25. 25 Pills are also numerous, and are made for various purposes. Those which relieve pain through sleep are called anodynes; unless there is overwhelming necessity, it is improper to use them; for they are composed of medicaments which are very active and alien to the stomach. There is one, however, which actually promotes digestion; it is composed of poppy-tears and galbanum, 4 grams each, myrrh, castory, and pepper, 8 grams each. Of this it is enough to swallow an amount the size of a vetch. Another, worse for the stomach, but more soporific, consists of mandragora 1 gram, celery-seed and hyoscyamus seed, 16 grams each, which are rubbed up after soaking in wine. One of the same size mentioned above is quite enough to take. But whether there is headache or ulceration or ophthalmia or toothache or difficulty in breathing or intestinal gripings or inflammation of the womb or pain in the hips of liver or spleen or ribs, or, whether owing to genital trouble, a woman collapses speechless, a pillar of the following kind counteracts pain by producing sleep: saxifrage, sweet flag, wild rue seed, 4 grams each, castory and cinnamon 8 grams, poppy-tears, panax root, dried mandrake apples, flowers of the round rush, 9 grams each, and 56 peppercorns. These are first pounded separately, then rubbed up all together, whilst gradually adding raisin wine until the mixture is either swallowed or dissolved in water and taken as a draught. Or take a good handful of wild poppy-heads when just ripe for collecting the juice and put into a vessel and boil with water sufficient to cover it. When this handful has been well boiled there, after being squeezed out it is thrown away; and with its juice is mixed an equal quantity of raisin wine, and heated until to consistency of sordes. When the mixture has cooled, pills are formed, the size of our beans; they are used in many ways. For they procure sleep whether taken as they are or in water; they relieve earache when a little rue-juice and raisin wine are added; when dissolved in wine they relieve gripings, and when mixed with cerate of rose-oil with the addition of a little saffron they relieve inflammation of the womb; also when smeared upon the forehead mixed with water they check the flow of phlegm into the eyes. Again if inflammation of the womb prevents sleep take saffron 1·33 grams, anise and myrrh, 4 grams each, poppy-tears 12 grams, hemlock seed 32 grams. These are mixed together, and taken up in old wine, and a pill the size of a lupin is dissolved in 125 cc. of water. It is dangerous, however, to give it when there is fever. For the relief of pain in the liver soda 1 gram, saffron, myrrh, Gallic nard, 4 grams each, are taken up in honey, and a pill the size of an Egyptian bean administered. A pill to stop pain in the side is made of pepper, aristolochia, nard, and myrrh in equal parts. A pill for pain in the chest is made from nard 4 grams, frankincense and casia, 12 grams each, myrrh and cinnamon, 24 grams each, saffron 32 grams, turpentine-resin 1 gram, honey three-quarters of a litre. The pill of Athenion for cough contains myrrh and pepper, 0·66 gram each, castory and poppy-tears, 4 grams each; these are rubbed down separately, then together, and two pills, the size of our bean, are given in the morning and two at bed-time. If cough prevents sleep the pill of Heracleides of Tarentum relieves both; it contains saffron 0·66 gram, myrrh, long pepper, costmary, galbanum, 1 gram each, cinnamon, castor and poppy-tears, 4 grams each. But if ulcers of the throat causing cough are to be cleaned, panax, myrrh and turpentine-resin, 28 grams each, galbanum 0·66 gram, hyssop 1 gram are rubbed together, and 250 cc. of honey added to them and as much swallowed as can be taken up on the finger. The pill of Cassius for colic contains saffron, anise, castory, 12 grams each, parsley 16 grams, pepper both long and round, 20 grams each, poppy-tears, round rush, myrrh, nard, 24 grams each; these are taken up in honey. It may be either swallowed as it is or dissolved in hot water. A draught for the expulsion of a dead foetus or placenta consists of ammoniac salt 4 grams, or of Cretan dittany 4 grams in water. In difficult labour hedge mustard in tepid wine should be administered on an empty stomach. The voice is strengthened by frankincense 4 grams in two cups of wine. For difficult micturition long pepper, castory, myrrh, galbanum, poppy-tears, saffron, costmary, 28 grams each; storax and turpentine-resin, 56 grams each, honey with absinth 42 cc. Of this an amount the size of an Egyptian bean should be taken in the morning and after dinner. A medicine for the windpipe is prepared as follows: casia, iris, cinnamon, nard, myrrh, frankincense, 4 grams each; saffron 1 gram; and 30 peppercorns boiled in a litre and a half of raisin wine until of the consistency of honey. Or, saffron, myrrh, frankincense, 4 grams each, similarly boiled in raisin wine to the same consistency. Or 750 cc. of raisin wine are boiled until a drop, if taken out, solidifies; thereupon pounded casia 4 grams is added.
25. CATAPOTIA quoque multa sunt, uariisque de causis fiunt. Anodyna uocant, quae somno dolorem leuant; quibus uti, nisi nimia necessitas urget, alienum est: sunt enim ex uehementibus medicamentis et stomacho alienis. Potest tamen etiam ad concoquendum, quod habet papaueris lacrimae, galbani, singulorum P. #1108 I; murrae, castorei, piperis, singulorum P. #1108 II. Ex quibus, quod erui magnitudinem habet, satis est deuorasse. Alterum stomacho peius, ad somnum ualentius, ex his fit: mandragorae P. #1108 #1109 #1110; apii seminis, item hyoscyami seminis, singulorum P. #1108 IIII; quae ex uino teruntur. Vnum autem eiusdem magnitudinis, quae supra posita est, abunde est sumpsisse. Siue autem capitis dolores siue ulcera siue lippitudo siue dentes * * siue spiritus difficultas siue intestinorum tormenta siue inflammatio uuluae est, siue coxa siue iecur aut lienis aut latus torquet, siue uitio locorum aliqua prolabitur et ommutescit, occurrit dolori per quietem eiusmodi catapotium: silis, acori, rutae siluestris seminis, singulorum P. #1108 I; castorei, cinnamomi, ⟨singulorum P.⟩ #1108 II; papaueris lacrimae, panacis radicis, mandragorae, malorum aridorum, iunci rotundi floris, singulorum P. #1108 II #1109 #1110; piperis grana LVI. Haec per se contrita, rursus instillato subinde passo, simul omnia teruntur, donec crassitudo sordium fiat. Ex eo paululum aut deuoratur, aut aqua diluitur et potui datur. Quin etiam siluestris papaueris, cum iam ad excipiendam lacrimam maturum est, manipellus qui manu conprehendi potest, in uas demittitur, et superinfunditur aqua, quae id contegat, atque ita coquitur. Vbi iam bene manipellus is coctus est ibidem * * * expressus proicitur; et cum eo umore passi pa⟨r⟩ mensura miscetur, inferue⟨fi⟩tque, donec crassitudinem sordium habeat. Cum infrixit, catapotia ex eo fiunt ad nostrae fabae magnitudinem, habentque usum multiplicem. Nam et somnum faciunt uel per se adsumpta uel ex aqua data, et aurium dolores leuant, adiectis exiguo modo rutae suci ac passi, et tormina supprimunt ex uino liquata, et inflammationem uuluae coercent mixta cerato ex rosa facto, cum paulum his croci quoque accessit; et ex aqua fronti inducta pituitam in oculos decurrentem tenent. Item si uulua dolens somnum prohibet, croci P. #1108 #1109 #1109; anesi, murrae, singulorum P. #1108 I; papaueris lacrimae P. #1108 III; cicutae seminis P. #1108 VIII miscentur excipiunturque uino uetere, et quod lupini magnitudinem habet in tribus cyathis aquae diluitur. Id tamen in febre periculose datur. Ad iecur sanandum nitri P. #1108 #1109 #1110; croci, murrae, nardi Gallici, singulorum P. #1108 I melle excipiuntur, daturque quod Aegyptiae fabae magnitudinem habeat. Ad lateris dolores finiendos piperis, aristolochiae, nardi, murrae pares portiones. Ad thoracis nardi P. #1108 I; turis, casiae, singulorum P. #1108 III; murrae, cinnamomi, singulorum P. #1108 VI; croci P. #1108 VIII; resinae terebenthinae P. ⟨#1108⟩ #1109 #1110; mellis heminae tres. Ad tussim Athenionis: murrae, piperis, singulorum P. #1108 #1109; castorei, papaueris lacrimae, singulorum P. #1108 I. Quae separatim contusa postea iunguntur, et ad magnitudinem fabae nostrae bina catapotia mane, bina noctu dormituro dantur. Si tussis somnum prohibet, ad utrumque Heraclidis Tarentini: croci P. #1108 #1109; murrae, piperis longi, costi, galbani, singulorum P. #1108 #1109 #1110; cinnamomi, castorei, papaueris lacrimae, singulorum P. #1108 I. Quod si purganda ulcera in faucibus tussientibus sunt, panacis, murrae, resinae terebenthinae, singulorum P. uncia; galbani P. #1108 #1109; hysopi P. #1108 #1109 #1110 conterenda sunt, hisque hemina mellis adicienda, et quod digito excipi potest, deuorandum est. Colice uero Cassi ex his constat: croci, anesi, castorei, singulorum P. #1108 III; petroselini P. #1108 IIII; piperis et longi et rotundi, ⟨singulorum⟩ P. #1108 V; papaueris lacrimae, iunci rotundi, murrae, nardi, singulorum P. #1108 VI; quae melle excipiuntur. Id autem et deuorari potest et ex aqua calida sumi. Infantem uero mortuum aut secundas expellit aquae potio, cui salis Hammoniaci P. #1108 I, aut cui dictamni Cretici ⟨P.⟩ #1108 I adiectum est. Ex partu laboranti erysimum ex uino tepido ieiunae dari debet. Vocem adiuuat turis P. #1108 I in duobus cyathis uini datum. Aduersus urinae difficultatem piperis longi, castorei, murrae, galbani, papaueris lacrimae, croci, costi unciae singulae; styracis, resinae terebenthinae pondo sextantes, melabsinthi cyathus. Ex quibus ad magnitudinem fabae Aegyptiae et mane et cenato dari debet. Arteriace uero hoc modo fit: casiae, iridis, cinnamomi, nardi, murrae, turis, singulorum P. #1108 I; croci P. #1108 I #1109 #1110; piperis grana XXX ex passi tribus sextariis decocuntur, donec mellis crassitudo his fiat. Aut croci, murrae, turis, singulorum P. #1108 I coiciuntur in passi eundem modum, eodemque modo decocuntur. Aut eiusdem passi heminae tres usque eo coquuntur, donec extracta inde gutta indurescat; eo adicitur tritae casiae P. #1108 I.
26. 26 Now that I have set out the properties of the medicaments, I will explain the classes of lesions harmful to the body: there are five; when something from without causes the lesion, as in the case of wounds; when some internal part has become corrupted, as in the case of canker; when some new formation has occurred, such as a stone in the bladder; when something has grown bigger, as when a vein swells up and is converted into a varix; when there is some defect, as when some part has been mutilated.
26. Cum facultates medicamentorum proposuerim, genera, in quibus noxa corpori est, proponam. Ea quinque sunt: cum quid extrinsecus laesit, ut in uulneribus; cum quid intra se ipsum corruptum est, ut in cancro; cum quid innatum est, ut in uesica calculus; cum quid increuit, ut uena, quae intumescens in uaricem conuertitur; cum quid deest, ut cum curta pars aliqua est. Ex his alia sunt, in quibus plus medicamenta, alia, in quibus plus manus proficit.
In some of these medicaments are more effectual, in others surgery. Postponing those conditions which demand in particular the scalpel and surgical treatment, I will speak now of those which chiefly require medicaments. As I have done before, I shall divide this part of treatment, and speak first of those lesions which may occur in any part of the body, then of those which attack particular parts. I shall begin with wounds.
Ego dilatis iis, quae praecipue scalpellum et manum postulant, nunc de is dicam, quae maxime medicamentis egent. Diuidam autem hanc quoque curandi partem sicut priorem et ante dicam ⟨de is,⟩ quae in QVAMLIBET PARTEM corporis incidunt, tum de is, quae certas partes infestant. Incipiam a uulneribus.
In this connexion, however, a practitioner should know above all which wounds are incurable, which may be cured with difficulty, and which more readily. For it is the part of a prudent man first not to touch a case he cannot save, and to the risk the appearance of having killed one whose lot is but to die; next, when there is grave fear without, however, absolute despair, to point out to the patient's relatives that hope is surrounded by difficulty, for then if the art is overcome by the malady, he may not seem to have been ignorant or mistaken. But while such steps become a prudent practitioner, it is like a mountebank to exaggerate a small matter in order to enhance his own achievement. It is right to commit himself to a statement that a case is simple in order that he may examine it with even more care for fear a case slight in itself may become worse by negligence on the doctor's part.
In his autem ante omnia scire medicus debet, quae insanabilia sint, quae difficilem curationem habeant, quae promptiorem. Est enim prudentis hominis primum eum, qui seruari non potest, non adtingere, nec subire speciem * * * eius, ut occisi, quem sors ipsius interemit; deinde ubi grauis metus sine certa tamen desperatione est, indicare necessariis periclitantis in difficili spem esse, ne, si uicta ars malo fuerit, uel ignorasse uel fefellisse uideatur. Sed ut haec prudenti uiro conueniunt, sic rursus histrionis est paruam rem adtollere, quo plus praestitisse uideatur. Obligarique aecum est confessione promptae rei, quo curiosius etiam circumspiciat, ne, quod per se exiguum est, maius curantis neglegentia fiat.
It is impossible to save a patient when the base of the brain, the heart, the gullet, the porta of the liver, or the spinal marrow has been pierced; when the middle of the lung, or the jejunum, or the small intestine, or the stomach, or kidneys have been wounded; or when the large blood-vessels and arteries in the region of the throat have been cut.
Seruari non potest, cui basis cerebri, cui cor, cui stomachus, cui iocineris portae, cui in spina medulla percussa est, cuique aut pulmo medius aut ieiunum aut tenuius intestinum aut uentriculus aut renes uulnerati sunt; cuiue circa fauces grandes uenae uel arteriae praecisae sunt.
Again, there is hardly ever recovery when either the lung or the thick part of the liver or the membrane enclosing the brain, or the spleen, womb, bladder, any of the intestines or diaphragm has been wounded in any part. There is also grave danger when the point of a weapon has gone down to the large blood-vessels deeply seated in the armpits or hams. Also wounds are dangerous wherever the blood-vessels are larger, because they may exhaust the patient by profuse bleeding. This occurs not only in the armpits and hams, but also in those blood-vessels which go to the anus and testicles. Moreover, a wound is a bad one whenever it is in the armpits or in the thighs or in hollow places or in joints or between the fingers; also whenever a muscle or sinew or artery or membrane or bone or cartilage is injured. The safest of all is a wound in the flesh.
Vix autem ad sanitatem perueniunt, quibus ulla parte aut pulmo aut iocineris crassum aut membrana, quae continet cerebrum, aut lienis aut uulua aut uesica aut ullum intestinum aut saeptum transuersum uulneratum est. Ii quoque in praecipiti sunt, in quibus usque ad grandes intusque conditas uenas in alis uel poplitibus mucro desedit. Periculosa etiam uulnera sunt, ubicumque uenae maiores sunt, quoniam exhaurire hominem profusione sanguinis possunt. Idque euenit non in alis tantum atque poplitibus, sed etiam in is uenis, quae ad anum testiculosque perueniunt. Praeter haec malum uulnus est, quodcumque in alis uel feminibus uel inanibus locis uel in articulis uel inter digitos est; item quodcumque musculum aut neruum aut arteriam aut membranam aut os aut cartilaginem laesit.
The above wounds are severer or slighter according to their situations. Still, whenever it is large, a wound makes for danger.
Tutissimum omnium, quod in carne est. Et haec quidem loco uel peiora uel mitiora sunt.
The class of wound and its shape are also important. For a contused would is worse than one simply incised, hence it is better to be wounded by a sharp weapon than by a blunt one. A wound is worse also if a piece is cut out, or if the flesh is cut away in one part and hanging free in another. A curved wound is worst, a straight linear one safest; hence a wound is more or less serious, according as it approximates to the former or to the latter shape.
Modo uero periculum facit, quodcumque magnum est. Aliquid etiam in uulneris genere figuraque est. Nam peius est, quod etiam conlisum quam quod tantum discissum est, adeo ut acuto quoque quam retunso telo uulnerari commodius sit. Peius etiam uulnus est, ex quo aliquid excisum est, exue quo caro alia parte abscisa alia dependet. Pessimaque plaga curua est: tutissima quae lineae modo recta est;
Again, both age and constitution and mode of life and the season have also some influence; for a boy or young adult heals more readily than does an old man; one who is strong than a weak man; a man who is not too thin or too fat than one who is either of these; one of sound habit than of unsound; one who takes exercise than a sluggard; one who is sober and temperate than one addicted to wine and venery. And the most opportune time for healing is the spring, or at any rate when the weather is neither cold nor hot, for wounds are harmed by excessive heat and excessive cold, but most of all by variations of these; hence autumn is the most pernicious season.
quo deinde propius huic illiue figurae uulnus est, eo uel deterius uel tolerabilius est. Quin etiam confert aliquid et aetas et corpus et uitae propositum et anni tempus; quia facilius sanescit puer uel adulescens quam senior, ualens quam infirmus; neque nimis tenuis neque nimis plenus, quam si alterum ex his est; integri habitus quam corrupti, exercitatus quam iners, sobrius et temperans quam uino uenerique deditus. Oportunissimumque curationi tempus uernum est, aut certe neque feruens neque frigidum, siquidem uulnera et nimius calor et nimium frigus infestant, maxime tamen horum uarietas;
Now most wounds are open to view; some are inferred from their situation, which we have pointed out elsewhere when indicating the positions of the internal parts. Since, however, some of these wounds are near at hand, and it is of importance whether the wound is superficial or has penetrated inwards, it is necessary to state the signs by which it is possible to recognize what has happened inside, and from which follow either hope or despair.
ideoque perniciosissimus autumnus est. Sed pleraque ex uulneribus oculis subiecta sunt; quorundam ipsae sedes indices sunt, quas alio loco demonstrauimus, cum positus interiorum partium ostendimus.
Now when the heart is penetrated, much blood issues, the pulse fades away, the colour is extremely pallid, cold and malodorous sweats burst out as if the body had been wetted by dew, the extremities become cold and death quickly follows.
Verum tamen quia quaedam uicina sunt, interestque uulnus in summa parte sit an penitus penetrauerit, necessarium est notas subicere, per quas, quid intus actum sit, scire possimus, et ex quibus uel spes uel desperatio oriatur.
But when the lung is pierced there is difficulty in breathing; frothy blood escapes from the mouth, red blood from the wound; and at the same time breath is drawn with a noise; to lie upon the wound affords relief; some stand up without any reason. Many speak if they have been laid upon the wound; if upon the opposite side they become speechless.
Igitur corde percusso sanguis multus fertur, uenae ⟨e⟩languescunt, color pallidissimus, sudores frigidi malique odoris tamquam inrorato corpore oriuntur, extremisque partibus frigidis matura mors sequitur. Pulmone uero icto spirandi difficultas est; sanguis ex ore spumans, ex plaga ruber; simulque etiam spiritus cum sono fertur; in uulnus inclinari iuuat;
Symptoms that the liver should have been wounded are that considerable haemorrhage occurs from under the right part of the hypochondria; the hypochondria are retracted towards the spine; the patient is eased by lying on his belly; stabbing pains spread upwards as high as the clavicle and its junction with the scapula; to which, not infrequently, also bilious vomiting is added.
quidam sine ratione consurgunt. Multi si in ipsum uulnus inclinati sunt, loquntur, si in aliam partem, obmutescunt. Iocineris autem uulnerati notae sunt multus sub dextra parte praecordiorum profusus sanguis; ad spinam reducta praecordia; in uentrem cubandi dulcedo; punctiones doloresque usque ad iugulum iunctumque ei latu⟨m⟩ scapularum os intenti;
When the kidneys have been penetrated, pain spreads down to the groin and testicles; urine is passed with difficulty, and it is either bloodstained or actual blood clot is passed.
quibus nonnumquam etiam bilis uomitus accedit. Renibus uero percussis dolor ad inguina testiculosque descendit;
But when the spleen has been pierced, black blood flows out from the left side; the hypochondria on that side together with the stomach become hard; great thirst comes on; pain extends to the clavicle as when the liver has been wounded.
difficulter urina redditur, eaque aut haec cruenta aut cruor fertur. At liene icto sanguis niger a sinistra parte prorumpit; praecordia cum uentriculo ab eadem parte indurescunt; sitis ingens oritur;
But when the womb has been penetrated, there is pain in the groins and hips and thighs; blood passes downwards in part through the wound, in part by the vagina; bilious vomiting follows. Some become speechless, some are mentally disturbed, others whilst composed in mind complain of pain in their sinews and eyeballs, and when dying they suffer like those wounded in the heart.
dolor ad iugulum sicut iocinere uulnerato uenit. At cum uulua percussa est, dolor inguinibus et coxis et feminibus est; sanguinis pars per uulnus, pars per naturale descendit; uomitus bilis insequitur. Quaedam obmutescunt, quaedam mente labuntur, quaedam sui conpotes neruorum oculorumque dolore urgeri se confitentur, morientesque eadem, quae corde uulnerato, patiuntur.
When the brain or its membrane has been wounded, blood escape through the nostrils, in some also through the ears; and generally bilious vomiting follows. Some lose their senses and take no notice when spoken to; some have a wild look; in some the eyes move from side to side as if they were out of control; generally on the third or fifth day delirium supervenes; many have also spasm of sinews. Again, before death many tear off the bandages with which their head has been bound up, and expose the bared wound to cold.
Sin cerebrum membranaue eius uulnus accepit, sanguis per nares, quibusdam etiam per aures exit; fereque bilis uomitus insequitur. Quorundam sensus optunduntur, appellatique ignorant; quorundam trux uultus est; quorundam oculi quasi resoluti huc atque illuc mouentur; fereque tertio uel quinto die delirium accedit; multorum etiam nerui distenduntur.
But when the gullet has been penetrated, hiccough and bilious vomiting follow; if any food or drink is swallowed, it is returned at once; pulsation of the blood-vessels fades away; thin sweat breaks out, following which the extremities become cold.
Ante mortem autem plerique fascias, quibus caput deligatum est, lacerant ac nudum uulnus frigori obiciunt. Vbi stomachus autem percussus est, singultus et bilis uomitus insequitur; si quid cibi uel potionis adsumptum est, ea redditur cito.
The signs when the small intestine and the stomach have been wounded are the same; for food and drink come out through the wound; the hypochondria become hard, sometimes bile is regurgitated through the mouth. Only in the case of the intestine the situation of the wound is lower down. All other intestinal wounds cause the emission of faeces or a faecal odour.
Venarum motus elanguescunt, sudores tenues oriuntur, per quos extremae partes frigescunt. Communes uero ieiuni intestini et uentriculi uulnerati notae sunt: nam cibus et potio per uulnus exeunt; praecordia indurescunt; nonnumquam bilis per os redditur. Intestino tantum sedes inferior est.
When the marrow which is within the spine has been crushed, there is either paralysis or spasm of sinews; sensation is interrupted; after some time there is involuntary evacuation from the parts below of either semen or urine of even faeces.
Cetera intestina icta uel stercus uel odorem eius exhibent. Medulla uero, quae in spina est, discussa nerui resoluuntur aut distenduntur; sensus intercidit;
But if the diaphragm has been penetrated, the praecordia are contracted upwards; the spine is painful; breathing is laboured; frothy blood escapes.
interposito tempore aliquo sine uoluntate inferiores partes uel semen uel urinam uel etiam stercus excernunt. At si saeptum transuersum percussum est, praecordia susum contrahuntur;
When the bladder has been wounded, the groins are painful; the hypogastrium becomes tense; blood is passed, instead of urine, the urine being discharged from the actual wound. The gullet is affected, and so the patients either vomit bile or hiccough. Coldness and after that death follows.
spina dolet; spiritus rarus est; sanguis spumans fertur. Vesica uero uulnerata dolent inguina: quod super pubem est, intenditur; pro urina sanguis, at ex ipso uulnere urina descendit. Stomachus adficitur: itaque aut bilem uomunt, aut singultiunt;
Even when these facts are known, there are still some other things to be learnt about wounds and ulcerations in general, of which we will now speak. From wounds, then, there comes out blood, or sanies, or pus. Blood everybody knows; sanies is thinner than blood, varying both in thickness and stickiness and colour. Pus is the thickest and whitest, more sticky than either sanies or blood. Now blood comes out from a fresh wound or from one which is already healing, sanies between these two periods, pus from an ulceration already beginning to heal. Again, the Greeks distinguish by name different kinds of sanies and pus. For there is a kind of sanies which is named either hidros or melitera; there is pus which is called alaeodes. Hidros is thin, whitish, and comes from a bad ulceration, especially when inflammation has followed upon a wound of a sinew. Melitera is thicker, stickier and whitish, something like honey. It is likewise discharged from bad ulcerations, when sinews near to joints have been wounded, and among such places especially from the knees. Elaeodes is thin, whitish, fatty, in colour and fattiness not unlike olive-oil; it appears in large ulcerations when they are healing. Blood is bad when it is too thin or too thick, livid or black in colour, or mixed with phlegm or variable; it is best when hot, red, moderately thick, and not sticky. Consequently from the first the treatment is more expeditious in the case of a wound from which good blood has flowed. Also later there is more hope in the case of wounds from which all the discharges are of the better kind. Thus sanies is bad when profuse, too thin, livid, or pallid or black or sticky or malodorous or when it erodes either the ulceration itself or the skin adjoining it; it is better when not profuse, moderately thick, reddish or whitish. But hidros is worse when it is profuse, thick, somewhat livid or pallid, stick, black, hot, malodorous; it is less serious when whitish, and when all the rest of its characteristics are the opposite of the foregoing. Melitera again is bad when profuse and very thick; better for being thinner and less copious. Amongst these discharges pus is the best; but it is likewise worse when profuse, thin, watery, and the more so if it is such from the beginning; and also if it is in colour like whey, if pallid, or livid, or like wine-lees; if, besides, it is malodorous, unless, however, it is the part which causes this odour. It is better, the smaller the quantity, the thicker and whiter; also if it is bland, odourless, uniform; none the less it should correspond in quantity with the size and age of the wound. For naturally there is more discharge, the larger the wound, si more when inflammation has not yet subsided. Elaeodes also is worse when large in quantity and but little fatty, the less in quantity and the more fatty the better.
frigus et ex eo mors sequitur. His cognitis etiamnum quaedam alia noscenda ad omnia uulnera ulceraque, de quibus dicturi sumus, pertinentia. Ex his autem exit sanguis, sanies, pus. Sanguis omnibus notus est: sanies est tenuior hoc, uarie crassa et glutinosa et colorata. Pus crassissimum albidissimumque, glutinosius et sanguine et sanie. Exit autem sanguis ex uulnere recenti aut iam sanescente, sanies [est] inter utrumque tempus, ⟨pus⟩ ex ulcere iam ad sanitatem spectante. Rursus et sanies et pus quasdam species Graecis nominibus distinctas habent. Est enim quaedam sanies, quae uel hidros uel melitera nominatur; est pus, quod elaeodes appellatur. Hidros tenuis, subalbidus ex malo ulcere exit, maximeque ubi neruo laeso inflammatio secuta est. Melitera crassior et glutinosior, subalbida, mellique albo subsimilis. Fertur haec quoque ex malis ulceribus, ubi nerui circa articulos laesi sunt, et inter haec loca maxime ex genibus. Elaeodes tenue, subalbidum, quasi unctum, colore atque pinguitudine oleo albo non dissimile; apparet in magnis ulceribus sanescentibus. Malus autem est sanguis nimium aut tenuis aut crassus, colore uel liuidus uel niger, aut pituita mixtus aut uarius: optimus calidus, ruber, modice crassus, non glutinosus. Itaque protinus eius uulneris expedita magis curatio est, ex quo sanguis bonus fluxit. Itemque postea spes in is maior est, ex quibus melioris generis quaeque proueniunt. Sanies igitur mala est multa, nimis tenuis, liuida aut pallida aut nigra aut glutinosa aut mali odoris, aut quae ipsum ulcus et iunctam ei cutem erodit: melior est non multa, modice crassa, subrubicunda aut subalbida. Hidros autem peior est multus, crassus, subliuidus aut subpallidus, glutinosus, ater, calidus, mali odoris: tolerabilior est subalbidus, qui cetera omnia contraria prioribus habet. Melitera autem mala est multa et percrassa: melior, quae tenuior et minus copiosa est. Pus inter haec optimum est; sed id quoque peius est multum, tenue, dilutum, magisque si ab initio tale est; itemque si colore sero simile, si pallidum, si liuidum, si faeculentum est; praeter haec, si male olet, nisi tamen locus hunc odorem excitat. Melius est, quo minus est, quo crassius, quo albidius; itemque si leue est, si nihil olet, si aequale est: modo tamen conuenire et magnitudini uulneris et tempori debet. Nam plus ex maiore, plus nondum solutis inflammationibus naturaliter fertur.
After these matters have been investigated, when a man has been wounded who can be saved, there are in the first place two things to be kept in mind: that he should die from haemorrhage or inflammation. If we are afraid of haemorrhage which can be judged both from the position and size of the wound and from the force of the flowing blood, the wound is to be filled with dry lint, and over that a sponge applied, squeezed out of cold water, and pressed down by the hand. If the bleeding is not checked thus, the lint must be changed several times, and if it is not effective when dry, it is to be soaked in vinegar. Vinegar is powerful in suppressing a flow of blood; and some, therefore, pour it into wounds. But then there is an underlying fear of another kind, that if too much diseased matter is forcibly retained in the wound it will afterwards cause great inflammation. It is on this account that no use is made, either of corrosives or of caustics, owing to the crust they induce, although most of these medicaments suppress bleeding; but if for once recourse is had to them, choose those which have a milder action. But if even these are powerless against the profuse bleeding, the blood-vessels which are pouring out blood are to be seized, and round the wounded spot they are to be tied in two places and cut across between so that the two ends coalesce each on itself and yet have their orifices closed. When circumstances do not even admit of this, the blood-vessels can be burnt with a red-hot iron. But even when there has been a considerable bleeding from a place where there is neither sinew nor muscle, such as the forehead or top of the head, it is perhaps best to apply a cup to a distant part, in order to divert thither the course of the blood.
Elaeodes quoque peius est multum, et parum pingue: quo minus eius, quoque id ipsum pinguius, eo melius est. Quibus exploratis, ubi aliquis ictus est qui seruari potest, protinus prospicienda duo sunt: ne sanguinis profusio neue inflammatio interemat. Si profusionem timemus, quod ex sede uulneris et ex magnitudine eius et ex impetu ruentis sanguinis intellegi potest, siccis lin⟨a⟩mentis uulnus inplendum est, supraque imponenda spongia ex aqua frigida expressa ac manu super conprimenda. Si parum sic sanguis conquiescit, saepius linamenta mutanda sunt, et si sicca parum ualent, aceto madefacienda sunt. Id uehemens ad sanguinem subprimendum est; ideoque quidam id uolneri infundunt. Sed alius rusus metus subest, ne nimis ualenter ibi retenta materia magnam inflammationem postea moueat. Quae res efficit, ut neque rodentibus medicamentis neque adurentibus et ob id ipsum inducentibus crustam sit utendum, quamuis pleraque ex his sanguinem supprimunt; sed, si semel ad ea decurritur, is potius, quae mitius idem efficiunt. Quod si illa quoque profluuio uincuntur, uenae quae sanguinem fundunt adprehendendae, circaque id quod ictum est duobus locis deligandae intercidendaeque sunt, ut et in se ipsae coea⟨n⟩t, et nihilo minus ora praeclusa habeant. Vbi ne id quidem res patitur, possunt ferro candenti aduri.
Against bleeding there is help in the foregoing measures, but against inflammation it lies simply in the bleeding itself. Inflammation is to be feared when a bone is injured or sinew or cartilage or muscle, or whenever there is little outflow of blood compared to the wound. Therefore, in such cases, it will not be desirable to suppress the bleeding early, but to let blood flow as long as it is safe; so that if there seems too little bleeding, blood should be let from the arm as well, at any rate when the patient is young and robust and used to exercise, and much more so when a drinking bout has preceded the wound. But if a muscle is seen to be wounded, it will be best to cut it right through; for when stabbed it causes death, when cut through it admits of cure.
Sed etiam satis multo sanguine effuso ex eo loco, quo neque neruus neque musculus est, ut puta in fronte uel superiore capitis parte, commodissimum tamen est cucurbitulam admouere a diuersa parte, ut illuc sanguinis cursus reuocetur. Et aduersus profusionem quidem in his auxilium est: aduersus inflammationem autem in ipso sanguinis cursu. Ea timeri potest, ubi laesum est uel os uel neruus uel cartilago uel musculus, aut ubi parum sanguinis pro modo uulneris fluxit. Ergo quotiens quid tale erit, sanguinem mature subprimere non oportebit, sed pati fluere, dum tutum erit; adeo ut, si parum fluxisse uidebitur, mitti quoque ex brachio debeat; utique si corpus iuuenile et robustum et exercitatum est, multoque magis si id uulnus ebrietas praecessit.
Now, when bleeding has been suppressed if excessive, or encouraged when not enough has escaped of itself, then by far the best thing is for the wound to become agglutinated. But this is possible for a wound in the skin, or even in the flesh, if nothing else has occurred to do it harm. Agglutination is possible if the flesh is hanging free at one part, whilst attached at another, provided, however, that the flesh is still sound, and has a connexion with the body to feed it. But with wounds which are being agglutinated, there are two treatments. For if the wound is in a soft part, it will be stitched up, and particularly when the cut is in the tip of the ear or the point of the nose or forehead or cheek or eyelid or lip or the skin over the throat or abdomen. But if the wound is in the flesh, and gapes, and its margins are not easily drawn together, then stitching in unsuitable; fibulae (the Greeks call them ancteres) are then to be inserted, which draw together the margins to some extent and so render the subsequent scar less broad. Now from the above it can be gathered also whether flesh which is hanging free at one part and attached at another, if it is still capable of juncture, demands suture or fibula. But neither of these should be inserted until the interior of the wound has been cleansed, lest some blood-clot be left in it. For blood clot turns into pus, and excites inflammation, and prevents agglutination of the wound. Not even lint which has been inserted to arrest bleeding should be left in, for this also inflames the wound. The suture or fibula should take up, not only skin but also some of the underlying flesh, where there is any, that it may hold more firmly, and not tear through the skin. And both are best used with a strand of a soft wool not too closely twisted that it may cause less irritation to the body, and both should be inserted at intervals not too distant or too close. For if the intervals are too distant, the wound is not held together; if too close, it is very hurtful, for the more often the needle this fixes the tissues, and the more places are wounded by the inserted stitches, the worse is the inflammation set up, especially in summer. Neither procedure needs any force, but is useful just so far as the skin follows that which draws it as if of its own accord. Generally, however, fibulae leave the wound wider open, a suture joins the margins together, but these should not be brought actually into contact throughout the whole length of the wound, in order that there may be an outlet for any humour collecting within. If any wound admits of neither of these, it should none the less be cleaned. Hence, upon every wound there is to be applied, first a sponge squeezed out of vinegar; or out of wine if the patient cannot bear the strength of vinegar. A slight wound is even benefited if a sponge is applied wrung out of cold water. But in whatever way it is put on, it is only of service while moist; and so it must not be allowed to become dry. And a wound can be treated without foreign and far-fetched and complicated medicaments. But if any one has not confidence in this treatment, a medicament should be put on, which has no suet in its composition, chosen from those which I have stated to be suitable for bleeding wounds: and especially, if it is a flesh wound, the composition called barbarum; if a wound of sinews or of cartilage or of some projecting part, such as the ears or lips, the seal of Polyides: the green composition called Alexandrian is also suitable for sinews; and that which the Greeks call rhaptousa for parts which project. When the body is bruised it is usual also for the skin to be broken to a small extent. When this occurs, it is not improper to lay it open more widely with a scalpel, unless there are muscles and sinews near, as it is inexpedient to cut into these. When it has been sufficiently opened, a medicament is seem to be put on. But if the skin over the contusion, although broken too little, yet must not be laid open more widely on account of sinews or muscles, then such applications should be made as gently extract humour, especially that which I have said is called rhypodes. It is also not inappropriate, when the wound is severe, after putting on what is beneficial, to lay on over this, wool saturated with vinegar and oil; or a poultice, gently repressant if to a soft part; or emollient to a part where there are sinews or muscles.
Quod si musculus laesus uidebitur, praecidendus erit: nam percussus mortiferus est, praecisus sanitatem recipit. Sanguine autem uel subpresso, si nimius erumpit, uel exhausto, si per se parum fluxit, longe optimum est uulnus glutinari. Potest autem id, quod uel in cute uel etiam in carne est, si nihil ei praeterea mali accedit. Potest caro alia parte dependens, alia inhaerens, si tamen etiamnum integra est et coniunctione corporis fouetur. In is uero, quae glutinantur, duplex curatio est. Nam si plaga in molli parte est, sui debet, maximeque si discissa auris ima est uel imus nasus uel frons uel bucca uel palpebra uel labrum uel circa guttur cutis uel uenter. Si uero in carne uulnus est hiatque neque in unum orae facile adtrahuntur, sutura quidem aliena est: inponendae uero fibulae sunt (ancteras Graeci nominant), quae oras, paululum tamen, contrahunt, quo minus lata postea cicatrix sit. Ex his autem colligi potest, id quoque, quod alia parte dependens alia inhaerebit, si alienatum adhuc non est, suturam an fibulam postulet. Ex quibus neutra ante debet imponi, quam intus uolnus purgatum est, ne quid ibi concreti sanguinis relinquatur. Id enim et in pus uertitur, et inflammationem mouet, et glutinari uolnus prohibet. Ne lin⟨a⟩mentum quidem, quod subprimendi sanguinis causa inditum est, ibi relinquendum est: nam id quoque inflammat. Conprehendi uero sutura uel fibula non cutem tantum sed etiam aliquid ex carne, ubi suberit haec, oportebit, quo ualentius haereat neque cutem abrumpat. Vtraque optima est ex acia molli non nimis torta, quo mitius corpori insidat, utraque neque nimis rara neque nimis crebra inicienda est. Si nimis rara est, non continet; si nimis crebra est, uehementer adficit, quia quo saepius acus corpus transuit quoque plura loca iniectum uinculum mordet, eo maiores inflammationes oriuntur magisque aestate. Neutra etiam uim ullam desiderat, sed eatenus utilis est, qua cutis ducentem quasi sua sponte subsequitur. Fere tamen fibulae latius uulnus esse patiuntur, sutura oras iungit, quae ne ipsae quidem inter se contingere ex toto debent, ut, si quid intus umoris concreuerit, sit qua emanet. Si quod uulnus neutrum horum recipit, id tamen purgari debet. Deinde omni uulneri primo inponenda est spongia ex aceto expressa: si sustinere aliquis aceti uim non potest, uino utendum est. Leuis plaga iuuatur etiam, si ex aqua frigida expressa spongia inponitur. Sed ea quocumque modo inposita est, dum madet, prodest; itaque ut inarescat, non est committendum. Licetque sine peregrinis et conquisitis et compositis medicamentis uulnus curare. Sed si quis huic parum confidit, imponere medicamentum debet, quod sine sebo compositum sit ex is, quae cruentis uulneribus apta esse proposui: maximeque, si caro est, barbarum; si nerui uel cartilago uel aliquid ex eminentibus, quales aures uel labra sunt, Poly⟨id⟩i s⟨ph⟩ragidem: Alexandrinum quoque uiride neruis idoneum est; eminentibusque partibus ea, quam Graeci rhaptusam uocant. Solet etiam colliso corpore exigua parte findi cutis. Quod ubi incidit, non alienum est scalpello latius aperire, nisi musculi neruique iuxta sunt; quos incidi non expedit. Vbi satis d⟨i⟩ductum est, medicamentum imponendum est. At si id, quod collisum est, quamuis parum d⟨i⟩ductum est, latius tamen aperiri propter neruos aut musculos non licet, adhibenda sunt ea, quae umorem leniter extrahant, praecipueque ex his id, quod rhypodes uocari proposui. Non alienum est etiam, ubicumque uulnus graue est, imposito quo id iuuetur, insuper circumdare lanam sucidam ex aceto et oleo; uel cataplasma, si mollis is locus est, quod leniter reprimat; si neruosus aut musculosus, quod emolliat.