Kitap 5
28
There is also an ulceration which the Greeks call therioma. This may arise spontaneously, and at times it may supervene upon ulceration from another cause. It has either a livid or black colour, a foul odour, and an abundant mucus-like discharge. The ulcer itself is insensitive to touch and applications; there is just disturbance by itching. But around there is pain and inflammation; sometimes even fever is set up, occasionally blood is discharged from the ulceration. This also is a spreading disease. And all these signs often extend, and there results from them an ulcer which the Greeks call phagedaena, because it spreads rapidly and penetrates down to the bones and so devours the flesh. This ulceration is uneven, bog-like; there is a large amount of glutinous discharge; the stench is intolerable, and the inflammation is greater than accords with the extent of the ulceration. Both therioma and phagedaena, like all canker, occur for the most part in the aged or those of a bad habit of body. Both are treated in the same way, but treatment is more necessary in the severer form. Firstly, a regimen must be enforced, so that the patient rests in bed, abstains from food for the first days, drinks very freely of water; also has the bowels moved by a clyster; then, on the subsidence of the inflammation, takes digestible food, avoiding everything acrid; drinks as much as he likes, but for the time being contents himself with water, except that at dinner he may drink a little dry wine. But fasting is not to be used for patients with phagedaena to the same extent as for those with therioma. Over the ulceration too should be dusted dry lign-aloes pounded up or vine-flower, and if this does no good, copper ore; and if by erosion of flesh a sinew has become exposed, it must first be covered by lint, to prevent the medicament from burning it. If still stronger remedies are required, then recourse must be had to more active caustics. But whatever the medicament to be sprinkled on, it ought to be applied by means of the flat end of a probe. Over this should be put either lint soaked in honey or olive-leaves boiled in wine or horehound; and this is to be covered over by lint well wrung out of cold water; the inflammatory swelling around is to be covered with repressant poultices. If there is no benefit from these measures, the place should be burnt with the cautery, exposed sinews being first carefully covered over. The tissue burnt, whether by caustic or by the cautery, is first to be cleaned, then to be filled up with new flesh, as is clear to anyone from what has been stated before.
