De Medicina |
Translator: Walter George Spencer
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| 181 |
Et hoc quidem commune esse et maribus et feminis potest : proprie uero quaedam ad feminas pertinent , ut in primis quod earum naturalia nonnumquam inter se glutinatis oris concubitum non admittunt . Idque interdum euenit protinus in utero matris ; interdum exulceratione in his partibus facta , et per malam curationem hi c oris sanescendo iunctis . Si ex utero est , membrana ori uoluae opposita est ; si ex ulcere , caro ide m repleuit .—Oportet autem membranam duabus lineis inter se transuersis incidere ad similitudinem litterae X , magna cura habita , ne urinae iter uioletur , deinde undique eam membranam excidere . A t si caro increuit , necessarium est recta linea patefacere ; tum ab ora uel uolsella uel hamo adprensa tamquam habenulam exc idere , et intus implicitum in longitudinem lin amentum ( lemniscum Graeci uocant ) in aceto tinctum d emittere , supraque sucidam lanam aceto madentem deligare ; tertio die soluere ulcus et sicut alia ulcera curare ; cumque iam ad sanitatem tendet , plumbeam fistulam medicamento cicatricem inducent e inlin ere eamque intus dare , supraque idem medicamentum inicere , donec ad cicatricem plaga perueniat .
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28 And whilst the foregoing can occur both in males and females, there are also some troubles which are peculiar to females, especially that occasionally their genitals do not allow of coitus, the orifices having coalesced. And this sometimes happens even in the mother's womb; sometimes when ulceration has occurred in those parts, and through bad treatment there the margins have become united during healing. If the condition is congenital a membrane obstructs the vulvar orifice; if due to ulceration flesh has filled the same. The membrane should be incised along two lines crossing one another like the letter X, great care being taken that the urethra is not injured; then the membrane is to be cut away all round. But if flesh has grown there, it must be laid open with a single straight cut; next when the margin has been seized either with a forceps or hook, a fine strip must be cut away from it, after which there is inserted wool rolled lengthwise (the Greeks call it lemniscus), dipped in vinegar, and over this is bandaged on greasy wool wetted with vinegar: this is changed on the third day and the wound treated like other wounds; and as soon as it begins to heal, a lead tube smeared with a cicatrizing ointment is passed in, and over this the same application applied until the cut surface has cicatrized. |
| 182 |
Vbi conc epit autem aliqua , si iam prope maturus partus intus emortus est neque excidere per se potest , adhibenda curatio est , quae numerari inter difficillima potest : nam et summam prudentiam moderationemque desiderat , et maximum periculum adfert . Sed ante omnia uuluae natura mirabilis cum in multis aliis tum in hac re quoque facile cognoscitur .—Oportet autem ante omnia resupinam mulierem transuerso lecto sic collocare , ut feminibus eius ipsius ilia conprimantur ; quo fit , ut et imus uenter in conspectu medici sit et infans ad os uoluae conpellatur . Quae emortuo partu id conprimit , ex interuallo uero paulum dehiscere †ut . Hac occasione usus medicus unctae manus indicem digitum primum debet inserere atque ibi continere , donec iterum ad aperiatur , rursusque alterum digitum demittere debebit , et per easdem occasiones alios , donec tota esse intus manus possit . Ad cuius rei facultate m multum confert et magnitudo uoluae et uis neruorum eius et corporis totius habitus et mentis etiam robur , cum praesertim intus nonnumquam etiam duae manus dari debeant . Pertinet etiam ad rem quam caldissimum esse imum uentrem et extrema corporis , nequedum inflammatione m coepis se , sed recenti re protinus adhiberi medicinam . Nam si corpus iam intumuit , neque demitti manus neque educi infans nisi aegerrime potest sequiturque saepe cum uomitu , cum tremore mortifera neruorum distentio . Verum intus emortuo corpori manus iniecta protinus habitum eius sentit . Nam aut in caput aut in pedes conuersum est , aut transuersum iacet ; fere tamen sic , ut uel manus eius uel pes in propinquo sit . Medici uero propositum est , ut eum manu derigat uel in caput uel etiam in pedes , si forte aliter conpositus est : ac si nihil aliud est , manus uel pes adprehensus corpus rectius reddit : nam manus in caput , pes in pedes eum conuertet . Tum si caput proximum est , demitti debet uncus undique leuis , acuminis breuis , qui uel oculo uel auri uel ori , interdum etiam fronti recte inicitur ; deinde adtractus infantem educit . Neque tamen quolibet is tempore extrahi debet : nam si conpresso uoluae ore id temptatum est , non emittente eo infans abrumpitur , et unci acumen in ipsum os uoluae delabitur ; sequiturque neruorum distentio et ingens periculum . Igitur conpressa uolua conquiescere , hiante leniter trahere oportet , et per has occasiones paulatim eum educere . Trahere autem dextra manus uncum , sinistra intus posita infantem ipsum , simulque eum derigere debet . Solet etiam euenire , ut is infans umore distendatur , exque eo profluat foedi odoris sanies . Quod si tale est , indice digito corpus illud forandum est , ut effuso umore extenuetur ; tum id leniter per ipsas manus recipiendum est . Nam uncus iniectus facile hebeti corpusculo labitur ; in quo quid periculi sit , supra positum est . In pedes quoque conuersus infans non difficulter extrahitur ; quibus adprehensis per ipsas manus commode educitur . Si uero transuersus est neque derigi potuit , uncus alae iniciendus , paulumque adtrahendus est ; sub quo fere ceruix replicatur , retroque caput a d relicum corpus spectat . Remedio est ceruix praecisa , ut separatim utraque pars auferatur . Id unco fit , qui prioris similis in interiorem tantum partem per totam aciem exacuitur . Tum id agendum est , ut ante caput , deinde reliqua pars auferatur , quia fere maiore parte extracta caput in uacuam uoluam prolabitur , extrahique sine summo periculo non potest . Si tamen id incidit , super uentrem mulieris duplici panniculo iniecto , ualens homo non inperitus a sinistro latere eius debet adsistere et super imum uentrem eius duas manus inponere alteraque alteram premere ; quo fit , ut illud caput ad os uoluae conpellatur ; idque eadem ratione , quae supra posita est , unco extrahere * . At si pes alter iuxta repertus est , alter retro cum corpore est , quicquid protractum , paulatim abscidendum est : et si clunes os uuluae urguere coeperunt , iterum retro repellendae sunt , conquisitusque pes eius adducendus . Aliaeque etiamnum difficultates faciunt , ut , qui solidus non exit , concisus eximi debeat . Quotiens autem infans protractus est , tradendus ministro est , ut is eum supinis manibus sustine at ; medicus deinde sinistra manu leniter trahere umbilicum debet ita ne abrumpat ; dextra eum sequi usque ad eas , quas secundas uocant ( quod uelamentum infantis intus fuit ) , isque ultimis adprehensis uenulas membranulasque omnes eadem ratione manu deducere a uolua , totumque illud extrahere et si quid intus praeterea concreti sanguinis remanet . Tum conpressis in unum feminibus , illa conclaui collocanda est modicum calorem sine ullo perflat u habente . Super imum uentrem eius inponenda lana sucida in aceto et rosa tincta . Reliqua curatio talis esse debet , qualis in inflammationibus et in is uulneribus , quae in neruosis locis sunt , adhibetur .
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29 Again when a woman has conceived, if the foetus, already nearly at term, dies inside and cannot get out of itself, an operation must be done, which may be counted among the most difficult; for it requires both extreme caution and neatness, and entails very great risk. But this shows, and not this only, how marvellous beyond all else is the womb. To begin with then the woman should be placed on her back across the bed, so that the iliac regions are compressed by her own thighs; by this means both her hypogastrium is in full view of the surgeon and the foetus is forced towards the mouth of the womb. This, after the death of the foetus contracts, but later on usually dilates a little. The surgeon making use of this opportunity should first insert the index finger of his greased hand, and keep it there until the mouth is opened again, and then he should insert a second finger, and the other fingers on the like opportunity, until the whole hand can be put in. To allow of this, much depends both on the size of the vagina, and the resistance of its sinewy tissues, and the patient's constitution, and also her strength of mind, especially since on occasion even both hands have to be passed in. It is also important that the hypogastrium and extremities should be kept very warm, that inflammation should not have begun, but that the treatment should be adopted without delay. For if the abdomen is already distended, the hand cannot be inserted nor can the foetus be extracted without the greatest suffering, and fatal spasm of the sinews often follows, accompanied by vomiting and tremor. But when the hand has reached the dead foetus its position is immediately felt. For it lies head on or feet foremost, or crosswise; generally, however, so that there is either a hand or foot within reach. It is the object now of the surgeon to direct it with his hand either into a head or even into a foot presentation, if it happens to be presenting otherwise: and if there is no other course, when a hand or foot is grasped, the trunk is straightened: for grasping a hand converts the presentation into a head one, grasping a foot into a foot presentation. Then if the head is nearest, a hook must be inserted which is completely smooth, with a short point, and this it is right to fix into an eye or ear or the mouth, even at times into the forehead, then this is pulled upon and extracts the foetus. But not every moment is proper for the extraction; for should this be attempted when the mouth of the womb is contracted, as there is no way out, the foetus is torn away from the hook, and its point then slips into the mouth of the womb itself; and there follows spasm of the sinews and great risk of death. Therefore whilst the mouth is contracted we should wait, and draw gently on the hook when it dilates, and so at these opportunities gradually extract the foetus. Now the right hand should pull the hook whilst the left is inserted within and pulls the foetus, and at the same time guides it. It also often happens that such a foetus is distended by fluid, and from it a foul sanies discharges. If so, the abdomen of the foetus is bored into by the index finger, when by escape of the fluid, the foetus is made smaller; then it is gently to be delivered by the hands alone. For if a hook is inserted it readily slips out of the soft little body, when the danger noted above is incurred. If the foetus has been turned to present by the feet it is also not difficult to extract; for the feet are grasped by the doctor's hands, and it is readily drawn out. But if the foetus is lying crosswise and cannot be turned straight, the hook is to be inserted into an armpit and traction slowly made; during this the neck is usually bent back, and the head turned backwards to the rest of the foetus. The remedy then is to cut through the neck, in order that the two parts may be extracted separately. This is done with a hook which resembles the one mentioned above, but has all its inner edge sharp. Then we must proceed to extract the head first, then the rest, for if the larger portion be extracted first, the head slips back into the cavity of the womb, and cannot be extracted without the greatest risk. Should this, however, happen, a folded pad is placed upon the woman's hypogastrium, and then a man strong, but not untrained, must stand on her left side, and place his two hands over the hypogastrium and press one over the other so that the head is forced to the mouth of the womb, when it must be extracted by the hook as described above. But if one foot presents whilst the other remains behind with the trunk, anything which has been drawn out must be cut away piecemeal; and if the buttocks begin to engage in the mouth of the womb they are to be pushed back and the foot of the foetus found and then drawn forwards. There are also other difficulties, which make it necessary to cut up and extract a foetus which does not come out whole. Now as soon as the foetus has been extracted it should be handed to the assistant to hold on his upturned hands, and the surgeon with his left hand must draw gently upon the navel cord, so as not to rupture it, whilst he passes his right hand along it up to what they called the secundines, which was the envelope of the foetus within the womb. When his hand has grasped the secundines including the whole of the blood vessels and membranes he brings them down from the womb in the same manner, and extracts the whole together with any retained blood clot. Then when the thighs have been tied together the woman is put to bed in a moderately warm room, which is free from draughts. Over the hypogastrium is placed greasy wool dipped in vinegar and rose oil. The rest of the treatment followed is the same as for inflammation and for wounds which are in the sinews. |
| 183 |
Ani quoque uitia , ubi medicamentis non uincuntur , manus auxilium desiderant . Ergo si qua scissa in eo uetustate induruerunt iamque callum habent , commodissimum est ducere aluum ; tum spongiam calidam admouere , ut relaxentur illa et foras prodeant . Vbi in conspectu sunt , scalpello singula excidere et ulcera renouare ; deinde inponere lin amentum molle , et supra linteolum inlitum melle ; locumque eum molli lana inplere et ita uincire ; altero die deincepsque ceteris lenibus medicamentis uti , quae ad recentia eadem uitia necessaria esse alias proposui ; et utique per primos dies sorbitionibus eum sustinere ; paulatim deinde cibis adicere aliquid , generis tamen eius , qu oius eodem loco praeceptum est . Si quando autem ex inflammatione pu ris quid in his oritur , ubi primum apparuit , incidendum est , ne anus ipse suppuret . Neque tamen ante properandum est : nam si crudum incisum est , inflammationis multum accedit , et puris aliquanto amplius concitatur . In his quoque uulneribus lenibus cibis isdemque medicamentis opus est . At tubercula , quae condylomata appellantur , ubi induruerunt , hac ratione curantur . Aluos ante omnia ducitur ; tum uulsella tuberculum adprehensum iuxta radices praeciditur . Quod ubi factum est , eadem sequntur , quae supra post curationem adhibenda proposui : tantummodo , si quid increscit , squama aeris coercendum est . Ora etiam uenarum fundentia sanguinem sic tolluntur . Vbi sanguis cui fluit , fames indicitur , aluus acrius ducitur , quo magis or a promoueantur ; eoque fit , ut omnia ue narum quasi capitula conspicua sint . Tum si capitulum exiguum est basimque tenuem habet , adstringendum lino paulum supra est , quam ubi cum ano committitur . Inponenda * * aqua calida spongia est , donec id liueat ; deinde aut ungue aut scalpello supra nodum id exulcerandum est . Quod nisi factum est , magni dolores subsequuntur , interdum etiam urinae difficultas . Si id maius est et basis latior , hamulo uno aut altero excipiendum est paulumque supra basim incidendum ; neque relinquendum quicquam ex eo capitulo neque quicquam ex ano demendum est . Quod consequitur is , qui neque nimium neque parum hamos ducit . Qua incisum est , acus debet inmitti infraque eam lino id capitulum alligari . Si duo triaue sunt , imum quo dque primum curandum est ; si plura , non omnia simul , ne tempore eodem undique tenerae cicatrices sint . Si sanguis profluit , excipiendum est spongia ; deinde linamentum inponendum ; unguenda femina et inguina et quicquid iuxta ulcus est ; ceratumque superdandum et farina hordiacia calida , inplendusque is locus est * * sic deligandus est . Postero die is desidere in aquam caldam debet eodemque cataplasmate foueri . Ac bis die , et ante curationem et post eam , ceruices ac femina liquido cerato perunguenda sunt ; tepidoque is loco continendus . Interpositis quinque aut sex diebus oriculario specillo linamenta educenda . Si capitula simul non exciderunt , digito promouenda ; tum lenibus medicamentis isdem , quae alia s posui , ulcera ad sanitatem perducenda . Finito uitio , quemadmodum agendum esset , iam alias exposui .
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30 Lesions of the anus also, when they do not yield to medicaments, require the aid of surgery. If, therefore, any fissure has persisted so long that it has become hard and callous, it is best to move the bowels by a clyster, then apply a hot sponge to soften the fissures and cause them to protrude. When brought into view each is excised and made into a fresh wound; then soft lint is put on and over this a pad smeared with honey, and all is covered with soft wool, fixed by a bandage; on the next and following days all the other emollient medicaments are to be used, which I said above, were required by such lesions when recent, and for the first few days at any rate the patient must live on fluids; then some food is gradually added, but of the class prescribed in the same passage. If however any pus arises in these fissures as the result of inflammation, as soon as it becomes evident, it is to be cut into, lest the anus itself suppurate. But this must not be done hastily, for if cut before it matures the inflammation is very much increased, and pus is somewhat more freely formed. Here too a light diet and emollient dressings are necessary. The tumours, which are called condylomata, when hardened are treated by the following method. First of all the bowel is clystered; then the tumour is seized with a forceps close to its roots and cut away. After this, the same course of treatment is followed as that described above; only if there is any excrescence it is repressed by copper scales. The mouths of veins which discharge blood are removed as follows. When any patient is losing blood, fasting is indicated, and a rather severe clystering of the bowel, to make the openings more prominent, and thus what may be called the little heads of the veins all come into view. Then if a head is very small and has a thin base it must be tied by a flax thread, a little above where it joins the anus. A sponge squeezed out of hot water is next to be applied until it becomes livid, then with a finger-nail or scalpel it is to be scratched off above the knot. Unless this is done great pain follows, and sometimes even difficulty in urinating. If the head is larger and the base broader, it is seized by one or two hooks, and an incision made a little above the base; in doing this nothing of the head should be left nor anything taken away from the anus. This is accomplished by not drawing upon the hooks either too much or too little. When the incision has been made, a pin should be passed through, and under the pin the head is tied round with a linen thread. If there are two or three, the lowest must be dealt with first; if more, they are not all treated at once, to avoid having tender scars in several places at once. If there is bleeding, it is taken up in a sponge; then lint is put on, the thighs and groins anointed, as well as the parts near the wound; over it is applied a cerate and a poultice of barley meal, and this part must be filled up with soft wool and then bandaged. The next day, the patient should sit in hot water and after that have the same poultice applied. Twice a day, before and after the operation, the necks and thighs are to be anointed with a liquid cerate; and the patient must be kept in a warm room. After five or six days, the bits of linen are removed by the aid of an earscoop. If the little heads do not come away at the same time, they are to be removed by the finger; then by the same soothing medicaments which I have described above, the wounds are healed up. After the trouble has been ended I have already noted elsewhere what must be done. |
| 184 |
Ab his ad crura proximus transitus est , in quibus orti uarices non difficili ratione tolluntur . H uc autem et earum uen ularum , quae in capite nocent , et eorum uaricum , qui in uent re sunt , curationem distuli , quoniam ubi que eadem est .—Igitur uena omnis , quae noxia est , aut adusta tabescit aut manu eximitur . Si recta est , si quamuis transuersa tamen simplex , si modica est , e a melius aduritur . Si curua est et uelut in orbes quosdam inplicatur pluresque inter se inuoluuntur , utilius eximere est . Adurendi ratio haec est : cutis superinciditur ; tum patefacta uena tenui et retuso ferramento candente modice premitur , uitaturque , ne plagae ipsius orae adurantur , quas reducere hamulis facile est . Id interpositis fere quaternis digitis per totum uaricem fit ; et tum superinponitur medicamentum , quo adusta sanantur . At exciditur hoc modo : cute eadem ratione super uenam incisa , hamulo orae excipiuntur ; scalpelloque undique corpore uena deducitur ; caueturque , inter haec ne ipsa laedatur ; eique retusus hamulus subicitur ; interpositoque eodem fere spatio , quod supra positum est , in eadem uena idem fit ; quae quo tendat , facile hamulo extento cognoscitur . Vbi iam idem , quacumque uarices sunt , factum est , uno loco adducta per hamulum uena praeciditur , deinde qua proximus hamus est , adtrahitur ibique rursus absciditur . Ac sic undique uaricibus crure liberato plagarum orae committuntur et super emplastrum glutinans in icitur .
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31 We next pass from the foregoing subjects to the legs, and if varicose veins occur there, they are removed by a procedure which is not difficult. To this place I have put off also the treatment of the small veins which cause trouble in the head, also of varicose veins on the abdomen, because it is all the same. Any vein therefore which is troublesome may be shrivelled up by cauterizing or cut out by surgery. If a vein is straight, or though crooked is yet not twisted, and if of moderate size, it is better cauterized. This is the method of cauterization: the overlying skin is incised, then the exposed vein is pressed upon moderately with a fine, blunt, hot cautery iron, avoiding a burn of the margins of the incision, which can easily be done by retracting them with hooks. This step is repeated throughout the length of the vein, generally at intervals of four fingers' breadth, after which a dressing is put on to heal up the burns. But excision is done in the following way: the skin is similarly incised over the vein, and the margins held apart by hooks; with a scalpel the vein is separated from surrounding tissue, avoiding a cut into the vein itself; underneath the vein is passed a blunt hook; the same procedure is repeated at the intervals noted above throughout the course of the vein which is easily traced by pulling on the hook. When the same thing has been done wherever there are swellings, at one place the vein is drawn forward by the hook and cut away; then, where the next hook is, the vein is drawn forwards and again cut away. After the leg has thus been freed throughout from the swellings the margins of the incisions are brought together and an agglutinating plaster put on over them. |