De Medicina |
Translator: Walter George Spencer
|
|
| 165 |
In ore quoque quaedam manu curantur . Vbi in primis dentes nonnumquam mouentur , modo propter radicum inbecillitatem , modo propter gingiuarum arescentium uitium .—Oportet in utrolibet candens ferramentum gingiuis admoueri , ut attingat leuiter , non insidat . Adustae gingiuae melle inlinendae et mulso eluendae sunt . Vt pura ulcera esse coeperunt , arida medicamenta inf rianda sunt ex is , quae reprimunt . Si uero dens dolores mouet eximique eum , quia medicamenta nihil adiuuant , placuerit , circumradi debet , ut gingiuae ab eo resoluantur ; tum is concutiendus est . Eaque facienda , donec bene moueatur : nam dens haerens cum summo periculo euellitur , ac nonnumquam maxilla loco mouetur ; idque etiam maiore periculo in superioribus dentibus fit , quia potest tempora oculosue concutere . Tum , si fieri potest , manu ; si minus , forfice , dens excipiendus est . Ac si ex essus est , ante uel linamento uel bene adcommodato plumbo replendus est , ne sub forfice confringatur . Recta uero forfex ducenda est , ne inflexis radicibus os rarum , cui dens inhaeret , parte aliqua frangat . Neque ideo nullum eius rei periculum est utique in dentibus breuibus , qui fere longiores radices non habent : saepe enim forfex cum dentem conprehendere non possit aut frustra conprehendat , os gingiuae prehendit et frangit . Protinus autem ubi plus sangu inis profluit , sci re licet , aliquid ex osse fractum esse . Ergo specillo conquirenda est testa , quae recessit , et uolsella protrahenda est . Si non sequitur , incidi gingiua debet , donec labans ossis testa recipiatur . Quod si factum statim non est , indurescit extrinsecus maxilla , ut is hiare non possit . Sed inponendum calidum ex farina et fico cataplasma est , donec ibi pus moueatur ; tum incidi gingiua debet . Pus quoque multum profluens ossis fracti nota est : itaque etiam tum id extrahi convenit ; nonnumquam etiam eo laeso fistula fit , quae eradi debet . Dens autem scaber , qua parte niger , radendus inlinendusque rosae flore contrito , cui gallae quarta pars et altera murrae sit adiecta ; continendumque ore crebro uinum meracum ; atque in eo casu uelandum caput , ambulatione multa , frictione capitis , cibo non acri utendum . At si ex ictu uel alio casu aliquid labant dentes , auro cum is , qui bene haerent , uinciendi sunt ; continendaque ore reprimentia , ut uinum , in quo malicorium decoctum , aut in quo galla candens coniecta sit . Si quando etiam in pueris ante alter dens nascitur quam prior excidat , is qui cadere debuit circumpurgandus et euellendus est : is qui natus est in locum prioris cotidie digito adur gendus, donec ad iustam magnitudinem perueniat . Quotienscumque dente exempto radix relicta est , protinus ea quoque ad id facta forfice , quam riza gran Graeci uocant , eximenda est . Tonsillas autem , quae post inflammationes indu ruerunt , antiades autem a Graecis appellantur , cum sub leui tunica sint , oportet digito circumradere et euellere : si ne si c quidem resoluuntur , hamulo excipere et scalpello excidere ; tum ulcus aceto eluere et inlin ere uulnus medicamento , quo sanguis supprimitur . Vua si cum inflammatione descendit , dolorique est et subrubicundi coloris , praecidi sine periculo non potest : solet enim multum sanguinem effundere : ita que melius est is uti , quae alias proposita sunt . Si uero inflammatio quidem nulla est , nihilo minus autem ultra iustum modum a pituita deducta sit , et est tenuis , acuta , alba , praecidi debet ; itemque si ima liuida et crassa , summa tenuis est . Neque quicquam commodius est quam uolsella prehendere , sub e aque quod uolumus excidere . Neque enim ullum periculum est , ne plus minusue praecidatur , cum liceat tantum infra uolsella m relinque re , quantum utile esse manifestum est ; idque praecidere , quo longior uua est quam esse naturaliter debet . Post curationem eadem facienda sunt , quae in tonsilla his proxime posui . Lingua uero quibusdam cum subiecta parte a primo die uincta est , qui ob id ne loqui quidem possunt .—Horum extrema lingua uolsella prehendenda est , sub eaque membrana incidenda , magna cura habita , ne uenae quae iuxta sunt uiolent ur et profusio sanguinis noceat . Reliqua curatio uulneris in prioribus posita est . Et plerique quidem ubi consanuerunt , locuntur : ego autem cognoui , qui succisa lingua cum abunde super dentes eam promeret , non tamen loquendi facultatem consecutus est . Adeo in medicina , etiam ubi perpetuum est , quod fieri debet , non tamen perpetuum est id , quod sequi conuenit . Sub lingua quoque interdum aliquid abscedit , quod fere consistit in tunica doloresque magnos mouet .—Quo , si exiguum est , incidi semel satis est ; si maius , summa cutis usque ad tunicam excidenda est ; deinde utrimque orae hamulis excipienda e et tunica undique circumdato liberanda * * * est , magna diligentia per omnem curationem habita , ne qua maior uena incidatur . Labra autem saepe finduntur eaque res habet cum dolore etiam hanc molestiam , quod sermo prohibetur ; qui subinde eas rimas cum dolore diducendo sanguinem citat . Sed has , si in summo sunt , medicamentis curare commodius est , quae ad ulcera oris fiunt . Si uero altius descenderunt , necessarium est tenui ferramento adurere ; quod spathae simile quasi transcurrere , non inprimi debet . Postea facienda eadem sunt , quae in auribus adustis exposita sunt .
|
12 In the mouth too some conditions are treated by surgery. In the first place, teeth sometimes become loose, either from weakness of the roots, or from disease drying up the gums. In either case the cautery should be applied so as to touch the gums lightly without pressure. The gums so cauterized are smeared with honey, and swilled with honey wine. When the ulcerations have begun to clean, dry medicaments, acting as repressants, are dusted on. But if a tooth gives pain and it is decided to extract it because medicaments afford no relief, the tooth should be scraped round in order that the gum may become separated from it; then the tooth is to be shaken. And this is to be done until it is quite moveable: for it is very dangerous to extract a tooth that is tight, and sometimes the jaw is dislocated. With the upper teeth there is even greater danger, for the temples or eyes may be concussed. Then the tooth is to be extracted, by hand, if possible, failing that with the forceps. But if the tooth is decayed, the cavity should be neatly filled first, whether with lint or with lead, so that the tooth does not break in pieces under the forceps. The forceps is to be pulled straight upwards, lest if the roots are bent, the thin bone to which the tooth is attached should break at some part. And this procedure is not altogether free from danger, especially in the case of the short teeth, which generally have shorter roots, for often when the forceps cannot grip the tooth, or does not do so properly, it grips and breaks the bone under the gum. But as soon as there is a large flow of blood it is clear that something has been broken off the bone. It is necessary therefore to search with a probe for the scale of bone which has been separated, and to extract it with a small forceps. If this does not succeed the gum must be cut into until the loose scale is found. And if this has been done at once, the jaw outside the tooth hardens, so that the patient cannot open his mouth. But a hot poultice made of flour and a fig is then to be put on until pus is formed there: then the gum should be cut into. A free flow of pus also indicates a fragment of bone; so then too it is proper to extract the fragment; sometimes also when the bone is injured a fistula is formed which has to be scraped out. But a rough tooth is to be scraped in the part which has co black, and smeared with crushed rose-petals to which a fourth part of ox-galls and the same amount of myrrh has been added; and at frequent intervals undiluted wine is to be held in the mouth; and in this case the head is to be wrapped up, and the patient should have much walking exercise, massage of his head and food which is not too bitter. But if teeth become loosened by a blow, or any other accident, they are to be tied by gold wire to firmly fixed teeth, and repressants must be held in the mouth, such as wine in which some pomegranate rind has been cooked, or into which burning oak galls have been thrown. In children too if a second tooth is growing up before the first one has fallen out, the tooth which ought to come out must be freed all round and extracted; the tooth which has grown up in place of the former one is to be pressed upwards with a finger every day until it has reached its proper height. And whenever, after extraction, a root has been left behind, this too must be at once removed by the forceps made for the purpose which the Greeks call rhizagra. Now tonsils which have become hardened after inflammation (they are called by the Greeks antiades) since they are enclosed in a thin tunic, should be scratched round with a finger and drawn out. But if they cannot be so detached they should be seized with a hook and excised with a scalpel; and the hollow then swilled out with vinegar and the wound smeared with something to check the blood. If the uvula, owing to inflammation is elongated downwards, and is painful and dusky red in colour, it cannot be cut away without danger; for usually much blood flows: and so it is better to employ the treatment described elsewhere. But if, though there is no inflammation, it has become drawn so far downwards owing to phlegm, and is thin, pointed and white, it should be cut away; so also when the tip is bluish black and thick, but the base thin. There is no better way than to seize it with a small forceps and below this to cut off as much as we wish. And there is no danger of cutting off too much or too little since we can leave below the forceps only that part which is clearly useless; and cut away what is in excess of the natural length of the uvula. After the operation the same treatment should be carried out as I have just described for the tonsils. Again the tongue in some persons is tied down from birth to the part underlying it, and on this account they cannot even speak. In such cases the extremity of the tongue is to be seized with a forceps, and the membrane under it incised, great care being taken lest the blood vessels close by are injured and bleeding causes harm. The treatment of the wound afterwards has been described above. And indeed many when the wound has healed have spoken; I have, however, known a case when, though the tongue has been undercut so that it could be protruded well beyond the teeth, nevertheless the power of speech has not followed. So it is that in the Art of Medicine even where there is a rule as to what ought to be done, yet there is no rule as to what result ensues. Sometimes also under the tongue an abscess occurs which is generally enclosed in a coat and causes much pain. If it is small, one cut is enough; if large, the skin over it is to be excised down to the coating; then the two margins are laid hold of with hooks, and the coating is to be freed from what it surrounds and completely extracted, taking great care throughout the operation that no large blood vessel is cut into. The lips often split, and this not only is painful but has the inconvenience that speech is hindered; as this is apt to enlarge the cracks painfully and so causes them to bleed. If the cracks are superficial they are better treated by the medicaments used for ulcerations of the mouth. But if the fissures have penetrated deeper, it is necessary to burn them with a fine cautery, spearhead shaped, which should as it were skim over them without being pressed down. Afterwards the same is to be done as for cauterization of the ears. |
| 166 |
At in ceruice inter cutem et asperam arteriam tumor increscit : bronchocelen Graeci uocant ; quo modo caro hebes , modo umor aliquis melli aquaeue similis includitur , interdum etiam minutis ossibus pili inmixti . Ex quibus quicquid est , tunica continetur .—Potest autem adurentibus medicamentis curari , quibus summa cutis cum subiecta tunica exestur . Quo facto , siue umor est , profluit ; siue quid densius , digitis educitur ; tum ulcus sub lin amentis sanescit . Sed scalpelli curatio brevior est . Medio tumore una linea inciditur usque ad tunicam ; deinde uitiosus sinus ab integro corpore separatur digito , totusque cum uelamento suo eximitur . Tum aceto , cui uel salem uel nitrum aliquis adiecit , * eluitur , oraeque una sutura iunguntur ; ceteraque eadem quae in aliis suturis superiniciuntur leuiterque inde , ne fauces * * urgeatque , deligatur . Si quando autem tunica eximi non potu erit , intus inspergenda adurentia ; lin amentisque id curandum est et ceteris pus mouentibus .
|
13 Now in the neck between the skin and the trachea, a tumour occurs which the Greeks call bronchocele, it contains now soft flesh, now a humour somewhat like honey or water, sometimes also hairs mixed up with minute bones; whatever the contents, they are enclosed in a coat. Treatment is possible by caustics which eat away the skin together with the underlying tunic. When this has been done, if there is humour inside, it flows out; if anything solid, it is turned out with the finger; the wound then heals under lint dressings. But treatment by the knife is shorter. A linear incision is made over the middle of the tumour down to the tunic; then the morbid pouch is separated by the finger from the sound tissue, and the whole is removed along with its covering. Next the wound is washed out with vinegar to which either salt or soda has been added, and the margins brought together by one suture; the rest of the applications are the same as in other cases of sutured wounds and after that it is lightly bandaged so as not to trouble the throat by pressure. But if it is impossible to take out the tunic, caustics are to be dusted into its interior, and it is then dressed with lint and other suppuratives. |
| 167 |
Sunt etiam circa umbilicum plura uitia , de quibus propter raritatem inter auctores parum constet . Verisimile est autem id a quoque praetermissum , quod ipse non cognouerat ; a nullo id , quod non uiderat , fictum . Commune omnibus est umbilicum indecore prominere : causae requiruntur . Meges tres has posuit : modo intestinum eo inrumpere ; modo omentum ; modo umorem . Sostratus nihil de omento dixit : duobus isdem adiecit carnem ibi interdum increscere , eamque modo integram esse , modo carcinomati similem . Gorgias ipse quoque omenti mentionem omisit : sed eadem tria causatus , spiritus quoque interdum eo dixit inrumpere . Heron omnibus his quattuor positis , et omenti mentionem habuit et eius , quod * * simul et omentum et intestinum habuerit . Quid autem horum sit , his indiciis cognoscitur . Vbi intestinum prolapsum est , tumor neque durus neque mollis est , omni frigore minuitur : non solum sub omni calore sed etiam retento spiritu crescit . Sonat interdum , atque ubi resupinatus est aliquis , delapso intestino ipse desidit . Vbi uero omentum est , cetera similia sunt ; tumor mollior et , ab ima parte latus , extenuatus in uertice est ; si quis adprehendit , elabitur . Vbi utrumque est , indicia quoque mixta sunt , et inter utrumque mollities : at caro durior est , semperque etiam resupinato corpore tumet , prementique non cedit , prioribus facile cedentibus . Si uitiosa est , easdem notas habet , quas in carcinomate exposui . Vmor autem si premitur , circumfluit : at spiritus pressus cedit , sed protinus redit , resupinato quoque corpore tumorem in eadem figura tenet . Ex his id , quod ex spiritu uitium est , medicinam non admittit ; caro quoque carcinomati similis cum periculo tractatur ; itaque omittenda est . Sana excidi debet idque uulnus lin amentis curari . Vmorem quidem * * uel inciso summo tumore effundunt , et uulnus isdem linamentis curant . In reliquis uariae sententiae sunt . Ac resupinandum quidem corpus esse res ipsa testatur , ut in uterum , siue intestinum siue omentum est , delabatur . Sinus uero umbilici tum uacus a quibusdam duabus regulis exceptus est , uehementerque earum capitibus deligatis ibi emortus : a quibusdam , ad imum acu traiecta duo lina ducente , deinde utriusque lini duobus capitibus diuersae partes adstrictae ; quod in uua quoque oculi fit : nam sic id , quod supra uinculum est , moritur . Adiecerunt quidam , ut antequam uincirent , summum una linea inciderent exciderentque : quo facilius digito demisso quod illuc inrupisset depellerent ; tum deinde uinxerunt . Sed abunde est iubere spiritum continere , ut tumor quantus maximus esse potest , se ostendat ; tum imam basem eius atramento notare , resupinatoque homine digitis tumorem eum premere , ut , si quid delapsum non est , manu cogatur . Post haec umbilicum adtrahere , et qua nota atramenti est , lino uehementer adstringere ; deinde partem superiorem aut medicamentis aut ferro adurere , donec emoriatur , atque ut cetera usta ulcus nutrire . Idque non solum ubi intestinum uel omentum uel utrumque est , sed etiam ubi umor est , optime proficit . Sed ante quaedam uisenda sunt , ne quod ex uinculo periculum sit . Nam curationi neque infans neque aut robustus annis aut senex aptus est , sed * a septimo fere anno ad quartum decimum . Deinde ei corpus idoneum est id , quod integrum est : at quod mali habitus est , quo due papulas , inpetigine m , similiaque habet , idoneum non est . Leuibus quoque tumoribus facile subuenitur : at in eorum , qui nimis magni sunt , curatione periculum est . Tempus autem anni autumnale et hibernum uitandum ; uer est idoneum maxime ac prima ae stas non aliena est . Praeter haec abstinere pridie debet ; neque id satis est , sed aluus quoque ei ducenda est , quo facilius omnia , quae excesserunt , intra uterum considant .
|
14 There are also around the navel many lesions about which, owing to their rarity, there is little agreement among authorities. But it is probable that each has passed over what was unknown to himself; while no one has depicted what he had not seen. Common to all cases is an ugly prominence of the umbilicus, and the causes are sought for. Meges gave three; rupture into it of the intestine, of the omentum, or of humour. Sostratus said nothing about the omentum; in addition to the other two he said that at times there was increase of flesh in that part, sometimes sound, sometimes cancerous. Gorgias himself also omitted mention of the omentum; but he gave the same number of causes, three, and said that occasionally wind also ruptured into it. Heron having given all these four causes, made mention of both the omentum and of that form which was caused simultaneously by the omentum and intestine. But which of these causes it is, may be recognized by the following indications. When intestine has prolapsed the swelling is neither hard nor soft; it is reduced by anything cold; and it increases not only under heat of all kinds but also when the breath is held. At intervals it rumbles, and if the patient lies down on his back the swelling subsides, as the intestine has slipped back. But when it is the omentum, whilst other signs are similar, the swelling is softer, broad at its base, thinned out towards its apex; if any one grasps it, it slips away. When both intestine and omentum have prolapsed, the signs are mingled, and the softness is intermediate between the two; but the flesh is harder, and even when the patient lies on his back there is always swelling, and it does not yield to pressure, to which the preceding forms yield readily. If it is malignant the signs are the same as I have stated for cancer. Humour fluctuates when pressed upon; wind, on the other hand yields under pressure, but returns at once, also the swelling retains the same shape when the patient lies down on his back. Of these varieties, the disorder due to wind does not admit of treatment; also cancerous flesh is dangerous to treat, so should be left alone. Sound flesh ought to be cut away and the wound dressed with lint. Some let out humour, either by perforating with a needle, or by cutting into the apex of the tumour, and then similarly dressing the wound with lint. As to the rest of the treatment opinions vary. Of course the patient must be laid on his back, in order that the swelling, whether it be intestine or omentum, may slip back into the abdomen. But when the navel sac was then empty, some caught it between two little rods, and fastened the ends of the rods tightly together, so that it mortified there; some passed a needle doubly threaded through the base of the sac, then knotted the two ends of each thread on opposite sides, as is done also in staphyloma of the eye; from in this way that part beyond the ligatures mortifies. Some, in addition, before tying the ends also cut into the protrusion along a marked line and excised it: in order that they might more easily insert a finger and push back whatever had ruptured into the sac; then at length they tied the ligatures. But it is quite enough to order the patient to hold his breath so that the tumour shows itself at its largest; then to mark its base with ink; next with the patient on his back, to compress the tumour with the fingers, so that whatever has not slipped back of itself is forced back by the hand. After this the umbilicus is drawn forwards, and tightly constricted with flaxen thread along the marks of the ink; next the part beyond the ligature is either burnt with caustics or with the cautery, until it mortifies, after which the wound is dressed like other burns. This method answers best, not only when it is intestine or omentum or both, but even when it is humour. But first precautions must be taken against any danger from the ligature. For neither an infant nor a robust adult nor an old man is suited to this treatment, but a child between seven and fourteen years of age. Secondly a suitable body for it is one that is sound, but where there is general ill-health, or pustules or eruptions, and such like, it is not suitable. The smaller tumours also are readily curable, but there is danger in the treatment of those which are excessively large. Moreover the autumn and winter seasons should be avoided, the spring is the best season, early summer is not unfavourable. The patient should also fast on the day before the operation, and that is not enough, but the bowels also are to be moved by a clyster, in order that all that has extruded may more readily return into the abdomen. |
| 168 |
Aquam is , qui hydropici sunt , emitti oportere alias dixi : nunc quemadmodum fiat , dicendum est . Quidam autem sub umbilico , fere quattuor interpositis digitis , in sinistra parte ; quidam ipso umbilico perforato id facere consuerunt : quidam cute primum adusta , deinde interiore abdomine inciso , quia , quod per ignem diuisum est , minus celeriter coit . Ferramentum autem d emittitur , magna cura habita , ne qua uena incidatur . Id tale esse debet , ut fere tertiam digiti partem latitudo mucronis impleat ; demittendumque ita est , ut membranam quoque transeat , qua caro ab interiore parte finitur ; eo tum plumbea aut aenea fistula coicienda est , uel recuruatis in exteriorem partem labris , uel in media circumsurgente quadam mora , ne tota intus delabi possit . Huius ea pars , quae intrat , paulo longior esse debet quam quae extra , ut ultra ulteriorem membranam procedat . Per hanc effundendus umor est ; atque ubi maior pars eius euocata est , cludenda demisso linteolo fistula est , et in uulnere , si ustum non est , relinquenda ; deinde per insequentes dies circa singulas heminas emittendum , donec nullum aquae uestigium appareat . Quidam tamen etiam non usta cute protinus fistulam recipiunt , et super uulnus spongiam expressam deligant ; deinde postero die rursus fistulam demittunt ( quod recens uulnus paulum diductum patitur ) , ut , si quid umoris superest , emittatur ; idque bis ita fecisse contenti sunt .
|
15 I have said elsewhere that in those who are dropsical the water ought to be let out: here I must describe how this should be done. Now some make the perforation about four fingers breadth below the navel, and to the left; some make it by perforating the navel itself; some first burn through the skin and then cut into the abdominal cavity, because flesh which has been divided by cautery heals less quickly. Now when entering the knife great care should be taken that no blood vessel is cut into. The knife must be such that its point should be about the third of a finger's breadth, and it should be so entered as to penetrate the membrane separating the flesh from the interior; then a lead or bronze tube should be inserted, either with lips curved back at its outer end, or with a collar round the middle so that the whole of it cannot slip inside. The part of the tube within the abdominal cavity should be a little longer than the part outside, in order that it may project inwards beyond the deeper membrane. Through this tube the humour is let out; and when the greater part has escaped, the tube is to be closed by a lint plug, and left in the wound if it was not burnt with a cautery; then on each of the following days about one hemina is let out, until there appears no trace of fluid. Some, however, even when the skin has not been cauterized, take out the tube forthwith, and then bandage on the wound a squeezed-out sponge; then on the next day they pass in a tube again (which the recent wound admits if it is slightly stretched) in order that any remaining fluid may be let out. They are satisfied when this has been done twice in this manner. |