De Medicina (Celsus)

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	De Medicina Author: Celsus	Translator: Walter George Spencer
161	Verum ut oculi multiplicem curationem etiam manus exigunt , sic in auribus admodum pauca sunt , quae in hac medicinae parte tractentur . Solet tamen euenire , uel a primo die protinus , uel postea facta exulceratione , dein per cicatricem aure repleta , ut foramen in ea nullum sit , ideoque audiendi usu careat . Quod ubi incidit , specillo temptandum est , altene id repletum , an in summo tantum glutinatum sit . Nam si alte est , prementi non cedit ; si in summo , specillum protinus recipit . Illud attingi non oportet , ne sine effectus spe distentio oriatur neruorum , et ex ea mortis periculum sit : hoc facile curatur . Nam qua cauom esse debet , uel medicamentum aliquod inponendum est ex adurentibus , uel candenti ferro aperiendum , uel etiam scalpello incidendum . Cumque id patefactum et iam ulcus purum est , coicienda eo pinna est , inlita medicamento cicatricem inducente , circaque id em medicamentum dandum , ut cutis circa pinnam sanescat ; quo fit , ut ea remota postea facultas audiendi sit . At ubi aures , in uiro puta , perforatae sunt et offendunt , traicere id cauum celeriter candente acu satis est , ut leuiter eius orae ulcerentur ; aut etiam adurente medicamento idem exulcerare , postea deinde inponere id , quod purget , tum quod eo loc o repleat et cicatricem inducat . Quod si magnum id foramen est , sicut solet esse in is , qui maiora pondera auribus gesserunt , incidere quod superest ad extremum oportet ; supra deinde oras scalpello exulcerare , et postea suere , ac medicamentum , qu o glutinetur , inponere . Tertium est , si quid ibi curti est , sarcire . Quae res cum in labris quoque et naribus fieri possit , eandem etiam rationem habeat , simul explicanda est .	8 Whilst the eyes demand many kinds of surgical treatment, there are but few affections of the ears which are dealt with by this branch of medicine. It does happen, however, whether from birth, or later when there has been ulceration and the ear becomes filled up by scarring, that there is no passage in the ear and so it cannot hear. When this is the case, we must try with a probe whether the part is filled up deeply, or whether there is merely a superficial agglutination. For if deeply, there is no yielding to pressure made on the probe; if superficial, the probe enters freely. The former should not be touched, lest, where there is no hope of success, a spasm may be set up, and from that may follow danger of death. The latter is easily treated. For where the passage should be, either one of the caustic medicaments is to be applied, or an opening made with the cautery, or the place may even be cut through with a scalpel. After it has been laid open, and the ulceration has been cleaned, a quill is to be inserted, smeared with a medicament to induce a scar, and the same medicament applied around, until the skin has healed round the quill; by this means when the quill has been removed, the faculty of hearing follows. But where the ears, in a man for instance, have been pierced and have become offensive, it is enough to pass a red hot needle quickly though the hole in order to blister its margins superficially or even to produce the same effect by a caustic; then afterwards to put on applications to clean the place and later what will make the flesh grow there and induce a scar. But if the hole is enlarged, as is usually the case with those who have worn heavy ear-rings, the rest of the lobule should be cut through; then the edges above made raw with a scalpel, and the wound sutured, and agglutinating medicaments put on. A third method, where there has been some mutilation, is to patch, and since this can be done in the case of the lips and nostrils as well, and the procedure is the same, the description too should be given at the same time.
162	Curta igitur in his tribus * * ac si qua parua sunt , curari possunt ; si qua maiora sunt , aut non recipiunt curationem , aut ita per hanc ipsam deformantur , ut minus indecora ante fuerint . Atque in aure quidem et naribus deformitas sola timeri potest : in labris uero , si nimium contracta sunt , usui quoque necessario iactura fit , quia minus facile et cibus adsumitur et sermo explicatur . Neque enim creatur ibi corpus , sed ex uicino adducitur ; quod in leui mutatione et nihil † eripere et fallere oculum potest , in magna non potest . Neque senile autem corpus , neque quod mali habitus est , neque in quo difficulter ulcera sanescunt , huic medicinae idoneum est , quia nusquam celerius cancer occupat aut difficilius tollitur . Ratio curationis eiusmodi est : id , quod cu rtum est , in quadratum derigere ; ab interioribus eius angulis lineas transuersas incidere , quae citeriorem partem ab ulteriore ex toto deducant ; deinde ea , quae sic resoluimus , in unum adducere . Si non satis iunguntur , ultra lineas , quas ante fecimus , alias duas lunatas et ad plagas conuersas immittere , quibus summa tantum cutis diducatur : sic enim fit , ut facilius quod adducitur sequi possit ; quod non est cogendum , sed ita adducendum , ut ex facili subsequatur et dimissum non multum recedat . Interdum tamen ab altera parte cutis * aut omnino adducta deformem , quem reliquit , locum reddit . Eiusmodi loci altera pars incidenda , altera intacta habenda est . Ergo neque ex imis auribus neque ex medio naso imisue narum partibus neque ex angulis labrorum quicquam adtrahere temptabimus : utri mque autem petemus , si quid summis auribus , si quid imis , si quid aut medio naso aut mediis naribus aut mediis labris deerit . Quae tamen inter dum etiam duobus locis cu rta esse consuerunt : sed eadem ratio curandi est . Si cartilago in eo , quod incisum est , eminet , excidenda est : neque enim aut glutinatur aut acu tuto traicitur . Neque longe tamen excidi debet , ne inter duas oras liberae cutis utrimque coitus puris fieri possit . Tum iunctae orae inter se suendae sunt utrimque cute adprehensa , et qua priores lineae sunt , ea quoque suturae iniciendae sunt . Siccis locis ut in naribus inlita spuma argenti satis proficit . In ulteriores uero lunatasque plagas li namentum dandum est , ut caro increscens uulnus impleat ; summaque cura quod ita sutum est , tuendum esse apparere ex eo potest , quod de cancro supra posui . Ergo etiam tertio quoque die fouendum erit uapore aquae calidae , rursusque idem medicamentum iniciendum ; fereque septimo die glutinatum est . Tum suturae eximi , et ulcus ad sanitatem perduci debet .	9 Mutilations then occur in these three parts and can be treated if they are small; if they are large, either they are not susceptible of treatment, or else may be so deformed by it as to be more unsightly than before. And indeed in the ear and nostrils the deformity is the only trouble; but in the case of the lips, if these have become too much contracted, there is also loss of a necessary function, because it becomes less easy both to take food and to speak plainly. Now new substance is not produced at the place itself, but it is drawn from the neighbourhood; and when the change is small this hardly robs any other part and may pass unnoticed, but when large, it cannot do so. And again, this procedure in unsuited to the aged, to those in bad bodily condition, and to those whose wounds heal with difficulty; because there are no cases in which canker sets in more quickly, or is more difficult to get rid of. The method of treatment is as follows: the mutilation is enclosed in a square; from the inner angles of this incisions are made across, so that the part on one side of the quadrilateral is completely separated from that on the opposite side. Then the two flaps, which we have freed, are brought together. If they cannot be sufficiently brought together, at each end beyond the original incisions semilunar cuts which only divide the skin are made with the horns pointing towards the incisions. This enables the edges to be brought together more easily. No force should be used, but the traction should be such that the edges easily approximate and, when left free, do not recoil much. At times, however, if the skin has been drawn across from one side to a considerable extent, or even at all, it makes the part which it has left unsightly. In a case of that sort, leaving that side untouched, an incision should be made only on the other side. For instance we should not attempt to make traction upon the lobules of the ears, the bridge of the nose, the margins of the nostrils, or the corners of the lips. But we shall try traction from either side if anything is required for the upper part of the ears, the tip of the nose, the bridge of the nose, the skin between the nostrils, and the middle of the lips. At times the mutilation is in two places, but the method of treatment is the same. Cartilage if it projects into the incision is to be cut away; for it does not agglutinate nor is it safely transfixed by a needle. But it should not be much cut away lest pus collect on each side between the two margins of loose skin. Then the margins after being brought together are to be sutured by taking up from each skin only, and the earlier incisions are also to be sutured. In dry parts such as the nostrils, it is sufficient to spread on litharge. But into the more distance semilunar wounds lint is to be placed in order that flesh may grow and fill the wound; and it is clear that the greatest attention should be paid to what is thus sutured, from what I mentioned above about canker. Consequently every third day the part should be steamed, then dressed as before; and generally the wound has adhered by the seventh day. Then the sutures should be removed, and the wound allowed to heal.
163	Polypum uero , qui in naribus nascitur , ferro praecipue curari iam alias posui . Ergo etiam hunc ferramento acuto in modum spathae facto resoluere ab osse oportet , adhibita diligentia , ne infra cartilago laedatur , in qua difficilis curatio est . Vbi abscis sus est , unco ferramento extrahendus est ; tum inplicitum linamentum uel aliquid ex penicillo respergendum est medicamento , quo sanguis supprimitur , eoque naris leuiter inplenda . Sanguine suppresso linamento ulcus purgandum est . Vbi purum est , eo pinna , eodem modo quo in aure supra positum est , medicamento inlita , quo cicatrix inducitur , intus demittenda , donec in tot um id sanescat .	10 As for the polypus which grows in the nostrils, I have already laid down elsewhere that the best treatment is with the knife. Therefore this too should be loosened from the bone by a sharp instru ment, shaped like a spear head, care being taken not to injure the cartilage under it, which is difficult to treat. When detached it is to be extracted by an iron hook; then the nostril is gently filled with lint folded or in a roll, soaked in something to stop the bleeding; when the bleeding has stopped, the ulceration is to be cleaned with a lint plug. When it is clean, insert a quill (as described above in the case of the ear), smeared with the medicament which causes a scar to form until healing is completed.
164	Id autem uitium , quod ozena Graece uocatur , si medicamentis non cederet , quemadmodum manu curandum esset , apud magnos chirurgos non rep peri . Credo quia res raro ad sanitatem satis proficit , cum aliquid in ipsa curatione torment i habeat . Apud quosdam tamen positum est uel fictilem fistulam uel enodem scriptorium calamum in narem esse coiciendum , donec susum ad os perueniat ; tum per id tenue ferramentum candens dandum esse ad ipsum os ; deinde adustum locum purgandum esse aerugine et melle : ubi purus est , Lycio ad sanitatem perducendum . Vel narem incidendam esse ab ima parte ad os , ut et conspici locus possit , et facilius candens ferramentum admoueri ; tum sui narem debere , et adustum quidem ulcus eadem ratione curari : suturam uero inlini uel spuma argenti uel alio glutinante .	11 Now as to the lesion called by the Greeks ozaena, I have found nothing in the writings of great surgeons about surgical treatment if it did not yield to medicaments. I believe this is because it seldom heals quite completely, though the treatment its involves considerable pain. Some, however, lay down that either an earthenware tube, or a smooth quill, is to be inserted into the nostril until it reaches the bone, and then a fine cautery point is passed down that tube right to the bone. The cauterized spot is afterwards dressed with verdigris and honey, and when clean is healed by applying lycium. Or the nostril may be laid open from its base as far as the bone, so that the place can be seen, and the cautery more easily applied; then the nostril must be sewn up, and the cauterized ulceration treated as above; the fine suture is dressed with litharge or other agglutinant.