De Medicina |
Translator: Walter George Spencer
|
|
| 153 |
Tertiam esse medicinae partem , quae MANV curet , et uulgo notum et a me propositum est . Ea non quidem medicamenta atque uictus rationem omittit , sed manu tamen plurimum praestat , estque eius effectus inter omnes medicinae partes euidentissimus . Siquidem in morbis , cum multum fortuna conferat , eademque saepe salutaria , saepe uana sint , potest dubitari , secunda ualetudo medicinae an corporis an * beneficio contigerit . In is quoque , in quibus medicamentis maxime nitimur , quamuis profectus euidentior est , tamen sanitatem et per haec frustra quaeri et sine his reddi saepe manifestum est : sicut in oculis quoque deprehendi potest , qui a medicis diu uexati sine his interdum sanescunt . At in ea parte , quae manu curat , euidens omnem profectum , ut aliquid ab aliis adiuuetur , hinc tamen plurimum trahere . Haec autem pars cum sit uetustissima , magis tamen ab illo parente omnis medicinae Hippocrate quam a prioribus exculta est . Deinde posteaquam diducta ab aliis habere professores suos coepit , in Aegypto quoque Philoxeno maxime increuit auctore , qui pluribus uoluminibus hanc partem diligentissime conprehendit . Gorgias quoque et Sostratus et Heron et Apollonii duo et Hammonius Alexandrini multique alii celebres uiri singuli quaedam reperierunt . Ac Romae quoque non mediocres professores , maximeque nuper T ryphon pater et Euelpistus et , ut scriptis eius intellegi potest , horum eruditissimus Meges quibusdam in melius mutatis aliquantum ei disciplinae adiecerunt . Esse autem chirurgus debet adulescens aut certe adulescentiae propior ; manu strenua , stabili , nec umquam intremescente , eaque non minus sinistra quam dextra promptus ; acie oculorum acri claraque ; animo intrepidus ; misericors sic , ut sanari uelit eum , quem accepit , non ut clamore eius motus uel magis quam res desiderat properet , uel minus quam necesse est secet ; sed perinde faciat omnia , ac si nullus ex uagitibus alterius adfectus oriatur . Potest autem requiri , quid huic parti proprie uindicandum sit , quia uulnerum quoque ulcerumque multorum curationes , quas alibi executus sum , chirurgi sibi uindicant . Ego eundem quidem hominem posse omnia ista praestare concipio ; atque ubi se diuiserunt , eum laudo qui quam plurimum percepit . Ipse autem huic parti ea reliqui , in quibus uulnus facit medicus , non accipit , et in quibus uulneribus ulceribusque plus profici manu quam medicamento credo ; tum quicquid ad ossa pertinet . Quae deinceps exequi adgrediar , dilatisque in aliud uolumen ossibus , in hoc cetera explicabo ; praepositisque is , quae IN QVALIBET CORPORIS PARTE fiunt , ad ea , quae prop rias sedes habent , transibo .
|
Book VII PROOEMIUM The third part of the Art of Medicine is that which cures by the hand, as I have already said, and indeed it is common knowledge. It does not omit medicaments and regulated diets, but does most by hand. The effects of this treatment are more obvious than any other kind; inasmuch as in diseases since luck helps much, and the same things are often salutary, often of no use at all, it may be doubted whether recovery has been due to medicine or a sound body or good luck. Besides, in cases where we depend chiefly upon medicaments, although an improvement is clear enough, yet it is often clear that recovery is sought in vain with them and gained without them: this can be seen for instance in treating the eyes, which after being worried by doctors for a long time sometimes get well without them. But in that part of medicine which cures by hand, it is obvious that all improvement comes chiefly from this, even if it be assisted somewhat in other ways. This branch, although very ancient, was more practised by Hippocrates, the father of all medical art, than by his forerunners. Later it was separated from the rest of medicine, and began to have its own professors; in Egypt it grew especially by the influence of Philoxenus, who wrote a careful and comprehensive work on it in several volumes. Gorgias also and Sostratus and Heron and the two Apollonii and Ammonius, the Alexandrians, and many other celebrated men, each found out something. In Rome also there have been professors of no mean standing, especially the late Tryphon the father and Euelpistus, and Meges, the most learned of them all, as can be understood from his writings; these have made certain changes for the better, and added considerably to this branch of learning. Now a surgeon should be youthful or at any rate nearer youth than age; with a strong and steady hand which never trembles, and ready to use the left hand as well as the right; with vision sharp and clear, and spirit undaunted; filled with pity, so that he wishes to cure his patient, yet is not moved by his cries, to go too fast, or cut less than is necessary; but he does everything just as if the cries of pain cause him no emotion. But it can be asked what is the proper province of this part of my work because surgeons claim for themselves the treatment of wounds as well, and of many of the ulcerations which I have described elsewhere. I for my part deem one and the same man able to undertake all of these; and when divisions are made, I praise him who has undertaken the most. I have myself kept for this part cases in which the practitioner does not find wounds but makes them, and in which I believe wounds and ulcerations to be benefited more by surgery than by medicine; as well as all that which concerns the bones. These cases I shall proceed to discuss in turn, and leaving to another volume the subject of bones I shall deal with the rest in this one; beginning with cases which occur anywhere in the body I shall pass on to those which occur in special situations. |
| 154 |
Luxata igitur , in quacumque parte corporis sunt , quam primum sic curari debent , ut , qua dolor est , ea scalpello cutis crebro incidatur , detergeaturque eodem auerso profluens sanguis . Quod si paulo tardius subuenitur iamque etiam rubor est , qua rubet corpus si tumor quoque accessit , quacumque is est , id optimum auxilium est . Tum superdanda reprimentia sunt , maximeque lana sucida ex aceto et oleo . Quod si leuior is casus est , possunt etiam sine scalpello inposita eadem mederi ; et si nihil aliud est , cinis quoque maxime ex sarmentis ( si is non est , quilibet alius ) ex aceto uel etiam ex aqua coactus .
|
1 First then the displacements, in whatever part of the body they are, ought to be immediately treated, so that the skin is several times incised with a sharp scalpel where the pain is, and the blood as it issues wiped off with the back of the knife. But if relief is rather slow in coming and there is now redness as well, and if, where the redness is, there is swelling in addition, wherever there is swelling this treatment is best. Repressants are then to be applied, in particular unscoured wool soaked in vinegar and oil. In a slighter case the same applications may afford relief even without the scalpel; and if there is nothing else at hand, wood-ash, preferably of vine twigs, or failing that any other kind, stirred to a paste in vinegar, or even in water. |
| 155 |
Verum hoc quidem promptum est : in is autem negotium maius est , quae per se uitio intus orto intumescunt et ad suppurationem spectant . Ea omnia genera abscessum esse alias proposui , medicamentaque his idonea executus sum : nunc superest , ut dicam in isdem quae manu fieri debeant . Ergo priusquam indurescant , cutem incidere et cucurbit ulam adcommodare oportet , quae quicquid illuc malae corruptaeque materiae coiit , extrahat ; idque iterum tertio die recte fit , donec omne indicium inflammationis excedat . Neque tamen fas non est nihil cucurbitulam agere : interdum enim fit , sed raro , ut , quicquid abscedit , uelamento suo includatur : id antiqui tunicam nominabant . Meges , quia tunica omnis neruosa est , dixit non nasci sub eo uitio neruum , quo caro consumeretur ; sed subiecto iam uetustiore pure callum circumdari . Quod ad curationis rationem nullo loco pertinet , quia quicquid , si tunica est , idem , si callus est , fieri debet . Neque ulla res prohibet , etiamsi callus est , tamen quia cingit , tunicam nominari . Tum pure quoque maturiore haec interdum esse consueuit ; ideoque quod sub ea est , extrahi per cucurbitulam non potest . Sed facile id intellegitur , ubi nihil admota illa mutauit . Ergo siue id incidit siue iam durities est , in hac auxilii nihil est , sed , ut alias scripsi , uel auertenda concurrens eo materia uel digerenda uel ad maturitatem perducenda est . Si priora contigerunt , nihil praeterea necessarium est . Si pus maturuit , in alis quidem et inguinibus raro secandum est , item ubicumque mediocris abscessus est , item quotiens in summa cute uel etiam carne uitium est , nisi festinare cu bantis inbecillitas cogit ; satisque est cataplasmatis efficere , ut per se pus aperiatur . Nam fere sine cicatrice potest esse is locus , qui expertus ferrum non est . Si autem altius malum est , considerari debet neruosusne is locus sit an non sit . Nam si sine neruis est , candenti ferramento aperiri debet ; cuius haec gratia est , quod exigua plaga diutius ad pus euocandum patet , paruaque postea cicatrix fit . At si nerui iuxta sunt , ignis alienus est , ne uel distendantur , uel membrum debilitent : necessaria uero opera scalpelli est . Sed cetera etiam subcruda aperiri possunt : inter neruos ultima expectanda maturitas est , quae cutem extenuet eique pus iungat , quo propius reperiatur . Iamque alia rectam plagam desiderant : in pan o , quia fere vehementer cutem extenuat , tota ea super pus excidenda est . Semper autem ubi scalpellus admouetur , id agendum est , ut et quam minimae et paucissimae plagae sint , cum eo tamen ut necessitati succurramus et in modo et in numero . Nam maiores sinus latius interdum etiam duabus aut tribus lineis incidendi sunt , dandaque opera , ut imus sinus exitum habeat , ne quis umor intus subsidat , qui proxima et adhuc sana erodendo sinuet . Est etiam in rerum natura , ut cutis latius excidenda sit . Nam ubi post longis morbis totus corporis habitus uitiatus est lateque se sinus suffudit et in eo iam cutis pallet , scire licet eam iam emortuam esse et inutilem futuram ; ideoque excidere commodius est , maxime si circa articulos maiores id euenerit , cubantemque aegrum fluens aluus exhaurit neque per alimenta quicquam corpori accedit . Sed excidi ita debet , ut plaga ad similitudinem myrtei folii fiat , quo facilius sanescat : idque perpetuum est , ubicumque medicus et quacumque causa cutem excidit . Pure effuso , in alis uel inguinibus , linamento opus non est sed spongia ex uino inponenda est . In ceteris partibus , si aeque linamenta superuacua sunt , purgationis causa paulum mellis infundendum , deinde glutinantia super danda : si illa necessaria sunt , super ea quoque similiter dari spongia eodem modo ex uino expressa debet . Quando autem linamentis opus sit , quando non sit , alias dictum est . Cetera eadem incisa suppuratione facienda sunt , quae , ubi per medicamenta rupta est , facienda esse proposui .
|
2 There is prompt relief in such cases; but there is more trouble where a lesion has arisen internally of itself which causes swellings and tends to suppuration. I have described elsewhere the various classes of abscession, and I have pointed out the suitable medicaments; it now remains to speak of those which should be treated by surgery. Before the abscession becomes hardened, the overlying skin should be scarified and a cup put on, in order to draw outwards whatever bad and corrupted matter has collected; and it is right to repeat this every third day until every indication of inflammation has gone. It may be, however, that the cupping has no effect; for at times, although seldom, it happens that the abscess is enclosed in a covering of its own, which the ancients named a coat. Meges, because every such coat is sinew-like, said that no sinew could be produced under a lesion by which flesh is eaten away; but that when pus has been there for a long time, a callus forms round it. This has no bearing upon the mode of treatment, for the same thing ought to be done, whether it be a coat, or a callus. There is nothing to prevent a callus being called a coat, since it covers. Moreover at times the coat has formed after the pus has become more matured; so that what is under it cannot be drawn out by cupping. But this is readily recognized when the application of a cup causes no change. Therefore when that happens, or there is already hardening, there is no help from cupping, but as I have said elsewhere it is whilst matter is collecting that it has to be diverted or dispersed, or else matured. In the two former contingencies no further treatment is needed. When pus has matured, if in the armpits or groins it will not often have to be cut into. The same is true when the abscess is of moderate extent, so also when it is in the skin, or even in the flesh, unless the patient's weakness forces us to hurry; it is sufficient to poultice in order to make the pus come out of its own accord. For the place which has not felt the knife may generally escape without a scar. But if the abscess is more deeply seated, we must consider whether the part has sinews or not. For if it is free from sinews, it should be laid open with a red-hot cautery-knife; which has this advantage, that a small wound continues open longer for the withdrawal of the pus, and the resulting scar is small. But if there are sinews near by, the cautery is unsuitable, lest spasm of the sinews ensues or paralysis of the limb; then the scalpel becomes necessary. But although abscesses elsewhere can be opened even whilst immature, where there are sinews, we must wait for them to be fully matured, since the skin then becomes thin, and the pus joins it, and so is nearer to get at. Most abscesses require a linear incision; but in that termed panus, because it generally thins out the skin extremely, all the skin overlying the pus is to be cut away. But when the scalpel is used, care should always be taken that the incisions made are as few and as small as possible, but enough in number and extent to afford the necessary relief. For the larger cavities may at times have to be cut into rather widely even by two or three incisions, and cuts must be so made that the deepest part of the cavity gets a vent, lest any fluid should be left there to eat its way gradually into adjoining tissue, which was previously sound. Also it is natural that the skin should have to be cut away rather widely. For when the whole bodily habit has become vitiated in the course of a prolonged disease and the abscess cavity has extended widely and the skin over it has already become pallid, then we can recognize that the skin is already dead and of no further use; and therefore the excision of overlying skin is better, especially if the suppuration is round about the larger joints, and if the patient, confined to bed, has been exhausted by diarrhoea, and gained nothing from his food. But the skin should be so cut out as to leave a myrtle leaf shaped wound, in order that it may heal more readily: and this should be the constant rule, whenever, or for whatever reason, the practitioner cuts out skin. Where the pus has been let out, for the armpit or groin lint plugging is unsuitable, but a sponge squeezed out of wine must be put on. In other parts, if likewise a lint plug is unnecessary, a little honey will be infused into the cavity to clean it, then agglutinants put on: if lint plugs are needed, over them also should be placed sponges similarly squeezed out of wine. But it has been said elsewhere when plugging is, and is not requisite. In all other ways the same procedure is to be followed after an abscess has been opened by incision, which I have described for one which has ruptured under medicaments. |
| 156 |
Protinus autem quantum curatio efficiat , quantumque aut sperari aut timeri debeat , ex quibusdam signis intellegi potest , fereque isdem , quae in uolneribus exposita sunt . Nam bona signa sunt somnum capere , facile spirare , siti non confici , cibum non fastidire : si febricula fuit , ea uacare ; itemque habere pus album , leue , non foedi odoris . Mala sunt uigilia , spiritus grauitas , sitis , cibi fastidium , febris , pus nigrum aut faeculentum et foedi odoris . Item procedente curatione eruptio sanguinis , aut si , antequam sinus carne impleatur , orae carnosae fiunt , illa quoque ipsa carne hebete nec firma . Deficere tamen animam uel ipsa curatione uel postea pessimum omnium est . Quin etiam morbus ipse siue subito solutus est , deinde suppuratio exorta est , siue effuso pure permanet , non iniuste terret . Estque inter causas timoris , si sensus in uulnere rodentium non est . Sed ut haec ipsa fortuna huc illucue discernit , sic medici partium est eniti ad reperiendam sanitatem . Ergo quotiens ulcus resoluerit , eluere id , si reprimendus umor uidebitur , uino ex aqua pluuiali mixto uel aqua , in qua lenticula cocta sit , debebit ; si purgandum erit , mulso ; rursusque inponere eadem . Vbi iam repressus uidebitur umor , ulcusque puru m erit , produci carnem conueniet , et foueri uulnus pari portione uini ac mellis , superque inponi spongiam ex uino et rosa tinctam . Per quae cum caro producatur , plus tamen ( ut alias quoque dixi ) uictus ratio eo confert ; id est solutis iam febribus et cibi cupiditate reddita balneum rarum , cotidiana sed lenis gestatio , cibi potionesque corpori faciundo aptae . Quae omnia per medicamenta quoque suppuratione rupta secuntur : sed quia magno malo uix sine ferro mederi licet , in hunc locum reseruata sunt .
|
3 Now how the treatment is succeeding, how much is to be either hoped or feared, can be learnt straightaway from signs which on the whole are the same as have been mentioned already for wounds. Good signs are: ready sleep, easy breathing, no harassing thirst, no aversion to food; for any feverishness to pass off; and for the pus to be white and uniform, not foul. Bad signs are: wakefulness, laboured breathing, thirst, aversion to food, fever, the pus dark or like wine lees, and foul. Again, bad signs in the course of the treatment are: haemorrhage, or if the margins become fleshy before the sinus has been filled up by flesh, and this flesh is insensitive and not firm. But the worst sign of all is a faint, whether during the dressing, or after it. Again there is some reason for anxiety when the illness suddenly subsides, and then suppuration breaks out; or if the illness persists after the pus has been let out. And one cause for anxiety is if the wound is insensible to corrosives. But while it is chance that makes the signs point now one way, now another, it is the practitioner's part to strive to bring about healing. Therefore whenever it is dressed, the abscess cavity should be washed out, with wine mixed with rain water or with a decoction of lentils, when the discharge seems to need checking; with honey wine when cleaning is required; after which it is dressed as before. When the discharge appears to be checked, and the cavity clean, then is the time to help the growth of flesh, both by irrigating with equal parts of wine and honey, and by laying on a sponge soaked in wine and rose oil. Although the growth of flesh is helped by these medicaments, this is better attained, as I have said elsewhere, by a careful regimen; this consists, after the cessation of the fever and a return of appetite, in an occasional bath, gentle rocking daily, food and drink suitable for making flesh. These prescriptions all apply to abscesses which have burst under medicaments; but they have been held over to this place because it is scarcely possible to cure a large abscess without using the knife. |