Aegineta Paulus

“ Straightway dimness of the eyes seizes them, and various pains all over the body, which are altogether slight, and not without enjoyment, supervene; wherefore Nicander has properly said, “and without suffering dies the man.” The colour is changed and becomes as green as grass, there is a gnawing pain at the orifice of the stomach, the forehead is constantly drawn upwards, the eyelids are moved insensibly as in sleep, and with these symptoms death cuts off the man before the third part of a day has passed over. In both these cases speedy amputation of the extremities averts the evil. ”

“ When a clot of blood obstructs the vein he directs us to squeeze it out, or to dissolve it with oil or vinegar. When coldness of the body, occasioned whether by the temperature of the air, or the nature of the disease, prevents the flow of blood, he recommends fomentations and frictions. When a piece of fat or flesh blocks up the opening of the vein, he says there is no remedy for it but to cut it out or push it aside. When the object is to produce a sudden depletion he directs us to make a large incision in the vein, but a small one when it is intended to procure revulsion. ”

“ Celsus treats of fistulæ with more than his wonted minuteness. This is his definition: “Id nomen est ulceri alto, angusto, calloso.” He has described all the complications of it with great accuracy. He directs us to commence by making an inspection with a probe or sound, so as to ascertain the state of the parts and of the discharge. If a soft body is felt at the bottom, we conclude that the fistula terminates in the flesh, but if a hard one is felt, we know that it ends with a bone. ”

“ Galen appears decidedly to have maintained with Hippocrates—‘that there is in the body no one beginning, but that all parts are alike, beginning and end: for a circle has no beginning.’ Agreeably to this idea, Galen remarks, that the brain cannot properly be said to derive its powers from the heart, since an animal will run, breathe, and cry after its heart has been taken out; nor can the heart be said properly to derive its powers from the brain, since it will palpitate and contract, after all communication with the brain is cut off, nay, after it has been removed from the body. ”

“ Cancer is an uneven swelling, rough, unseemly, darkish, painful, and sometimes without ulceration (which Hippocrates called also concealed cancer) , and if operated upon, it becomes worse, and sometimes with ulceration, for it derives its origin from black bile, and spreads by erosion; forming in most parts of the body, but more especially in the female uterus and breasts. It has the veins stretched on all sides as the animal the crab (cancer) has its feet, whence it derives its name. ”

“ When there is only contusion of the nerve, if along with it there be contusion of the skin and ulceration, the cataplasm of the flour of beans and of oxymel will be a fit one, but you may add sometimes the flour of tares, and some iris; and when the contusion is attended with pain, you may mix a little liquid pitch with it. If there be no contusion of the skin, it will be more discutient to bathe frequently with an oil of a heating nature, I mean that of dill, of rue, of iris, or of marjoram. When the whole nerve is cut asunder no danger will result from it, but the part will be mutilated ”

“ If the disease arise from the opening of a vein, we are to grasp as much as possible of the tumour in the hand, to push a needle through it armed with a double thread, when the aneurism is to be firmly bound with the threads in the manner described in the operation for staphyloma. When danger is apprehended from the falling out of the threads, we are to introduce another needle armed with another thread under the whole tumour at the opening made by the first needle, and to tie the threads in four places. ”

“ A fistula is difficult to cure when it has no orifice, is blind, ends with a bone, and has many windings. All the rest are, in general, easily cured. We proceed with them thus: having placed the patient in a supine posture, with the legs elevated, so that the thighs may be bent upon the belly, as when an injection of the bowels is administered, if the fistula terminate superficially, having introduced a sound or ear-specillum through the orifice of it, we cut the skin which covers it at one incision. ”

“ Those who experience a dislocation backwards can neither extend the ham nor the knee, nor can they bend the limb before bending the groin also. The leg appears shorter, the groin looser, and the head of the thigh is to be felt at the buttock. When, then, from infancy, or simply, when for a length of time the limb has been neglected after being dislocated, and allowed to remain so, the cure is impracticable, callus having been already formed. But when the luxation is recent, it may be managed in the way recommended by Hippocrates. ”

“ When, therefore, the membranes of the brain are wounded, there is intense pain of the head, the eyes are fiery, the tongue red, and there is aberration of intellect; but if it is attended with a wound of the brain, there is prostration of strength, with loss of speech, distortion of the countenance, vomiting of bile, a discharge of blood from the nostrils, an evacuation of a white and pultaceous fluid by the auditory foramen, and of ichor, if it can find a passage by the wound. If the weapon has penetrated to the cavity of the chest, and sufficient room is left for it, the breath passes out. ”

“ If the fracture be at the elbow, the fore-arm is to be taken in with the bandage, the figure of the elbow-joint being preserved. And so in like manner with the other members, such as the fore-arm, the thigh, and the leg; and when the fracture is in any part near a joint, and not in the middle of the limb, the joint is to be bound along with it. After the bandaging the moderns immediately apply splints, in order to preserve the bones which have been set in their proper shape, tightening them agreeably to the patient’s feeling and the swelling occasioned by the inflammation. ”

“ When the swelling is much raised up to a point, unconcocted, thin, and devoid of vitality, we must cut out a piece either like a triangle, or like a myrtle leaf, or of some other angular figure, because the circular is unfavorable to cicatrization. Those which are not pointed we open by a simple incision, and when we find a sinus, if the part is fleshy and the skin proper for uniting, we only make such incisions into the part as will allow the matter to be discharged; but if it be thin and very devoid of flesh we make a simple incision along its whole length ”

“ Some apply a tube about the barbs, so that when they draw out the weapon the flesh may not be torn by the barbs. If the wound does not become inflamed, we may use sutures, and heal it up like a bloody wound; but if it inflame we may remove the inflammation by embrocations, cataplasms, and the like. If the weapon be poisoned we must, if possible, cut off all the flesh which has imbibed the poison, which is known by its being altered from the sound flesh, for it appears pale, livid, and as it were dead. ”

“ And those kinds which attack a great part of the body are to be supposed more difficult to cure than those which are confined to a small space, and old cases than recent. Some, therefore, in leuce, have approved of burning by iron, consisting simply of the application of heat. Others, dreading the pain of burning, and the scar arising from it, as being no less unseemly than leuce itself, have had recourse to escharotic medicines, such as they say will produce a scar of the natural colour. ”

“ Those then which form in the legs, arms, and extremities it is not safe to cut out, for there is danger lest the part be mutilated. But those about the head or forehead we operate upon by dividing the skin with a scalpel, and if the tumours be small, seizing them with a flesh forceps and cutting them out by the roots. But if they are larger, we transfix them with hooks, and remove them by dissecting them from the skin, and uniting the lips with sutures, complete the cure by the treatment applicable to fresh wounds. ”

“ When the stone falls into the neck of the bladder a sudden retention of urine takes place. Of those cut for the stone, children to the age of fourteen are the best subjects for the operation, on account of the softness of their bodies: old men are difficult to cure because ulcers of their bodies do not readily heal; and the intermediate ages have an intermediate chance of recovery. And again, those who have larger stones recover best because they have become habituated to the inflammation, whereas those who have smaller recover with difficulty for the opposite cause. ”

“ When the abscess is situated at the mouth of the womb, so as that it can be operated upon, we must not be in haste in having recourse to incision, nor until the disease be ripened, and the inflammation has increased to its utmost, and the vascular bodies which surround it have become attenuated, owing to the importance of the uterus in the system. In operating, the woman should be placed on a seat in a supine posture, having her legs drawn up to the belly, and her thighs separated from one another. ”

“ The large intestines are easily cured, but the small ones with difficulty, and the jejunum is utterly incurable, from the multitude of its convolutions and the magnitude of its vessels, and owing to its coats being thin and nervous; besides, it receives all the bile in an undiluted state, and is nearest to the liver. The under and fleshy parts of the stomach we may attempt to cure, for we may succeed, not only because these parts are thicker, but because curative medicines are more readily applied to them, owing to their situation. ”

“ Thus, to give an example from the Arabians, Averrhoes says, our famous physician, Abumeron Avenzoar, states that venesection ought not to be had recourse to until the body is purged, for the veins being emptied of blood attract the crude superfluities. (Collig. vii, 1.) This rule of practice is now too little attended to. In general Celsus holds that the second or third day of a disease is the fittest time for abstracting blood. He forbids bleeding upon the very onset of a fever, which he says is enough to kill a man outright. ”

“ Celsus follows the line of practice recommended by Hippocrates. In cases of compound dislocations at the shoulder and hip-joint, he states that the danger is great if they are left unreduced, but pronounces death to be certain if they are reduced. Like Hippocrates, he approves of immediate reduction only in dislocations of the bones of the feet and hands. Even these, however, are not to be interfered with while the parts are in an inflamed state. He approves of bleeding, a spare diet, and rest. When a naked bone protrudes and cannot be got restored to its place, he advises it to be sawed off. ”

“ Some enumerate also the capillary fracture, but it is a very narrow fissure which eludes the senses, and therefore, being often overlooked owing to the symptoms of it not being obvious, it occasions death. An indentation is not a division of a bone, and, therefore, such an injury is not properly called a fracture, but is, as it were, a protrusion and bending of the skull inwardly, forming a hollow without a solution of continuity, as when vessels made of copper, or the raw hide of an ox, are struck on the outside. ”

“ The Greek writers on toxicology do not treat of copper as a poison; but the Arabians have done so in brief terms, all agreeing in recommending the same treatment as in cases of poisoning with arsenic. (See Avicenna, Rhases, Haly Abbas, and Alsaharavius.) These authorities, likewise, lay down in very succinct terms the treatment of poisoning by iron, which they direct to be conducted upon general principles. They in particular recommend laxative and demulcent medicines. ”

“ But if the medicine is unknown to us, we must have recourse immediately to such things as are generally applicable to those who have taken any poison whatever; for to wait until the consequent symptoms have come on, is to render the case hopeless, since owing to the remedies being too long of being applied such symptoms can hardly be removed: wherefore, without delay, we must give warm oil by itself or with water, and force them to vomit, or if oil is not at hand, butter with hot water may be given, or a decoction of mallows, or of linseed, or of spelt, or of fenugreek, or of nettle seed. ”

“ When the poison is known to be of a stupefying nature, garlic is to be given, or the theriac and assafœtida in undiluted wine. When it is particularly deleterious, the cure is to be effected by means of the mithridate, theriac, musk, and other aromatics. He inculcates the necessity of preventing sleep and of rousing by every possible means. The patient is to be covered with aromatic cloths, the pit of his stomach is to be rubbed, his face is to be fanned, his hair pulled, and in short, everything is to be done to prevent him from sinking into a state of stupor. ”

“ When a person is bitten by the cerastes the part becomes tumefied, with hardness and blisters, and from the bite there flows an ichor which is sometimes black and sometimes pale, and like leeks; the whole system becomes of a dark pale colour, with erection of the privy member, and mental alienation; then dimness of sight comes on, and they die at last convulsed, as in tetanus. When a person is bitten by an asp, the bite resembles the prick of a needle, being very small in appearance, and without tumefaction, and it discharges blood not copiously but in small quantity, and of a black colour. ”

“ Having, therefore, made a lunated incision below the breast, and dissected away the skin, we unite the parts by sutures. But if, as in women, the breast incline downward, owing perhaps to its magnitude, we make in it two lunated incisions, meeting together at the extremities, so that the smaller may be comprehended by the larger, and dissecting away the intermediate skin, and removing the fat, we use sutures in like manner. But if, through mistake, we should cut away too little, we must again remove what is redundant, and apply the remedies for fresh wounds. ”