De Medicina |
Translator: Walter George Spencer
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| 173 |
His propositis ad singulas species ueniendum est . Ac si cui paulo puero intestinum descendit , ante scalpellum experienda uinctura est . Fascia eius rei causa fit , cui imo loco pila adsuta est ex panniculis facta , quae ad repellendum intestinum ipsi illi subicitur ; deinde reliqua fasciae pars arte circumdatur ; sub quo saepe et intus conpellitur intestinum et inter se tunicae glutinantur . Rursus si aetas processit , multumque intestini descendisse ex tumore magno patet , adiciunturque dolor et uomitus , quae stercore ex cruditate eo delapso fere accidunt , scalpellum adhiberi sine pernicie non posse manifestum est : leuandum tantummodo malum et per alias curationes extrahendum est . Sanguis mitti ex brachio debet ; deinde , si uires patiuntur , inperanda tridui abstinentia est ; si minus , certe pro ui corporis quam longissima . Eo uero tempore superhabendum cataplasma ex lini semine , quod ante aliquis ex mulso decoxerit . Post haec et farina hordiacia cum resina inicienda , et is demittendus in solium aquae calidae , cui oleum quoque adiectum sit ; dandumque aliquid cibi lenis calidi . Quidam etiam aluum ducunt ; id deducere aliquid in scrotum potest , educere ex eo non potest . Per ea uero , quae supra scripta sunt , leuato malo , si quando alias dolor reuerterit , eadem mod o ualere q uae n ouim us erunt facienda . Si ne dolore quoque si multa intestina prolapsa sunt , secari superuacuum est , non quo non excludi a scroto possint , nisi tamen inflammatio prohibuit , sed quo repulsa inguinibus inmorentur ibique tumorem excitent , atque ita fiat mali non finis sed mutatio . At in eo , quem scalpello curari oportebit , simul atque ad mediam tunicam uulnus in inguine factum peruenerit , du obus hamulis ea iuxta ipsas oras adprehendi debebit , cum deductis omnibus membranulis medicus eam liberet . Neque enim cum periculo laeditur , quae excidenda est , cum intestinum esse nisi sub ea non possit . Vbi deducta autem erit , ab inguine usque ad testiculum incidi debebit sic , ne is ipse laedatur ; tum excidi . Fere tamen hanc curationem puerilis aetas et modicum malum recipit . Si uir robustus est maiusque id uitium est , extrahi testiculus non debet , sed in sua sede permanere . Id hoc modo fit . Inguen eadem ratione usque ad mediam tunicam scalpello aperitur , eaque tunica eodem modo duobus hamis excipitur sic , ut a ministro testiculus eatenus contineatur , ne per uulnus exeat ; tum ea tunica deorsum uersus scalpello inciditur , sub ea index digitus sinistrae manus ad imum testiculum d emittitur , eumque ad plagam conpellit ; deinde dextrae manus duo digiti , pollex atque index , uenam et arteriam et neruum tunicamque eorum a superiore tunica deducunt . Quod si aliquae membranulae prohibent , scalpello resoluuntur , donec ante oculos tota iam tunica sit . Excisis , quae excidenda sunt , repositoque testiculo , ab ora quoque eius uulneris , quod in inguine est , demenda habenula paulo latior est , quo maior plaga sit et plus creare carni s possit .
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20 After this introduction, we come to particular conditions. And if in a young child intestine prolapses, bandaging should be tried before the knife. For this a strip of linen is taken, to one end of which is stitched a ball of rags which is placed on the prolapse itself so as to push back the intestines: then the rest of the strip of bandage is firmly tied all round; under this the intestines are often forced inside and the tunics become agglutinated together. Again, if the patient is older, and the large size of the swelling shows that much of the intestines has come down, and if in addition there is pain and vomiting, which generally happens because faeces from undigested food have slipped down, then it is clearly impossible to employ the knife except harmfully; the trouble can only be mitigated, and must be drawn out by other measures. Blood should be let from the arm, then if the patient's strength permits, fasting for three days should be prescribed, or else at least for as long as the strength allows. Meanwhile a plaster of linseed first boiled in honey wine is to be kept on over the hernia. Later one of barley meal with resin is to be applied, and the patient immersed in a bath of hot water to which olive oil also has been added; after which some light warm food is to be given. Some also employ a clyster; but that can only bring down something into the scrotum, and cannot evacuate anything from it. When by the measures just described, the disease has been mitigated, if at any time pain recurs, the same measures will have to be repeated which we have just found to be beneficial. If without causing any pain, a large amount of intestine has prolapsed, it is useless to operate; not that it is impossible to push back the intestines out of the scrotum, unless inflammation prevents it, but because as they are forced back they may become impacted in the groins and give rise to a swelling, so that the trouble is not ended but only changed in position. But in a case which is suitable for treatment by the knife, as soon as the incision made in the groin reaches the middle tunic, this must be seized near the margins by a couple of hooks, when, after drawing down all the fine membranes the surgeon sets it free. Nor is there any danger in wounding what has to be cut out, since the intestine must lie underneath it. When the middle tunic has been thus drawn down, it is slit open from the groin to the testicle, but so as not to injure the latter; then it is cut away. Generally, however, this treatment is only admissible in boyhood and when the trouble is limited. For a robust man with a more extensive disorder the testicle should not be turned out, but kept in position. The procedure is as follows. The groin is laid open as before down to the middle tunic, and this tunic is seized as described above with two hooks, whilst the assistant keeps the testicle in its place, so that it does not come out of the wound; then the middle tunic is cut into with a scalpel towards its lower part, and through the opening the index finger of the left hand is passed beneath the testicle which is forced up into the wound; then the thumb and forefinger of the right hand separate the vein, the artery and the cord, and their tunic from the one above them. Any little membranes in the way are divided with a scalpel until now the entire tunic comes into view. After cutting away what has to be excised, and replacing the testicle, a rather broad strip is to be pared off from the edges of the wound in the groin, so that by making the wound broader it may form more flesh. |
| 174 |
At si omentum descendit , eodem quidem modo quo supra scriptum est , aperiendum inguen , deducendaeque tunicae sunt . Considerandum autem , maiorne is modus an exiguus sit . Nam quod paruulum est , super inguen in aluum uel digito uel auerso specillo repellendum est ; si plus est , sinere oportet dependere , quantum ex utero prolapsum est , idque adurentibus medicamentis inlin ere , donec emoriatur et excidat . Quidam hic quoque duo lina acu tra iciunt , binisque singulorum capitibus diuersas partes adstringunt , sub quo aeque sed tardius emoriatur . Adicitur tamen hic quoque celeritati , s i omentum super uinculum linitur medicamentis , quae sic exedunt , ne erodant : septa Graeci uocant . Fuerunt etiam qui omentum forfice praeciderent , quod in paruolo non est necessarium ; si maius est , potest profusione m sanguinis facere , siquidem omentum quoque uenis quibusdam etiam maioribus inligatum est . Neque uero si discusso uentre id prolapsum forfice praeciditur , cum et emortuum sit et aliter tutius auelli non possit , inde huc exemplum transferendum est . Vulnus autem curari , si reiectum omentum est , sutura debet ; si amplius fuit et extra emortum est , excisis oris , sicut supra positum est . Si uero umor intus est , incidendum est in pueris quidem inguen , nisi in his quoque id liquoris eius maior modus prohibet ; in uiris uero et ubicumque multus umor subest , scrotum . Deinde si inguen incisum est , ea protractis tunicis umor effundi debet ; si scrotum et sub hoc protinus uitium est , nihil aliud quam umor effundendus abscidendaeque membranae sunt , si quae eum continuerunt ; deinde eluendum id ex aqua , quae uel salem adiectum uel nitrum habeat ; si sub media imaue tunica , totae eae extra scrotum conlocandae excidendaeque sunt .
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21 But if omentum comes down, the groin is to be cut into as described above, and the tunics drawn down. Then it must be considered whether the mass is rather large or only small. For when quite small the omentum may be pushed back beyond the groin into the abdominal cavity, either with the finger, or with the opposite end of a probe; if the mass is larger what has prolapsed from the belly should be left hanging out of the wound, and smeared with caustic medicaments until it mortifies and falls off. In this condition too some transfix the tumour with a doubly threaded needle, and tie the two ends of each thread on opposite sides, under which treatment it mortifies, but more slowly. This may, however, be hastened by smearing the omentum beyond the ligature with medicaments which eat it away but do not erode; the Greeks call them septa. Some have cut away the omentum with shears. If it is quite small, this is unnecessary; if larger, bleeding may follow, because the omentum itself is connected with blood vessels, some rather large. And although in the case of an abdominal wound, prolapsed omentum is cut away with shears after it has mortified and there is no other safe way of removing it, no precedent can be drawn from that for this case. As to the treatment of the wound when the omentum has been replaced, it should be stitched; if the quantity was large, and has been left outside to mortify, the margins should be pared as described above. But if a hydrocele occurs, in boys an incision is to be made in the groin, unless in their case too the large quantity of liquid prevents it; in men, and when there is a large amount of fluid, a scrotal incision is made. So then if the incision is in the groin, when the tunics have been drawn forwards the humour must then be evacuated there; if in the scrotum, and if the trouble is immediately beneath, there is nothing to do but to let out the fluid and cut away any membranes which are keeping it in; then the incision is washed with water to which salt or nitre has been added. If the fluid is under the middle tunic, or under the inner one, these tunics have to be brought out of the scrotal wound, and cut away. |
| 175 |
Ramex autem , si super ipsum scrotum est , adurendus est tenuibus et acutis ferramentis , quae ipsis uenis infigantur , cum eo ne amplius quam has urant ; maximeque , ubi inter se implicatae glomerantur , eo ferrum id admouendum est . Tum super farina ex aqua frigida subacta inicienda est , utendumque eo uinculo , quod idoneum esse ani curationibus posui . Tertio die lenticula cum melle inponenda est ; post eiectis crustis ulcera melle purganda , rosa inplenda , ad cicatricem aridis lin amentis perducenda sunt . Quibus uero super mediam tunicam uenae tument , incidendum inguen est , atque tunica promenda ; ab ea uenae digito uel manubriolo scalpelli separandae . Qua parte uero inhaerebunt , et a b superiore et ab inferiore parte lino uinciendae ; tunc sub ipsis uinculis praecidendae , reponendusque testiculus est . At ubi supra tertiam tunicam ramex insedit , mediam excidi necesse est ; deinde , si duae tresue uenae tument , et ita pars aliqua obsidetur , ut maior eo uitio uacet , idem faciendum , quod supra scriptum est , ut et ab inguine et ab testiculo deligatae uenae praecidantur , isque condatur . Sin totum id ramex obsederit , per plagam demittendus digitus index erit , subiciendusque uenis sic , ut paulatim eas protrahat , eaeque adducendae , donec is testiculus par alteri fiat . Tum fibulae oris sic iniciendae , ut simul eas quoque uenas conprehenda nt. Id hoc modo fit : acus ab exteriore parte ora m uulneris perforat ; tum non per ipsam uenam sed per membranam eius emittitur per eamque in alteram oram conpellitur . Vena uulnerari non debet , ne sanguinem fundat . Membrana semper inter has uenas est , ac neque periculum adfert , et filo conprehensa illas abunde tenet . Itaque etiam satis est duas fibulas esse . Tum uenae , quaecumque protractae sunt , in ipsum inguen auerso specillo conpelli debent . Soluendi fibulas tempus inflammatione finita et purgato uulnere est , ut una simul et oras et uenas cicatrix deuinciat . Vbi uero inter imam tunicam et ipsum testiculum neruumque eius ramex est ortus , una curatio est , quae totum testiculum abscidit . Nam neque ad generationem quicquam is confert , et omnibus indecore , quibusdam etiam cum dolore dependet . Sed tum quoque inguen incidendum , media tunica promenda atque excidenda est ; idem imae faciundum ; neruus , ex quo testiculus dependet , praecidendus . Post id uenae et arteriae ad inguen lino deligandae et infra uinculum abscidendae sunt .
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22 Now a varix, when in the scrotal skin, must be burnt with finely pointed cauteries, which penetrate into the veins themselves, but so that nothing deeper than the veins is burnt; the cautery is to be applied especially where the veins form a twisted mass. Then flour which has been steeped in cold water is put on and over this the bandage I have described as suitable after anal operations. On the third day lentil meal with honey is applied: after the crusts have separated the ulcers are to be cleaned with honey, filled with rose oil, and cicatrized with dry lint. But when the veins overlying the middle tunic swell, the groin is to be incised and the tunic pressed out into the wound; from it the veins are separated by a finger or the handle of the scalpel. But at the part where they are still attached, the veins are to be tied with linen thread both above and below that part; then cut away just beyond the ligatures and the testicle replaced. But when the varix is situated upon the inner tunic, it is necessary to cut through the middle tunic; then, if but two or three veins are swollen and some part only is involved, so that most of it is still free of the disease, the same is to be done as described above, so that the veins after being ligatured on the side of the groin and testicle respectively are cut away, after which the testicle is replaced. But if the varix involves the whole of one testis, the index finger is to be passed into the wound and under the veins, so as to draw them gradually forward, and they must be brought up until the testicle of that side is level with the opposite one. Then pins are passed through the edges so that at the same time they take up the veins as well. It is done in this way: the pin perforates from without through one edge of the wound, then it is passed not through an actual vein but through its membrane, and is pushed out through this to the opposite margin of the incision. There is always a membrane between these veins, and no danger is involved, and when the pin has been fixed by a thread it holds the veins fast enough. Then whatever veins have been drawn forwards should be pushed back within the inguinal wound by the reverse end of the probe. The time to take out the pins is when the inflammation has ceased and the wound has cleaned, so that one and the same scar may bind together simultaneously both the margins of the incision and the veins. But if a varix has developed between the inner tunic and the testicle itself and its cord, there is but one method of treatment, to excise the testicle entirely. For it is now useless for generation, and always hangs down in an ugly way, while it is sometimes painful as well. But in this case also the groin is to be cut into, the middle tunic pressed out and cut away, and the inner tunic likewise. Then the cord by which the testicle is suspended is to be cut through. After this the veins and arteries towards the groin are to be ligatured with linen thread, and cut away below the ligature. |
| 176 |
Caro quoque , si quando inter tunicas concreuit , nihil dubi est , quin eximenda sit ; sed id ipso scroto inciso fieri commodius est . At si neruus in duruit , curari res neque manu neque medicamento potest . Vrguent enim febres ardentes et aut uirides aut nigri uomitus ; praeter haec ingens sitis et linguae aspritudo ; fereque a die tertio spuma ns bilis aluo cum rosione redditur . At neque adsumi facile cibus neque contineri potest , neque multo post extremae partes frigescunt , tremor oritur , manus sine ratione extenduntur ; deinde in fronte frigidus sudor , eumque mors sequitur .
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23 Flesh also, if it ever grows between the tunics, must certainly be cut out; but it is better to make an incision through the scrotum itself. But if the cord has become indurated, the condition cannot be cured either by surgery, or by medicaments. For burning fevers and green or black vomit oppress the patients, and besides these great thirst and roughness of the tongue; and generally from the third day frothy bile is passed in a smarting motion. But the patient cannot readily either take food, or retain it; not long after the extremities grow cold, tremor arises, the hands are outstretched involuntarily; then a cold sweating on the forehead is followed by death. |