6. THE stomach is the president of pleasure and disgust, being an important neighbour to the heart for imparting tone, good or bad spirits, from the sympathy of the soul. This is the primary power of the stomach. These things have been described by me in another place. The offspring of pleasure are, good digestion, good condition, and good colour of the body; of disgust, their contraries, and also sometimes depression of spirits, when proper nutrition is wanting; and in melancholic patients, loathing of food. If, then, this organ be diseased, there is dislike and abomination of articles of food, not only if administered, but even if the food is not seen; nay, the very remembrance of them is attended with nausea, distress, water-brash, and heart-ache; and in certain cases there is salivation and vomiting. Even when the body wastes, provided their stomach remain empty, they bear this pain more easily than that produced by the administration of food. But if at any time they are compelled by necessity to take food, the pain is worse than hunger; the act of masticating in the mouth occasions sufferance, and to drink is a still greater pain. And it is not that they suffer thus from suitable food, and bear more unusual food well; owing to a change from that which is natural to the opposite, there is a painful sensation as to everything, an aversion to, and dislike of, all kinds of food. Along with these there is pain between the scapulæ, much greater after the administration of food or drink; loathing, distress, sight dull, noises of the ears, heaviness of the head, torpidity of the limbs, their joints sink under them; palpitation in the hypochondriac region; phantasy, as of the spine being moved towards the lower limbs; they seem as if carried about, now this way and now that, whether they stand, or lie down, like reeds or trees shaken by a gale of wind; they belch out a cold and watery phlegm. But if there be bile in bilious persons, they have dimness of sight, and no thirst, even when owing to the food they appear thirsty; are sleepless, torpid, drowsy, not from true sleep, but like those in comatose affections; emaciated, very pale, feeble, relaxed, imbecile, dispirited, timid, inactive, quick to passion, very moody; for such persons at times have fallen into a state of melancholy. These mental emotions necessarily attend the affection when in connection with the stomach; but certain people, recognising the parts which sympathise, and from which the most dreadful symptoms arise, reckon the stomach as the cause. But the contiguity of the heart, which is of all organs the first, is a strong confirmation of the truth of what I say; for the heart is placed in the middle of the lungs, and this intermediate space comprehends the stomach; and, moreover, both are connected with the spine; and from this vicinity to the heart arise the heart-ache, prostration of strength, and symptoms of melancholy. There are other, and, indeed, innumerable causes of this disease; but the principal is, much pus poured forth by the belly through the stomach. It is familiar to such persons as from their necessities live on a slender and hard diet; and to those who, for the sake of education, are laborious and persevering; whose portion is the love of divine science, along with scanty food, want of sleep, and the meditation on wise sayings and doings—whose is the contempt of a full and multifarious diet; to whom hunger is for food, water for drink, and watchfulness in place of rest; to whom in place of a soft couch, is a hammock on the ground without bed-clothes, a mean coverlet, a porous mantle, and the only cover to whose head is the common air; whose wealth consists in the abundant possession and use of divine thought (for all these things they account good from love of learning); and, if they take any food, it is of the most frugal description, and not to gratify the palate, but solely to preserve life; no quaffing of wine to intoxication; no recreation; no roving or jaunting about; no bodily exercise nor plumpness of flesh; for what is there from which the love of learning will not allure one?—from country, parents, brothers, oneself, even unto death. Hence, to them, emaciation of the frame; they are ill-complexioned; even in youth they appear old, and dotards in understanding; in mind cheerless and inflexible; depraved appetite, speedy satiety of the accustomed slender and ordinary food, and from want of familiarity with a varied diet, a loathing of all savoury viands; for if they take any unusual article of food, they are injured thereby, and straightway abominate food of all kinds. It is a chronic disease of the stomach. But inflammations, defluxions, heart-burn, or pain thereof, are not called the Stomachic affection. Summer brings on this disease, whence springs the complete loss of digestion, of appetite, and of all the faculties. With regard to the period of life, old age; for in old men, even without any disease, owing to their being near the close of life, the appetite is nearly gone.
6. στόμαχος ἡδονῆς καὶ ἀηδίης ἡγεμών· καρδίης καίριον γειτόνευμα ἐς τόνον καὶ θυμὸν, ἢ ἀθυμίην, τῆς ψυχῆς συμπαθείῃ· ἥδε στομάχου πρώτιστα δύναμις. τάδε μὲν οὖν μοι ἄλλῃ λέλεκται. ἀπότοκοι ἡδονῆς μὲν, εὐπεψίη, εὐσαρκίη, εὐχροίη τοῦ σώματος· ἀηδίης δὲ τουτέων τἀναντία, κοτὲ καὶ ἀθυμίη μὴ ἔχων τροφὴν, μελαγχολώδεσι δὲ κἀποσιτίη. ἢν οὖν ὅδε νοσέῃ, μῖσος καὶ ἀποστροφὴ τῶν γευμάτων, οὐκ ἢν προσαίρωνται μόνον, ἀλλὰ κἢν ἀθέητα μὲν ᾖ τὰ σιτία. ἀναπεμπάζονται δὲ ναυτίῃ, ἢ ἀπορίῃ, ἢ πλάδῳ, ἢ καρδιαλγίῃ· καὶ σιαλοχόοι δὲ, καὶ ἔμετοι ἐνίοις. κἢν ὁμῶς τὸ σῶματείρῃ, ἢν γαστὴρ μείνῃ κενεὴ τῶνδε, τόνδε πόνον Ῥηΐτερον φέρει τῆς προσάρσιος. ἢν δὲ καὶ ὑπʼ ἀνάγκης κοτὲ ἐς τὴν ἐδωδὴν ἴῃ, πολλὸν κάκιον ὅδε πόνος τοῦ λιμοῦ· ἐν τῷ στόματι λεῆναι ἄλγος, καταπιεῖν μέζων ὀδύνη· ἀτὰρ καὶ οὐχὶ πρὸς μὲν τὰ οἰκεῖα τοιῶσδε· ἐς δὲ τὰ ἀλλόκοτα χρηστῶς, ἀλλαγῇ τῶν κατὰ φύσιν ἐς τὸ ἔμπαλιν· ἀχθηδὼν ἐς πάντα, καὶ φυγὴ καὶ μῖσος σιτίων· ἐπὶ δὲ τοῖσι μεσσηγὺ τῶν ὠμοπλατέων χωρίοισιν ἄλγος· πολὺ δὲ καὶ μέζον, ἢν προσφέρωνται καὶ καταπίνωσι· ἄση, ἀπορίη, ὄψιες ἀμαυραὶ, ὤτων ἦχοι, βάρεα κεφαλῆς, νάρκη μελέων. καὶ τὰ γυῖα λύονται· παλμὸς ἐν τοῖσι ὑποχονδρίοισι, φαντασίη τῆς Ῥάχιος ἐς τὼ σκέλεε κινευμένης, ἄλλοτε ἄλλῃ τῇδε κἀκεῖσε φέρεσθαι δοκέουσι, κἢν ἑστήκωσι, κἢν κατακέωνται, ὅκως ὑπὸ αὔρης ἀνέμων κάλαμοι, ἢ δένδρεα· φλέγμα ψυχρὸν, ὑδαρὲς ἀποβλύζουσι. ἐπὴν δὲ καὶ χολὴ ᾖ πικροχόλοισι, σκοτώδεες, ἄδιψοι κἢν ἐπʼ ἐδέσμασι διψῆν δοκέωσι, ἄγρυπνοι, νωθροὶ, νυσταλέοι, οὐχ ὕπνῳ ἀτρεκέϊ· κωματώδεσι δʼ ὁμοιοπαθέες, ἰσχνοὶ, ἔξωχροι, ἀσθενέες, ἔκλυτοι, λειποδρανέες, ἄψυχοι, δειλοὶ, ἡσύχιοι· ἐξαπίνης δὲ ὀργίλοι· κάρτα μελαγχολώδεες. καὶ γὰρ ἐξώκειλάν κοτε ἐς μελαγχολίην οἱ τοιοίδε. τάδε μέντοι τῆς ψυχῆς, τοῦ στομάχου ἐνδιδόντος, εἶναι δεῖ τὴν πάθην· οἱ δὲ δὴ ἄνθρωποι οὐκ εἰδότες τὰ ξυμπαθέα μέρεα, ἐφʼ οἷσι τὰ δεινότα τα γίγνεται, τὸν στόμαχον αἴτιον ἡγοῦνται· μέγα δὲ ἐς πίστιν ὧν λέγω ἡ ξυνάφεια τῆς καρδίης, ἔνθα πάντων ἡ ἀρχή. μέσον γὰρ ἐνίζει τῷ πνεύμονι ἡ καρδίη, ἡ δὲ τούτων μεσότης τὸν στόμαχον συνάπτει· ἄμφω δὲ προσπεφύκασιτῇ Ῥάχι· διὰ τόδε πρὸς τὴν καρδίην γειτόνημα, καὶ καρδιαλγίη, καὶ τὰ μελαγχολώδεα. αἰτίαι δὲ τῆς νούσου, καὶ ἄλλαι μὲν μυρίαι, καιρίη δὲ, πῦον συχνὸν ἀπὸ κοιλίης διὰ στομάχου χυθέν. ξύνηθες δὲ καὶ τοῖς ὑπό τε ἀνάγκαις ἐκδεδιῃ τημ ένοις λεπτῇ καὶ σκληροτέρῃ διαίτῃ, ἀτὰρ καὶ τοῖσι ἐς παιδείην πονεῦσι, καὶ ἐς τήνδε τλήμοσι, οἷσι θείης μὲν μαθήσιος ποθὴ, ὀλιγοσιτίη δὲ καὶ ἀγρυπνίη, καὶ μελεδώνη λόγων τε καὶ πρηγμάτων σοφῶν· οἷσι ὑπεροψίη μὲν διαίτης ἁδρῆς καὶ ποικίλης, λιμὸς δὲ ἡ τροφὴ, καὶ ὕδωρ ποτὸν, καὶ ἐν ὕπνῳ ἀϋπνίη. οἷσι μαλθακὴ μὲν εὐνὴ ἄστρωτος χαμαὶ, ἀμφίβλημα δὲ εὐτελὲς, ἀμπεχόνη ἀραιὴ, τὸ δὲ τοῦδε κράνος ὁ κοινὸς ἀὴρ, πλοῦτος δὲ ἐννοίης θείης περιουσίη τε καὶ χρῆσις. τάδε γὰρ αὐτέοισι ἀγαθὰ γίγνεται ἔρωτι παιδείης· καὶ εἰ προσαίρονται, εὐτελὲς μὲν σιτίον, οὐδὲ ἐς κόρον ἐδωδῆς, ἀλλʼ ἐς ζωὴν μοῦνον· οὐκ ἐπʼ οἴνῳ θώρηξις, οὐ θυμηδίη· οὐ Ῥέμβος καὶ περίοδοι, οὐ σωμάτων ἄσκησις, οὐδὲ σαρκῶν περιβολή. τίνος γὰρ οὐκ ἂν ἀπάγοι παιδείης ἔρως; πατρίδος, τοκήων, κασιγνήτων, ἑωυτῶν μέσφι θανάτου. τοῖσδε οὖν τηκεδὼν μὲν τοῦ σκήνεος, ἄχροοι τὴν μορφὴν, καὶ ἐν νεότητι γηραλέοι, καὶ ὑπʼ ἐννοίης κωφοὶ, ψυχὴν δὲ ἀμειδέες, ἀμείλιχοι· στομάχου δὲ κακοσιτίη· ταχὺς ὁ κόρος τῆς ξυνήθεος εὐτελέος καὶ ἑτοίμου τροφῆς, ἀηθείῃ δὲ ποικίλης ἐδωδῆς ὄκνος δὲ πάντων γευμάτων. ἢν δὲ καὶ λάβωσίτι τῶν ξένων, βλάβη, ἀπόστροφοι εὐθὺς ἐς πάντα. ἥδε ἐστὶ στομάχου χρονιη νοῦσος· φλεγμοναὶ δὲ καὶ Ῥεύματα, καὶ καρδιωγμὸς, ἢ πόνος, στομαχικὸν οὐ κικλήσκεται πάθος. θέρος ἄγει τήνδε νοῦσον· ἔνθα καὶ πέψιος καὶ ὀρέξιος καὶ πάντων ἀδυναμίη. ἡλικίη δὲ γῆρας, οἷσι καὶ δίχα πάθεος διὰ τὸ τοῦ βίου τέλος, καὶ ἡ ὄρεξις ἐς τέρμα ἥκει.
7. THE stomach being the digestive organ, labours in digestion, when diarrhœa seizes the patient. Diarrhœa consists in the discharge of undigested food in a fluid state; and if this does not proceed from a slight cause of only one or two days’ duration; and if, in addition, the patient’s general system be debilitated by atrophy of the body, the Cœliac disease of a chronic nature is formed, from atony of the heat which digests, and refrigeration of the stomach, when the food, indeed, is dissolved in the heat, but the heat does not digest it, nor convert it into its proper chyme, but leaves its work half finished, from inability to complete it; the food then being deprived of this operation, is changed to a state which is bad in colour, smell, and consistence. For its colour is white and without bile; it has an offensive smell, and is flatulent; it is liquid, and wants consistence from not being completely elaborated, and from no part of the digestive process having been properly done except the commencement. Wherefore they have flatulence of the stomach, continued eructations, of a bad smell; but if these pass downwards, the bowels rumble, evacuations are flatulent, thick, fluid, or clayey, along with the phantasy, as if a fluid were passing through them; heavy pain of the stomach now and then, as if from a puncture; the patient emaciated and atrophied, pale, feeble, incapable of performing any of his accustomed works. But if he attempt to walk, the limbs fail; the veins in the temples are prominent, for owing to wasting, the temples are hollow; but also over all the body the veins are enlarged, for not only does the disease not digest properly, but it does not even distribute that portion in which the digestion had commenced for the support of the body; it appears to me, therefore, to be an affection, not only of the digestion, but also of the distribution. But if the disease be on the increase, it carries back the matters from the general system to the belly, when there is wasting of the constitution; the patients are parched in the mouth, surface dry and devoid of sweat, stomach sometimes as if burnt up with a coal, and sometimes as if congealed with ice. Sometimes also, along with the last scybala, there flows bright, pure, unmixed blood, so as to make it appear that the mouth of a vein has been opened; for the acrid discharge corrodes the veins. It is a very protracted and intractable illness; for, even when it would seem to have ceased, it relapses again without any obvious cause, and comes back upon even a slight mistake. Now, therefore, it returns periodically. This illness is familiar to old persons, and to women rather than to men. Children are subject to continued diarrhœa, from an ephemeral intemperance of food; but in their case the disease is not seated in the cavity of the stomach. Summer engenders the disease more than any other of the seasons; autumn next; and the coldest season, winter, also, if the heat be almost extinguished. This affection, dysentery and lientery, sometimes are engendered by a chronic disease. But, likewise, a copious draught of cold water has sometimes given rise to this disease.
7. κοιλίη, σπλάγχνον πεπτήριον, κάμνει τὴν πέψιν, ὁκότε διάρροια τὸν ἄνθρωπον ἴσχει· καὶ ἔστιν ὑγρῆς τροφῆς ἀπέπτου ἡ διάρροια· ἀλλʼ ἢν μὴ ἐπὶ σχεδίου τῆς αἰτίης γίγνοιτο τόδε ἐς μίην ἢ δευτέρην ἡμέρην μούνην, πρὸς δὲ καὶ ὅλος ὁ ἄνθρωπος ἀσθενέει, ἀτροφίῃ τοῦ σκήνεος, χρονίη νοῦσος ἡ κοιλιακ ὴ γίγνεται, ἀτονίῃ τοῦ πέσσοντος θερμοῦ, καὶ ψύξι τῆς κοιλίης· εὖτε λύεται μὲν ἐς θερμὸν ἡ τροφή· ἀλλʼ οὐκ ἐκπέσσει θερμὸν, οὐδὲ ἐς χυμὸν οἰκεῖον τρέπει, ἡμιτελέα δὲ λείπει ἀδρανείῃ τοῦ τέλεος. ἡ δὲ ἀφεθεῖσα τῆς ἐργασίης ἐς κακὸν ἀλλοιοῦται καὶ χροιῇ καὶ ὀδμῇ καὶ συστάσι. λευκὴ μὲν γὰρ καὶ ἄχολος ἡ χροιὴ, κάκοδμα δὲ καὶ βορβορώδεα· ὑγρὴ δὲ καὶ ἀσύστατος ἀπραγίῃ, μούνην δὲ ἀρετὴν ἴσχουσα τῆς πέψιος τὴν ἀρχήν. διὰ τόδε φυσώδεες ἐς τὴν γαστέρα, ἐρυγαὶ ξυνεχέες, κακώδεες, ἢν δὲ καὶ κάτω περήσωσι, τρύζει μὲν τὰ ἔντερα, φῦσαι δὲ διεξιᾶσι δασεῖαι, ὑγραὶ, ἀργιλώδεες· φαντασίαι δὲ ἐπʼ αὐτέοισι ὡς διεκθέοντος ὑγροῦ· πόνος τῆς κοιλίης βαρὺς, ὁκοῖον νύγμα, ἄλλοτε καὶ ἄλλοτε· ἰσχνὸς δὲ καὶ ἄτροφος ὥνθρωπος, ὠχρὸς, ἀδρανής· οὐδέν τι πρῆξαι τῶν συνήθων εὔτονος. ἀλλὰ κἢν βαδίζῃ, λύεται τὰ μέλεα, φλέβες κροτάφων ἐπηρμέναι, ἀτροφίῃ γὰρ κοιλοκρόταφοι, ἐπίφλεβοι δὲ καὶ παντὶτῷ σώματι. οὐ γὰρ οὐ πέσσει μοῦνον ἡ νοῦσος, ἀλλʼ οὐδὲ τὴν ἀρχὴν ἐς τὸν ὄγκον ἀναδιδοῖ. δοκέει γάρ μοι οὐ τῆς πέψιος μοῦνον, ἀλλὰ καὶ τῆς ἀναφορῆς τὸ πάθος ἔμμεναι. ἦν δὲ καὶ ἐπʼ αὐξήσει ἡ νοῦσος γίγνηται, ἄγει καὶ τὰ ἀπὸ τοῦ παντὸς εἰς τὴν κοιλίην πάλιν, εὖτε ἤδη τηκεδὼν τῆς ἕξιος. αὐαλέοι δὲ τὸ στόμα, ἄνικμοι δὲ τὴν ἐπιπολὴν, ἀνίδρωτες, κοιλίη ἄλλοτε πυριφλεγὴς ὡς ἀπʼ ἄνθρακος, ἄλλοτε δὲ ὡς ἀπὸ κρυστάλλου ψυχροστ αγής. κοτὲ δὲ καὶ αἷμα τοῖσι ἐσχάτοισι ἐν σκυβάλοισι ἐπιρρέει ξανθὸν, ἄκρητον, ἀμιγὲς, ὡς δοκέειν φλεβὸς στόμιον ἀνεῶχθαι. ἀνεσθίει γὰρ τὸ δριμὺ τὰς φλέβας. μήκιστον καὶ δυσαλθὲς κακὸν, καὶ γὰρ ἢν δοκέῃ πεπαῦσθαι, ἄνευ φανερῆς προφάσιος παλινδρο μέει ἐσαῦθις ἠδὲ καὶ ἐπὶ σμικρῇ ἁμαρτωλῇ παλίνορσος ἥκει. ἐς περίοδον γοῦν ἤδη φοιτῇ. γέρουσι ξύνηθες τὸ κακὸν, καὶ γυναιξὶ μᾶλλον ἢ ἀνδράσι. παιδίοισι δὲ διάρροια μὲν ξυνεχὴς, ἐφημέρῳ ἀκρασίῃ τροφῆς. ἀλλʼ οὐ κοιλίης κύτεϊ ἡ νοῦσος. τίκτει δὲ θέρος τῶν ἄλλων ὡρέων μᾶλλον· μετόπωρον δεύτερον, χειμὼν δὲ ὁ ψυχρότατος, ἢν ἀγχοῦ σβέσιος τὸ θερμὸν ἥκῃ· ἐπὶ χρονίῃ δὲ νούσῳ καὶ ἥδε καὶ δυσεντερίη καὶ λειεντερίη τίκτεται. ἀλλὰ καὶ χανδὸν ψυχροποσίη κοτὲ ξυνέστησε τὴν νοῦσον.
8. PERSONS in colic are cut off speedily by volvulus and tormina. There are very many causes of this affection. The symptoms are, heaviness during abstinence from food, particularly in the part most affected; much torpor; they are inactive, lose appetite, become emaciated, sleepless, swollen in countenance. And if the colon be affected in connection with the spleen, they are of a dark-green colour; but of a light-green when in connection with the liver, from the sympathy of the nearest viscera. And if they take food, even in small quantity, and such as is not flatulent, they become very flatulent, and have a desire to pass wind, which, however, does not find vent: forced eructations upwards, but without effect; or, if any should be forcibly expelled, the flatus is fetid and acid which escapes upwards. The kidneys and bladder sympathise, with pain and ischuria; but in such cases the symptoms interchange with one another. But a greater wonder than these, —an unexpected pain has passed down to the testicles and cremasters; and this sympathetic affection has escaped the observation of many physicians, who have made an incision into the cremasters, as if they were the particular cause of the disease. But in these cases also the symptoms interchange with one another. From this disease are produced other diseases; abscesses and ulcers, of no mild character; dropsies and phthisis, which are incurable. For the disease is formed from cold and thick humours, and a copious and glutinous phlegm; but, also, it comes on with a frigid period of life, a cold season, and a cold locality, and during a hard winter.
8. Κωλικοὶ δὴ κτείνον ται εἰλεῷ καὶ στρόφῳ ὀξέως. πάνυ μὲν οὖν αἴτια μυρία ἴσχει τῆς διαθέσιος· σημήϊα, βάρος μὲν ἐπʼ ἀσιτίῃ, ἔνθα δὴ τὸ πάθος μάλιστά γε κραίνει· ὄκνος πουλὺς, νωθέες, ἀπόσιτοι, ἰσχνοὶ, ἄγρυπνοι, οἰδαλέοι πρόσωπα· κἢν μὲν πρὸς τῷ σπληνὶ νοσέῃ κῶλον, μελάγχλωροι. λευκόχλωροι δὲ, ὁκόσοις πρὸς ἥπατι, ξυμπαθείῃ τῶν ἄγχιστα σπλάγχνων· ἢν δὲ προσαίρωνται τροφὴν, καὶ ἐπὶ σμικρῇ καὶ ἀφύσῳ κάρτα φυσώδεες, καὶ προθυμίη μὲν ἐς διαπνοὴν, ἀδιέξοδοι δὲ φῦσαι, ἐρυγαί τε ἄνω βιώμεναι, ἀτὰρ καὶ αἵδε ἀτελέες. ἢν δέ πηπερήσῃ βίᾳ, φῦσαι βρωμώδεες μὲν αἱ ἄνω καὶ ὀξυρεγμιώδεες· νεφροὶ καὶ κύστις ξυμπαθέα πόνῳ καὶ ἰσχουρίῃ· τουτέοισι ἄλλα ἀντʼ ἄλλων. θωῦμα δὲ τουτέων μέζον, ἐς ὄρχιας καὶ κρεμαστῆρας ἀδόκητον ἄλγος ἐπιφοιτῇ· πολλοὺς τῶν ἰητρῶν ἥδε ἡ ξυμπαθείη λήθει. καὶ γὰρ καὶ ἐξέταμόν κοτε τοὺς κρεμαστῆρας, ὡς ἰδίην ἔχοντας αἰτίην. ἀλλὰ γὰρ καὶ τουτέοισι ἀντʼ ἄλλων ἄλλα. γίγνονται δὲ καὶ ἀπότοκοι τοῦδε νοῦσοι, ἀποστάσιες μὲν καὶ ἕλκεα οὐκ εὐήθεα· ὕδεροι δὲ καὶ φθίσιες, ἀναλθέα. ἐπὶ γὰρ ψύξι καὶ χυμοῖσι παχέσι καὶ φλέγματι πολλῷ κολλώδεϊ ξυνίσταται ἡ νοῦσος· ἀτὰρ καὶ ἡλικίῃ καὶ ὥρῃ ψυχρῇ ἐπιφοιτῇ, χώρῃ, καὶ χείματι καρτερῷ.
9. OF the intestines, the upper being thin and bilious (χολώδεα) as far as the cœcum, have got the Greek name χολώδες. From these proceed the lower, which are thick and fleshy, as far as the commencement of the Rectum.
9. ἐντέρων τὰ μὲν ἄνω λεπτὰ καὶ χολώδεα μέσφι τοῦ τυφλοῦ, χολάδες ἐπίκλην· ἀπὸ δὲ τουτέων τὰ κάτω παχέα καὶ σαρκώδεα μέσφι τῆς ἀρχῆς τοῦ εὐθέος ἐντέρου.
Wherefore ulcers form in all of them; and the varieties of these ulcers constitute Dysentery: on this account, these diseases are complex. For some of them erode the intestines superficially, producing only excoriation; and these are innocuous; but they are far more innocent if the affections be low down. Or if the ulcers be yet a little deeper, they are no longer of a mild character. But ulcers which are deep and have not stopped spreading, but are of a phagedænic, painful, spreading, and gangrenous character, are of a fatal nature; for the small veins get corroded in the course of their spreading, and there is an oozing of blood in the ulcers. Another larger species of ulcers: thick edges, rough, unequal, callous, as we would call a knot in wood: these are difficult to cure, for they do not readily cicatrise, and the cicatrices are easily dissolved.
ἐγγίγνεται οὖν ἐν ἅπασι ἕλκεα· δυσεντερίη δὲ τῶνδε τῶν ἑλκέων αἱ ἰδέαι. διὰ τόδε ποικίλαι ἔασι αἱ νοῦσοι. τὰ μὲν γὰρ ἐπιπολῆς ξέει ἔντερα, ἀναδορὴν μούνην ποιεύμενα, καὶ ἔστιν ἀσινέα. ἀτὰρ δὲ ἀσινέστερα πολλὸν, ἢν κάτω ᾖ τὰ πάθη· ἀλλʼ ἢν δὲ σμικρῷ μὲν ἔτι βαθύτερα τὰ ἕλκεα, οὐκ εὐήθεα δὲ καὶ τάδε. ἄλλα βαθέα καὶ οὐχ ἱστάμενα, ἀλλʼ ἐσθιόμενα, ὀδυνώδεα, ἕρποντα, καὶ ἐπισφακελίζοντα, θανατώδεα. ἀτὰρ καὶ φλέβια ἐπὶ τῇσι νομῇσι γίγνονται περίβρωτα, ἔν τε τοῖσι ἕλκεσι καὶ στάξιες αἱμορραγίας· τὸ μέζον ἄλλο εἶδος ἑλκέων· ὀχθώδεα, τρηχέα, ἀνώμαλα, τυλαίνια, ὡς ἐν ξύλῳ ὄζον εἴπομεν. δυσαλθέα τάδε, οὔτε γὰρ ὠτειλὴν Ῥηϊδίως ἴσχει, Ῥηΐτερόν τε γὰρ λύονται.
The causes of dysentery are manifold; but the principal are, indigestion, continued cold, the administration of acrid things, such as myttôtos, onions by themselves, garlic, food of old and acrid flesh, by which dyspepsia is produced; also unaccustomed liquids, cyceon, or zythus (ale), or any similar beverage produced in any country as a substitute for wine to quench thirst. But also a blow, exposure to cold, and cold drink, create ulcerations.
αἰτίαι δὲ δυσεντερίης μυρίαι, ἐπίκαιροι δὲ, ἀπεψίαι, ψύξιες συνεχέες, δριμέων πρόσαρσις, μυττωτῶν, κρομμύου αὐτοῦ, σκορόδου, κρεῶν παλαιῶν δριμέων ἐδωδή. ἐφʼ οἷσι ἀπεψίη· ὑγρὸν ἄηθες, κυκεὼν, ἢ βρυτέων πόμα, ἢ οἷα κατὰ χώρην ἑκάστην ἀντὶ οἴνου γίγνεται δίψεος ἄκεα. ἀτὰρ καὶ πληγὴ καὶ ψύξις καὶ ψυχροποσίη τίκτουσι ἕλκεα.
The dejections and the circumstances attendant on the ulcers are different in different cases; for, if superficial, when from above, the discharges are thin, bilious, devoid of odour except that which they derive from the intestines; those from the jejunum are rather more coloured, saffron-like, and fetid. Those dejections which contain the food in a dissolved state but rough, are sometimes fetid in smell when the ulcers are gangrenous, and sometimes have the smell as if from scybala. But in the ulcerations from the parts below, the discharges are watery, thin, and devoid of smell. But if deeper they are like ichor, reddish, of the colour of dark wine, or like the washings of flesh; and these are sometimes by themselves and sometimes with the fæces, these being dissolved in the surrounding fluid, devoid of bile and of smell; or they are evacuated in a consistent and dry state, lubricated with the surrounding fluid. But if the ulcers be larger and smoother, in those above they are bilious, and pinch the parts from which they come and through which they pass (they even pinch the anus), for the bile is acrid, more especially if from an ulcer; and the bile is fatty, like grease. In the deeper ulcers below, a thick clot of blood with phlegm, like flesh not very fat, or like the scrapings of the bowels: nay, even entire portions are mixed up with them; they are discharged white, thick, mucous, like chopped tallow, along with the humour in which they float: these proceed from the rectum: but sometimes they are merely mucous, prurient, small, round, pungent, causing frequent dejections and a desire not without a pleasurable sensation, but with very scanty evacuations: this complaint gets the appellation of tenesmus. But from the colon there are discharged pieces of flesh, which are red, large, and have a much larger circumference. If the ulcers become deep, and the blood thick and feculent, these are more fetid than the former; but if the ulcers spread and are phagedænic, and if nothing will stop them, above, in addition to being intensely bilious, the dejections become saffron-like, frothy, feculent, blackish, like woad or like leeks, thicker than the former, fetid like a mortification; food now undigested, as if only masticated by voracious teeth. But if the under parts are also corroded, black clots of blood, thick, fleshy, very red, clotted, sometimes, indeed, black, but at other times of all various colours, fetid, intolerable; involuntary discharges of fluids. And sometimes a substance of considerable length, in many respects not to be distinguished from a sound piece of intestine, has been discharged, and, to those ignorant of the matter, has caused apprehension about the intestine: but the fact is this,—the intestines, like the stomach, consist of two coats, which lie close to one another in an oblique manner; when, therefore, the connection between them is dissolved, the inner coat, being separated to some length, protrudes externally, while the outer one remains alone, incarnates, and gets cicatrised, and the patients recover and live unharmed. It is the lower gut alone which suffers thus, owing to its fleshy nature. And, if blood be discharged from any vessel, it runs of a bright red or black colour, pure, and unmixed with food or scybala; and if a concretion is spread over it like broad spiders’ webs, it coagulates when cold, and no longer would be taken for a secretion of blood; but being discharged with much flatulence and noise, it has the appearance of being much larger than its actual amount. Sometimes, also, a purulent abscess forms in the colon, nowise different from the other internal ulcers; for the symptoms, the pus, and the mode of recovery are the same. But if there be hard secretions of matters resembling flesh, as if pounded, and like rough bodies, the abscess is not of a mild nature. Sometimes a copious discharge of water takes place from the colon in the form of dysentery, which has freed many patients from dropsy. In a word, such are the ulcers in the intestines; and their forms and the secretions from them as I have described.
αἱ δὲ ἐκκρίσιες καὶ τὰ ξυνεόντα τοῖσι ἕλκεσι ἕτερα καὶ ἕτερα, ἐπʼ ἄλλοισι καὶ ἄλλοισι. ἢν μὲν γὰρ ἐπιπολῆς ἔῃ, ἄνωθεν μὲν λεπτὰ, χολώδεα, ἄνοσμα, πλὴν ὁκόσον ἀπʼ ἐντέρων. τὰ δὲ ἀπὸ τῆς νήστιος κατακορέα μᾶλλον, κροκοειδέα, κακώδεα· τὰ δὲ καὶ ξὺν τῇ τροφῇ λελυμέν ῃ μὲν, ἀλλὰ τρηχείῃ, ἄλλοτε κάκοδμόν ἐστι, τὰ δὲ ἕλκεα σηπεδώνεα ἄλλοτε δὲ ἴσχει, ὡς ἀπὸ σκυβάλων μοῦνον τὴν ὀσμήν· ἀπὸ δὲ τῶν κάτω ἐπὶ τοῖσι ἕλκεσι, ὑδατώδεα, λεπτὰ, ἄνοσμα· ἢν δὲ ἐπὶ μᾶλλον βαθέα, ἰχωροειδέα, ὑπέρυθρα, οἰνώδεα, ἢ ὅκως κρεῶν πλύμα. ἄλλοτε μὲν ἰδίῃ τάδε, ἄλλοτε δὲ ξὺν τοῖσι κοπρίοισι· καὶ τάδε ὑγρὰ λελυμένα τῷ περιρρόῳ, ἄχολα, ἄνοσμα· ἢ ξυνεστῶτα, ξηρὰ ἐξίασι, ὀλισθηρὰ τῷ περιρρόῳ· ἢν δὲ μέζω καὶ λειότερα ᾖ τὰ ἕλκεα, ἐπὶ μὲν τοῖσι ἄνω, χολώδεα, καὶ ἀφʼ ὧν καὶ διʼ ὧν ἔρχεται — καὶ γὰρ τὴν ἕδρην, — δάκνει. δριμεῖα γὰρ ἡ χολὴ, καὶ ἐπὶ μᾶλλον ἢν ἀφʼ ἕλκεος· καὶ ἡ χολὴ δὲ πίων ὅκως λίπας. ἐπὶ δὲ τοῖσι βαθυτέροις τοῖσι κάτω αἱμάλωψ παχὺς σὺν φλέγματι, σαρκοειδέα οὐ κάρτα πίονα, ξυσματώδεα, ὡς ἀπʼ ἐντέρων εἶναι. ἀτὰρ καὶ ὅλα συμμέμικται μέρεα· φέρεται λευκὰ, παχέα, μυξώδεα, στέατι ξυγκοπέντι ἴκελα, ξὺν τῷ περιρρόῳ. τάδε μέντοι ἀπὸ τοῦ εὐθέος τοῦ παραμήκεος ἐντέρου. ἄλλοτε δὲ μυξώδεα μοῦνον, ὀδαξώδεα, σμικρὰ, στρογγύλα, δακνώδεα, ἐξαναστάσιας πυκινὰς, καὶ προθυμίην ξὺν ἡδονῇ ποιεύμενα, ἐκκρίσιας δὲ κάρτα σμικράς· τεινασμὸς τοῦδε ἡ ἐπίκλησις. ἀπὸ δὲ τοῦ κώλου φέρονται καὶ σάρκες ἐξέρυθροι καὶ μεγάλαι, περιγραφὴν πολλὸν μέζονα ἔχουσαι· εἰ δὲ βαθέα γίγνεται τὰ ἕλκεα, καὶ αἷμα παχὺ, τρυγῶδες, τάδε κάκοδματῶν πρόσθεν μᾶλλον. ἐπην δὲ ἕρπῃ καὶ ἐσθίῃ τὰ ἕλκεα, καὶ ἴσχηται μηδαμᾶ ἐπὶ μηδενὶ, ἄνωθεν μὲν πρὸς τοῖσι χολώδεσι τοῖσι κατακορέσι, κροκώδεα, καὶ ἔπαφρα, τρυγίζοντα, καὶ μέλανα, ἰσατώδεα, πρασοειδέα, παχύτερατῶν πρόσθεν, κακώδεα, ὅκως ἡ σηπεδὼν, διαχωρέει. τροφὴ νῦν ἀπεπτοτέρη, ὡς ὑπὸ ὀδόντων λάβρων τετριμμένη μοῦνον. ἢν δὲ τὰ κάτω ἀνεσθίηται, αἱμάλωπες μέλανες, παχέα, σαρκοειδέα, ἐξέρυθρα, θρομβώδεα, ἄλλοτε μὲν μέλανα, ἄλλοτε δὲ παντοίως ποικίλα, κάκοδμα, οὐ φορητὰ, ἀφέσιες τῶν ὑγρῶν ἀβούλητοι· ἀπελύθη κοτὲ καὶ εὔμηκες ἄκριτον κατὰ πλεῦνα, ὅκως ὑγιὲς τὸ ἔντερον, καὶ δέος παρέσχεν ἀμφὶ ἔντερον τοῖσι ἀγνοοῦσι τοῦ πρήγματος. τὸ δέ ἐστι τοιόνδε. τῶν ἐντέρων, ὅκως τῆς κοιλίης, χιτῶνες ἔασι δοιοί· ἀτὰρ καὶ ἀλλήλοισι ἐπιβάλλουσι οἵδε λοξοί. ἢν οὖν ἡ διπλόη λυθῇ, ὁ μὲν ἐντὸς χιτὼν ἀποστὰς ἐς μῆκος ἔξω χωρέει, ὁ δὲ ἐκτὸς μίμνει μοῦνος, καὶ σαρκοῦται, καὶ ἐπωτειλοῦται, καὶ ἀλθέξονται, καὶ ζώωσι ἀσινέες. πάσχει δὲ τὸ κάτω μοῦνον, αἰτίη δὲ τῶν χιτώνων τὸ σαρκοειδές. ἢν δὲ αἷμα ἀπό τευ ἀγγείου φέρηται ξανθὸν, ἢ μέλαν, καθαρὸν Ῥέει, ἀμιγὲς τροφῆς, ἢ σκυβάλων ἄτερ. εἰ δὲ ἐπίπαγοςἐπιπετάννυτο πλατέσι ἀραχνίοισι ἴκελος θρομβοῦται, ἢν ψυχθῇ· οὐδὲ γὰρ ἡ πίστις αἵματος ἔκκρισις· τῷ δὲ Ῥοίζῳ πολλῷ ξὺν πνεύματι μέζων τῆς περιστάσιος ἡ φαντασίη τῆς ἐκκρίσιος. γίγνεταί κοτε καὶ ἐν κώλῳ πύου ἀπόστασις, οὐδέν τι τῶν ἄλλων τῶν ἐντὸς ἑλκέων ξενοπρεπεστέρη. καὶ γὰρ τὰ σημήϊα καὶ τὸ πῦον καὶ ἡ ἄλθεξις τῶν ἑλκέων ἡ ὠυτή. ἢν δὲ ἐκκρίσιες σκληραὶ τῶν σαρκοει δέων ἔωσι, τετριμμέναι, τρηχέσι σώμασι ἴκελαι, ἡ ἀπόστασις οὐ τοῦ εὐήθεος τρόπου· ῥέει κοτὲ πολλὸν ἀπὸ τοῦ κώλου ὕδωρ, δυσεντεριώδεα τρόπον. ὕδρωπος τόδε μυρίους ἐρρύσατο. τὰ μὲι ἕλκεα, ὡς ἔπος εἰπεῖν, τὰ ἐν τοῖσι ἐντέροισι τοιάδε·
I will now describe the symptoms accompanying each of these states of disease, whether the ulcers be mild or malignant. To speak in general terms, then, if the excoriation is superficial, whether it be above or below, the patients are free from pain and from fever, and get better without being confined to bed, in various ways, by merely some slight changes of diet. But if ulceration supervene, in the upper bowels there are tormina, which are pungent, acrid, as if from the presence of a small amount of hot bile; and occasionally there is suppuration: indeed, for the most part, there is suppuration, or digestions imperfectly performed, though there is no want of appetite. But if the ulcers form in the lower part of the bowels, they are much less dangerous than in those above, for the bowels there are of a much more fleshy nature than those above. But if those above become hollow and phagedænic, there are acute fevers, of a latent kind, which smoulder in the intestines; general coldness, loss of appetite, insomnolency, acid eructations, nausea, vomiting of bile, vertigo: but if the discharge become copious, and consist of more bilious matters, the tormina become permanent, and the other pains increase; sometimes there is prostration of strength, feebleness of the knees; they have ardent fever, are thirsty, and anxious; black vomiting, tongue dry, pulse small and feeble. Akin to these are the fatal symptoms I have stated among those of malignant ulcers; cardiac affections even to deliquium animi, from which some never recover, but thus expire. These dangerous symptoms are common also to erosions of the lower intestines if the ulcers spread, and the discharge be not checked, only that the tormina and pains are below the umbilicus where the ulcers are situated. The forms of the secretions are such as I have said; but if they be small at first, and there be a postponement of their spreading for a long time, various changes take place in the ulcers, some subsiding, and others swelling up, like waves in the sea. Such is the course of these ulcers. But if nature stand out, and the physician co-operate, the spreading may, indeed, be stopped, and a fatal termination is not apprehended, but the intestines remain hard and callous, and the recovery of such cases is protracted.
ἀτὰρ ἠδὲ καὶ ἡ τῶνδε ἰδέη, καὶ αἱ ἀπὸ τῶνδε ἐκκρίσιες, ὁκόσας ἔλεξα. φράσω δὲ καὶ τὰ ξυνεόντα ἑκάστοισι τῶν νοσεόντων, ἤν τε εὐήθεα, ἤν τε σιναρὰ ᾖ τὰ ἕλκεα. ἀθρόον μὲν οὖν εἰρήσθω, ἢν ἐπιπολῆς ἀναδορὴ, ἤν τε ἄνω, ἤν τε κάτω ἔῃ, ἄπυροι, ἄπονοι, ὀρθοστάδην ὑγιαζόμενοι, σμικρῆσι τῇσι διαίτῃσι ἑτεροίως. ἢν δὲ ἕλκος ἐγγένηται, ἐπὶ μὲν τοῖσι ἄνω στρόφος δακνώδης, δριμὺς, ὡς ἀπὸ χολῆς θερμῆς σμικρῆς, ἔμπυοι ἄλλοτε καὶ ἄλλοτε· τὸ δὲ πλέον, ἔμπυοι. ἢ πέψιες ἡμιτελέες, οὐκ ἀπόσιτοι· ἢν δὲ τοῖσι κάτω ἕλκεα γένηται, πολλόν τι ἀσινέστερα τῶν ἄνω· καὶ γὰρ τὰ ἔντερα πολλόν τι μᾶλλον τῶν ἄλλων σαρκοειδέα. ἢν δὲ κοῖλα καὶ ἀνεσθίοντα ἐς τὰ ἄνω γένηται, πυρετοὶ ὀξέες, ἀλαμπέες, ἐν τοῖσι σπλάγχνοισι ὑποβρύχιοι, περίψυξι ς, ἀποσιτίη, ἀγρυπνίη· ἐρυγαὶ κακώδεες, ναυτίη, χολῆς ἔμετοι, σκοτοδίνη· ἢν δὲ πολλὴ μὲν ἡ φορὴ, χολωδεστέρων δὲ γίγνηται, ἐπίμονοι στρόφοι, καὶ ἄλλοι πόνοι μᾶλλον· ποτὶ καὶ ἐκλύσιες δυνάμιος, ὑπολύσιες γουνάτων, καυσώδεες, διψαλέοι, ἀσώδεες, ναυτίη μελάνων, γλῶσσα ξηρὴ, σφυγμοι σμικροὶ, ἄτονοι. τουτέων ἀδελφὰ, ὀκόσαἐπὶ τοῖσι κακοειδέσι ἕλκεσι ἔλεξα τὰ θανατώδεα. καρδιώσσουσι μέσφι λειποθυμίης. μετεξέτεροι δὲ οὐδὲ ἐς ἀνάκτησιν ἐπαλινδρόμησαν· ἀλλʼ οὕτως ἐξέθανον· τάδε τὰ δεινὰ ξυνὰ καὶ τῇσι ἀπὸ τῶν κάτω ἐντέρων διαβρώσεσι, ἢν νέμηται μὲν τὰ ἕλκεα, ἄσχετος δὲ ἡ φορή· πλὴν ὁκόσον οἱ στρόφοι καὶ οἱ πόνοι ὑπὸ τὸν ὀμφαλὸν κάτω, ἔνθα τὰ ἕλκεα. ἰδέαι δὲ αἵδε τῶν ἐκκρίσεων, ὁκοίας ἔλεξα. ἢν δὲ ἐπὶ τοῖσι πρώτοισι σμικρὰ ᾖ, ἀνακωχὴ δὲ εἰς μακρὸν ᾖ νομῆς, ἄλλα ἐπʼ ἄλλοις ἕλκεα γίγνεται, τῶν μὲν πρηϋνομέ νων, ἄλλων δὲ κορυφουμένων, ὅκως ἐν θαλάσσῃ κύματα. τοιόνδε τὸ τῶν ἑλκέων χύμα. ἢν δὲ καί κοτε ἐπαρκέσῃ μὲν ἡ φύσις, συνασκήσῃ δὲ καὶ ὁ ἰητρὸς, πέπαυται μὲν ἡ νομὴ, καὶ θάνατον οὐκ ὀρρωδέει, σκληρὰ δὲ καὶ ὀχθώδεα μίμνει τὰ ἔντερα, καὶ τῶνδε ἐς μακρὸν ἡ ἄλθεξις.
In hemorrhage from the bowels, if it proceed from a large vein or artery, it is sudden death; for neither is it possible to introduce the hand so as to reach the ailment, nor to apply any medicine to the sore. And even if the hemorrhage were restrained by the medicine, the escape from death would not be certain; for, in some cases, the falling off of a large eschar widens the mouth of the vein, and when clots form within, and remain there, the disease is incurable. It is necessary, then, to cure hemorrhages in their commencement. Its approach, also, for the most part is obvious, although not in all cases quite apparent: anxiety attends, with restlessness, heaviness in the part where the rupture is to take place, ruddiness of the countenance if the blood has not yet burst forth. And if the vein has burst lately, for the most part the symptoms are alleviated; but if it has been a longer time ago, this takes place more slowly, and with more difficulty. Such are the ulcers in the intestines.
αἱμορραγίῃ δὲ ἀπʼ ἐντέρων, ἢν μὲν μεγάλης φλεβὸς ἢ ἀρτηρίης ἔῃ, ὠκὺς ὁ θάνατος. οὐδὲ γὰρ οὐδὲ τὴν χεῖρα δυνατὸν ἔσω ἐσμάσασθαι, καὶ τοῦ ἄλγεος θιγεῖν, ἢ φάρμακον αὐτῷ τῷ ἕλκεϊ προσβάλλειν. καί τοι καὶ εἰ ἐπίσχοιτο ἡ αἱμορραγίη φαρμάκῳ, οὐκ ἀτρεκὴς τοῦ θανάτου ἡ φυγή. μετεξετέροισι γὰρ μεγάλης ἐσχάρης ἔκπτωσις τῆς φλεβὸς τὸ στόμιον ἐς μέζον εὐρύνει· εὖτε καὶ θρόμβοι ἔνδον ἐγγίγνονται καὶ μίμνουσι ἔσω, ἄφυκτος ἡ νοῦσος. χρὴ οὖν ἀρχομένῃσι αἱμορραγίῃσι ἀρήγειν. δήλη δὲ ὡς ἐπίπαν γίγνεται μέλλουσα, εἰ καὶ μὴ πάμπαν εὔσημος· ἄση ξύνεστι, ἀπορίη, βάρος τοῦ τόπου, ἔνθα Ῥήσσεται, ἐρύθημα τοῦ προσώπου, ἢν μηδέκω Ῥαγῇ· κἢν μὲν ἡ φλὲψ νεορραγὴς ἔῃ, ὡς ἐπίπαν μαλθάσσεται πάμπαν. ἢν δὲ πρόσω ᾖ χρόνου, χαλεπώτερον καὶ βραδύτερον. τοιάδε μὲν τὰ ἐν ἐντέροις ἕλκεα.
They occur in the season of summer; next in autumn; less in spring; least of all in winter. Diarrhœa attacks children and adolescents, but dysentery adults and young persons. In old age convalescence is difficult, and cicatrization protracted. Corroding sores are unusual in old persons, but yet hemorrhage is in accordance with old age.
γίγνεται δὲ θέρεος ὥρῃ· δεύτερον φθινοπώρου, ἧσσον ἦρος, ἥκιστα χειμῶνος. καὶ διάρροιαι μὲν, παιδίοισι καὶ μειρακίοισι· δυσεντερίη δὲ ἀκμάζουσι καὶ νέοισι· γῆρας δὲ δυσαλθὲς καὶ ἐς ὠτειλήν χρόνιον· τὰ δὲ ἀνεσθιόμενα γέρουσι ἀήθεα· ἀτὰρ καὶ αἱμορραγίη ξύμφωνος γήρᾳ.
10. IF many thick and hard cicatrices form after dysenteries, and broad and very deep ulcerations of the upper intestines, the food passes from them to those below in a fluid state, without separation of the nutritious part; for the cicatrix shuts up the pores by which the nutriment is carried upwards. The patient, therefore, is seized with atrophy, loss of colour and of strength. The affection gets the appellation of Lientery, this name being applied to a cicatrix of the intestines. And here the affection is from ulcers. But sometimes the intestines do not acquire cicatrization, but yet usage and habit reconcile the intestines to the discharge. For, the heat in these parts, if congealed, neither at times performs digestion, nor is the nutriment distributed upwards; but being unchanged, owing to weakness, it fails to undergo any part of the process. But if the purging, though of vitiated matters, be temporary, and not confirmed, a simple vomit after food will sometimes remove the disease. But if the exciting cause be prolonged, and get confirmed, it does no good. A chronic disease, and cachexia so mild as not to confine the patient to bed, will engender this disease. But dropsies sometimes have terminated favourably in this disease; a change from one evil to another, but still a better change.
10. ἢν ἐπὶ δυσεντερίῃσι καὶ ἕλκεσι πλατέσι καὶ κάρτα βαθέσι τῶν ἄνω ἐντέρων ὠτειλαὶ ἐγγίγνωνται πυκναὶ, παχεῖαι, στερέμνιοι, τὰ σιτία ἐκ τῶνδε ἐς τὰ κάτω διεκθέει, ὑγρὰ, ἀδιάκρι τα τοῦ τροφίμου· τὸ γὰρ τῶν ἐντέρων ἀραιὸν διʼ οὗπερ ἐς τὴν ἄνω φορὴν ἡ τροφὴ ἀναΐσσει, ἀπέκλεισεν ἡ ὠτειλή. ἀτροφίη οὖν τὸν ἄνθρωπον ἴσχει καὶ ἀχροίη, καὶ ἀτονίη. ἐπικλην τὸ πάθος λειεντερίη ἴσχει, — τὸ ἐπὶ τῇ οὐλῇ λέγω τῶν ἐντέρων, — τοὔνομα. καὶ νῦν μὲν ἐξ ἑλκέων ἐστὶ ἡ πάθη· ἄλλοτε δὲ ἔντερα μὲν ὠτειλὴν οὐκ ἴσχει· ἔθος δὲ καὶ μελέτη διαρρυεῖσα ἐκδιδάσκει τὰ ἔντερα. τὸ γὰρ ἐν τουτέοισι θερμὸν ἢν καταψυχθέν κοτε μήτε καταπέσσῃ, μήτε ἐς τὴν ἀναφορὴν ἀναΐσσῃ, ἄκρατον δὲ ὑπʼ ἀσθενίης ἔῃ, διαδιδρήσκει πᾶν ἔργον ἡ τροφή. ἀλλʼ ἢν μὲν σχέδιος καὶ μὴ ἑδραίη γένηται ἡ κάθαρσις, ἀλλὰ φαύλη, ἁπλοῦς ἔμετος ἀπὸ σιτίων ἔλυσε τὴν νοῦσον. ἢν δὲ προσοκείλῃ χρόνῳ, καὶ ἐν ἕδρῃ ἵζῃ ἡ αἰτίη τουτέων, οὐδὲν ὠφελέει. τίκτει δὲ καὶ χρονίη νοῦσος, καὶ ὀρθοστάδην καχεξίη· ἀτὰρ καὶ ὕδρωπές κοτε ἐς τόδε ἀπέσκηψαν εὐτυχῶς, ἐς κακὸν μὲν ἐκ κακοῦ, ἀλλὰ κρέσσων ἡ διαδοχή.
11. THE uterus in women is beneficial for purgation and parturition, but it is the common source of innumerable and bad diseases; for not only is it subject to ulcers, inflammation, and the fluor, but, if the whole organ be suddenly carried upwards, it quickly causes death. The fatal diseases of an acute nature connected therewith have been described elsewhere: but the chronic affections are, the two species of fluor; hardness; ulcers, part mild, but part malignant; prolapsus of the whole, or of part. The fluor, then, is either of a red or white colour; its appearance indicates this. It is the red if it consist of bright red blood, and the varieties thereof; or livid, or black and thin, or thick and coagulated, like a thrombus; or white, like water; or a bright ochre colour, like bile: in thickness like a thinnish or thin and fetid ichor. The white flux (or fluor albus) is like pus, and the true form like white whey; but a clot of blood frequently runs off with the pus. But there is an infinite variety of forms of it, as regards more or less quantity. Its periods sometimes agree with those of the menstrual purgation, but it does not continue the regular time as before; there is not much blood, but it flows during many days; the interval is for a few days, but is quite free from discharge. Another variety as to the period: the first purgation is at the regular time, but it occurs two or three times during each month. Another variety: a continual flux; small, indeed, every day, but by no means small during the whole month; for the uterus never closes its mouth, labouring under relaxation, so as to permit the flow of the fluid: but if it neither intermits nor diminishes, they die of hemorrhage. The symptoms are, the woman’s colour in accordance with those of the discharge; sleepless, loathes food, anxious, relaxed, especially in the red flux, and subject to pains; the discharge fetid in both varieties, but to a greater and less extent at different times; for the white is worse if the putrefaction be unusually great; and sometimes the red, if the erosion be exacerbated. In a word, the black is the worst of all; the livid next; the pale, the white, and the purulent, are more protracted, indeed, but less dangerous. Of these the pale is worse indeed, but much better when mixed with the customary discharge. Now the customary discharge is red in all its varieties. But, indeed, the red are worse in old women; but the white are not at all so to the young; but even to them that which is customary is less troublesome. Another white fluor: the menstrual discharge white, acrid, and attended with an agreeable pruritus; along with which the discharge of a white thick fluid, like semen, is provoked. This species we call female gonorrhœa. It is a refrigeration of the womb, which therefore becomes incapable of retaining its fluids; hence, also, the blood changes to a white colour, for it has not the purple colour of fire. The stomach, also, is subject to the affection, and vomits phlegm; and also the bowels are similarly affected in diarrhœa. Ulcers, too, are formed in the womb; some broad and attended with tingling, which, being close together, are, as it were, a superficial excoriation; pus thick, without smell, scanty. These ulcers are mild. But there are others deeper and worse than these, in which the pains are slight, pus somewhat more abundant, much more fetid, and yet, notwithstanding, these also are mild. But if they become deeper, and the lips of the sores hard or rough, if there is a fetid ichor, and pain stronger than in the former case, the ulcer corrodes the uterus; but sometimes a small piece of flesh is cast off and discharged, and this sore not coming to cicatrization, either proves fatal after a long time, or becomes very chronic. This sore gets the appellation of phagedæna. The sores also are dangerous if in these cases the pain gets exacerbated, and the woman becomes uneasy. From the sore there is discharged a putrid matter, intolerable even to themselves; it is exasperated by touching and by medicines, and irritated by almost any mode of treatment. The veins in the uterus are swelled up with distension of the surrounding parts. To the skilled, it is not difficult to recognise by the touch, for it is not otherwise obvious. Febrile heat, general restlessness, and hardness is present, as in malignant diseases; the ulcers, being of a fatal nature, obtain also the appellation of cancers. Another cancer: no ulceration anywhere, swelling hard and untractable, which distends the whole uterus; but there are pains also in the other parts which it drags to it. Both these carcinomatous sores are chronic and deadly; but the ulcerated is worse than the unulcerated, both in smell and pains, in life and in death. Sometimes the whole uterus has protruded from its seat, and lodged on the woman’s thighs; an incredible affliction! yet neither has the uterus not been thus seen, nor are the causes which produce it such as do not occur. For the membranes which are inserted into the flanks, being the nervous (ligamentous?) supporters of the uterus, are relaxed; those at the fundus, which are inserted into the loins, are narrow; but those at its neck, on each side to the flanks, are particularly nervous and broad, like the sails of a ship. All these, then, give way if the uterus protrude outwardly, wherefore this procidentia generally proves fatal; for it takes place from abortion, great concussions, and laborious parturition. Or if it do not prove fatal, the women live for a long time, seeing parts which ought not to be seen, and nursing externally and fondling the womb. It would appear that, of the double membrane of the womb, the internal lining coat is sometimes torn from the contiguous one, for there are two transverse plates of the coat; this, then, is thrown off with the flux, and in abortion and laborious parturition, when it adheres to the placenta. For if it be forcibly pulled, the coat of the uterus being stretched,..... But if the woman do not die, it is either restored to its seat, or but a small part appears externally, for the woman conceals it with her thighs. Sometimes the mouth of the womb only, as far as the neck, protrudes, and retreats inwardly if the uterus be made to smell to a fetid fumigation; and the woman also attracts it if she smells to fragrant odours. But by the hands of the midwife it readily returns inwards when gently pressed, and if anointed beforehand with the emollient plasters for the womb.
11. τῇσι γυναιξὶ ὑστέρη ἀγαθὴ μὲν ἐς κάθαρσιν καὶ τόκον, ξυμφορὴ δὲ νούσων μυρίων τε καὶ κακῶν. οὐ γὰρ ἑλκέων ἢ φλεγμασίης ἢ Ῥοῦ μοῦνον, ἀλλὰ κἢν ἐξαπίνης ὅλη ἄνω κινέηται, ὠκέως κτείνει. γεγράφαται μὲν οὖν ἐν ἄλλοισι, ὁκοῖα τῶν ἀπʼ αὐτέης ἦν ὀλέθρια ὀξέα. τὰ δὲ χρόνια Ῥόος διπλόος, σκληρίη, ἕλκεα, τὰ μὲν ἀσινέα, τὰ δὲ κακοήθεα· πρόπτωσις ὅλης, ἢ μέρεος. ῥόος μἒν οὖν, ἐρυθρὸς, ἢ λευκόχροος· ἰδέα δηλοῖ. ἐρυθρὸς μὲν, ἢν αἷμα ξανθὸν, καὶ αἱ τοῦδε ἰδέαι, ἢ πελιδνὸν ἢ μέλαν, καὶ λεπτὸν, ἢ παχὺ καὶ πεπηγὸς, οἷον θρόμβοι· λευκὸς ὡς ὕδωρ, ἢ ὠχρόξανθος ὡς χολή. παχὺς δὲ ὅκως ὑπόλεπτος, ἢ λεπτὸς ἰχὼρ καὶ κάκοδμος. λευκὸς δὲ ὡς πῦον, ὁ δὲ ἀτρεκὴς, ὡς λευκὸς ὄρρος· ἀτὰρ καὶ αἱμάλωψ κοτε τῷ πύῳ συνεκρέει. μυρίαι δὲ ἄλλαι παρὰ τὸ μᾶλλον τουτέων καὶ ἧττον ἰδέαι. περίοδος δὲ ἄλλοτε μὲν ἡ ἐπὶ μῆνα κάθαρσις, ἀλλʼ οὐκ ἐς τὴν ἀρχαίην ξυνίσταται προθεσμίην. οὐ πολλὸν μὲν τὸ αἷμα, ἐν ἡμέρῃσι δὲ πολλῇσι ἐκρέει· ὀλιγήμερος δὲ ἡ διάλειψις, ἀλλὰ καθαρή. ἄλλος περιόδου τρόπος, εἰς προθεσμί ην δὲ καὶ οὐκ ἐς πλῆθος περὶ πλεῖστον ἡ πρώτη κάθαρσις· δὶς δὲ καὶ τρὶς καθαίρονται ἀνὰ πάντα τὸν μῆνα· ἄλλη ἰδέη, ἄσχετος μὲν ἡ Ῥοὴ καὶ σμικρὴ ἐφʼ ἡμέρης ἑκάστης, ἀλλὰ εἰς τὸν ὅλον μῆνα οὐ πάγχυ βαιή. οὐδὲ γὰρ ὑστέρη μύει τὸ στόμα, ἀλλὰ οἴγνυται, πάρεσιν ἐς Ῥύσιν ὑγρότητος πάσχουσα· εἰ δὲ μήτε διαλείπει μήτε σμικρὸν ἐκρέει, αἱμορραγίῃ θνήσκουσι. σημήϊα δὲ, πρὸς τῇσι χροιῇσι τοῦ Ῥόου ἡ χροιὴ τῆς ἀνθρώπου· ἄγρυπνοι, ἀπόσιτοι, ἀσσώδεες, ἔκλυτοι ἐπὶ τὸ ἐρυθρὸν μᾶλλον, καὶ ὀδυνώδεες, καὶ κάκοδμον ἐπʼ ἀμφοῖν τὸ Ῥεῦμα· ἀλλὰ μᾶλλον καὶ ἧσσον ἄλλοτε καὶ ἄλλοτε. ὁ μὲν γὰρ λευκὸς κακίων, ἢν μέζων που ἡ σηπεδὼν ἔῃ· ἄλλοτε δὲ ὁ ἐρυθρὸς, ἢν ἀγριαίνῃ ἡ διάβρωσις. ἀθρόον δὲ εἰρήσθω, μέλας μὲν ἁπάντων κακίων, πελιδνὸς δεύτερον, ὠχρὸς δὲ καὶ λευκὸς καὶ πυώδης, μακρότεροι μὲν, ἧσσον δὲ κινδυνώδεες. τούτων δὲ αὐτέων ὁ ὠχρὸς κακίων μὲν, πολλὸν δὲ κρέσσων ὁ τῷ συνήθεϊ μεμιγμένος. ξυνήθης δὲ ἐρυθρὸς μὲν καὶ τὰ τοῦδε εἴδεα· τὸ δὲ ἀληθὲς γεραιτέρῃσι κακίονες οἱ ἐρυθροί· ἥκιστα δὲ νεήνισι οἱ λευκοί. ἀτὰρ καὶ ἀσινέστεροι ταύτῃσι οἱ ξυνήθεες· ἄλλος Ῥόος λευκὸς, ἡ ἐπιμήνιος κάθαρσις λευκὴ, δριμεῖα, καὶ ὀδαξώδης ἐς ἡδονήν· ἐπὶ δὲ τοῖσι καὶ ὑγροῦ λευκοῦ, παχέος, γονοειδέος πρόκλησις. τόδε τὸ εἶδος γονόρροιαν γυναικείαν ἐλέξαμεν. ἔστι δὲ τῆς ὑστέρης ψύξις, οὕνεκεν ἀκρατὴς τῶν ὑγρῶν γίγνεται· ἀτὰρ καὶ τὸ αἷμα ἐς χροιὴν λευκὴν ἀμείβει. τοῦ γὰρ πυρὸς οὐκ ἴσχει τὸ φοινίσσον. τήνδε τὴν πάθην καὶ στόμαχος νοσέει καὶ ἐμέει φλέγμα· ἀτὰρ καὶ ἔντερα ὁμοίην ἴσχει, εὖτε τὴν διάρροιαν νοσέει. γίγνεται ἕλκεα καὶ ἐν ὑστέρῃ, τὰ μὲν πλατέα, κνησμώδεα, ἅπερ ἅλια, ὅκως ἀναδορή τις ἐπιπολῆς, πῦον παχὺ, ἄνοσμον, ὀλίγον. εὐήθεα τάδε τὰ ἕλκεα· ἄλλα τουτέων βαθύτερα καὶ κακίονα, οἷς πόνοι σμικροὶ, πῦον ὀλίγῳ πλεῖον, μᾶλλον κάκοδμα, ἀλλʼ ἔμπης εὐήθεα καὶ τάδε. ἢν δὲ ἐπὶ μᾶλλον βαθέα γίγνηται, καὶ τὰ χείλεα τῶν ἕλκεων ἀπηνέα ἢ τρηχέα, ἰχώρ τις κακώδης, καὶ πόνος τῶν πρόσθεν μέζων, ἀνεσθίει δὲ τὴν ὑστέρην τὸ ἕλκος· ἐξήκει δέ κοτε καὶ ἀπολυθέντι σαρκίον· μὴ εἰς ὠτειλὴν ἰὸν μήκιστον κτάνει τόδε, ἢ χρόνιον γίγνεται κάρτα. τόδε καὶ φαγέδαινα κικλήσκεται. ὀλέθρια δὲ τὰ ἕλκεα, ἢν πρὸς τοῖσι ἄλγος ὀξύνῃ, καὶ ἡ ἄνθρωπος ἀπορῇ. σηπεδὼν δὲ ἀπὸ τοῦ ἕλκεος Ῥέει οὔτε αὐτέῃσι φορητὴ, ἀγριαίνει ψαύσεσί τε καὶ φαρμάκοισι, καὶ χαλεπαίνει πως καὶ ἰητρίῃ· φλέβες δὲ ἐν ὑστέρῃ ἐς ὄγκον αἴρονται ξὺν περιτάσεσι τῶν πέλας· ἔστι δὲ πεπνυμένοισι οὐκ ἄσημον τῇ ἁφῇ. οὐ γὰρ ἄλλως δῆλον· πῦρ δὲ καὶ ἄση τοῦ παντὸς καὶ σκληρίη ξύνεστιν, ᾗπερ τοῖσι θηριώδεσι, θανατώδεα ὄντα ἕλκεα, ἀτὰρ καὶ ἐπίκλησιν ἴσχει καρκίνων. ἄλλος καρκίνος· ἕλκος μὲν οὐδαμῆ, ὄγκος δὲ σκληρὸς, ἀτέραμνος· ξυντιταίνει δὲ τὴν ὑστέρην ὅλην, ἀτὰρ καὶ ἄλγεα κατὰ τὰ ἄλλα ὅσα ἐφέλκει· ταῦτα δὲ ἄμφω τὰ καρκινώ δεα καὶ χρόνια καὶ ὀλέθρια· πολλὸν δὲ τὸ ἕλκος τοῦ ἀνελκώτου κάκιον καὶ ὀσμῇ, καὶ πόνοισι, καὶ ζωῇ, καὶ θανάτῳ. ἐξίσταταί κοτε τῆς ἕδρης ἡ ὑστέρη ὅλη, καὶ ἐπὶ τοῖσι μηροῖσι τῆς γυναικὸς ἱζάνει· ἄπιστος ἡ ξυμφορὴ, ἀλλʼ οὐκ ἀθέητος ἡ ὑστέρη, οὐδὲ ἀγέννητος ἡ αἰτίη. ξυνδίδουσι γὰρ οἱ ὑμένες, οἱ πρὸς τοὺς λαγόνας, ὀχῆες τῆς ὑστέρης ἐόντες νευρώδεες· οἱ μὲν κατὰ πυθμένα πρὸς τὴν ὀσφὺν λεπτοί· οἱ δὲ κατʼ αὐχένα ἔνθα καὶ ἔνθα πρὸς τοὺς λαγόνας· οἱ δὲ μάλιστα νευρώδεες, πλατέες ὅκως νεὼς λαίφεα. πάντες οὖν ξυνδίδουσι οἵδε, ἢν ἔξω ἡ ὑστέρη ἀΐσσῃ. κτείνει μὲν οὖν τὰ πολλὰ ἔκπτωσις ἥδε. γίγνεται γὰρ ἐπὶ ἀμβλωσμ ῷ, καὶ σεισμοῖσι μεγάλοισι, καὶ βιαίῳ τόκῳ· ἢν δὲ μὴ κτάνῃ, ἐς μακρὸν αἵδε ζώουσιν, ὁρέουσαι τὰ μὴ θεητὰ καὶ τιθηνοῦσαι ἔξω καὶ βαυκαλῶσαι τὴν ὑστέρην. δοκέει δέ κοτε τῆς διπλόης τῆς ὑστέρης ὁ ἔνδον ὑπεζωκὼς χιτὼν, ἀποσπᾶσθαι τοῦ ξυναφέος. δοιαὶ γὰρ αἱ σχίδες μὲν αἱ ἐπηλλαγμέναι χιτῶνος· ὅδε οὖν ἀφίσταται μὲν καὶ Ῥεύματι, καὶ ἐντρωσμῷ καὶ βιαίῳ τόκῳ, εὖτε ἐπὶ τῷ χορίῳ προσπέφυκεν αὐτέη. ἢν γὰρ τόδε ἕλκηταιβίῃ, συνεκπεράσας ὁ τῆς ὑστέρης χιτὼν … ἀλλὰ ἢν μὴ ἐκθάνῃ ἡ γυνὴ, παλίνορσος τὸ αὐτὸ συνήφθη κοτὲ στάθμῃ, ἢ σμικρὸν ἔξω φαίνεται· σκέπει γὰρ τοῖσι μηρίοισι ἡ γυνή. προσπίπτει κοτὲ τὸ στόμιον τῆς ὑστέρης μοῦνον μέσφι τοῦ αὐχένος, ἀλλʼ αὖθις εἴσω δύεται, ἢν ὀσφραίνηται ἡ ὑστέρη θυμιήσι κακώδεϊ. ἕλκει δὲ αὐτέην καὶ ἡ γυνὴ, ἢν ὀσφραίνηται θυμιητῶν εὐωδέων. ἀτὰρ καὶ χερσὶ μαίης ἀτρέμα εἴσω θέει, ἡσυχῆ πιεζευμένη καὶ χριομένη πρόσθεν τοῖσι ὑστέρης μειλίγμασι.