CHAP. XX. Of the Tophi, or knots which grow at the joints of such as are troubled with the Gout.
* 1.1SOme that are troubled with the Gout, have knotty bunches growing in their joints, which by the ancients were called Tophi. These are generated by the congestion of gross, viscid and crude phlegm, with a little admixtion of an acrid and cholerick humor. These matters re∣main setled in the part, for that it being too weak cannot digest and depress them; wherefore being there impact, they easily concrete into a certain plaster-like or chalk-like substance, whilest by the adventitious and burning heat caused by pain, and the gouty malignity, their more subtle part is dispersed,* 1.2 but the grosser subsides. Yet sometimes the unfit application of repercussive or discussive medicines is a cause of the generation of these Tophi. For by the former, the impact matter is incrassated and gathered together; but by the la••er, the subtle part being discussed, the remnant that subsides, concretes into Tophi. Those medicines which are made to mollifie, ought to have a moderately heating, and humecting faculty, that they may diffuse, and as it were dis∣solve the impact matter; such is warm water, the decoction of emollient herbs, the decoction of calvs or sheeps entrails, heads and feet: after these or the like fomentations, you shall use the following medicine. ℞. axungiae human anseris & gallinae, medul. cervin an. ℥ii. tereb. ven. ℥i. aq. vitae parum, cerae quantum sufficit, fiat unguentum molle. Then this which followeth will be good ℞. r••d. alth lili••rum, bryon lapath. acuti, an. ℥iiii. c••quantur completè & tra••iciantur per setaceum; adde gum. amm••n. bdel galb op. pa••acis in aceto dissolutorum ℥i medul. cervin. ℥ i ss. incorporentur simul, & applice••∣tur. Or else, ℞. olei liliorum, amygd dul. medullae cruris cer. an. ℥ii ss. mucag. sem. lini alth. foenugr. an. ℥i. cerae quantum fufficit; fiat ceratum. Or else, ℞. empl de vig•• cum mercuris, & cerat de esipo humi∣dà descript. Philagrii••an. ℥ii. malexentur simul cum olei lilier. fiat ••ossa. O else. ℞. gum amm••n op••pa••. galb bdel. dissolutorum in aceto an. ℥ii. panno linteo calatis, adde pulv. sulph nitr. sinapi. pyrethri an. ℥ ss. sty∣racis, liq. & axung hum an. ℥i. res. pini, tereb. ven. an. ℥ ss. cerae quantum sufficit, fiat ceratum molle. This which follows is thought most effectual in the opinion of Galen and Avicen. ℞. pedes percel, bene salsos,* 1.3 nu iiii. veterem pernam. cum illis c. que; addendo sub finem, radicis bryoniae, lapath. acut. •••• ℥iii ax∣ungia tauri, & medul. cervi. an. ℥i cum caseo putrefacto fiat empl ••olle ad u••um. This which follows is also most effectual. ℞. casei acris & putrefacti, ℥iiii. pulv. sulph. vivi euphorb. & py••••th an. ʒiii. de c••ctionis veteris pernae & porcellerum quod sufficit ad incorporandum, ducantur in mortario•• & fiat empl. ad usum. Or else, ℞. spumae nitri, ℥vi. tereb. ℥ii. olei veteris, lixivii, que lanae pileorum lavantur, & cerae quantum sufficit,* 1.4 fiat ceratum satis molle. After the use of emollients, a fumigation shall be made in this manner: Heat a cogle-stone, mill-stone or brick red hot in the fire, take it forth and cast upon it a sufficient quantity of very sharp vinegar, and aqua vitae, the rising vapor shall be diligent∣ly received by the affected member, for this hath a faculty to attenuate and cut gross, viscid, and plaster-like matter, yea also, and to break the skin; yet that is broken oft time of its own accord without the help of either medicine or instrument. To conclude, these medicines which are good to mollifie sci•• thus tumors, the same are also good to soften the gouty knots and tophi But we must note; that these knotty bunches are sometimes suppurated, not truly by the impact and plaster-like matter, but by a new defluxion comming on a sudden, and then it is necessary to make way for the contained matter, which being done, first there cometh forth an humor like milk, then a plaster-like matter, then it leaves behinde it an ulcer to be cured by applying thereto empl••gratiâ Dei, and others as the Surgeon shall think sit.