De Medicina |
Translator: Walter George Spencer
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Hactenus reperiuntur ea genera morborum , quae in totis corporibus ita sunt , ut is certae sedes adsignari non possint : nunc de is dicam , quae sunt IN PARTIBVS . Facilius autem omnium interiorum morbi curationesque in notitiam uenient , si prius eorum sedes breuiter ostendero . Caput igitur , eaque , quae in ore sunt , non lingua tantummodo palatoque terminantur , sed etiam quatenus oculis nostris exposita sunt . In dextra sinistraque circa guttur uenae grandes , quae sph agitides nominantur , itemque arteriae , quas carotidas uocant , sursum procedentes ultra aures feruntur . At in ipsis ceruicibus glandulae positae sunt , quae interdum cum dolore intumescunt . Deinde duo itinera incipiunt : alterum asperam arteriam nominant , alterum stomachum . Arteria exterior ad pulmonem , stomachus interior ad uentriculum fertur ; illa spiritum , hic cibum recipit . Quibus cum diuersae uiae sint , qua coeunt exigua in arteria sub ipsis faucibus lingua est ; quae , cum spiramus , attollitur , cum cibum potionemque adsumimus , arteriam claudit . Ipsa autem arteria , dura et cartilaginosa , in gutture adsurgit , ceteris partibus residit . Constat ex circulis quibusdam , compositis ad imaginem earum uertebrarum , quae in spina sunt , ita tamen ut ex parte exteriore aspera , ex interiore stomachi modo leuis sit ; eaque descendens ad praecordia cum pulmone committitur . Is spongiosus , ideoque spiritus capax , et a tergo spinae ipsi iunctus , in duas fibras ungulae bubulae modo diuiditur . Huic cor adnexum est , natura musculosum , in pectore sub sinistriore mamma situm ; duosque quasi uentriculos habet . At sub corde atque pulmone trauersum ex ualida membrana saeptum est , quod praecordiis uterum diducit ; idque neruosum , multis etiam uenis per id discurrentibus ; a superiore parte non solum intestina , sed iecur quoque lienemque discernit . Haec uiscera proxuma sed infra tamen posita dextra sinistraque sunt . Iecur a dextra parte sub praecordiis ab ipso saepto orsum , intrinsecus cauum , extrinsecus gibbum ; quod prominens leuiter uentriculo insidet , et in quattuor fibras diuiditur . Ex inferiore uero parte ei fel inhaeret : at lienis sinistra non eidem saepto sed intestino innexus est ; natura mollis et rarus , longitudinis crassitudinisque modicae ; isque paulum costarum regione in uterum excedens ex maxima parte sub his conditur . Atque haec quidem iuncta sunt . Renes uero diuersi ; qui lumbis summis coxis inhaerent , a parte earum resimi , ab altera rotundi ; qui et uenosi sunt , et uentriculos habent , et tunicis super conteguntur . Ac uiscerum quidem hae sedes sunt . Stomachus uero , qui intestinorum principium est , neruosus : a septima spinae uertebra incipit , circa praecordia cum uentriculo committitur . Ventriculus autem , qui receptaculum cibi est , constat ex duobus tergoribus ; isque inter lienem et iecur positus est , utroque ex his paulum super eum ingrediente . Suntque etiam membranulae tenues , per quas inter se tria ista conectuntur , iungunturque ei saepto , quod transuersum esse supra posui . Inde ima uentriculi pars paulum in dexteriorem partem conuersa , in summum intestinum coartatur . Hanc iuncturam ΠΥΛΩΡΟΝ Graeci uocant , quoniam portae modo in inferiores partes ea , quae excreturi sumus , emittit . Ab ea ieiunum intestinum incipit , non ita inplicitum ; cui tale uocabulum est , quia numquam quod accepit , continet , sed protinus in inferiores partes transmittit . Inde tenuius intestinum est , in sinus uehementer inplicitum : orbes uero eius per membranulas singuli cum in terioribus conectuntur ; qui in dexteriorem partem conuersi et e regione dexterioris coxae finiti , superiores tamen partes magis complent . Deinde id intestinum cum crassiore altero transuerso committitur ; quod a dextra parte incipiens , in sinisteriorem peruium et longum est , in dexteriorem non est , ideoque caecum nominatur . At id , quod peruium est , late fusum atque sinuatum , minusque quam superiora intestina neruosum , ab utraque parte huc atque illuc uolutum , magis tamen in sinisteriores inferioresque partes , contingit iecur atque uentriculum ; deinde cum quibusdam membranulis a sinistro rene uenientibus iungitur , atque hinc dextra recuruatum in imo derigitur , qua excernit ; ideoque id ibi rectum intestinum nominatur . Contegit uero uniuersa haec omentum , ex in feriore parte leue et strictum , ex superiore mollius ; cui adeps quoque innascitur , quae sensu , sicut cerebrum quoque et medulla , caret . At a renibus singulae uenae , colore albae , ad uesicam feruntur : ureteras Graeci uocant , quod per eas inde descendentem urinam in uesicam destillare concipiunt . Vesica autem in ipso sinu neruosa et duplex , ceruice plena atque carnosa , iungitur per uenas cum intestino eoque osse , quod pubi subest . Ipsa soluta atque liberior est , aliter in uiris atque in feminis posita : nam in uiris iuxta rectum intestinum est , potius in sinistram partem inclinata : in feminis super genitale earum sita est , supraque elapsa ab ipsa uulua sustinetur . Tum in masculis iter urinae spatiosius et conpressius a ceruice huius descendit ad colem : in feminis breuius et plenius super uuluae ceruicem se ostendit . Volua autem in uirginibus quidem admodum exigua est ; in mulieribus uero , nisi ubi grauidae sunt , non multo maior , quam ut manu conprehendatur . Ea , recta tenuataque ceruice , quem canalem uocant , contra mediam aluum orsa , inde paulum ad dexteriorem coxam conuertitur ; deinde super rectum intestinum progressa , iliis feminae latera sua innectit . Ipsa autem ilia inter coxas et pubem imo uentre posita sunt . A quibus ac pube abdomen susum uersus ad praecordia peruenit : ab exteriore parte euidenti cute , ab interiore leui membrana inclusum , quae omento iungitur ; peritonaeos autem a Graecis nominatur .
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Book IV 1 Thus far I have dealt with those classes of diseases which so affect bodies as a whole, that fixed situations cannot be assigned to them: I will now speak of diseases in particular parts. Diseases of all the internal parts and their treatment, however, will come under view more readily if I first describe briefly their institutions. The head, then, and the structures within the mouth are not only bounded by the tongue and palate, but also by whatever is visible to our eyes. On the right and left sides around the throat, great blood-vessels named sphagatides, also arteries called carotids, run upwards in their course beyond the ears. But actually within the neck are placed glands, which at times become painfully swollen. From that point two passages begin: one named the windpipe, the more superficial, leads to the lung; the deeper, the gullet, to the sm; the former takes in the breath, the latter food. Though their courses diverge, where they are joined, there is a little tongue in the windpipe, just below the fauces, which is raised when we breathe, and, when we swallow food and drink, closes the windpipe. Now the actual windpipe is rigid and gristly; in the throat it is prominent, in the remaining parts it is depressed. It consists of certain little rings, arranged after the likeness of those vertebrae which are in the spine, but in such a way that whilst rough on the outer surface, the inside is smooth like the gullet; descending to the praecordia, it makes a junction with the lung. The lung is spongy, and so can take in the breath, and at the back it is joined to the spine itself, and it is divided like the hoof of an ox into two lobes. To the lung is attached the heart, which, muscular in nature, is placed under the left breast, and has two small stomach-like pockets. Now, under the heart and lung is a transverse partition of strong membrane, which separates the belly from the praecordia; it is sinewy, and many blood-vessels also take their course through it; it separates from the parts above not only the intestines but also the liver and the spleen. These organs are placed against it but under it, on the right and left sides respectively. The liver, which starts from the actual partition under the praecordia on the right side, is concave within, convex without; its projecting part rest lightly on the stomach, and it is divided into four lobes. Outside its lower part the gall-bladder adheres to it: but the spleen to the left is not connected to the same partition, but to the intestine; in texture it is soft and loose, moderately long and thick; and it hardly projects at all from beneath the ribs into the belly, but is hidden under them for the most part. Now the foregoing are joined together. The kidneys on the other hand are different; they adhere to the loins above the hips, being concave on one surface, on the other convex; they are both vascular, have ventricles, and are covered by coats. These then are the situations of the viscera. Now the gullet, which is the commencement of the intestines, is sinewy; beginning at the seventh spinal vertebra, it makes a junction in the region of the praecordia with the stomach. And the stomach, which is the receptacle of the food, consists of two coats; and it is placed between the spleen and the liver, both overlapping it a little. There are also fine membranes by which these three are interconnected, and they are joined to that partition, which I have described above as transverse. Thence the lowest part of the stomach, after being directed a little to the right, is narrowed into the top of the intestine. This juncture the Greeks call pylorus, because, like a gateway, it lets thru into the parts below whatever we are to excrete. From this point begins the fasting intestine, not so much infolded; it has this name because it does not hold what it has received, but forthwith passes it on into the parts below. Beyond is the thinner intestine, infolded into many loops, its several coils being connected with the more internal parts by fine membranes; these coils are directed rather to the right side, to end in the region of the right hip; however, they occupy mostly the upper parts. After that spot this intestine makes a junction crosswise with another, the thicker intestine; which, beginning on the right side, is long and pervious towards the left, but not towards the right, which is therefore called the blind intestine. But that one which is pervious being widespread and winding, and less sinewy than the upper intestines, has a flexure on both sides, right and left, especially on the left side and in the lower parts and touches the liver and stomach, next it is joined to some fine membranes coming from the left kidney, and thence bending backwards and to the right, it is directed straight downwards to the place where it excretes; and so it is there named the straight intestine. The omentum too, which overlies all these, is at its lower part smooth and compact, softer at its upper part; fat also is produced in it, which like the brain and marrow is without feeling. Again from the kidneys, two veins, white in colour, lead to the bladder; the Greeks call them ureters, because they believe that through them the urine descending drops into the bladder. Now the bladder, sinewy and in two layers at its bag, is at its neck bulky and fleshy; it is connected by blood-vessels with the intestine, and with that bone which underlies the pubes. The bladder itself is loose and rather free, and situated differently in men and women: for in men it is close to the straight intestine, being inclined rather to the left side; in women it is situated over the genitals, and whilst free above, is supported actually by the womb. Again, in males, a longer and narrower urinary passage descends from the neck of the bladder into the penis; in women, a shorter and wider one presents itself over the neck of the womb. Now the womb in virgins is indeed quite small; in women, unless they are pregnant, it is not really much larger than a handful. Beginning over against the middle of the rectum by a straight narrow neck, which they call canalis, it is then turned a little towards the right hip joint; next, as it rises above the right intestine, its sides are fastened into the woman's ilia. Again, these ilia are situated between the hip joints and the pubes at the bottom of the abdomen. From them and from the pubes the abdominal wall extends upwards to the praecordia; it is covered visibly upon the outside by skin, inside by a smooth membrane which makes a junction with the omentum; and it is named by the Greeks peritoneal membrane. |
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His uelut in conspectum quendam , quatenus scire curanti necessarium est , adductis , remedia singularum laborantium partium exsequar , orsus a capite ; sub quo nomine nunc significo eam partem , quae capillis tegitur : nam oculorum , aurium , dentium dolor , et si qui similis est , alias erit explicandus . In capite autem interdum acutus et pestifer morbus est , quem ΚΕΦΑΛΑΙΑΝ Graeci uocant ; cuius notae sunt horror calidus , neruorum resolutio , oculorum caligo , mentis alienatio , uomitus , sic ut uox supprimatur , uel sanguinis ex naribus cursus , sic ut corpus frigescat , anima deficiat . Praeter haec dolor intolerabilis , maxime circa tempora uel occipitium . Interdum autem in capite longa inbecillitas , sed neque grauis neque periculosa , per hominis aetatem est : interdum grauior dolor sed breuis , neque tamen mortiferus , qui uel uino uel cruditate uel frigore uel igne aut sole contrahitur . Hique omnes dolores modo in febre , modo sine hac sunt ; modo in toto capite , modo in parte , interdum sic ut oris quoque proximam partem excrucient . Praeter haec etiam num inuenitur genus , quod potest longum esse ; ubi umor cutem inflat , eaque intumescit et prementi digito cedit : ΥΔΡΟΚΕΦΑΛΟΝ Graeci appellant . Ex his id , quod secundo loco positum est , dum leue est , qua si t ratione curandum , dixi , cum persequerer ea , quae sani homines in inbecillitate partis alicuius facere deberent . Quae uero auxilia sunt capitis , ubi cum febre dolor est , eo loco explicitum est , quo febrium curatio exposita est . Nunc de ceteris dicendum est . Ex quibus id , quod acutum est , idque , quod supra consuetudinem intenditur , idque , quod ex subita causa etsi non pestiferum tamen uehemens est , primam curationem habet , qua sanguis mittatur . Sed id , nisi intolerabilis dolor est , superuacuum est , satiusque est abstinere a cibo ; si fieri potest , etiam potione ; si non potest , aquam bibere . Si postero die dolor remanet , aluum ducere , sternumenta euocare , nihil adsumere nisi aquam . Saepe enim dies unus aut alter totum dolorem hac ratione discutit , utique si ex uino uel cruditate origo est . Si uero in his auxilii parum est , tonderi oportet ad cutem ; dein considerandum est , quae causa dolorem excitarit . Si calor , aqua frigida multa perfundere caput expedit , spongiam concauam inponere subinde in aqua frigida expressam ; unguere rosa et aceto , uel potius his tinctam lanam sucidam imponere aliaue refrigerantia cataplasmata . At si frigus nocuit , caput oportet perfundere aqua calida marina uel certe salsa , aut in qua laurus decocta sit ; tum caput uehementer perfricare ; deinde calido oleo implere , ueste uelare . Quidam id etiam deuinciunt ; alii ceruicalibus uestimentisque onerant , et sic leuantur ; alios calida cataplasmata adiuuant . Ergo etiam ubi causa incognita est , uidere oportet , refrigerantia magis an calfacientia leniant , et is uti , quae experimentum adprobarit . At si parum causa discernitur , perfundere caput , primum calida aqua , sicut supra praeceptum est , uel salsa , uel ex lauro decocta , tum frigida posca . Illa in omni uetusto capitis dolore communia sunt : sternumenta excitare , inferiores partes uehementer perfricare ; gargarizare iis , quae saliuam mouent ; cucurbitulas temporibus et occipitio admouere ; sanguinem ex naribus extrahere ; resina subinde tempora reuellere , et imposito sinapi exulcerare ea , quae male habent ante linteolo subiecto , ne uehementer adrodat ; candentibus ferramentis , ubi dolor est , ulcera excitare ; cibum permodicum cum aqua sumere ; ubi leuatus est dolor , in balineum ire , ibi multa aqua , prius calida , deinde frigida per caput perfundi : si discussus ex toto dolor est , etiam ad uinum reuerti , sed postea semper antequam quicquam aliud aquam bibere . Dissimile est id genus , quod umorem in caput contrahit . In hoc tonderi ad cutem necessarium est ; deinde inponere sinapi sic ut exulceret ; si id parum profuit , scalpello utendum est . Illa cum hydropicis communia sunt : exerceatur , insudet , uehementer perfricetur , cibis potionibusque utatur urinam praecipue mouentibus .
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2 Having made a sort of survey as it were of these organs, so far as it is necessary for a practitioner to know them, I shall follow out the remedies for the several parts when diseased, starting with the head; under that term I now mean that part which is covered with hair; for pain in the eyes, ears and teeth and the like will be elsewhere explained (VI.6‑9, VII.7‑12). In the head, then, there is at times an acute and dangerous disease, which the Greeks call cephalaia; the signs of which are hot shivering, paralysis of sinews, blurred vision, alienation of the mind, vomiting, so that the voice is suppressed, or bleeding from the nose, so that the body becomes cold, vitality fails. In addition there is intolerable pain, especially in the region of the temples and back of the head. Again, there is sometimes a chronic weakness in the head, which, although neither severe nor dangerous, lasts through life; sometimes there is more severe pain, but of short duration, and not fatal, which is brought about by wine or indigestion or cold or heat or the sun. And all these pains occur, sometimes with fever, sometimes without fever; sometimes they affect the whole head, sometimes a part only; at times so as to cause excruciating pain also in the adjacent part of the face. Besides the foregoing there is a class which may become chronic, in which a humour inflates the scalp, so that it swells up and yields to the pressure of the fingers. The Greeks call it hydrocephalus. Of these forms, that mentioned second, while it is slight, is to be treated by the regimen I have stated when I was describing what healthy men should do in the case of weakness of any part (I.4). For pain in the head accompanied by fever the remedies have been detailed when describing the treatment of fevers in general (III.3‑17). Now to speak of the rest. Of these the case that is acute, also that which surpasses ordinary limits, and that which is of sudden causation and although not deadly, is yet violent, has its primary remedy in blood-letting. But this measure is unnecessary, unless the pain is intolerable, and it is better to abstain from food; also from drink, when possible; if not possible, then to drink water. If, on the day following, pain persists, the bowels should be clystered, sneezing provoked, and nothing but water taken. For often, in this way, all the pain is dispersed within one or two days, especially if it has originated from wine of indigestion. But if there is little benefit from the above, the head should be shaved down to the scalp; then it should be considered what cause excited the pain. If the cause was hot weather, it is well to pour cold water freely over the head, to put on the head a concave sponge now and again wrung out of cold water; to anoint the head with rose oil and vinegar, or better to put on unscoured wool saturated with the same, or else other refrigerant plasters. But if cold has done the harm, the head should be bathed with warm sea-water, or at any rate salt and water, or with a laurel-leaf decoction, after which the head should be rubbed smartly, have warm oil poured on it, and then be covered up. Some even bandage up the head, some load it with neck-wraps and mufflers, and so get relief; warm plasters give help in other cases. Hence, even when the cause is unknown, it should be observed whether cooling or heating methods afford the more relief, and to make use of those which experience has approved. But if the cause is not known, the head should be bathed, first in warm water as noted above, or in salt and water, or in the laurel decoction, next in cold vinegar and water. For all long-standing pain in the head, the following are the general measures: to provoke sneezing; to rub the legs smartly; to gargle things which provoke salivation; to apply cups to the temples and occiput; to draw blood from the nostrils; to pluck upon the skin of the temples frequently by the aid of pitch plasters; to apply mustard in order to cause ulcers over the site of the pain, after having put a layer of linen over the skin to prevent violent erosion; to excite ulcerations by cautery, applied over the seat of the pain; to take food in great moderation, with water; after the pain has been relieved, to go to the bath, and there to have much water poured over the head, first hot, then cold; if the pain has been quite dispersed, the patient may even return to wine, but should always before anything else drink some water. The class in which humour collects upon the head is different. In that case it is necessary to shave the head to the scalp; then to apply mustard until it causes ulcers; if this is of little avail, recourse must be had to the scalpel. The following measures are the same as for dropsical patients: exercise, sweating, smart rubbing, and such food and drink as will specially promote urination. |
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Circa faciem uero morbus innascitur , quem Graeci ΚΥΝΙΚΟΝ ΣΠΑΣΜΟΝ nominant . Isque cum acuta fere febre oritur ; os cum motu quodam peruertitur . Accedit crebra coloris in facie totoque in corpore mutatio ; somnus in promptu est .—In hoc sanguinem mittere optimum est : si finitum eo malum non est , ducere aluum : si ne sic quidem discussum est , albo ueratro uomitum mouere . Praeter haec necessarium est uitare solem , lassitudinem , uinum . Si discussum his non est , utendum est cursu , frictione in eo , quod laesum est , leni et multa ; in reliquis partibus breuiore sed uehementi . Prodest etiam mouere sternumenta ; caput radere , idque perfundere aqua calida uel marina uel certe salsa , sic ut ei sulpur quoque adiciatur ; post perfusionem iterum perfricare ; sinapi manducare , eodemque tempore adfectis oris partibus ceratum , integris idem sinapi , donec adrodat , imponere . Cibus aptissimus ex media materia est .
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3 Again, about the face there originates an affection which the Greeks call "dog spasm." And it begins along with acute fever; the mouth is drawn to one side by a peculiar movement, and so it is nothing else than a distortion of the mouth. In addition there is frequent change of colour in the face as well as over all the body, also an inclination to sleep. In this case blood-letting is the best thing; if that does not end the disorder, the bowels are moved with a clyster; when not even thus dispersed, vomiting is provoked by white hellebore. It is necessary besides to avoid the sun, fatigue and wine. If it is not dispersed by these measures, use running, rubbing of the affected part gently and repeatedly, also rub other parts for less time, but smartly. It is also useful to provoke sneezing; to shave the head, to pour over it hot sea water, or at any rate salt and water, provided that sulphur is also added; after this affusion the patient should again be rubbed; should chew mustard, applying at the same time to the parts of the mouth affected a wax salve, likewise to the unaffected parts mustard until it produces erosion. Food of the middle class is most suitable. |
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At si lingua resoluta est , quod interdum per se , interdum ex morbo aliquo fit , sic ut sermo hominis non explicetur , oportet gargarizare ex aqua , in qua uel thymum uel hysopum uel nepeta decocta sit ; aquam bibere ; caput et os et ea , quae sub mento sunt , et ceruicem uehementer perfricare ; lasere linguam ipsam lin ere ; manducare quae sunt acerrima , id est in sinapi alium , cepam ; magna ui luctari , ut uerba exprimantur ; exerceri retento spiritu ; caput saepe aqua frigida perfundere ; nonnumquam multam esse radiculam , deinde uomere .
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4 But if there is paralysis of the tongue, which sometimes occurs of itself, sometimes is produced by some disease, so that the man's speech is not distinct, he should gargle a decoction of thyme, hyssop or mint; drink only water; have the head, face, the parts under the chin and the neck smartly rubbed; the tongue itself smeared with laser; chew very acrid materials, mustard, onion, garlic, and strive with all his force to pronounce words; hold his breath at exercise; frequently pour cold water over his head; on occasion eat a quantity of radish and then vomit. |