applied on lint to ulcerated cancers.
For the cervix, it is advisable to use an instrument made of gold or silver that allows for the free and safe expulsion of cancerous matter and the release of foul vapors. This instrument should be hollow, approximately five or six fingers long, and about the size of a thumb at the upper end, with multiple holes for drainage. The lower end should be about two fingers thick, designed with a spring mechanism to adjust the opening as needed. Two strings or ties should be attached to secure it in place, as illustrated in the accompanying diagram.
A Vent made like a pessary for the womb affected with a cancerous ulcer.
The remedy for non-ulcerated cancers, which involves a plate of lead coated with quicksilver, should not be dismissed. Galen himself attests that lead serves as an effective treatment for malignant and chronic ulcers. Additionally, Guido Cauliacensis, a respected figure in ancient medicine, notes that these lead plates, when treated with quicksilver, act as antidotes to malign ulcers that resist the effects of other treatments, effectively diminishing their malignancy and harmful nature.
This remedy was prescribed by the esteemed physician Hollerius, who instructed me to apply it to the Lady of Montigni, a maid of honor to the Queen Mother, who was suffering from a cancer in her left breast that was the size of a walnut. Although this treatment did not completely heal her, it successfully prevented further growth of the tumor.
Eventually, weary of the situation, she sought the help of another physician who boldly promised swift relief. Tragically, she discovered, at the cost of her life, how perilous and ineffective a treatment for cancer could be when approached as one would treat other ulcers. This physician, having discarded our remedy, began a treatment regimen involving softening, heating, and drawing agents. However, as pain, inflammation, and other symptoms intensified, the tumor expanded to such a degree that the fluid could no longer be contained, causing the breast to stretch and rupture, akin to a pomegranate splitting open at maturity.
In the aftermath, an excessive flow of blood ensued, prompting the physician to apply caustic powders to address the hemorrhage. Unfortunately, this only exacerbated the inflammation and pain, leading to fainting spells. Ultimately, instead of achieving the promised health, the poor soul succumbed in the physician’s care.
The fever that occurs in scirrhous tumors resembles a quartan fever, or at least closely aligns with its characteristics, due to the nature of the melancholic humor from which it arises. This humor, confined to a specific area where the tumor forms, generates putrid vapors that excessively heat the heart and inflame the humors contained within it, leading to the onset of fever. A quartan fever is defined as one that recurs every fourth day, with two days of remission in between.
The primary causes of this fever stem from factors that exacerbate melancholic humors in the body. These include the prolonged consumption of legumes, coarse and burnt bread, salted meats and fish, as well as heavy foods such as beef, goat, venison, aged hare, old cheese, cabbage, thick and muddy wines, and other similar items.
Natural Factors: Individuals with a cold and dry temperament, particularly those in old age, as well as cold and corpulent men with small, hidden veins and a swollen, weak spleen, are commonly affected by quartan fevers.
Unnatural Factors: This fever, or ague, often occurs in autumn—not only because this season is cold and dry, which facilitates the accumulation of melancholic humors, but also due to the transformation of these humors into adust melancholy as a result of the preceding summer’s heat. This transformation can lead to more severe and dangerous quartans than those arising from simple melancholic humor. Additionally, during cold and dry seasons in similarly temperate regions, individuals with comparable dispositions are more susceptible to quartans, especially if they lead a life marked by pain, danger, and sorrow.
Contrary to Nature: The fever episodes are characterized by intense shaking, which can create a sensation akin to the breaking or rattling of bones. Each episode typically occurs every fourth day and is accompanied by an itching sensation throughout the body, often manifesting as thin scales and pustules, particularly on the legs. Initially, the pulse is weak, slow, and deep, while the urine appears white and watery, tending towards a darker hue.
As the fever subsides and the matter is processed, the urine may turn black—not due to any malign symptom or excessive heat, which would be fatal—but rather as a result of the expulsion of the accumulated matter. Each episode of quartan fever lasts approximately 24 hours, with a 48-hour intermission. It frequently originates from obstructions, pain, and scirrhus of the spleen, as well as the suppression of menstrual flow and hemorrhoids.
Quartan fevers that arise in summer tend to be shorter in duration, whereas those that occur in autumn can be prolonged, particularly if they persist into winter. Fevers resulting from a succession of liver, spleen, or other pre-existing diseases are typically more severe than those that arise independently and often culminate in dropsy. However, quartans that develop without underlying bowel issues and in patients who adhere to a physician’s dietary guidance tend to be less harmful, potentially alleviating more serious and chronic conditions such as melancholy, epilepsy, convulsions, and madness. This is because the melancholic humor, responsible for these ailments, is expelled every fourth day through the quartan fever’s episodes.
A quartan fever, assuming no errors in treatment, typically does not persist for more than a year. However, according to the opinion of Avicenna, some quartans have been known to last up to twelve years. Generally, a quartan that begins in autumn often resolves by the following spring.
When the quartan is caused by adust blood, choler, or salt phlegm, it is usually easier and quicker to cure than one that arises from adust melancholic humor. The melancholic humor, being inherently terrestrial, is more challenging to resolve than other humors. When subjected to adustion (where the finer particles dissolve and the coarser ones settle), it becomes even more stubborn, dense, malignant, and acrid.
The treatment for quartan fever primarily relies on two approaches: diet and medication. The dietary recommendations should counteract the underlying cause of the fever, particularly concerning the six factors deemed unnatural, as much as possible. Therefore, the patient should avoid pork, flatulent, viscous, and glutinous foods, as well as marshy fowl, salted meats, venison, and any items that are difficult to digest. The consumption of white wine, which is moderately warm and thin, is beneficial for thinning and breaking up the dense humors, as well as for promoting urination and sweating. Indeed, at the onset of a fit, a glass of such wine can induce vomiting—a remedy of such significance that many have found relief through it.
If one wishes to provoke vomiting, there is no better time than immediately after a meal. At this point, it is more easily elicited due to the stomach’s fibers being moistened and relaxed, facilitating a quicker onset of vomiting. This, in turn, leads to a more abundant, effective, and comfortable expulsion of phlegmatic and choleric humors. During a quartan fever, the stomach often harbors various crudities due to an increased influx of melancholic humor, which, with its cold and dry qualities, disrupts natural functions.
Additionally, engaging in exercise and massage before meals can be beneficial. The patient should also cultivate positive emotions that counteract the underlying cause of the fever, such as laughter, feasting, music, and other enjoyable activities that promote pleasure and joy.
At the outset, the patient must be treated with care and gentleness, and we should refrain from administering strong medications until the disease has persisted for some time. The humor, which is particularly stubborn at the beginning when nature has yet to make any efforts, becomes even more resistant, terrestrial, and dry due to the almost fiery heat of acrid medicines.
If the body is abundant in blood, it is necessary to draw some by opening the median or basilic vein in the left arm. Care should be taken: if the blood appears thick and dark, we should allow it to flow more freely; if it seems thinner and tinged with a healthy red color, we should stop the flow immediately.
To address the underlying matter of this fever, it must be matured, digested, and reduced using syrups made from Epithymum, Scolopendrium, Maidenhair, and Agrimony, along with waters derived from Hops, Bugloss, Borage, and similar herbs. I sincerely attest, before God, that I have successfully treated many cases of quartan fever by administering a potion of a small amount of treacle dissolved in about two ounces of aqua vitae. Additionally, at the onset of a particular fit, I have sometimes used two or three grains of musk dissolved in Muskadine, particularly after general purgations when the humor and body are prepared and the patient’s strength is robust. Indeed, an entrenched quartan fever can rarely be resolved unless the body is significantly heated by food and medications.
Therefore, it is not entirely implausible that many assert they have successfully alleviated quartan fever by consuming a draught of wine infused with sage leaves each morning upon rising. Additionally, it is beneficial to anoint the entire spine with warming oils shortly before the onset of a fever, particularly those that target the nervous system. Oils such as those derived from rue, walnuts, and peppers, combined with a small amount of aqua vitae, can be effective.
For this purpose, oil of castoreum, prepared by boiling it in an apple of colocynth (with the seeds removed) over hot coals until reduced by half, and mixed with a small quantity of powdered pepper, pelitory of Spain, and euphorbium, is particularly excellent. Such applications not only help mitigate the severity of the intense shaking associated with the fever but also promote sweating. The humid heat of these oils can help dispel the stubborn humor that resists the body’s expulsive efforts, as melancholy can be likened to the dross and sediment of the blood.
Conversely, if the quartan fever is caused by acrid bile, one should anticipate a cure through the use of cooling and moistening medicines, such as sorrel, lettuce, purslane, and broths made from cucumbers, gourds, melons, and pumpkins. In this scenario, employing hot medications would exacerbate the condition by resolving the subtler components of the humor.
Thus, Trallianus claims to have treated such quartan fevers solely with the repeated application of cooling epithems just before the onset of the fit. This encapsulates the approach to curing true and legitimate intermittent fevers—those stemming from a single humor. The treatment of what are termed “bastard intermittent fevers,” which arise from impure or mixed humors, can also be easily inferred. For instance, when a fever results from a blend of phlegmatic and choleric humors, the remedies must be similarly mixed. In cases of a confused fever that exhibits both quotidian and tertian characteristics, treatment should involve a combination of medicines aimed at expelling both phlegm and bile.
An aneurysm is defined as a soft, palpable tumor formed by blood and vital spirits accumulating beneath the skin and muscles due to the dilation or relaxation of an artery. The author of the definitions suggests that any dilation of a venous vessel can be termed an aneurysm. Galen describes an aneurysm as an opening resulting from the anastomosis of an artery. It can also occur when a wounded artery closes too slowly, while the tissue above it becomes agglutinated, filled with flesh, and cicatrized. This often happens following poorly executed surgical procedures or negligent healing. Consequently, aneurysms arise from anastomosis, dilation, rupture, erosion, and wounding of arteries.
These conditions can occur in any part of the body but are more frequently observed in the throat, particularly in women after a difficult labor. During intense efforts to hold their breath for childbirth, the arteries may dilate and rupture, leading to an effusion of blood and vital spirits beneath the skin. The signs of an aneurysm include a swelling that may vary in size, accompanied by pulsation and a color consistent with the natural complexion of the skin. The tumor is soft to the touch and may completely disappear if pressed, as the arterial blood and spirits rush back into the artery. However, once pressure is released, the pulsation returns almost immediately. Some aneurysms emit a noticeable hissing sound when pressure is applied, due to the vital spirit moving forcefully through a constricted passage.
In cases of significant rupture, such sounds are absent because the spirit flows through a larger opening. Large aneurysms, particularly in the armpits, groin, and other areas with major vessels, are often inoperable. The substantial blood and spirit loss that follows such an incision can lead to death, making surgical intervention perilous. I once observed this with a priest from Saint Andrews, M. John Maillet, who had an aneurysm near his shoulder the size of a walnut. I advised him against surgery, warning that it could endanger his life. Instead, I recommended alleviating the condition with double cloths soaked in nightshade juice and whey cheese, or with cooling and astringent remedies, applying a thin plate of lead to support the area. He was advised to avoid anything that could thin or inflame the blood, particularly excessive vocal strain.
Despite adhering to this regimen for a year, the tumor continued to grow. Eventually, he sought the help of a barber who mistakenly treated it as a common abscess, applying a caustic agent that resulted in a significant opening. The next morning, an overwhelming amount of blood flowed from the wound, and he, astonished, called for assistance, regretting not having followed my advice. Tragically, before I could arrive, he succumbed to his injuries.
Thus, I caution young surgeons against hastily opening aneurysms unless they are small and located in less critical areas devoid of large vessels. Instead, they should consider a more cautious approach: make a small incision in the skin over the aneurysm until the artery is visible, gently separate it from surrounding tissues, and then use a blunt, curved needle threaded with a string to bind it. The string can then be cut, allowing nature to heal the artery by forming new tissue over the cut ends. The remainder of the treatment can proceed as with simple wounds.
Aneurysms occurring in internal organs are generally incurable, particularly those arising from prior treatments for the French disease. In such cases, the blood becomes so heated and thinned that it cannot be contained within the arterial walls, leading to extreme dilation. I encountered this in the body of a tailor who collapsed while playing tennis due to an aneurysm in the arterial vein. Upon dissection, I discovered a large volume of blood in his chest cavity and an artery dilated to an alarming size, with its inner wall exhibiting a bony structure.
This phenomenon illustrates the remarkable providence of nature, which acts to create a new barrier to mitigate the violent flow of blood and vital spirits. However, one should also consider whether the application of cooling and astringent medicines contributes to this hardening, as suggested by Galen’s writings.
Be cautious not to misinterpret the signs of an aneurysm. In large cases, there may be no detectable pulsation, nor can blood be forced back into the artery by applying pressure to the skin. This may occur if the volume of blood exceeds the capacity of the artery or if it has become solidified into clumps. When this happens, the lack of proper circulation can lead to putrefaction, resulting in severe pain, gangrene, and ultimately, death.