Of Medicine, in Eight Books

by Aulus Cornelius Celsus

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

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

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

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

Of fistulas.

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

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

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

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

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