There is not so great danger of a cancer[ EZ ], unless it be irritated by the imprudence of the physician. This disease generally happens in the superior parts, about the face, the nose, ears, lips, and breasts of women. It also rises from the liver, or spleen. About the place there are pricking pains; it is immoveable, and unequally swelled; it is also sometimes insensible. Around it the veins are inflated, and tortuous; and either pale or livid; in some also, they are concealed from view. Touching the part gives pain to some, to others none. Sometimes it is harder, or softer, than it ought naturally to be, without any ulcer; at other times, all other circumstances being as above described, there is likewise an ulcer. Sometimes it has no peculiar characteristic to distinguish it; at other times it resembles those which the Greeks call condylomata[ FA ], but has an asperity and magnitude peculiar to itself. And its colour is red, or resembling that of a lentil. Neither is it safe to cut it; for immediately there follows either a palsy, or a convulsion. Often when a person receives a blow upon it, he loses his speech and faints. In some also if the tumour itself be compressed, the contiguous parts grow tense and swell. Now this is a very bad kind[(79)]. Its general progress is this; first appears what the Greeks call a cacoethes[ FB ], then it becomes a carcinoma, without an ulcer. From that an ulcer; and from an ulcer a thymium.
None of these can be removed but the cacoethes[(80)]; the rest are irritated by every method of cure; and the more violent the operations are, the more angry they grow. Some have made use of caustic medicines; others of the actual cautery; others cut them out with a knife. Nor was any person ever relieved by medicine; but after cauterizing, the tumours have been quickened in their progress, and increased till they proved mortal; when they have been cut out, and cicatrized, they have, notwithstanding, returned, and occasioned death. Whereas, at the same time, most people, by using no violent methods to attempt the extirpation of the disease, but only applying mild medicines, to sooth it, protract their lives, notwithstanding the disorder, to an extreme old age. But no body can pretend to distinguish a cacoethes, which is curable, from a carcinoma, which is not, otherwise than by time and experiments.
Therefore, so soon as this disease is perceived, caustic medicines ought to be applied; if the disorder is alleviated, and its symptoms grow milder, we may proceed both to incision and the actual cautery; if it is immediately irritated, we may conclude, that it is already a carcinoma; and every thing acrid and severe is to be taken away. But if the part is hard, without any ulcer, it is sufficient to apply a very mellow fig, or the plaister called rhypodes. If there is an ulcer, but not rising above the surface of the skin, the cerate of rose oil is to be put on, with the addition of a powdered shell, with smith’s forge water. If it grows fungous, copper scales (which is the gentlest caustic) must be tried, till there is no rising above the other parts; provided still that it does not exasperate; if it does, we ought to be content with the same cerate.
Of a therioma.
There is also an ulcer, which the Greeks call therioma[ FC ]. This both comes of itself, and sometimes is consequent upon an ulcer produced from another cause. The colour is either livid or black; the smell is bad; it discharges copiously a humour like mucus; it is sensible neither of the touch, nor of medicine; and is only disturbed by itching. About it there is a pain and inflammation. Sometimes also a fever comes on. Sometimes there is a haemorrhage from the ulcer, and this disorder spreads, by which all the symptoms often increase. From these proceeds the ulcer which the Greeks call herpes esthiomenos[ FD ], voracious herpes; because by spreading quickly, and penetrating even to the bones, it devours the body. The surface of this ulcer is unequal, resembling dirt; and there is in it a great quantity of glutinous humour, an intolerable smell, and an inflammation more violent, than is found in an ulcer of that size. Both of them, as indeed all the kinds of gangrenes, happen chiefly to old people, or those, who are in a bad habit of body.
The manner of curing both is the same; but the greater disease requires the sharper remedy. And the regimen must first be regulated; the patient must rest in his bed, for some days abstain from food, drink water very plentifully, and have a clyster given him. Then, when the inflammation is gone, let him take food of a good juice[(81)], avoiding every thing acrid; he may drink as much as he will, provided he be content in the day-time with water but at supper, he may also drink some rough wine. But the abstinence should not be equally severe in a herpes, and a therioma. This then is the regimen necessary.
Externally upon the ulcer, must be sprinkled powder of dry aloes, and if that does but little service, chalcitis. But if any nerve, by the flesh being destroyed, be laid bare, it must be covered first with linen, lest it be burnt by that medicine. If there is need of remedies still more powerful, we must make use of those compositions, that cauterize more strongly. Now when any medicine is sprinkled on, it ought to be done by the broad end of a probe[(82)]. Over it should be applied either lint with honey, or olive leaves boiled in wine, or horehound: and these must be covered with linen dipped in cold water, and then well squeezed. And all round, where there is a tumour from the inflammation, repellent cataplasms must be applied. If by these methods it grows no better, the place ought to be cauterized with a hot iron; the nerves that are in view being first covered. By what has been said on other occasions, it will be clear enough to any body, that a part, which is burned either by medicines or the actual cautery, must first be cleansed, and then filled up.
Of the ignis sacer.
The ignis sacer ought also to be numbered amongst bad ulcers. There are two species of it. The one is of a colour inclining to ruddy, or a mixture of red and pale, and the surface is roughened by contiguous pustules, of which no one is bigger than another, but they are very numerous, and exceeding small. In these there is almost always pus, and often a redness attended with heat; and that spreads, sometimes when the part first affected is healing, sometimes when it is ulcerated, in which case, the pustules breaking, one continued ulcer is formed, discharging a humour, which seems to be betwixt sanies and pus. It attacks chiefly the breast, or sides, or extremities, and particularly the soles of the feet. The other kind comes with an ulceration in the surface of the skin, but without going deep, broad, inclining to a livid colour, but unequal; and the middle part of it heals, while the extremities spread; and often that, which seemed to be sound, ulcerates again. But the skin round about it, which is to receive the disease, grows tumid, and hardish, and the colour of it is a blackish red. And this disease too generally attacks old people, or those, that are in a bad habit, but chiefly in their legs.
Now every ignis sacer, though it be the least dangerous of those disorders, which have the disposition to spread, yet is, I had almost said, the hardest to cure of them all. The most effectual remedy is a fever for one day, which consumes the noxious humour. The thicker and whiter the pus is, so much the less is the danger. It does good also to excoriate the part below the ulcer by scourging, that the more pus may be evacuated, and the matter drawn out, which corrupts the flesh there. But notwithstanding if a slight fever comes on, there is a necessity for abstinence, lying a-bed, and clysters. In every ignis sacer, neither mild and glutinous food, nor salt and acrid are proper; but what is betwixt these: such as unleavened bread, fish, kid, birds, and except the wild boar, almost all venison. If there is no febricula, both gestation and walking are serviceable, and rough wine, and the bath; and in this disorder, as well as that mentioned before, the drink ought to be more plentiful than the food.