316 GENUINE WORKS OF HIPPOCRATES. 9. When the gut protrudes and will not remain in its place, scrape the finest and most compact silphium (assafætida ?) into small pieces and apply as a cataplasm, and apply a sternutatory medicine to the nose and provoke sneezing, and having moistened pomegranate rind with hot water, and having powdered alum in white wine, pour it on the gut, then apply rags, bind the thighs together for three days, and let the patient fast, only he may drink sweet wine. If even thus matters do not proceed properly, having mixed vermilion with honey, anoint. 10. If procidentia ani be attended with a discharge of blood, pare off the rind of the root of wakerobin, then pound and mix flour with it, and apply it warm as a cataplasm. Another:-Having scraped off the rind of the most tender roots of the wild vine, which some call psilothrion, boil in a dark austere wine undiluted; then having pounded, apply as a tepid cataplasm; but mix also flour and stir it up with white wine and oil in a tepid state. Another:-Having pounded the seed of hemlock, pour on it a fragrant white wine, and then apply in a tepid state as a cataplasm. 11. But if it be inflamed, having boiled in water the root of the ivy, finely powdered, and mixing the finest flour, and stirring it up with white wine, apply as a cataplasm, and mix up some fat with these things. Another: Take the root of the mandrake, especially the green (fresh) root, but otherwise the dried, and having cleaned the green root and cut it down, boil in diluted wine, and apply as a cataplasm; but the dry may be pounded and applied as a cataplasm in like manner. Another:-Having bruised the inner part of a ripe cucumber to a soft state, apply as a cataplasm.' 12. If there be pain without inflammation, having roasted red natron, and pounded it to a fine powder, and added alum and roasted salts,' finely triturated, mix together in equal proportions; then having mixed it up with the best pitch and spread upon a rag, apply, and bind. Another:Having pounded the green leaves of capers, put into a bag and bind on the part; and when it appears to burn, take it away and apply it afterward; or, if you have not the leaves of capers, pound the rind of its roots, and having mixed it up with dark-colored wine, bind on the part in the same manner. This is a good application also for pains of the spleen. Of these poultices, those which are cooling, stop the discharge; those which are emollient and heating, discuss; and those which are attractive, dry up and attenuate. This disease is formed when bile and phlegm become seated in the parts. When the anus is inflamed, it should be anointed with the ointment, the ingredients of which are resin, oil, wax, plumbago, and suet, these being all melted and applied quite hot as a catapalasm. One cannot help being struck with the admirable judgment with which the ingredients in these cataplasms are selected. What articles so likely to soothe irritation and allay pain, as hemlock, mandragora, cucumber, and the like? The process of roasting salts is minutely described by Dioscorides (v., 125). ON HEMORRHOIDS. THE ARGUMENT. THAT this little work is a continuation of the preceding one "On Fistulæ," is admitted by all the authorities, ancient and modern. In the first paragraph is described the formation of hemorrhoids from bile or phlegm, which are determined to the rectum and inflame the blood in the veins, so that they become gorged, and the gut swells, and when the parts are injured by the passage of hard fæces, the vessels squirt out blood. In the second, the author boldly declares that such operations as those of cutting, sewing, binding, and applying septics to the anus, although formidable in name, are by no means so much so in reality, as might be suspected. He then describes in very lucid terms the method of applying the actual cautery to the hemorrhoids. He directs the patient to be properly secured, and the piles having been made to protrude, are to be burnt by means of red-hot irons. The after-treatment is then distinctly laid down, first by cataplasms and by means of a soft sponge, secured with a shawl. In the third, the operation of excising the hemorrhoids is described along with the subsequent management by means of astringent applications and a piece of sponge. In the fourth, the condyloma is described, and the mode of operating upon it when it protrudes is most minutely described. He directs that the tumor should be torn away with the finger, and the decoction of galls applied to the place. In the fifth is described the proper mode of procedure when the tumor is far up the rectum. The great principle of treatment which he lays down is to remove it by the roots, in which case, he says, there is no risk of bleeding, whereas, if it be separated elsewhere, there will be a dangerous discharge of blood. In the sixth is described the process of burning the hemorrhoid, first by means of an iron conducted within a canula, or if neither excision nor the actual cautery be practicable, with caustics, by means of which, he says, the pile will separate like a piece of burnt hide. The ingredients in his applications are sulphate of copper, alum, and the like. In the last paragraph is given the treatment of what was described by 320 GENUINE WORKS OF HIPPOCRATES. the ancients as hemorrhoids of the female parts of generation. It consists in fomenting them with certain things cf a soothing and stimulant nature. What gives this treatise the most interest is the description contained in it of the method of curing hemorrhoids by the actual and potential cauteries. Neither of these methods are much known in this country, but both are often practiced in France. The caustic most frequently used is the Vienna paste, which, I believe, is a preparation from the potassa fusa. It is applied by means of a forceps, porte-caustique. I have often applied successfully the simple caustic potass. The French surgeons also operate with the actual cautery. See the English edition of Malgaigne's Operative Surgery, p. 445. ON HEMORRHOIDS. 1. THE disease of the hemorrhoids is formed in this way: if bile or phlegm be determined to the veins in the rectum, it heats the blood in the veins; and these veins becoming heated attract blood from the nearest veins, and being gorged the inside of the gut swells outwardly, and the heads of the veins are raised up, and being at the same time bruised by the fæces passing out, and injured by the blood collected in them, they squirt out blood, most frequently along with the fæces, but sometimes without fæces. It is to be cured thus: 2. In the first place it should be known in what sort of a place they are formed. For cutting, excising, sewing, binding, applying putrefacient means to the anus,-all these appear to be very formidable things, and yet, after all, they are not attended with mischief. I recommend seven or eight small pieces of iron to be prepared, a fathom in size, in thickness like a thick specillum, and bent at the extremity, and a broad piece should be on the extremity, like a small obolus.' Having on the preceding day first purged the man with medicine, on the day of the operation apply the cautery. Having laid him on his back, and placed a pillow below the breech, force out the anus as much as possible with the fingers, and make the irons red-hot, and burn the pile until it be dried up, and so as that 1I would direct the attention of my surgical readers to the form of the ancient cautery or burning iron; it resembles a small coin, that is to say, it was a disk. I have often thought that modern practitioners in surgery erred in making their cauteries globular, instead of making them flat disks like the ancient. Several of the burning irons delineated by Scultet are of this shape. See, in particular, Tab. xxxviii., f. 4. Le cautère mummulaire of the French surgeons is formed exactly upon the model of the ancient cautery here noticed by Hippocrates. See Malgaigne, Méd. Opèrat., p. 22. He describes it as being "un disque de douze lignes de diamètre sur quatre d'épaisseur.” |