An abscess also sometimes gathers under the tongue; which is generally included in a coat, and excites violent pains. If this be small, it is sufficient to make one incision into it: if larger, the surface of the skin must also be cut off to the coat, then the lips of it are to be laid hold of on both sides with small hooks, and the membrane must be freed from its connections all round; great care being taken in this operation not to wound any large vein.
Of chopped lips.
The lips are frequently chopped; which besides the pain, is attended with this inconvenience, that it hinders our speaking, as that action by opening the fissures causes them to bleed, and to give pain. If these be only in the surface, it is better to treat them by those medicines, which are composed for ulcers of the mouth: if they are deeper, it is necessary to cauterize them with a thin iron; which being made in the form of a spatha, ought to slide over them as it were, and not press upon them. Afterwards, the same method must be followed, as was laid down in cauterized ulcers of the nostrils.
CHAP. XIII. OF THE BRONCHOCELE.
In the neck, between the skin and the wind-pipe, a tumour rises, which the Greeks call bronchocele[ HJ ], in which there is contained sometimes insensible flesh, at other times a humour like honey or water; sometimes also hairs mixed with small bones. Whatever that be, which is contained in the coat, it may be cured by caustic medicines, which burn the surface of the skin, together with the coat below it. When this is done, if it be a humour, it runs out; if it be any thing substantial, it is taken out by the fingers; then the ulcer is healed by lint. But the cure by the knife is more expeditious. An incision is made in one line in the middle of the tumour down to the coat; after which, the morbid body is separated by the finger from the sound parts, and is taken out entire with its coat: then it is washed with vinegar, to which either salt or nitre has been added; and the lips are joined by one stitch. The other applications are the same as in other sutures; afterwards it must be bound up gently, lest it press the fauces. If it should happen that the coat cannot be taken out, we must sprinkle escharotics into it, and dress it with lint and other digestives.
CHAP. XIV. OF THE OPERATIONS PERFORMED AT THE NAVEL.
There are several disorders about the navel, concerning which, because they are very uncommon, authors are not agreed. Now it is probable, that each one omitted what he had not met with, and that none of them feigned a disease he had not seen. An indecent prominence of the navel is common to them all. The question is, what are its causes? Meges has assigned three; that sometimes the intestine makes its way into that part, sometimes the omentum, at other times a humour. Sostratus has not mentioned the omentum. To the other two he has added, that flesh sometimes grows there; which is sometimes sound, at other times of a cancerous nature. Gorgias also has omitted the omentum, but allowing the other three causes, says, that air too sometimes is forced into this part. Heron has mentioned all these four, and the omentum too; and that species also, in which there is both the omentum and the intestine.
The following symptoms discover what species it is. When the intestine is protruded, the tumour is neither hard nor soft; is lessened by cold, increases not only by heat, but even by keeping in the breath; sometimes it sounds; and when a person lies on his back, the intestine returns of itself, and the swelling subsides. When it is the omentum, the other symptoms are similar, but the tumour is softer, and from its base, tapers towards the top; and if one takes hold of it, it slips away. Where both these are together, the symptoms are also complicated, and the degree of softness is between both. But flesh is harder, and there is a swelling always, though the patient lies on his back; it does not yield to pressure, whereas the former easily does. If it be corrupted, it has the same appearances which I described in a cancer. A humour, if it be pressed, fluctuates. Air gives way to pressure, but quickly returns; and when the body is in a supine posture, the tumour retains the same figure.