Of Medicine, in Eight Books

by Aulus Cornelius Celsus

PREFACE.

That surgery makes the third part of medicine, is both universally known, and has been already observed. This does not indeed discard medicines, and a proper regimen; but yet the principal part is accomplished by the hand. And the effect of this is the most evident of all the parts of medicine. For as fortune contributes a good deal to the cure of distempers, and the same things are often salutary, often fruitless; it may be doubted, whether the recovery be owing to physic, or the constitution. In those diseases also, in which we chiefly make use of medicines, although their success be pretty evident, nevertheless it is plain, that health is both sought for by their means in vain, and often restored without them. As may be observed with regard to the eyes, which after having long suffered from the applications of physicians, sometimes recover of themselves. But in surgery it is manifest that the success, though it may be somewhat promoted by other means, is chiefly to be ascribed to this. Now this branch, though it be the most ancient, yet has been more cultivated by Hippocrates the father of all medicine, than by his predecessors. Afterwards being separated from the other parts, it began to have its peculiar professors, and received considerable improvements in Egypt, as well as elsewhere, principally from Philoxenus, who has treated of this part fully, and with great accuracy, in several volumes. Gorgias also, and Sostratus, the two Herons, and the two Apollonii, and Ammonius Alexandrinus, and many other celebrated men, have each of them made some discoveries. And at Rome too professors of no small note, and particularly of late Tryphon the father, and Euelpistus the son of Phleges, and Meges the most learned of them all, as appears from his writings, by altering some things for the better have made considerable additions to this art.

A surgeon ought to be young, or at most but middle aged, to have a strong and steady hand, never subject to tremble, and be no less dexterous with his left than his right hand; to have a quick and clear sight; to be bold, and so far void of pity, that he may have only in view the cure of him, whom he has taken in hand, and not in compassion to cries either make more haste than the case requires, or his cut less than is necessary; but to do all, as if he was not moved by the shrieks of his patient.

Now it may be asked what peculiarly belongs to this branch: because surgeons assume to themselves the curing of many wounds and ulcers, which I have treated of elsewhere. I can very well suppose the same person capable of performing all these: and since they are divided, I esteem him most, whose skill is most extensive. For my part, I have left to this branch those cases, in which the physician[(1)] makes wound, where he does not find one; and those wounds and ulcers, in which I believe manual operation to be more useful than medicines; lastly whatever relates to the bones. Which things I shall consider in order, and deferring the bones to another book, I shall in this explain the two former; so treating first of these, which are found indifferently in every part of the body, I shall proceed to those, that fall upon particular parts.

CHAP. I. OF CONTUSIONS.

Contusions, in whatever part of the body they are, ought as soon as possible to be treated in this manner; the skin of the part, where the pain is, must be cut in several places, and the grumous blood issuing from them must be wiped away with the back of the knife. If it is not taken in time, and there is a redness, so much of the skin as is red must be cut; if there is a tumour too, wherever that extends, the same remedy is still the best. Then repellents are to be applied over it; and particularly sordid wool squeezed out of vinegar and oil. But if the hurt be more slight, the same applications without an incision may perform the cure. And if nothing else is at hand, ashes, especially of burnt twigs; if they are not to be got, any other ashes mixed up with vinegar, or even with water.

CHAP. II. OF THE OPERATIONS NECESSARY IN SUPPURATED TUMOURS.

The foregoing case is easily managed. But there is more trouble with those tumours, that come from an internal cause, and tend to suppuration. That all these are kinds of abscesses, I have elsewhere shewn, and treated of the medicines proper for them: it now remains, that I mention the manual operations necessary for their cure. Wherefore it is requisite, before they grow hard, to cut the skin, and apply a cupping vessel to evacuate any bad and corrupted matter which may have been collected there: and this may be repeated a second and third time, till all the symptoms of an inflammation be gone. Nevertheless, it is not right to trust[(2)] entirely to the cupping vessel.

Sometimes also it happens, though rarely, that a collection of pus is inclosed in a covering of its own: the ancients called this a coat. Meges, because every coat is nervous, affirmed a nerve was not generated in a disorder, which destroyed the flesh, but that the pus being lodged below for a long time, was surrounded with a callosity. This however has not the least relation to the method of cure; because the same course, that ought to be pursued if it be a coat, is also necessary if it be a callosity. And though it should be a callosity, yet as it invelops something, there is no reason against calling it a coat. And then again, it is not uncommon for this to be found even before the suppuration is formed[(3)], and therefore what is below it cannot be extracted by a cupping vessel. But this is easily discovered, when the application of that instrument has made no change. Therefore, where-ever that happens, or when there is already a hardness, nothing is to be expected from this remedy: but as I have directed elsewhere, either the afflux of matter to the part must be diverted, or it must be discussed, or brought to a perfect suppuration. If either of the former has taken place, nothing further is necessary. If the pus has been maturated, in the armpits and groin an incision is rarely to be made: likewise where-ever the abscess is but small; also where-ever the malady is in the surface of the skin, or even in the flesh; unless the weakness of the patient obliges us to lose no time. And it is sufficient by cataplasms to assist the pus to make its own way. For the part, that has not been touched by an instrument, is generally free from a scar. If the malady lies deeper, it ought to be considered whether the part be nervous or not. For if it be nervous, it should be opened by the actual cautery; the reason of which is, that a small wound may keep open longer for evacuating the pus, and the cicatrix afterwards may be small. But if there be nerves near it, the actual cautery is improper, lest convulsions follow, which may debilitate[(4)] the limb; yet the assistance of the knife is necessary. The others may be opened before they be quite mature: but amongst tendons the utmost ripeness is to be waited for, that the skin may be thin, and the pus brought close to it, that it may be the sooner found. And some again require a wound[(5)] in a straight direction, as those in the flesh: but others render the skin extremely thin; and in such the whole surface of it above the pus must be cut away. Now in all cases where the knife is used, care must be taken, that the wounds be as small and as few in number as possible: with this caution, however, that we do all the case requires, both with regard to size and number: for larger cavities require broader incisions; sometimes even in two or three different directions. And we must endeavour that the deepest part of the sinus shall have a free discharge, lest any of the humour settle within, which by corroding the contiguous parts yet sound, may make sinuses there. Cases also sometimes occur, in which the skin must be taken off to a more considerable breadth. For when after long distempers, the habit of the whole body has been vitiated, and the sinus is enlarged to a great compass, and the skin is pale; we may take it for granted that it is already mortified, and will be useless: therefore it is more proper to cut it off: and especially if this happen about the larger joints, and the patient has been troubled with a purging while he was confined to his bed, and he gains no flesh by the nourishment he takes. But the excision should be made in the form of a myrtle leaf, that it may heal the more easily. And this rule must constantly be observed, whenever a physician upon any account cuts away the skin. After the pus is discharged, in the armpits and groin there is no need of lint, but a sponge squeezed out of wine must be laid on. In the other parts, if lint is equally needless, a little honey must be infused to cleanse it; then agglutinants are to be applied: if lint be necessary, over it also in like manner ought to be laid a sponge squeezed out of wine in the same way. When lint is necessary, and when not, has been determined elsewhere. The other directions are to be observed when the suppurated tumour is cut, which I gave for one, that has been broke by medicines.

CHAP. III. OF THE GOOD OR BAD SYMPTOMS OF SUPPURATIONS.

It is soon known from the nature of the symptoms, how a cure advances, and what event is to be hoped or feared: and these are commonly the same with what have been laid down in wounds. For they are good signs to sleep, to breathe easily, not to be troubled with thirst, not to loathe food, if there has been a slight fever, to be free of it: also that the pus be white, smooth, and not fetid. The bad signs are wakefulness, difficulty in breathing, thirst, loathing of food, a fever, and the pus black, or feculent, and fetid: also a hemorrhage in the process of the cure; or if before the cavity is filled up with flesh, the lips become callous, and the flesh there be dull of sensation, and spongy. But for a person to faint either in the dressing or afterwards, is worst of all. Moreover, if the fever cease suddenly, before the suppuration is begun, or if it continue after the discharge of the pus, these are just grounds for fear. There is room to fear also, if the wound is not sensible of corrosive medicines. But whatever symptoms shall happen to arise, it is the part of a physician to endeavour the recovery of his patient. Therefore, as often as he shall open a wound, he ought to wash it, if it seems necessary to repel the humour, with a mixture of wine and rain water, or with a decoction of lentils in water: if it needs cleansing, with mulse; and to apply the same dressings again. When the humour shall appear to be stopt, and the ulcer clean, it will be convenient to promote the growth of the flesh, and dress the ulcer with equal parts of wine and honey, and apply a sponge dipt in wine and oil of roses, which things are incarning. A proper regimen however, as I have observed elsewhere, is more effectual for this purpose: that is, when the fever is removed, and the appetite restored, bathing now and then, daily but mild gestation, and such kinds of food and drink as are of the most nourishing nature. All which rules also hold with regard to an abscess, that has been broken by medicines. But because it is hardly possible to cure a large tumour without the knife, the mention of these has been reserved to this place.

CHAP. IV. OF FISTULAS.

With regard to fistulas, if they penetrate pretty deep, so that a collyrium cannot reach the bottom of them, if they are tortuous, or consist of several sinuses, operations are more useful than medicines; and those, that run in a transverse direction below the skin, give less trouble than such as go directly inward. Therefore, if the fistula be transverse under the skin, a probe ought to be introduced, and an incision made upon that. If it be tortuous, its windings are to be followed by the probe and knife. And the same course must be taken, if several of them appear like rivulets uniting their streams. When we have reached to the end of the fistula, all the callosity must be cut out, and fibulae applied to it with medicines to agglutinate. But if it points directly inward, when its direction is found by a probe, that sinus must be cut out: then a fibula put upon the lips of the skin, and agglutinating medicines laid over it; or if the ulcer be very foul (which sometimes happens from a carious bone) when that also is cured, medicines to promote a digestion.

Of fistulas amongst the ribs.

It is common for fistulas to extend beneath the ribs. When this case occurs, the rib in that part must be cut through on both sides, and taken out, lest any thing corrupt be left within. It is usual for them also, when they have got through the ribs, to penetrate the transverse septum, that divides the intestines from the superior viscera. Which circumstance may be known, both from the situation, and from the violence of the pain, and because sometimes the air comes out with the matter, as it were bubbling, and particularly when the patient keeps in his breath. For this case there is no remedy. In the other kinds about the ribs, which are curable, greasy medicines are hurtful, and therefore we should use such as are adapted to wounds: but the best application is dry lint, or if any thing requires to be cleansed, the same dipped in honey.

Of fistulas in the belly.

There is no bone within the skin of the belly; but fistulas in that part are extremely dangerous; insomuch that Sostratus believed them incurable. That they are not always so, experience has shewn. And indeed, which may seem very wonderful, a fistula opposite to the liver and spleen, and stomach, is more safe than one opposite to the intestines: not that the thing is of its own nature more pernicious there, but because it exposes to a danger of another kind. The reason of which fact some authors have but little understood, though their experience convinced them of this difficulty. For the belly itself is often wounded by a weapon, and the intestines, that have fallen out, are replaced, and the wound united by sutures: the manner of doing which I shall point out presently. Therefore, when a small fistula has even penetrated the abdomen, it may be cut out, and the lips of it joined by a suture. But if the fistula spreads wider within, upon its being cut out, it must necessarily leave a pretty large vacuity, which cannot be sewed up without great violence; especially on the internal side, where there is a kind of membrane, which the Greeks call peritonaeum, that surrounds the abdomen. Therefore, as soon as a person begins to walk or move, the suture breaks, and the intestines are let loose, so that the patient must perish. But the case is not always desperate; and therefore, we must attempt the cure of smaller fistulas there.

Of fistulas in the anus.

Fistulas in the anus require a particular treatment. A probe being put into them, an incision must be made in the skin at its further end: then the probe must be drawn out at the new orifice with a thread following it, which was put through an eye made in the other end for the purpose. There the thread must be taken hold of, and tied to the other end, that it may gently take hold of the skin above the fistula: and the thread should be made of crude lint[(6)], double or triple, and so twisted as to make one string. In the mean time the patient may go about his business, walk, bathe, and eat, just as if he were in the most perfect health. Only loosing this knot[(7)] twice a day, the string must be drawn in such a manner, that the part, which was above, may then be within the fistula. And the thread must not be suffered to rot, but every third day, the knot must be untied, and at its one end must be fixed a fresh ligature, which when the old one is drawn out, must be left in the fistula with a like knot. For thus it gradually cuts the skin that is above the fistula: and, at the same time, the part that has been eat through by the thread, heals; whilst the remainder, which is pinched by the thread, continues to be cut by it. This method of cure is long, but is attended with no pain.

Those, that are for making quick dispatch, ought to tie the skin tight with the string, that it may be the sooner cut; and at night to introduce some small slips of a penecillum, that the skin may be made thin by the same means that it is distended; however this occasions pain. The dispatch, as well as the pain, is increased, if both the string and the penecillum be turned with some one of those medicines, which I mentioned, for consuming a callosity. It may happen, however, that the use of the knife may be necessary, even in this part, if the fistula points inward, or consists of several sinuses. Wherefore in these kinds, the probe must be introduced, and the skin must be cut in two lines, so that betwixt them a very small habenula may be cut out[(8)], to prevent the lips from uniting presently; and that room may be left for pledgits of lint, as few of which as possible ought to be laid on; and the same course must be pursued as was directed in abscesses. But if, from one orifice, there shall be several sinuses, that sinus, that runs straight, must be opened with a knife, and the others, that branch from it, which will then appear, must be tied with a ligature. If any one penetrate so deeply, that an instrument cannot be safely used, a collyrium must be put in.

The food, in all these cases, whether the treatment be by an operation, or by medicines, ought to be moist; the quantity of drink pretty liberal, and for a long time water. And when the flesh begins to sprout up, then indeed the bath may be used, but sparingly, and such food as plumps the body.

CHAP. V. OF EXTRACTING WEAPONS OUT OF THE BODY.

Weapons, that lodge in the body, are very often troublesome to extract. For there are some difficulties, which arise from their different forms; others from the situation of the parts, into which they have penetrated. Now every weapon is extracted, either on that side, where it entered, or on that, to which it points. In the first case it returns by the way itself made: in the other, it receives one from the knife; for the flesh is cut directly upon the point of the weapon. If the weapon does not lie deep, but is in the surface of the flesh, or at least has not past through large veins and nervous parts, the best method is to pull it out by the way it entered. But if the space, through which the weapon must return, be greater than that, which is to be laid open, and it has already past through veins and nerves, it is more expedient to open what remains, and extract it that way; for it is both nearer at hand, and is drawn out with more safety. And in one of the larger limbs, if the point of the weapon has past beyond the middle of it, it will heal the more readily for being open quite through, as the remedies will act at both extremities of the wound. But if the weapon is to be brought back the same way, the wound must be enlarged, that it may move the more easily, and occasion the less inflammation; which will be considerable, if the body be lacerated by the weapon as it returns. And in like manner, if an opening be made on the opposite part, it ought to be so large, as not to be increased afterwards by the weapon passing through it. In either case, the greatest caution must be used not to cut a tendon, or a large vein, or an artery. When any of these are exposed, it must be laid hold of with a blunt hook, and drawn aside from the knife. When an incision is made large enough, the weapon must be taken out: then also the same method, and the same precaution are to be used, lest any of the abovementioned parts should be injured, which lie under the weapon, that is to be extracted.

Of arrows.

The foregoing directions are general: besides which, there are some particular rules for the several kinds of weapons, which I shall immediately subjoin. Nothing is so easily lodged in the body as an arrow, and it goes to the greatest depth. The reasons are, both that it moves with great force, and because it is small. Therefore, it must be extracted more frequently on the opposite part, than on that by which it entered, and especially because it is generally surrounded with beards, which lacerate more, if they be drawn backward than forward. But an orifice being made on the opposite part, the flesh ought to be opened by an instrument made in the form of the Greek letter ν; and when the point appears, if the shaft adheres to it, it must be pushed forward, till it can be taken hold of at the opposite part, and extracted. If that is already broke off, and only the iron head is within, the point must be taken hold of by the fingers, or a forceps, and thus pulled out. And there is no other method of extracting it, when it is thought adviseable to pull it out by the orifice it entered at: for after the wound is enlarged, either the shaft, if that be lodged within, must be pulled out; or if that be not there, the iron itself. But if the beards are visible, and they are short and small, they ought to be broke off with a forceps, and the weapon, when freed of them, to be brought out; if they are larger and stronger, they must be covered with writing reeds split, to prevent their lacerating any part, and thus pulled out. This is the method observed in extracting arrows.

Of broad weapons.

But if a person has a broad weapon lodged within his flesh, it is not proper to draw it out at the opposite part, lest we add another great wound to the large one already made. It must therefore be pulled out with a certain kind of iron instrument, which the Greeks call the graphiscus of Diocles[ GP ], because it was invented by Diocles, whom I have already taken notice of among the ancient and greatest physicians. This is a plate of iron, or sometimes of copper, at the one end, having two claws turned downwards on each side; the other perforated and folded back on each side; bent a little at that extremity, which has the claws; and likewise on the other, which is perforated. This is introduced transversely, hard by the weapon; and then, when it has reached its point, it is turned a little, that it may receive the weapon into the perforation. When the point is in the hole, the operator, clapping two of his fingers to the claws at the other end, draws out at once his instrument and the weapon.

Of leaden bullets, &c.

A third kind of weapon, which requires sometimes to be pulled out, is a leaden bullet, or a stone, or some such thing, which having broke through the skin, is entirely lodged within. In all these cases, the wound must be enlarged, and what is within must be extracted by a forceps the way it entered.

But there is an additional difficulty attending every wound, where the weapon is either fixed in a bone, or has sunk into an articulation between two bones. If, in a bone, the weapon must be moved to and fro, till the part, which gripes the point, gives way, and then the weapon must be extracted, either with the hand, or a forceps. Which is also the method of extracting the teeth. And it is very rare that the weapon does not follow in this way. But if it still remains, it may be forced out with some kind of instrument. The last resource, when it is not extracted, is to make a perforation near it by a terebra, and from that opening, to cut the bone in the form of the letter v, opposite to the weapon, in such a manner, that the opening of the lines be directed towards the weapon; when this is done, it must necessarily give way, and be easily taken out.

If it has made its way into an articulation between two bones, the two limbs must be bound up with rollers and straps, and by means of these drawn contrary ways, to stretch the tendons: which being extended, will leave a larger space between the bones, so that the weapon may be extracted without difficulty. Care must be taken, as I observed in other cases, in its extraction, that no nerve, vein, or artery be wounded by the weapon, whilst it is extracting, which is to be guarded against by the method mentioned before.

Of poison­ous weapons.

But if a person be wounded by a poisoned weapon, all that is above mentioned being, if possible, still more expeditiously executed, he must also be treated in the method prescribed for one that has drunk poison, or been bit by a serpent. The treatment of the wound itself, after the extraction of the weapon, is the same as if nothing had been lodged there; of which I have said enough elsewhere.

CHAP. VI. OF A GANGLION, MELICERIS, ATHEROMA, STEATOMA, AND OTHER TUBERCLES OF THE HEAD.

These are cases that occur in any part of the body indifferently: the rest have certain seats, which I am going to speak of, beginning with those in the head. In this a great number and variety of tubercles rise, called ganglia[ GQ ] melicerides[ GR ], atheromata[ GS ]; there are some other kinds, to which authors give different names; to which I shall also add steatomata[ GT ]: which though they often arise in the neck, and in the armpits, and sides, I have not mentioned separately; since all of them differ but little, and neither are threatening, nor require any different treatment from each other. Now all these rise from a very small beginning, and increase gradually for a long time, and are inclosed each in a coat of its own. Some of them are hard, and resist pressure, others are soft and yielding; some of them are bald in a part, others remain covered with hair, and are commonly without pain. What their contents are, though it may be pretty well guessed at, yet cannot be certainly known, till they be taken out. However, generally in these that resist, there are found either some stony substance, or a number of hairs concreted together: but in those that yield, something resembling honey, or thin pulticula, or the scrapings of cartilage, or insensible or bloody flesh; and these are commonly of different colours. And for the most part ganglia are elastic: the atheroma contains a liquor like thin pulticula: the meliceris a more liquid one, which therefore fluctuates upon being pressed: there is a fat substance in the steatoma, and that generally has the largest circumference, and so relaxes the whole surface of the skin above it, as to make it slide backward and forward; whereas, in the rest, it is more bound. It is proper first to shave them all if they be covered with hair, and then to cut them through the middle, that whatever was collected within may be evacuated. But the coat of the steatoma must also be cut; because it is not easily separated from the skin and subjacent flesh. In the others the coat is to be preserved entire: and immediately, when it appears white and tense, it must be separated by the handle of the knife from the skin and flesh, and taken out together with its contents. If, however, it should happen, that the lower side of the coat adheres to a muscle, lest that be wounded, the upper side must be taken away, and the lower left in its place. When the whole is extracted, the lips must be brought together, and a fibula put upon them, and over that an agglutinating medicine. When either the whole coat, or any part of it is left behind, medicines to promote a digestion must be applied.

CHAP. VII. OF THE DISEASES OF THE EYES, WHICH ARE CURED BY MANUAL OPERATIONS.

But as the foregoing disorders do not differ much either in their nature, or method of cure, so these in the eyes, which require manual operations, are both different in their kinds, and require different methods of cure.

Of vesicles in the upper eye-lids.

In the upper eye-lids then it is common for fat and heavy vesicles to rise, which scarcely allow the eye to be raised, and occasion gentle, but constant fluxes of gum in the eyes. And they commonly happen to children. In this case, it is necessary to compress the eye with two fingers, and thus stretching the skin, to cut with the knife in a transverse line, with a very light hand, in such a manner as not to wound the vesicle, and so that it may pass out when a way is made for it; then to catch hold of it with the fingers, and pull it out: for it easily separates. After this the part ought to be anointed over with any of these collyriums, that are used in lippitudes; by which means it is covered with a cicatrix in a very few days. It is more troublesome, when the vesicle is cut: for it discharges its humour, and cannot be laid hold of after, because of its smallness. If that accident should happen, one of the medicines that promotes a digestion, may be laid on.

Of a crithe.

In the eye-lid, likewise, above the lashes, there grows a small tubercle, which from its resemblance to a barley-corn, is, by the Greeks, called crithe[ GU ]. It is contained in a coat, and seldom maturates. Upon this should be applied hot bread, or wax heated now and then, provided the degree of heat be no more, than the part can easily bear: for by this method it is often discussed, sometimes maturated. If pus appear, it ought to be divided by a knife, and the contained humour squeezed out: and to be afterwards treated with the same warmth, and anointed, till it recover a sound state.

Of chalazia.

Other tubercles not unlike this, grow in the eye-lids; but however not of the same form, and also moveable, when they are impelled this way or that by the finger: which because of their resemblance to hail-stones, the Greeks call chalazia[ GV ]. These ought to be cut on the external side, if they be immediately under the skin; on the internal, if they lie below the cartilage; after that, they must be separated by the handle of the knife from the sound parts. And if the wound be on the internal side, it must be anointed at first with mild, and afterwards more acrid medicines; if, on the external, an agglutinating plaister must be applied over it.

Of the unguis.

The unguis, called by the Greeks, pterygium[ GW ], is a small nervous membrane, which arising from the angle of the eye, sometimes reaches to the pupil, and obstructs the sight. It oftener begins from the angle, near the nose, sometimes too from that towards the temples. It is no difficult matter to discuss this, when recent, by the medicines, which lessen cicatrices in the eyes. If it be of long standing, and has acquired some thickness, it ought to be cut out. After an abstinence of one day, the patient must be placed in a seat, either with his face opposite to the physician, or with his back to him, in such a manner, that he may recline his head upon his breast. Some, if the disease be in the left eye, chuse to have him set with his face to the physician; if in the right, in the reclined posture. One eye-lid ought to be opened by an assistant, and the other by the physician. If the physician face him, he must take hold of the lower one; if he be reclined, the upper one. Then the physician is to fix under the extremity of the unguis, a small sharp hook, with its point turned a little inward; and to let go the eye-lid, which is then to be held by an assistant, and taking hold of the hook, he is to lift up the unguis, and pass a needle through, drawing a thread after it; then to lay aside the needle, and take hold of the ends of the thread, and by them raising up the unguis, if it adheres any where to the eye, to separate it by the handle of the knife, till he come to the angle; then alternately sometimes to slacken, sometimes to draw it, that so both its origin and the extremity of the angle may be found. For there is a double danger attends it; either lest some part of the unguis be left, which being ulcerated is hardly ever cured, or lest the caruncle be cut away from the angle; for if the unguis be drawn away with too much force, that also follows, and comes away. If it is torn off, an orifice is opened, through which afterwards a humour always descends, which the Greeks call rhyas[ GX ]. The true termination then of the angle must be found out. When that plainly appears, the knife is to be used, the unguis not being too straight drawn; and then this small membrane is to be cut out in such a manner, that no part of the angle be wounded. Afterwards lint covered with honey must be laid on, and over that a linen cloth, and either spunge, or sordid wool. The following days the eye must be opened daily, lest the eye-lids be agglutinated together by a cicatrix (for that is also a third danger) and lint be put on in the same way: lastly, it must be anointed with a collyrium, that cicatrizes ulcers.

But this operation should be performed in the spring, or at least before winter. Which circumstance, though it belongs to several places, it will be sufficient to mention once for all. For there are two kinds of cures; one, in which we are not at liberty to chuse a time, but that must be laid hold of, that offers, as in wounds and fistulas; another, in which we are not pressed for time; but it is quite safe and easy to wait the most convenient season; as is the case in these disorders, which both increase slowly, and are not extremely painful. In such, we must defer it till spring; or if there is any urgent circumstance, the autumn however, is better than the winter or summer; and of that the middle, when the excessive heats are gone, and the colds not yet set in. Now the more necessary the part is, whose cure shall be undertaken, the greater will the danger be it is exposed to. And often by how much larger the wound is to be made, so much the more must the season of the year be regarded.

Of an encan­this.

From the operation for the unguis, as I observed, disorders arise, which may also sometimes proceed from other causes. For sometimes after the imperfect excision of an unguis, or upon some other occasion, a tubercle grows in the angle, which hinders the entire opening of the eye-lids; the Greek name for it is encanthis[ GY ]. It ought to be laid hold of with a hook, and cut round; and here also the operator must be cautious not to cut away any thing from the angle itself. Then a small piece of lint must be sprinkled either with cadmia, or copperas; and the eye-lids being opened it must be introduced into that angle, and bound over in the same manner as the former; and for some following days must be dressed in like manner, first bathing it with water, just warm, or even cold water.

Of the ancylo­bleph­aron.

Sometimes the eye-lids grow together, and the eye cannot be opened. Which is often attended with this disorder besides, that the eye-lids adhere to the white of the eye; that is when an ulcer in either of them has been negligently cured. For as it heals, what might, and ought to have been separated, will be agglutinated; both species of the distemper is called by the Greeks ancyloblepharon[ GZ ]. When the eye-lids only cohere, they are separated without difficulty; but sometimes to no purpose: for they are agglutinated again. However trial ought to be made; because the case often turns out well. Therefore the broad end of the probe must be introduced betwixt them, and the eye-lids separated by that; then small penecilla are to be put between them, till the ulceration of the part be cured. But when the eye-lid adheres to the white of the eye itself, Heraclides the Tarentine advises to cut under it gently with a knife with great caution, lest any thing be cut away either from the eye, or the eye-lid; and if that cannot be entirely avoided, rather to take something from the eye-lid. After these let the eye be anointed with such medicines as cure an asperity; and the eye-lid be inverted every day, not only that the medicine may be applied to the ulcer, but also to prevent its adhesion: the patient himself must also be charged to raise it often with two fingers. I do not remember an instance of one person cured by this method. Meges too tells us he tried many ways, and never was successful; for the eye-lid always adhered again to the eye.

Of the aegi­lops.

Again in that angle, that is next the nose, from some disorder, a kind of small fistula is opened, through which gum[(9)] perpetually distils; the Greeks call it ægilops[ HA ]. And this gives constant uneasiness to the eye; sometimes also eating through the bone, it penetrates to the nostrils. This sometimes is of a cancerous nature; when the veins are tense and crooked, the colour of it is pale, the skin hard, and irritated by a slight touch, and it raises an inflammation in the contiguous parts. It is dangerous to attempt the cure of those, that are cancerous: for it even hastens death. And it is needless to meddle with such as reach to the nostrils: for neither do they heal. But the cure of these in the angle may be attempted; though it should be known however that it is difficult; and the nearer to the angle the opening is, so much the more difficult, because there is a very little room for the management of the hand; yet it is easier to cure the disorder when recent. The top of the opening must be taken hold of with a small hook; and then all the cavity as I directed in fistulas, must be cut out to the bone; and the eye and other contiguous parts being well covered, the bone must be strongly cauterized with a hot iron. But if it be already affected with a caries, that a thicker scale may cast off, some apply caustic medicines; as copperas, or chalcitis, or rasile verdigrease: which method is both slower, and not so effectual. When the bone is cauterized, the remaining part of the cure is the same as in other burns.

Of hairs in the eye lashes ir­ri­tat­ing the eye.

The hairs of the eye-lids sometimes irritate the eye; and that from two causes. For sometimes the skin of the eye-lid is relaxed, and falls down; whence it happens, that the lashes are turned in upon the eye itself, because the cartilage is not also relaxed; at other times, beside the natural row of hairs, another grows under it, which point directly inward upon the eye. The methods of cure are these. If preternatural hairs have grown, an iron needle thin and broad, like a spatha[(10)], must be put into the fire, and when it is red-hot, the eye-lid being lift up in such a manner, that the offending lashes are in the view of the operator, it must be passed from the angle close to the roots of the hair, till it move over the third part of the eye-lid; then it must be applied a second and third time, as far as the other angle. The consequence of which is, that all the roots of the hairs being burnt, die away. Then a medicine to prevent an inflammation must be applied: and when the eschars have cast off, it must be brought to cicatrize. This kind heals very easily. Some alledge that it is proper to pierce the external part of the eye-lid near the eye-lashes with a needle, which must be passed through with a woman’s hair doubled for a thread; and when the needle has gone through, that the offending hair must be taken up into the loop of the woman’s hair, and by that drawn upward to the superior part of the eye-lid, and there to be glued down to the flesh, and a medicine applied to close up the orifice thus made: for that this will cause the eye-lash to point afterwards externally. This in the first place cannot be practised, but upon a pretty long hair; whereas they generally grow short there. And then if there be several hairs, the patient must suffer a long torture, and the needle passing so often through will raise a great inflammation. Lastly, when any humour is settled there, the eye being irritated both before by the hairs, and afterwards by the perforations of the eye-lids, it is hardly possible to prevent the glutinous matter, which fastens the hair, from being dissolved: and thus of course the hair returns to the place, from whence it was drawn away.

The method of cure for a relaxed eye-lid, which is universally practised, never fails of success. For the eye being closed, one must take hold of the middle part of the skin of the eye-lid, whether it be the upper or the lower, with his fingers, and raise it; then consider how much must be taken away, to reduce it to its natural condition. For there are two dangers attending this case; lest if too much be cut off, the eye cannot be covered; if too little, the end be not obtained, and the patient have suffered to no purpose. The part, which it shall be thought needful to cut, must be marked by two lines with ink in such a manner, that betwixt the range of hairs and the line nearest to it, some space may be left for the needle to lay hold of. These things being determined, the knife is to be used: and if it be the upper eye-lid, the incision next the eye-lashes must be made first; if the inferior one, last: and it must begin in the left eye, at the angle next the temple; in the right, at the angle next the nose; and what lies between the two lines must be cut out. Then the lips of the wound are to be joined together by a single stitch, and the eye must be covered; and if the eye-lid does not descend far enough, it must be relaxed; if too much, it must be either straiter drawn, or a small habenula again cut off from that lip of the wound, which is farthest from the eye-lashes. When it is cut off, other stitches must be added, not above three. Moreover a scarification must be made in the upper eye-lid, under the roots of the eye-lashes, that being raised from the inferior part they may point upwards: and this alone will be sufficient for the cure, if they are but little turned in. The lower eyelid does not need this process. When these are done, a spunge squeezed out of cold water must be bound on: the day following an agglutinating plaister should be applied. On the fourth, the stitches must be taken away, and the wound anointed with a collyrium, to prevent an inflammation.

Of the lag­oph­thal­mus.

Sometimes from this operation, when too much of the skin is cut away, it happens, that the eye cannot be covered. And this sometimes proceeds from another cause. The Greeks call the disorder lagophthalmos[ HB ]. When too much of the eye-lid is wanting, there is no remedy for it; if but a small part, it may be cured. An arched incision must be made in the skin a little below the eye-brow, with its horns pointing downward. The wound ought to go as deep as the cartilage, but without injuring it: for if that be cut, the eye-lid falls down, and cannot afterwards be raised. Let the skin then be only divided, so as to allow it to descend a little in the lower part of the eye; which will be the consequence of the wound’s gaping above. Let lint be put into it to prevent the union of the divided skin, and to generate a little flesh in the middle: and when this has filled up the part, the eye is afterwards properly covered by the eye-lid.

Of an ec­tro­pium.

As it is a disorder of the upper eye-lid not to descend far enough to cover the eye, so there is a disease of the lower, in which it is not raised high enough, but hangs down, and cannot be brought close to the other. And this also sometimes proceeds from a similar fault in the cure, sometimes even from old age. The Greeks call it ectropium[ HC ]. If it happens from a faulty cure, the treatment is the same as in the foregoing case: only the horns of the wound are turned towards the cheeks, and not to the eye. If it proceed from old age, the whole of it must be cauterized externally with a thin plate of iron; then anointed with honey; and from the fourth day fomented with hot water, and anointed with medicines to bring on a cicatrix.

Of the sta­phyl­oma.

These then are the general disorders, that commonly occur in the parts about the eye, the angles, and eye-lids. In the eye itself the external coat is sometimes raised, either from the rupture or relaxation of some of the internal membranes; and it resembles a raisin stone in its form, whence the Greeks call it a staphyloma[ HD ]. There are two methods of cure for it. One is to pass through the middle, at the root of it, a needle with a double thread; then to tie tight the ends of one of the threads above, and of the other below; which by cutting it gradually may bring it off. The other is, to cut out from its surface about the bigness of a lentil; then to rub in spodium or cadmia. When either of these is done, the white of an egg must be spread upon wool and applied; and afterwards the eye must be fomented with the steam of hot water, and anointed with mild medicines.

Of clavi.

Callous tubercles in the white of the eye are called clavi; which name is given them from their figure. The best method is to pierce them at their very roots with a needle; and below that to cut them off, and then to anoint with mild medicines.

Description of the eye.

I have already elsewhere mentioned a cataract, because when recent, it is often removed by medicines. But when it is of long standing, it requires a manual operation, and one, which may be reckoned amongst the nicest. Before I treat of this, I shall give a short account of the nature of the eye; the knowledge of which, as it is of importance in several other parts, so it is peculiarly necessary here. The eye then has two external coats; the exterior of which by the Greeks is called ceratoides[ HE ]; and this, where it is white, is pretty thick, but before the pupil is thinner. The interior coat is joined to this, in the middle where the pupil is, and is concave, with a small aperture; round the pupil it is thin, but at a distance from it, something thicker; and by the Greeks is called chorioides[ HF ]. As these two coats surround the internal part of the eye, they again join behind it, and becoming finer, and uniting together, pass through the opening, which is between the bones, to the membrane of the brain, and are fixed to it. Under these, in the part where the pupil is, there is a void space; then again below, is an exceeding fine coat, which Herophilus called arachnoides[ HG ], the middle part of which subsides, and in that cavity is contained somewhat, which from its resemblance to glass the Greeks call hyaloides[ HH ]. This is neither liquid, nor dry; but seems to be a concreted humour; from the colour of which, that of the pupil is either black, or grey, though the external coat be white. This is inclosed by a small membrane, which proceeds from the internal part of the eye. Under these is a drop of humour resembling the white of an egg, from which proceeds the faculty of vision. By the Greeks it is called chrystalloides.

Of a cata­ract.

Now a humour concretes under the twoὑαλοειδὴς. coats, where I mentioned the void space to be, either from a disease, or a blow; and being gradually indurated, it obstructs the interior faculty of vision. There are several species of this malady, some of which are curable, and others not. For if the cataract be small, immoveable, of the colour of sea-water, or burnished iron, and leaves some sense of light on its sides, there remains hope. If it is large, if the black part of the eye, losing its natural appearance, is changed into some other, if the cataract be of the colour of wax[(11)], or gold; if it slides and moves to and fro, it is scarcely ever cured. And for the most part, the more severe the disease, or the greater the pains of the head, or the more violent the blow has been, which gave rise to it, so much the worse it is. Neither is old age a proper time of life for a cure; which without an additional disease causes a dimness of sight: nor even childhood; but the middle age betwixt these. Neither is a very small eye, nor one, that is hollow, fit for this operation. And there is also a certain maturity of the cataract itself: wherefore we must wait till it seems to be no longer fluid, but to have concreted with a certain degree of hardness.

Before the operation, the patient must use a spare diet, drink water for three days, the day immediately preceding take nothing at all. After this preparation he must be set in a light place, in a seat facing the light, and the physician must sit opposite to the patient on a seat a little higher; an assistant behind taking hold of the patient’s head, and keeping it immoveable; for the sight may be lost for ever by a slight motion. Moreover the eye itself, that is to be cured, must be rendered more fixed by laying wool upon the other, and tying it on. The operation must be performed on the left eye by the right hand, and on the right by the left hand. Then the needle sharp pointed[(12)], but by no means too slender, is to be applied, and must be thrust in, but in a straight direction, through the two coats, in the middle part betwixt the black of the eye and the external angle opposite to the middle of the cataract, care being taken to wound no vein. And it must not be introduced with timidity[(13)] neither, because it comes into a void space. A person of very moderate skill cannot but know when it arrives there; for there is no resistance to the needle: when we reach it, the needle must be turned upon the cataract, and gently moved up and down there, and by degrees work the cataract downward below the pupil; when it has past the pupil, it must be prest down with a considerable force, that it may settle in the inferior part. If it remain there, the operation is compleated. If it rises again, it must be more cut with the same needle, and divided into several pieces; which when separate, are both more easily lodged, and give less obstruction. After this the needle must be brought out in a straight direction, and the white of an egg spread upon wool must be applied, and over that something to prevent an inflammation, and then the eye be bound up.

Afterwards there is a necessity for rest, abstinence, mild unctuous medicines, and food (which it is soon enough to give on the day following) at first liquid, that the jaws may not be too much employed, then when the inflammation is gone, such as was directed in wounds. To which we must add this rule, that the patient’s drink be water for a pretty long time.

Of a flux of gum.

I have already treated of a flux of thin gum, which infests the eyes, so far as the cure depends upon medicines. I now come to these cases, that require manual operation. Now we observe that some people’s eyes never grow dry, but are always moistened with a thin humour; which circumstance occasions a constant asperity, and from slight causes excites inflammations, and lippitudes, and in fine renders a person uneasy all his life. And this disorder in some no remedy can relieve; in others it is curable. Which difference ought first of all to be known, that we may relieve the one, and not meddle with the other.

And in the first place, it is in vain to attempt the operation in those, who have this disorder from their infancy, because it will certainly continue to their dying day. Secondly, it is needless, where the discharge is not great, but acrid; because they are not assisted by a manual operation, but are brought to a sound state by medicines, and a proper diet for generating a thicker phlegm. Broad heads also are hardly susceptible of the remedy. Then it makes a difference whether the gum be discharged by the veins, that lye between the skull and the skin, or by those between the membrane of the brain and the skull: for the former moisten the eyes by the temples; the others by the way of those membranes, that go from the eyes to the brain. Now a remedy may be applied to those veins, that discharge above the bone, but not to those below the bone[(14)]. Neither can relief be given, where the discharge comes from both places; because when one part is relieved, nevertheless the other remains disordered.

The source of the disorder is discovered by this method. After shaving the head, such medicines, as stop the gum in a lippitude, ought to be laid on from the eye-brows as far as the top of the head: if the eyes begin to be dry, it appears that they are moistened by those veins, which are under the skin: if the moisture is not diminished, it is manifest it descends from below the bone: if a humour still flows[(15)], but in less quantity, the disorder is from both. In most patients however the complaint is found to be derived from the superior veins; and therefore the greater number may be relieved. And this is very well known, not only in Greece, but amongst other nations too: so that no part of medicine has been more clearly explained in any country.

Some practitioners in Greece cut the skin of the head in nine lines; two straight ones in the occiput, one transverse above these; then two above the ears, one also transverse betwixt them; and lastly three straight ones between the top of the head and the forehead. Others drew these incisions in a straight direction from the top of the head to the temples; and discovering from the motion of the jaws the origins of the muscles, made gentle incisions in the skin above these, and separating their lips by means of blunt hooks, they inserted lint in such a manner, as to prevent the edges of the skin from uniting, and to cause flesh to sprout up in the middle, which might bind those veins, from whence the humour passes to the eyes. Others again have drawn a line with ink from the middle of one ear to the middle of the other, and another line from the nose to the crown of the head; and where these lines met, made an incision with a knife; and after the effusion of blood, cauterized the bone in that part. And notwithstanding this, they also applied the actual cautery to the rising veins both in the temples, and betwixt the forehead and crown of the head.

It is a common method of cure to cauterize the veins in the temples, which indeed are generally turgid in this kind of disorder; but that they may be more inflated and show themselves better, the neck must first be tied pretty strait. And the veins must be cauterized with small and blunt irons; till the flux of gum upon the eyes stop: for that is a sign the passages are blocked up, by which the humour was conveyed.

However it is a more effectual method, when the veins are small and lie deep, and therefore cannot be separated[(16)], to make a ligature about the neck in the same manner, and the patient keeping in his breath, that the veins may rise the more, to mark with ink these in the temples, and between the crown of the head and the forehead; then loosing the neck, to cut the veins, where these marks are, and discharge blood; when a sufficient quantity has flowed, to cauterize them with small irons: in the temples indeed with caution; lest the muscles lying below, which secure the jaws, be hurt; but betwixt the forehead and the crown so strongly, that a scale may cast off from the bone.

But the method of the Africans is still more efficacious, who cauterize the crown of the head to the bone, so as to make it cast off a scale. But nothing is better than what is done in Gallia Comata, where they separate the veins in the temples, and the upper part of the head. The manner of treating cauterized parts I have already explained. At present I shall add this one direction; that when veins are cauterized, we should not endeavour to hasten the separation of the eschars, nor the filling up of the ulcers; lest either an hemorrhage ensue, or the pus be quickly suppressed; since it is fit these parts be dried by the latter, and it is not proper they should be exhausted by the former. If however an hemorrhage should at any time happen, medicines for stopping blood must be rubbed in, but not such as will prove caustic. Now the method of separating veins, and what is to be done, when they are separated, I shall explain, when I come to the varices of the legs.

CHAP. VIII. OF THE OPERATIONS REQUISITE IN THE EARS.

But as the eyes require many operations, so in the ears there are very few disorders, which come under this branch of medicine. However it sometimes happens, either immediately from the birth, or some time after, when there has been an ulceration, and the ear has been filled by a cicatrix, that there is no opening in it, and there it is deprived of the faculty of hearing. When this happens, trial must be made with a probe whether it be filled up to any depth, or be only agglutinated in the surface. For if it be deep, it does not yield to the pressure; if superficial, it presently receives the probe. The first ought not to be touched, lest a convulsion follow without any hopes of success, and from that there may be a danger of death; the other is easily cured. For where the foramen ought to be, either some caustic medicine must be applied, or it must be opened by the actual cautery, or even cut with a knife. And when that is opened, and the ulcer is clean, a quill must be introduced there, armed with a cicatrizing medicine; and round something must be applied, to promote the healing of the skin about the quill; the effect of which is, that after it is removed, the patient has the faculty of hearing.

But where the ears have been bored and give offence, it is sufficient to pass a hot needle through the cavity very quick, that its lips may be slightly ulcerated; or even to ulcerate it with a caustic medicine; then afterwards to apply something to deterge it; next somewhat to fill up the part, and bring on a cicatrix. But if this opening be large, as it generally is in those who have worn heavy ear-rings, it is proper to cut through what remains,[(17)] to its extremity; then above that to scarify the edges of the foramen with a knife, and afterwards to stitch them, and apply an agglutinating medicine. The third case consists in giving a supply to any part, that is deficient; which as it may also be done in the lips and nose, and the method is the same, it will be best to treat of it once for all.

CHAP. IX. THE OPERATION NECESSARY IN A WANT OF SUBSTANCE IN THE EARS, LIPS, AND NOSE.

Defects in these three parts, if they be small[(18)], may be cured: if considerable, they either do not admit of a cure, or by the cure itself are so deformed, that they were less offensive before. And in the ear indeed, and the nose, deformity is the only thing to be feared: but in the lips, if they are too much contracted, there is also a disadvantage in respect of their use; because the food is taken, and the speech is articulated with more difficulty. For flesh is not generated there; but is brought from the adjacent part. Which though in a slight mutilation it may both cause no defect, and escape observation, in a great one cannot. Now an old person is not a proper subject for this operation, nor one in a bad habit of body, nor one in whom ulcers heal with difficulty; because there is no part, where a gangrene more quickly seizes, or is harder to remove.

The method of cure is this; to reduce that, which is mutilated, into a square; from its interior angles to cut in transverse lines, so as to divide the part, that lies within these lines, from that beyond them; then to draw together the parts we have thus opened: if they do not fully meet, then beyond the lines we made before, to cut in two places in a lunated form, with the horns turned towards the wound, so as only to separate the surface of the skin: for by this means what we draw together will be more at liberty to follow; which is not to be forced by violence, but gently drawn, so as it may easily follow, and when let go, not recede far.

Sometimes however, the skin not being altogether brought from one side, renders the part, which it has left, deformed[(19)]. In such a place an incision must be made only on one side, and the other kept untouched. Therefore we must not attempt to draw any thing either from the lower part of the ears, or the middle of the nose, or the lower parts of the nostrils, or from the angles of the lips. We may draw on both sides, where there is any defect in the upper parts of the ear, or the lower parts or the middle of the nostrils, or the middle of the lips: which however are sometimes mutilated in two places; but the method of cure is the same. If a cartilage projects in the part where the incision is made, it must be cut off; for it neither unites again, nor is safely pierced by the needle. Neither must much of it be cut away, lest between the two extremities of the skin freed from it on both sides, there should be a collection of pus. Then the lips of the wound being brought into contact, must be stitched together, the skin being taken up on both sides; and where the lines above mentioned are, there also the suture must be used. In dry parts, as the nostrils, the application of litharge does very well. Into the interior and lunated incisions lint must be put; that granulations of flesh may fill up the wound. And that the part thus sewed must be attended to with the greatest care, may appear from what I said before of a gangrene. Therefore every third day, it must be fomented with the steam of hot water, and the same medicine applied again, which commonly on the seventh day unites it. Then the stitches ought to be taken out, and the ulcer healed up.

CHAP. X. OF THE EXTIRPATION OF A POLYPUS IN THE NOSE.

I have elsewhere said that the knife is the principal cure for a polypus growing in the nostrils. Wherefore it is necessary to separate this from the bone with a sharp iron instrument made in the form of a spatha: care being taken not to hurt the cartilage below, which is difficult to cure. When it is cut off, it must be extracted with an iron hook. Then a piece of lint twisted, or some part of a penecillum must be sprinkled with a styptick medicine, and the nostrils be gently filled with it. The blood being stopped, the ulcer must be deterged with lint. When it is clean, a quill armed with a cicatrizing medicine must be introduced within, in the same manner as was directed in the ear, till it be entirely sound.

CHAP. XI. OF THE CHIRURGICAL CURE OF AN OZÆNA.

I do not find in the eminent surgeons any operation for the cure of that disorder, which the Greeks call ozæna, when it does not yield to medicines. I suppose because the operation seldom works a cure, and is nevertheless attended with great pain. By some however it is directed to introduce either a small cannula, or writing reed into the nostril, till it reach up to the bone; then through this to pass a small hot iron to the very bone; next to deterge the cauterized part with verdigrease and honey; and when clean, to heal it up with lycium: Or that an incision be made in the nostril from its extremity to the bone, that the part may be seen, and the hot iron may be more easily applied; then that the nostril be stitched; and the cauterized ulcer cured as in the former method; and litharge or some other agglutinant laid upon the suture.

CHAP. XII. OF THE OPERATIONS REQUISITE IN THE MOUTH.

Of the teeth.

In the mouth also some disorders are cured by manual operation. Here in the first place the teeth are sometimes loosened, either by reason of the weakness of their roots, or from the gums decaying. It is proper in both cases to apply a hot iron to the gums, so as to touch them gently, but not to make a deep impression. The gums when cauterized must be rubbed with honey, and washed with mulse. When the ulcers begin to be clean, some dry repellent medicines must be sprinkled upon them.

But if a tooth occasions pain, and it seems proper to extract it, because medicines give no relief, it ought to be scraped all round, that the gum may be loosened from it; then it is to be shook; which must be continued till it move easily: for the extraction of a fast tooth is attended with the greatest danger, and sometimes the jaw-bone is dislocated. It is attended with more danger still in the upper teeth; because it may give a shock to the temples or eyes. After these precautions, the tooth is to be taken out, if possible, by the hand, if not, by a forceps.

But if it be corrupted before, its cavity must be filled up either with lint, or lead well adapted to it, lest it break under the forceps. The forceps must be drawn out straight, lest the thin bone, to which the tooth adheres, be fractured in some part by its bended roots. Neither is this without danger; especially in the short teeth, which generally have longer roots; for often, when the forceps cannot lay hold of the tooth, or does it without success, it takes hold of the jaw-bone, and breaks that.

One may immediately be sure, when there is a large effusion of blood, that something is broken off from the bone. Therefore the scale, that has come off, must be sought for by a probe, and taken out with a vulsella. If it does not come away, the gum ought to be cut, till the scale loosened from the bone can be taken out. And if it be not entirely broken, but the external part of the jaw swells, so that the mouth cannot open, on the outside must be applied a warm cataplasm of meal and figs, till it bring on a suppuration there; then an incision must be made in the gum. A copious discharge of pus is also a sign of a fractured bone: so that even then it is proper to extract it. Sometimes too, when it is injured, there is a fissure, which ought to be scraped.

A rough tooth ought to be scraped, where it is black, and rubbed with the powder of rose leaves, with an addition of one-fourth part of galls, and another of myrrh; and pure wine must be held in the mouth frequently. And in this case the head must be covered, the patient must walk much, make use of friction to his head, and a diet not acrid.

But if either, from a blow, or some other misfortune, some of the teeth are loosened, they must be tied with gold to those that are firm; and restringents must be held in the mouth, such as wine, in which pomegranate bark has been boiled, or in which hot galls have been infused. And if one tooth should happen to grow in children, before the former has fallen out, that, which should have dropped, must be scraped round and pulled out; that which is growing in the place of the former, must be pushed into its proper place, with the finger, every day, till it come to its just size. Whenever a tooth is extracted, and its root has been left, that also must be immediately taken out by a forceps made for that purpose, which the Greeks call rizagra.

Of in­dur­ated tonsils.

Tonsils, that are indurated, after an inflammation, called antiades[ HI ] by the Greeks, when they are covered by a slight coat, should be disengaged all round by the finger, and pulled out. If they are not separated by this method, it is necessary to take hold of them with a small hook, and cut them out with a knife; then to wash the ulcer with vinegar, and rub the wound with a styptic medicine.

Of the uvula.

The uvula, if it is inflamed, and falls down, and is painful, and of a ruddy colour, cannot be cut without danger; for there is commonly a great effusion of blood: therefore it is better to make use of those remedies I have mentioned elsewhere. But if there be no inflammation, and nevertheless it is relaxed to a great length by a humour, and is small, sharp, and white, a portion of it ought to be cut off: and likewise, if the extremity of it be livid and thick, and the superior part small. There is no better method than to take hold of it with a vulsella (a kind of forceps), and under that, to cut off what we think fit: for there is no danger, that either too much or too little be cut off; as we have it in our power to leave no more below the vulsella, than appears to be useless, and to cut off so much as shall reduce the uvula to its natural magnitude. After the operation, the same applications are proper, which were prescribed above for the tonsils.

Of the tongue.

The tongue, in some people, is joined with the part below it from their birth; who are by that means deprived of speech. The end of their tongue must be taken hold of with a vulsella, and the membrane below it cut; great care being taken, that the contiguous veins be not wounded, and the patient hurt by an effusion of blood. The remaining part of the cure of the wound is already directed in the preceding cases. And most people speak, as soon as it is healed. But I have known an instance, where a person after the cutting of his tongue, though he could thrust it far enough beyond his teeth, did not attain the faculty of speaking. Thus it happens in the practice of physic, that what is always right to do, is not always attended with success.

An abscess under the tongue.

An abscess also sometimes gathers under the tongue; which is generally included in a coat, and excites violent pains. If this be small, it is sufficient to make one incision into it: if larger, the surface of the skin must also be cut off to the coat, then the lips of it are to be laid hold of on both sides with small hooks, and the membrane must be freed from its connections all round; great care being taken in this operation not to wound any large vein.

Of chopped lips.

The lips are frequently chopped; which besides the pain, is attended with this inconvenience, that it hinders our speaking, as that action by opening the fissures causes them to bleed, and to give pain. If these be only in the surface, it is better to treat them by those medicines, which are composed for ulcers of the mouth: if they are deeper, it is necessary to cauterize them with a thin iron; which being made in the form of a spatha, ought to slide over them as it were, and not press upon them. Afterwards, the same method must be followed, as was laid down in cauterized ulcers of the nostrils.

CHAP. XIII. OF THE BRONCHOCELE.

In the neck, between the skin and the wind-pipe, a tumour rises, which the Greeks call bronchocele[ HJ ], in which there is contained sometimes insensible flesh, at other times a humour like honey or water; sometimes also hairs mixed with small bones. Whatever that be, which is contained in the coat, it may be cured by caustic medicines, which burn the surface of the skin, together with the coat below it. When this is done, if it be a humour, it runs out; if it be any thing substantial, it is taken out by the fingers; then the ulcer is healed by lint. But the cure by the knife is more expeditious. An incision is made in one line in the middle of the tumour down to the coat; after which, the morbid body is separated by the finger from the sound parts, and is taken out entire with its coat: then it is washed with vinegar, to which either salt or nitre has been added; and the lips are joined by one stitch. The other applications are the same as in other sutures; afterwards it must be bound up gently, lest it press the fauces. If it should happen that the coat cannot be taken out, we must sprinkle escharotics into it, and dress it with lint and other digestives.

CHAP. XIV. OF THE OPERATIONS PERFORMED AT THE NAVEL.

There are several disorders about the navel, concerning which, because they are very uncommon, authors are not agreed. Now it is probable, that each one omitted what he had not met with, and that none of them feigned a disease he had not seen. An indecent prominence of the navel is common to them all. The question is, what are its causes? Meges has assigned three; that sometimes the intestine makes its way into that part, sometimes the omentum, at other times a humour. Sostratus has not mentioned the omentum. To the other two he has added, that flesh sometimes grows there; which is sometimes sound, at other times of a cancerous nature. Gorgias also has omitted the omentum, but allowing the other three causes, says, that air too sometimes is forced into this part. Heron has mentioned all these four, and the omentum too; and that species also, in which there is both the omentum and the intestine.

The following symptoms discover what species it is. When the intestine is protruded, the tumour is neither hard nor soft; is lessened by cold, increases not only by heat, but even by keeping in the breath; sometimes it sounds; and when a person lies on his back, the intestine returns of itself, and the swelling subsides. When it is the omentum, the other symptoms are similar, but the tumour is softer, and from its base, tapers towards the top; and if one takes hold of it, it slips away. Where both these are together, the symptoms are also complicated, and the degree of softness is between both. But flesh is harder, and there is a swelling always, though the patient lies on his back; it does not yield to pressure, whereas the former easily does. If it be corrupted, it has the same appearances which I described in a cancer. A humour, if it be pressed, fluctuates. Air gives way to pressure, but quickly returns; and when the body is in a supine posture, the tumour retains the same figure.

Of these species, that which proceeds from air, does not admit of a cure. It is dangerous also to meddle with flesh that resembles a cancer; and therefore it must be let alone. Where it is sound, it ought to be cut out, and the wound dressed with lint. Some discharge the humour by making an incision in the top of the tumour, and cure that also by lint. With regard to the others, the opinions are various. However, the circumstances themselves make it plain, that the body must be laid in a supine posture; that whether it be the intestine or the omentum, it may fall back into the abdomen. Then the cavity of the navel being empty, by some is laid hold of by two regulae[(20)], and their ends being tied tight, the part mortifies: by others it is pierced to the bottom with a needle, followed by two threads, and is tied on the one side and the other by the two ends of each of these threads (as is done in the staphyloma of the eye) for by this means the part above the ligature mortifies. Others added this process to the operation: before tying, they made a single incision on the top, that, by introducing a finger, they might push back the protruded part, and then made the ligature. But it is sufficient to order the patient to hold in his breath, that the tumour may show itself in its full magnitude; then to mark the base of it with ink; and laying the person on his back, to press down the tumour, that if any part has not returned, it may be forced in by the hand; this done, to draw up the navel, and where the mark of the ink is, to tie it strongly with a thread; then to cauterize the part above the ligature, either with medicines, or the actual cautery, till it be mortified; and to dress the ulcer like other burns. This method is very successful not only when the intestine, or the omentum, or both are contained in it, but even where it is a tumour.

But some circumstances are to be considered, before proceeding to the operation, that no danger may arise from the ligature. For neither an infant, nor an adult, nor an old man are proper subjects for this method of cure; but generally such as are from seven to fourteen years old. Next, that person is in a fit condition for it, whose body is sound; but one, who is in a bad habit, and labours under papulæ, impetigoes, and the like disorders, is not a proper subject. Slight tumours also are easily removed; but there is danger in attempting to cure those that are too large. The autumnal and winter season of the year must be avoided. Spring is most suitable: and the beginning of summer is not amiss. Besides these precautions, it is necessary to fast the day before. Nor is that sufficient; for a clyster must also be given, that all the protruded parts may the more easily subside within the abdomen.

CHAP. XV. THE METHOD OF DISCHARGING THE WATER IN HYDROPICK PEOPLE.

I have elsewhere observed, that it is necessary to discharge the water in dropsical patients. I must now describe the manner of performing it. Some do it below the navel, about four fingers breadth to the left: some by perforating the navel itself. Others first cauterize the skin, and then make an incision through the interior teguments, because what is divided by the actual cautery unites less quickly. The instrument is to be introduced with great care not to wound any vein. It ought to be of such a form, that the breadth of its point should be about the third part of a finger; and it must be introduced so as to pass through the membrane also, which separates the flesh from the internal part; then a leaden or copper pipe must be introduced into it, its lips being either spread outward, or surrounded with some check to prevent its slipping through. The part that goes within ought to be a little longer than that without, that it may reach beyond the internal membrane. By this the water must be evacuated, and when the greater part of it is discharged, the pipe must be stopped with a bit of linen, and left in the wound, if it was not cauterized. Then on the following days, about a hemina must be let out every day, till no water appears to remain. Some even take out the pipe, though the skin has not been cauterized, and tie over the wound a spunge squeezed out of cold water, or vinegar, and the day following introduce the pipe again (which the recent wound, by being a little stretched open, will admit of) that so, if any humour remains, it may be evacuated; and this they recommend to be done only twice.

CHAP. XVI. OF WOUNDS OF THE BELLY AND INTESTINES.

Sometimes the belly is perforated by a wound; upon which the intestines roll out. When this happens, it must be first of all considered, whether they be unhurt; and then whether they retain their natural colour. If the smaller intestine be perforated, I have already observed, that there is no cure for it. The large intestine may be sewed; not that there is any reliance on the cure, but because a doubtful hope is preferable to certain despair: for it sometimes reunites. However, if either the intestine be livid, or pale, or black, which symptoms also are necessarily attended with a want of sensation, all remedies are vain. But if they yet retain their proper colour, they must be treated with great expedition; for they are changed in a moment, when exposed to the external air, to which they are not accustomed. The patient must be laid on his back, with his hips raised pretty high; and if the wound be so narrow, that the intestines cannot be conveniently reduced, a sufficient opening must be made by incision. And if the intestines are already become too dry, they must be washed with water mixed with a little oil. Then the assistant ought gently to separate the lips of the wound with his hands, or even with two hooks passed through the peritonaeum, and the physician must insert those intestines first that came out last, in such a manner as to preserve the order of their several convolutions. When they are all replaced, the patient must be shook gently, which causes all the intestines to return to their proper places, and settle there. These being lodged, the omentum must also be considered; and if any part of that be already black or mortified, it must be cut off by the scissars; if any of it is sound, it must be reduced upon the intestines. Now, neither a suture of the skin alone, nor of the interior membrane is sufficient, but both of them together. And that must be performed with two threads, and sewed closer than in other places; because it may both be more easily broken by the motion of the belly, and this part is not so liable to violent inflammations. Therefore, threads are to be put into two needles, and these held in both hands; the interior membrane must be sewed first, beginning at the extremity of the wound, in such a manner, that the needle may pass from the internal towards the external part, the left hand carrying it through the right lip, and the right hand through the left, by which means, the points of the needles are always farthest from the intestines, and the blunt part next to them. When each side is pierced once, the needles must be changed in the hands, that the needle, which was in the left hand, may be in the right, and that come into the left, which the right held before: and in the same manner they must pass through the lips again; and also a third and fourth time, and so on, the hands each time interchanging the needles, and thus the wound must be closed. Then the same threads and needles must be brought to the skin, and in like manner both sutures be performed on that part too; the needles always passing from the internal part, and from the one hand to the other. Afterwards agglutinants must be applied: to which it is needless to repeat, from time to time, that it is necessary to add either spunge or sordid wool squeezed out of vinegar. When these are applied, a gentle bandage ought to be passed round the belly.

CHAP. XVII. OF A RUPTURE OF THE PERITONAEUM.

Sometimes either from a blow, or keeping in the breath too long, or by the pressure of a heavy load, the internal membrane of the abdomen breaks, when the skin above is whole: which also frequently happens to women from pregnancy; and it generally occurs about the ilia. The consequence is, that the flesh above being soft, does not bind the intestines strongly enough, and the skin distended by them forms an indecent tumour. And this disease is cured in different ways. For some passing a needle with two threads into the base of the tumour, tie it on both sides in the same manner described in the cases of the navel and the staphyloma, that whatever is above the ligature may mortify. Others cut out the middle of it in the form of a myrtle leaf (according to the rule before laid down for all cases of a like nature) and then join the lips by a suture. However, the best method is to lay the patient on his back, and try by the hand, in what part the tumour yields most, because the membrane must necessarily be ruptured there, and resist more, where it is sound: then, where it appears to be ruptured, incisions are to be made in two lines[(21)] by a knife, that the part betwixt them being cut out, the internal membrane may have a recent wound on both sides; because what has been long disunited does not unite by a suture. The place being laid open, if the membrane in any part should appear not to be fresh wounded, a small slip must be cut off, only to ulcerate its edges. What else relates to the suture, and the remaining part of the cure, has been above directed.

Of varices in the belly.

Besides these, some people have varices in their bellies; but as the method of cure here does not differ from that which is practised in the legs, and being about to describe it by and by, I shall refer it to that place.

CHAP. XVIII. A DESCRIPTION OF THE TESTICLES, AND THEIR DISEASES.

I now come to those diseases which arise in the private parts about the testicles: which, that I may the more easily explain, I shall first give a short account of the nature of the part. The testicles then have something resembling small glands[(22)]: for they do not discharge blood, and are void of all sensation; the coats, however[(23)], which contain them, are pained in wounds and inflammations. Now each of them hangs from the groin by a nerve (the vas deferens) which the Greeks call cremaster[ HK ]: and with each descends both a vein and an artery. And these are covered with a membrane, thin, nervous, not sanguineous, and white, which by the Greeks is called elytroides[ HL ]. Over that is a firmer coat, which adheres strongly in the lowest part to the interior one. The Greeks call it dartos[ HM ]. Besides, there are many small membranes, which inclose the veins and arteries, and those nerves; and betwixt the two coats in the superior part they are thin and open. Thus far then the coats and vessels are peculiar to each testicle. But there is a sinus common to both, and to all the internal part, which is also exposed to our view. The Greeks call it oscheum[ HN ]; in our language it is scrotum. And this in the lower part is slightly connected with the middle coats, above only envelopes them.

Under this then several disorders occur: which happen sometimes when these coats, which I said had their origin from the groin, are ruptured; at other times, when they are entire: for sometimes the coat, which ought to separate the intestines from the inferior parts, is either first inflamed from a distemper, and afterwards burst by the weight, or ruptured at once by some wound. Then either the omentum alone, or that and the intestine together, fall down into it by their own weight. And finding a way there, they bear down gradually from the groin upon the inferior parts, and by and by divide the nervous coats, which, for the reason I gave before, are open. The Greeks call these enterocele[ HO ] and epiplocele[ HP ]: with us an indecent, but common name for them is hernia.

Now if the omentum descends, the tumour in the scrotum is never removed either by fasting, turning the body one way or another, or placing it in any particular posture; and if the breath be kept in, it is not much increased, is unequal to the touch, and soft and slippery.

But if the intestine also descends, the tumour without any inflammation sometimes lessens, at other times increases, and it is generally free from pain, and when a person is at rest, or lies down, it sometimes entirely subsides, at other times it is so diminished, that a very small part of it remains in the scrotum; but upon vociferation, or repletion, and a violent exertion of force in bearing a great weight, it increases: by cold it is contracted, by heat dilated; and at that time the scrotum is both round and smooth to the touch, and what lies within is slippery; if it be pressed, it returns to the groin; and being let go, it rolls down again with a murmuring kind of noise, and this happens in the lesser degrees of this malady. But sometimes from the reception of excrements, the swelling is vastly enlarged, and cannot be reduced; and occasions pain at such times to the scrotum and groin, and abdomen. Sometimes too the stomach is affected, and throws up first reddish coloured bile, then green, and in some even black.

Sometimes the membranes being entire, a fluid distends this part: and there are also two species of this. For it either collects between the coats, or in the membranes, which surround the veins and arteries in that part, when they are oppressed, and have grown callous. Neither has that fluid betwixt the coats one certain seat: for sometimes it lodges between the external and middle, sometimes betwixt the middle and internal coat. The Greeks call this by the general name of hydrocele[ HQ ], of whatever species it be. Our countrymen, not being acquainted with any distinctions, include this also under the same name as the former disorders.

Now in these there are some symptoms, that belong to all, and others, that are peculiar to each particular species. The general are such as indicate the collection of a fluid; the particular, its seat. We know a fluid is contained within, if there be a tumour, that never disappears entirely, but is sometimes lessened by fasting, or a slight fever, and chiefly in children. And this is soft, if there is not a very great quantity of fluid within; but if it has greatly increased, it resists like a bottle filled, and tightly tied; the veins in the scrotum also are inflated; if we press upon it with our finger, the fluid yields, and fluctuating raises the part that is not pressed; and it appears through the scrotum, as if it were in a glass or a horn; and in itself is attended with no pain. The seat of it is thus known: If the water be betwixt the external and middle coat, when we press with two fingers, it gradually returns between them; the scrotum is somewhat lax and whitish; if it is stroked, it stretches little or nothing; the testicle can neither be seen nor felt in that part. But if it is within the middle coat, the scrotum is more stretched and raised higher, so that the penis above it is concealed under the swelling.

Besides these, when the coats are equally entire, a ramex grows there. The Greeks call it cirsocele[ HR ], when the veins swell. These being sometimes twisted, and rolled up toward the superior part, fill either the scrotum, or the middle coat, or the innermost one; sometimes they grow even within the innermost coat about the testicle itself and its nerve. Those that are in the scrotum itself are exposed to view; and those which lie upon the middle or innermost coat, as being deeper, are not indeed equally discernible, but yet are visible; besides that there is both some swelling, according to the size and capacity of the veins, and it also resists pressure more, and is unequal by reason of the varicous dilatations of the veins; and on that side where it is, the testicle is more dependent than it should be. But when this malady has grown upon the testicle itself and its nerve, the testicle hangs down much lower, and becomes less than the other, as being deprived of its nutriment.

Sometimes, though seldom, flesh grows between the coats. The Greeks call that sarcocele[ HS ].

Sometimes too the testicle itself swells from an inflammation, and also brings on fevers; and unless the inflammation has quickly ceased, the pain reaches to the groin and ilia; and these parts swell, and the nerve, by which the testicle hangs, is enlarged, and grows hard at the same time.

Besides the foregoing, the groin is also sometimes filled with ramices; which case they call bubonocele[ HT ].

CHAP. XIX. GENERAL DIRECTIONS FOR OPERATIONS IN THE FOREGOING DISEASES ABOUT THE TESTICLES.

These disorders being known, we must proceed to treat of their cure: in which some things are common to them all, some proper to the particular kinds. I shall first speak of the general: and now treat of those, which require the knife. For those, that are either incurable, or ought to be treated in a different manner, I shall take notice of, when I come to the particular species. Now the incision is made sometimes in the groin, sometimes in the scrotum. In either method it is necessary for the patient to drink water for three days before; and the preceding day even to fast: on the day of the operation, he must be laid on his back; and if the incision is to be in the groin, and that is covered with hair, it must first be shaved; then the scrotum being extended to render the skin tense, the incision must be made at the bottom of the belly, where the inferior coats are joined to the abdomen. It must be opened boldly, till the external coat, which is the scrotum itself, be cut, and the middle one come in view. When the wound is made, there is an opening toward the inferior parts. Into that the fore finger of the left hand must be introduced, that by separating the intervening membranes it may enlarge the sinus. And an assistant taking hold of the scrotum with his left hand, must extend it upward, drawing it away as much as possible from the groin; at first with the testicle, while the physician cuts away by the knife, if he cannot separate them by his finger, all the small membranes, that are above the middle coat; after this, letting go the testicle, that it may slip down, and come near to the wound, and be brought out thence by the finger, and laid upon the belly with its two coats. And if any part of it is corrupted, it must be cut off. And as several veins are dispersed upon it, the small ones may be cut at once, but the larger should be first tied with a pretty long thread, to prevent a dangerous hemorrhage from them.

But if the middle coat be affected, or the disease lies below it, it must be cut out in such manner, that in the higher part close to the groin it should be clean cut off: but the whole must not be taken away below; for what is strongly connected at the base of the testicle with the innermost coat, cannot be cut off without the greatest danger, and for that reason must be left there.

The same method is to be taken in the innermost coat too, if that be injured. But it must be cut off, not at the top of the wound in the groin, but a little below that; lest it bring on inflammations by wounding the membrane of the abdomen. Neither on the contrary must too much of it be left; lest afterwards it form a sinus, and afford a receptacle to the same distemper.

The testicle being thus cleansed must be gently let down through the wound, with the veins, and arteries and its nerve; and care must be taken, that no blood fall into the scrotum, and that it does not remain coagulated in any part: which will be prevented, if the physician has been careful to tie the veins. The threads, by which their ends are secured, must hang without the wound: and when a suppuration comes on, they will fall off without any pain. Upon the wound itself must be put two fibulæ; and over them an agglutinating medicine.

It is sometimes necessary to cut off something from one of the lips, that the cicatrix may be larger and broader. When this is the case, the lint must not be pressed down upon it, but only laid on lightly; and over it some medicines to repel an inflammation, such as sordid wool, or spunge squeezed out of vinegar; every thing else must be used as when a suppuration ought to be excited. But when it is necessary to make the incision beneath, the patient being laid on his back, the left hand must be put below the scrotum; and a strong hold must be taken of it, and the incision made; if the seat of the disorder be small, the incision must be moderately sized, so as to leave a third part of the scrotum below entire, in order to support the testicle; if it be larger, the wound may be greater, a little at the bottom only being left entire, upon which the testicle may rest. But the knife at first should be held in a straight direction, with a very light hand, till it divide the scrotum itself; then the point of it must be turned aside a little, to cut the transverse membranes, that are between the external and middle coats. But the middle coat ought not to be touched, if the disease lie above it; but if it lies below the middle coat, that must be cut too; as likewise the third, if that cover the malady. Wherever the disorder is found, the assistant should squeeze the scrotum gently at the lower part; and the physician having separated the inferior part by his finger, or the handle of the knife, should bring the coat out of the wound, and make such an incision with an instrument, which from its figure is called corvus, that he may introduce his fore and middle fingers: when this is done, the remaining part of the coat must be cut, and the knife must pass between the two fingers, and whatever is noxious must either be taken out, or be allowed to run out.

Whatever coat is injured in the operation must be cut off; and the middle one, as I observed before, as high as possible at the groin; the innermost one a little lower. But before they are cut off, the vessels ought to be tied very carefully by a thread; and the ends of this thread must be left without the wound, which must be done also in other veins, where the ligature is requisite.

When that is done, the testicle must be returned into its place: and the lips of the scrotum joined together by a suture: and the stitches must not be too few, lest they be not agglutinated, and the cure prove tedious; nor yet too many, lest they increase the inflammation. And in this case too we must be cautious, that no blood remain in the scrotum: afterwards agglutinants must be applied.

If however blood has made its way into the scrotum, or any coagulated blood has fallen down into it, an incision should be made below it; and after cleansing it, a spunge moistened with sharp vinegar must be applied round it. A wound that has been made for these reasons, after it is tied up, if there be no pain, must not be opened for the first five days; but either the wool or spunge, that lies over it, must be sprinkled twice a day with vinegar alone; if there be pain, it must be opened on the third day; and where there are fibulæ, they must be cut; and where lint, that must be changed; and what is put on, must be wet with oil of roses and wine. If the inflammation increases, to the foregoing applications must be added a cataplasm of lentils and honey, of pomegranate bark boiled in a rough wine, or a mixture of these. If the inflammation does not give way to them, after the fifth day, the wound must be fomented with plenty of hot water, till the scrotum itself be both extenuated, and become more wrinkled; then a cataplasm must be applied of wheat meal, with an addition of pine resin; which, if the patient be a robust man, must be boiled up with vinegar; if more delicate, with honey. And whatever the disorder has been, if there be a great inflammation, without doubt medicines to promote a suppuration must be applied.

But if pus is generated within the scrotum, a small incision ought to be made to give a vent; and so much lint is to be applied as to cover the orifice. When the inflammation is removed, upon account of the nerves, the last-mentioned cataplasm, and then cerate must be used. This is the peculiar treatment of wounds of this kind. All other things both in regard to the manner of dressing, and the diet, should be conformable to the directions we have given about other wounds.

CHAP. XX. OF THE CURE OF A RUPTURE OF THE INTESTINE INTO THE SCROTUM.

These things being premised, we must descend to the particular species. And if the intestine comes down in a young child, a bandage must be made trial of before the knife: for this purpose a roller is sewed, to which in one part a bolster is used made of cloths, which is applied under the intestine to repel it; and then the rest of the roller is bound tight about him: by means of which, the intestine is often forced in, and the coats are agglutinated together. Again if the patient be advanced in years, and from the largeness of the tumour it appears, that much of the intestine has fallen down, and the case is attended with pains and vomiting (which generally proceeds from the excrements getting down into that part by a crudity) it is plain that the knife cannot be used without fatal consequences; the complaint is therefore only to be alleviated; and the intestine evacuated by other methods.

The patient ought to be bled in the arm: and then if his strength will admit, abstinence must be enjoined for three days; if he cannot bear that, at least as long as his strength will allow. At the same time must be kept upon it a cataplasm of lintseed boiled in mulse. After these both barley meal with resin must be applied, and the patient put into a bath of warm water mixed with oil; and some light and hot food must be given. Some even administer clysters. These may carry something into the scrotum, but cannot evacuate any thing from thence. The disease being mitigated by the methods above prescribed, if the pain returns at any time, the same course must be pursued.

If a great portion of the intestine has fallen down without pain, it is also needless to make an incision; not but that it may be removed from the scrotum (unless an inflammation prevent) but because when repelled thence, it stops at the groin, and raises a tumour there; and thus there is not a termination, but a change of the malady.

But where the use of the knife is proper, as soon as the wound made in the groin shall reach to the second coat, that must be taken hold of near the lips with two small hooks, while the physician disengages it by taking out all the small membranes: for that, which is to be cut, cannot be injured without danger, as the intestine must lie below it. When it shall be separated, an incision must be made from the groin to the testicle, care being taken not to wound the last; then it must be cut out. For the most part however this operation is only practicable in children, and in a moderate degree of the malady.

But if it be a robust man, and the disorder be more considerable, the testicle ought not to be taken out, but to remain in its place. The operation is performed in this manner. The groin is opened in the same way by a knife, as far as the middle coat; and this coat in like manner is taken hold of with two hooks, and the testicle is held by an assistant[(24)], so as to prevent its coming out at the wound; then an incision must be made downward in this coat with a knife; and below it the fore finger of the left hand is introduced to the bottom of the testicle, which it forces up to the wound: then the thumb and fore finger of the right hand separate the vein and artery, and their nerve, and coat from the external coat. And if any small membranes obstruct this, they are divided by the knife, till the coat be wholly exposed to view. When all is cut out, that requires excision, and the testicle is replaced, a pretty broad habenula is to be taken from the lip of the wound in the groin, that the wound may be the larger, and generate the more flesh.

CHAP. XXI. OF THE CURE OF A RUPTURE OF THE OMENTUM INTO THE SCROTUM.

But if the omentum descends, the groin must be opened, and the coats separated in the same manner as directed before. And it must be considered whether it be a large or small part of it. For when it is very small, it must be forced back over the groin into the abdomen by a finger or the broad end of a probe: if it is large, whatever has fallen out of the abdomen must be allowed to remain there; and it must have escharotic medicines laid on it, till it mortify and fall off. Some in this case pass through it a needle with two threads, and tie the two ends of each contrary ways; by which it mortifies with equal certainty, but not so soon. The effect is accomplished sooner, if the part of the omentum above the ligature be rubbed with eating medicines, but not corrosive; they are called septica by the Greeks. There have been others, who have cut off the omentum with scissars: which is not necessary, where the quantity is small; and if large, it may occasion an hemorrhage; for the omentum is also connected by veins, and some of them large. Neither can this practice be justified by an example drawn from the cases of the belly opened by a wound, where the part of the omentum, which falls out, is cut away by the scissars: since in this case, it is both mortified, and cannot be taken off in any other way more safely. If the omentum be reduced, the wound ought to be stitched; or if it has been large and has mortified externally, the lips must be cut off, as proposed before.

Of a hydro­cele.

If there be a fluid within the membranes, an incision must be made, in boys upon the groin, unless too large a quantity of fluid forbid the operation in that place; but in men, and where-ever there is a large quantity, the scrotum must be opened. Then if the incision be made in the groin, the coats must be drawn out at that part, and the humour evacuated; if at the scrotum, and the disease be immediately below that coat, there is no more required but to evacuate the humour, and cut away any of the membranes, that happen to contain it; then it must be washed with water, and an addition either of salt, or nitre: if the disease lie within the middle or innermost coat, they must be taken entirely out of the scrotum and cut off.

CHAP. XXII. OF A RAMEX IN THE SCROTUM.

A ramex situated upon the scrotum must be cauterized with small and sharp irons run into the veins themselves, provided they burn nothing else: it is peculiarly necessary to apply the cautery where they are twisted and rolled together; afterwards meal mixed up with cold water must be laid on; and the bandage must be applied, which I recommended for the anus; on the third day lentils with honey must be put to it: after the separation of the eschars, the ulcers must be deterged with honey, embrocated with rose oil, and brought to cicatrize by dry lint. Where the veins above the middle coat swell, the groin must be cut, and the coat brought without the orifice; after which the veins are to be separated from it by the finger, or the handle of the knife, and where they adhere, tied both above and below by a thread; then they must be cut through close to the ligatures, and the testicle replaced. But if the ramex be situated upon the innermost coat, it is necessary to cut out the middle one. And then if two or three veins swell, so that some part be affected, but the greater part be from the disease, the same method must be pursued as directed above; that is, the veins being tied both at the groin and testicle, may be cut off, and the testicle reduced to its place. But if the ramex have seized upon the whole of it, the fore finger must be introduced through the wound, and put under the veins, so as to draw them out gradually and uniformly, till the one testicle be equal to the other; then fibulæ are to be put in the lips in such a manner, as to lay hold of these veins likewise. It is done thus. A needle passes through the lip from the external part, and then is directed not through the vein itself, but its membrane, and from thence is forced into the other lip. The veins ought not to be wounded, lest they discharge blood. There is always a membrane between these veins, which occasions no danger, and holds them fast enough, when taken up by the thread: and therefore two fibulæ are sufficient. After this, whatever veins have been brought out, should be returned into the groin with the broad end of the probe. The time for loosing the fibulæ is, when the inflammation is gone, and the ulcer deterged; that the cicatrix may at once bind up both the lips and the veins.

When the ramex has grown between the innermost coat, and the testicle itself and its nerve, the only cure is to cut off the whole testicle: for it does not in the least contribute to generation, and hangs down in all indecently, in some even with pain. But in this case too, an incision is to be made in the groin, and the middle coat must be drawn out and cut away; the innermost one is to be treated in the same manner; and the nerve, by which the testicle depends, to be cut off. After this, the veins and arteries must be tied by a thread at the groin, and cut off below the ligature.

CHAP. XXIII. OF A SARCOCELE.

If flesh happen to grow between the coats, it must certainly be taken out; and the most convenient way of doing it is by an incision in the scrotum.

But if the nerve be indurated, the disorder cannot be cured either by the hand or medicines. For the patients are oppressed with ardent fevers, and either green, or black vomitings, besides these a violent thirst, and roughness of the tongue; and generally about the third day, frothy bile is discharged by stool, which excoriates the parts; and food can neither be easily taken or retained; not long after, the extremities grow cold, a tumour comes on, the hands are expanded involuntarily; then comes on a cold sweat in the forehead, which is followed by death.

CHAP. XXIV. OF A RAMEX IN THE GROIN.

When there is a ramex in the groin, if the swelling be small, a single incision ought to be made; if it be larger, it ought to be done in two lines, that what lies between may be cut out; and then without taking away the testicle, as I have above shewn to be sometimes practised in a rupture of the intestines, the veins must be taken up, and tied, where they adhere to the coats, and cut off below these knots. The cure of this wound is no way different from others.

CHAP. XXV. THE OPERATIONS REQUISITE IN THE DISORDERS OF THE PENIS.

From those we are to proceed to the operations upon the penis. If the glans be bare, and a person chuses for the sake of decency to have it covered, that may be done; but more easily in a boy than a man; and more easily in one, to whom it is natural, than in another, who according to the custom of some nations has been circumcised; better where the glans is small, and the skin about it pretty large, and the penis itself short, than where there is quite the reverse of these circumstances. The cure of these, in whom it is natural, is performed in this manner. The skin about the glans is laid hold of, and extended till it cover it, and tied there; then near the pubes a circular incision is made on the skin of the penis, till it be laid bare; and great caution is used not to cut either the urinary pipe, or the veins in that part. When this is done, the skin is drawn towards the ligature, so that a part near the pubes is laid bare resembling a hoop; then over it is applied lint, that the flesh may grow and fill it up, and the breadth of the wound may afford a sufficient covering to the glans. But the ligature must be continued till a cicatrix be formed, leaving only in the middle a small passage for the urine. But in a person, that has been circumcised, under the circle of the glans, the skin ought to be separated by a knife from the inner part of the penis. This is not very painful, because the extremity being loosened, it may be drawn backwards by the hand, as far as the pubes; and no hemorrhage follows upon it. The skin being disengaged, is extended again over the glans; then it is bathed with plenty of cold water, and a plaister put round it of efficacy in repelling an inflammation. For the following days the patient is to fast, till he be almost overcome with hunger, lest a full diet should perhaps cause an erection of that part. When the inflammation is gone, it ought to be bound up from the pubercles to the circle of the glans; and a plaister being first laid on the glans, the skin ought to be brought over it; for thus it will happen, that the inferior part may be united, and the superior heal so as not to adhere.

On the contrary, if the glans be covered, so that it cannot be denuded (which malady the Greeks call phymosis) it must be opened: which is done in this manner. An incision is made in the prepuce below its extremity, in a right line to the frænum; and the upper part being thus relaxed, may be drawn back. But if this be not effectual, either upon account of the straitness or hardness of the prepuce, a piece of skin must be immediately cut out in the lower part in the form of a triangle, with its vertex at the frænum, and the base at the extremity of the prepuce. Then lint is to be applied over it, and other medicines to heal it. And it is necessary to continue at rest till it be cicatrized; for walking, by the attrition it causes, renders the ulcer foul.

Of in­fibu­lat­ing boys.

Some have made a practice of infibulating boys, sometimes upon account of their health[(25)]: the method of doing it is this. The skin that covers the glans is extended, and marked on both sides with ink, where it may be perforated, and then is let go. If these marks return upon the glans, too much has been taken up, and it ought to be marked nearer the extremity: if the glans is not reached by them, that part is proper for the fibula. Then where the marks are, the skin is pierced by a needle followed by a thread, and the two ends of this thread are tied together, and moved every day, till small cicatrices be formed about the orifice. When these are confirmed, the thread is taken out, and a fibula put in, which, the lighter it is, is so much the better. But this operation however is more frequently needless than necessary.

CHAP. XXVI. OF THE OPERATION NECESSARY IN A SUPPRESSION OF URINE, AND LITHOTOMY.

Sometimes when no urine is made, an operation is necessary to discharge it, either because the passage is collapsed from old age, or because a stone, or some other concretion from blood has obstructed it within; and a moderate inflammation also often prevents it from being evacuated in a natural way. And this is requisite not only in men, but in women too sometimes. For this purpose are made copper pipes; and that these may serve for all bodies larger and smaller, a physician must have by him three for men, and two for women. Of the male kind, the largest is fifteen fingers breadth long, the middle size twelve, the least nine; for the females, the greater is nine, and the lesser six. They ought to be curved, but more especially the male kind, and very smooth; and their diameter neither too large, nor too small.

The patient then is to be laid on his back, in the same manner as is described in the operation for the stone, either on a couch or bed. The physician standing on the right side, ought with his left hand to take hold of the penis if it be a man, and with his right to introduce the pipe into the urinary passage; and when it comes to the neck of the bladder, by an inclination of the pipe and the penis at once, to force it into the bladder, and when the urine is evacuated, to take it out again. In a woman, the urethra is both shorter, and straighter, and resembles a caruncle, being situated between the labia pudenda above the vagina; and they as frequently require assistance, but it is not attended with so much difficulty.

Sometimes a stone sliding into the urethra, sticks, where that grows narrower[(26)], not far from the end; if possible it ought to be drawn out either by a specillum oricularium, or the instrument, with which the stone is extracted in cutting for that distemper. If that has proved impracticable, the prepuce must be drawn out as much as possible, and the glans being covered, must be tied by a thread; then on one side a longitudinal incision must be made into the penis, and the stone extracted; after this the prepuce is let go; for by this means the sound part of the skin covers the incision in the penis, and the urine will be discharged in the natural way.

Since I have made mention of the bladder and stone, the place itself seems to require me to subjoin the chirurgical cure for calculous patients, when they can be relieved no other way. But since that is a very dangerous method, it is by no means proper to undertake it precipitately. Nor is it to be attempted in every season, nor at all times of life, nor in every degree of the disease; but only in the spring, and upon a patient, whose age exceeds nine years, and not fourteen; also if the disease has arisen to such a height that it can neither be overcome by medicines, nor protracted, but that in some time it must kill. Not but that now and then even a rash attempt succeeds; however it more frequently fails in this case, because there are more kinds and seasons of danger, all which I shall mention together with the operation itself.

Therefore when it is resolved to try the last remedy, for some days before, the body must be prepared by diet, that is, by taking moderately wholesome food, no way glutinous, and drinking water. In the mean time the patient must exercise by walking, to cause the stone to descend towards the neck of the bladder. Whether this has happened may be known by introducing the fingers, as I shall shew in the operation. When that is certain, the boy must first fast for a day; and then the operation must be performed in a warm place; which is conducted in this manner.

A strong and skilful man sits down upon a high seat, and laying the boy, whose back is towards him, in a supine posture, setting his hips upon his knees, takes hold of him, and drawing up his legs, orders the boy to put down his hands to his hams, and pull them toward his body with all his might, and at the same time he holds them in that posture. But if the patient be pretty strong, two able men must sit behind him on two contiguous seats, and both their seats, and their legs next each other must be tied together, to prevent their giving way. Then he is placed upon both their knees in the same manner, and the one according as he sits, lays hold of his left leg, and the other of his right; and at the same time he himself draws up his hams. Whether he be held by one or two, they lie forward with their breasts upon his shoulders. Whence it happens, that the sinus above the pubes, between the ilia, is extended without any wrinkles, and the bladder being compressed into a small compass, the stone may be the more easily laid hold of. Besides, two strong men are placed one at each side, who stand by, and do not suffer either the one or two, that hold the boy, to give way.

Then the physician, having carefully pared his nails, introduces his fore and middle fingers of the left hand together, being first slightly anointed with oil[(27)], into the anus of the patient, and lays the fingers of his right hand lightly upon the lowest part of his abdomen; lest if his fingers on both sides at once should press strongly upon the calculus, it might hurt the bladder. And this must not be done hastily, as in most cases; but so as may be safest: for hurting the bladder brings on convulsions, with a danger of death. And first of all the stone is sought for about the neck: where if it be found, it is expelled with less trouble; and therefore I said the operation was not to be attempted, unless this were known by its proper signs. If either it was not there, or has gone backward, the fingers are applied to the end of the bladder; and the right hand being removed also beyond it, it is brought gradually down.

And when the stone is found (as it must necessarily fall between the surgeon’s hands) it is drawn down with the greater caution by how much it is smaller and smoother, lest it escape, that is, lest there be a necessity to harass the bladder again and again. Therefore the right hand is always kept before the stone; and the fingers of the left force it downwards, till it come to the neck. Into which part, if it be oblong, it must be forced so as to come out prone[(28)]; if flat, so as to be transverse; if square, that it may rest upon two angles; if it be larger at one end, so that the smallest may pass first. In a round one, from the figure itself it is plain, there is no difference, save that if it be smoother in one part than another, that should come out first.

When it is brought to rest upon the neck of the bladder, a lunated incision must be made in the skin, near the anus, as far as the neck of the bladder, with the horns pointing a little towards the ischia; then in that part where the bottom of the wound is straiter, again under the skin[(29)], another transverse wound must be made, by which the neck may be cut; till the urinary passage be open in such a manner, that the wound is something larger than the stone. For those, who through fear of a fistula (which in that part the Greeks call ouroruas[ HU ]) make but a small opening, are reduced to the same inconvenience with greater danger; because the stone, when it is brought away by force, makes a passage, if it does not find one. And this is even more pernicious, if the shape or asperity of the stone contribute any thing to it: whence both an hemorrhage and convulsion may ensue. But though a person escape these, the fistula will be much larger, when the neck is lacerated, than it would have been if cut.

When the opening is made, the stone comes into view; the size of which makes a material difference with respect to its management. Therefore if it be small, it may be pushed forward on one side, and drawn out on the other by the fingers. If larger, a crotchet[(30)] made for the purpose must be put over the upper part of it. This at its extremity is thin, beat out into the form of a semicircle, broad and blunt; on the external part smooth[(31)], where it comes in contact with the wound; on the inside rough, where it touches the stone. And it ought to be pretty long; for one too short has not force enough to extract it. When it is fixed, it ought to be inclined to each side, that the stone may appear, and be held fast, because if it be laid hold of, it also gives way to it. And the necessity for this is, lest when the crotchet begins to be drawn, the stone may fly inward, and the crotchet fall upon the edge of the wound, and lacerate it, the danger of which I have already shewn.

When it appears that the stone is securely held, a triple motion must be made, almost at the same instant, to both sides, and then externally; but this must be done gently, and the stone must be first drawn a little forward; after this, the end of the crotchet must be raised upward, that it may be farther within the bladder, and bring it out the more easily. But if the stone cannot be conveniently held at the superior part, its side must be taken hold of. This is the most simple method.

But a variety of circumstances requires some particular observations. For there are some stones not only rough, but also full of sharp points, which falling of themselves into the neck of the bladder, are extracted without any danger. But if they are within the bladder, it is neither safe to seek them, nor draw them forward; because when they wound it, they bring on convulsions and death; and more especially if any point is fixed in the bladder, and causes it to fall into folds, as it is brought down towards the neck. Now a stone is discovered to be in the neck, when the urine is made with greater difficulty than ordinary; and to be pointed, when it comes away bloody; and this is particularly to be tried by the fingers, and the operation is not to be attempted unless we are sure it is there. And even then the fingers must be introduced, and opposed to it behind tenderly, lest they wound by pushing it with violence; then the incision must be made. And in this case also many have made use of the knife. Meges (because the knife being weak might fall on some prominence of the stone, and after having cut the flesh above it, would not divide where there is a hollow, but leave what will require a second incision) made an iron straight instrument, with a broad back on its upper part, and its lower part semicircular and sharp. This being taken between his fore and middle fingers, and his thumb laid upon it, he prest it so, that together with the flesh, he might cut any part of the stone that was prominent: by which he gained this advantage, that he made a sufficient opening at once. Now in whatever method the incision in the neck is made, a rough stone ought to be extracted gently; no violence being used for the sake of expedition.

But a sandy stone is easily discovered both before the operation, from the discharge of sandy urine, and in the operation; because it makes but a faint resistance to the fingers, and that not equally, and besides is apt to slide away. Also urine, that brings off with it something like scales, discovers the stones to be soft, and that they are composed of several small ones not firmly united together. All these it is proper to bring away gently, changing alternately the fingers in such a manner, that they may not hurt the bladder, and no broken relics stay behind, which may afterwards render the cure difficult. Any of these, that come into view, must be extracted either by the fingers or crotchet.

But if there are several stones, they must every one be taken out; but if any very small one remain, it may rather be left: for it is difficult to find it in the bladder; and when found, it quickly escapes. Thus by long search the bladder is hurt, and mortal inflammations are brought on; in so much that some, though they were not cut, when the bladder has been long, and to no purpose, roughly handled, by the fingers, have died. Besides all which, a small stone being brought to the wound afterwards by the urine, drops out.

In case the stone appears so large, that it cannot be extracted without lacerating the neck, it must be split. The author of this contrivance was Ammonius, who upon that account was called Lithotomus[ HV ] (the stone-cutter.) It is done in this manner. A crotchet is fixed upon the stone with so sure a hold as to prevent it from recoiling inward: then an iron instrument of moderate thickness, with a thin edge, but not sharp, is made use of. This is applied to the stone, and being struck on the other side, cleaves it; great care being taken, that neither the instrument come to the bladder, nor any thing fall in by the breaking of the stone.

These operations are performed upon females much in the same manner, concerning whom a very few peculiarities must be mentioned. For in them, where the stone is very small, cutting is unnecessary; because it is forced by the urine into the neck, which is both shorter, and laxer than in men: therefore it often drops out of itself, and if it sticks in the urinary passage, which is narrower, it is however extracted without any harm by the abovementioned crotchet. But in larger stones the same method is necessary. However, in a virgin, the fingers should be introduced into the rectum as in a man, in a married woman by the vagina. Again, in a virgin, the incision must be made below the left lip of the pudendum; but in a married woman, between the urinary passage, and the bone of the pubes; the wound also must be transverse in both places, and we need not be alarmed if the hæmorrhage be considerable from a female body.

When a stone is extracted, if the patient be strong, and not greatly spent, we may let the blood flow to lessen the inflammation. And it is not amiss for the patient to walk a little, that if any grumous blood remain within, it may drop out. But if it does not cease of itself, it must be stopped, lest the strength be entirely exhausted; and this is to be done immediately after the operation in weak patients. For as a person is in danger of a convulsion, whilst the bladder is fatigued, so there is another fear, when the applications are removed, lest there be such an hæmorrhage as to prove mortal: to prevent which, the patient ought to sit down in sharp vinegar with the addition of a little salt; by which means both the blood commonly stops, and the bladder is contracted, and therefore is less inflamed. But if that does little service, a cupping vessel must be applied, both in the knees[(32)] and hips, and above the pubes too.

When either a sufficient quantity of blood has been evacuated, or the hæmorrhage stopped, the patient must be laid upon his back, with his head low, and his hips a little raised; and over the wound must be applied a double or triple linen cloth wet with vinegar. Then after an interval of two hours, he must be let down in a supine posture into a bath of hot water, so that he may be under water from the knees to the navel, the other parts being covered with clothes, only with his hands and feet bare, that he may be both less exhausted, and be able to continue there the longer. This commonly produces a plentiful sweat; which in the face is to be now and then wiped off by a spunge. And the rule for the continuance of this bathing is, till it hurts by weakening. After that the patient must be anointed plentifully with oil, and a handful of soft wool saturated with warm oil, must be laid on, so as to cover the pubes and hips, and groin, and the wound itself, which must still remain covered with the linen beforementioned; and this is to be moistened now and then with warm oil; that it may both prevent the admission of cold to the bladder, and gently mollify the nerves. Some make use of healing cataplasms. These do more hurt by their weight, which by pressing upon the bladder[(33)] irritates the wound, than service by their heat: and for that reason, not so much as any kind of bandage is necessary.

On the day following, if there be a difficulty in breathing, if the urine is not evacuated, or if the part above the pubes has immediately swelled, we may be assured, that grumous blood has staid within the bladder. Therefore the fingers being introduced in the same manner as above, the bladder must be handled gently, and whatever has happened to be coagulated there dispersed; by which means it is afterwards discharged from the bladder through the wound. Neither is it improper to inject through the wound into the bladder by a syringe, a mixture of vinegar and nitre; for if there be any bloody concretions, they are discussed in that way. And these may be done even the first day, if we are afraid of any thing being within; especially when weakness has prevented the evacuation of it by walking. The other methods laid down for the preceding day, the putting him into the bath, applying the cloth, and wool in the manner above described, are to be continued.

But a boy is neither to be put so often into the warm water, nor kept there so long at a time, as a youth; the weak, as the strong; one affected with a slight inflammation, as another, in whom it is more violent; one whose body is disposed to evacuations, as he that is bound. But in the mean time, if the patient sleep, and his breathing be equal, his tongue moist, his thirst tolerable, his lower belly not at all swelled, and the pain and fever moderate, we may take it for granted that the cure goes on well.

But in such patients the inflammation ceases commonly about the fifth or seventh day: when that is abated, the bath is needless. Only the wound, as the patient lies in a supine posture, must be fomented with hot water, that if the urine corrodes, it may be washed away. Digestive medicines must be laid on; and if the ulcer appears to want deterging, honey may be applied. If that corrodes, it must be tempered with rose oil. The enneapharmacum plaister seems fittest for this intention, for it both contains suet to promote digestion, and honey to deterge the ulcer, marrow also, and especially that of veal, which is particularly efficacious in preventing a fistula from remaining. And at that time lint is not necessary over the ulcer; but is properly laid above the medicine to keep that on. But when the ulcer is cleansed, it must be brought to cicatrize by lint alone.

At this time, however, if the cure has not proceeded happily, various dangers arise: which one may quickly prognosticate, if there be a continual watching, or a difficulty of breathing, if the tongue be dry, if there be a violent thirst, if the bottom of the belly swells, if the wound gapes, if the urine that makes its way through it, does not corrode it; in like manner, if before the third day some livid stuff drops out; if the patient makes no answers to questions, or very slowly; if there are vehement pains; if after the fifth day violent fevers come on, and a nausea continues; if lying upon the belly is the most agreeable posture. However nothing is worse than a convulsion, and a bilious vomiting before the ninth day. But there being reason to fear an inflammation, it must be obviated by abstinence, and moderate food seasonably administered; and by applying, at the same time, fomentations, and the other means above prescribed.

CHAP. XXVII. OF A GANGRENE AFTER CUTTING FOR THE STONE.

The next danger is that of a gangrene. This is known by a discharge of fetid sanies both by the wound and the penis, and together with that, something not very different from grumous blood, and little films like small locks of wool; it is also known by the lips of the wound being dry, by a pain in the groin, by the continuance of the fever, and its increase at night, and by the accession of irregular shudderings. Now it must be considered to what part the gangrene spreads. If to the penis, that part grows hard and red, and is painful to the touch, and the testicles swell, if to the bladder, a pain of the anus follows, the hips swell, the legs cannot be easily extended; but if to one side, it is apparent to the sight, and has these same symptoms on either side, but not so violent.

The first circumstance of importance is, that the body lie in a proper posture, that the part into which the disease is propagated be always laid highest. Thus if it tends to the penis, the patient should lie supine; if to the bladder, upon his belly; if to one side, upon the other, which is sound. Then as to the means of cure, the patient must be put into a bath made of a decoction of horehound, or cypress, or myrtle, and the same liquor must be injected into the wound by a syringe; then a mixture of lentils and pomegranate bark both boiled in wine must be laid on; or bramble, or olive leaves boiled in the same manner, or other medicines, which we have prescribed for restraining and cleansing gangrenes. And if any of these shall be in a dry form, they must be blown in through a writing reed.

When the gangrene begins to stop, the ulcer should be washed with mulse. And at this time cerate must be avoided, which softens the flesh, and prepares it for receiving the infection. Rather let washed lead with wine be laid on; over which shall be applied the same spread upon a linen cloth: by which a cure may be accomplished. Nevertheless we should not be ignorant, that when a gangrene has begun, the stomach, which has a certain sympathy with the bladder, is often affected; whence it happens, that the food can neither be retained, nor if any is retained, can it be concocted, nor the body nourished; and therefore the wound can neither be deterged nor incarned: which must of necessity soon bring on death.

But as it is not possible, by any means, to save patients under these circumstances, from the first day however, the method of cure must be regularly observed. In the conduct of which some caution is also necessary with regard to the food and drink: for at the beginning, none but moist food ought to be given; when the ulcer is deterged, of the middle kind; greens and salt fish are always hurtful. A moderate quantity of drink is required: for if too little is drunk, the wound is inflamed, the patient labours under a want of sleep, and the strength of the body is diminished: if too much be taken, the bladder is frequently filled, and by that means irritated. It is too plain to require a frequent repetition, that the drink must be nothing but water.

It generally happens from a diet of this kind, that the belly is bound. A clyster must be given of a decoction of fenugreek or mallows in water. The same liquor mixed with rose oil, must be injected into the wound by a syringe, when the urine corrodes it, and prevents it from being cleansed. For the most part, at first, the urine is discharged by the wound; whilst it is healing, it is divided, and part begins to be discharged by the penis, till the wound be entirely closed: which happens sometimes in the third month, sometimes not before the sixth, at other times after a whole year.

And we should not despair of a solid agglutination of the wound, unless where the neck has been greatly lacerated, or many and large caruncles, and at the same time some nervous substances have come away by a gangrene. But the greatest precaution must be used, that no fistula, or at least a very small one, be left there. Therefore, where the wound tends to cicatrize, the patient should lie with his thighs and legs extended: unless the stones have been soft or sandy; for in that case the bladder is not so soon cleansed: and, therefore, it is necessary for the wound to be longer open; and never to be brought to cicatrize till nothing more of that nature be discharged.

But if the lips have united before the bladder was cleansed, and the pain and inflammation have returned, the wound must be separated by the fingers, or the broad end of a probe, to allow a passage to what causes the pain: which being evacuated, and the urine having come away pure for a pretty while, cicatrizing medicines must at length be laid on, and the feet extended, as I directed before, as close to one another as possible.

But if from those causes, which I mentioned, there appears to be danger of a fistula, to close it the more easily, or at least to contract it, a leaden pipe must be introduced into the anus[(34)]; and the legs being extended, the thighs and ancles must be tied together, till there be a cicatrix as good as we can obtain.

CHAP. XXVIII. OF THE OPERATIONS REQUIRED WHEN A MEMBRANE, OR FLESH OBSTRUCTS THE VAGINA IN WOMEN.

The foregoing diseases may happen both to men and women. But some are peculiar to women; as in the first place, where the vagina, by its lips being joined, does not admit of coition. And this happens sometimes in the womb of the mother; at other times, from an ulcer in those parts, and the lips, in healing, having by bad management been united. If it be from the birth, a membrane obstructs the vagina: if from an ulcer, it is filled up with flesh.

In the membrane an incision must be made in two lines crossing each other, in the form of the letter X, great care being taken not to wound the urinary passage; and then the membrane is to be cut out. But if flesh has grown there, it is necessary to open it in a straight line; then taking hold of it with a vulsella or hook, to cut off a small habenula, as it were, from the orifice of the vagina, after which must be introduced a piece of lint rolled in a long form (by the Greeks called lemniscus) dipped in vinegar; and over this sordid wool moistened with vinegar is to be bound on; the third day, these are to be removed, and the part dressed like other wounds. And when it begins to heal, it is proper to introduce into the part a leaden pipe armed with a cicatrizing medicine; and over that to apply the same medicine, till the wound be cicatrized.

CHAP. XXIX. THE METHOD OF EXTRACTING A DEAD FOETUS OUT OF THE WOMB.

When a woman conceives, if the foetus dies in the womb, near the time of delivery, and cannot come away of itself, an operation is necessary. This may be reckoned amongst the most difficult: for it both requires the highest prudence and tenderness, and is attended with the greatest danger. But above all, the wonderful nature of the womb, as in other cases, so in this also, is easily discovered.

In the first place, it is proper to lay the woman on her back, across a bed, in such a posture, that her ilia may be compressed by her thighs: whence it happens, that both the bottom of her belly is presented to the view of the physician, and the child is forced to the mouth of the womb; which is close shut, when the foetus is dead, but at intervals opens a little. The physician, making use of this opportunity, having his hand anointed, ought to introduce, at first, the fore-finger, and keep it there till the mouth be opened again, and then he must introduce another finger, and the rest upon the like opportunities offering, till his whole hand be within it. Both the capacity of the womb, and the strength of its nerves, and the habit of the whole body, and even the fortitude of the mind conduce much to the facility of doing this: especially, as in some cases, it is necessary to have both hands within the womb.

It is of importance, that both the bottom of the belly, and the extremities of the body be as warm as possible; and that an inflammation be not begun, but that help be administered instantly, while the case is recent. For if the body be already swelled, the hand can neither be introduced, nor the fœtus brought away without the greatest difficulty; and together with a vomiting and tremor, there generally follow mortal convulsions. When the hand is introduced upon the dead fœtus, it immediately discovers its posture: for it is either turned upon the head, or the feet, or lies transverse but commonly in such a manner; that either its hand or foot is near.

The intention of the physician is, by his hand, to turn the child, either upon its head, or even upon its feet, if it happened to be in a different posture. And if there is no other hinderance, taking hold of the hand or foot puts the body in a better posture: for the hand being laid hold of, will turn it upon the head, and the foot upon its feet. Then if the head is nearest, a crotchet should be introduced, in every part smooth, with a short point, which is properly fixed, either in the eye, or the ear, or the mouth, sometimes even in the forehead; and then being drawn outwards, brings away the child. Yet it is not to be extracted at any moment of time indifferently: for should it be attempted, when the mouth of the womb is shut, there being no exit for the child, it breaks to pieces, and the point of the crotchet slips upon the mouth of the womb itself, and there ensue convulsions, and extreme danger of death. Therefore, it is necessary to forbear, when the womb is shut; and when it opens, to draw gently; and every such opportunity to extract it gradually. The right hand must draw the crotchet, the left being kept within, must pull the child, and at the same time direct it.

It sometimes happens, that the child is distended with water, and there is a fœtid sanies discharged from it. If this be the case, the body must be perforated with the fore-finger, that its bulk may be lessened by the discharge of the humour: then it must be taken out gently by the hands only: for the crotchet being fixed in a putrid body, easily loses its hold. The danger attending which, I have already pointed out.

But a child being turned upon its feet, is not difficult to extract: for these being taken hold of, it is easily brought away by the hands alone.

If it be transverse, and cannot be got into a proper direction, a crotchet must be fixed in the armpit, and gradually pulled: in this case, the neck is generally doubled, and the head turns back upon the body. The remedy is, to cut through the neck, that the two parts may be brought away separately. This is done by a crotchet, which resembles the former, save that it is sharp all along the internal part. Then we must endeavour to bring away the head first, after that, the rest of the body: because generally, when the largest part is extracted, the head slips back into the womb, and cannot be extracted without the greatest danger.

However, if this has happened, a double cloth must be laid upon the belly of the woman, and a strong and skilful man ought to stand at her left side, and put both his hands upon the lower part of her belly, and press with one upon another: by which means the head is forced into the mouth of the womb, and may then be extracted by the crotchet, in the manner above described.

But if one foot be found at the mouth of the womb, and the other is behind, with the body, whatever is protruded, must be gradually cut away. And if the buttocks begin to press upon the mouth of the womb, they must be thrust back again, and the other foot sought for and brought forward. There are also some other difficulties, which make it necessary to cut the child into pieces, when it cannot be brought away entire.

Whenever a fœtus is brought away, it must be delivered to an assistant; who must take it in his hands, and then the physician ought to draw the umbilical cord gently with his left hand, but not to break it, and with the right to follow it, as far as what they call the secundines, which were the covering of the fœtus within the womb; and taking hold of the extremities of these, to separate all the small veins and membranes in the same manner, by his hand, from the womb, and to extract the whole of it, and any concreted blood that remains within. Then the woman’s thighs must be laid close together, and she placed in a room moderately warm, without any thorough air. To the bottom of her belly must be applied sordid wool dipped in vinegar and rose-oil. The remaining part of the cure ought to be the same, as is used in inflammations, and such wounds as are in nervous parts.

CHAP. XXX. THE OPERATIONS REQUIRED IN DISEASES OF THE ANUS.

Diseases of the anus also, when they are not removed by medicines, require the assistance of the hand. Therefore, if any fissures, in that part, by long continuance, have become indurated, and are already callous, it is most proper to give a clyster; then to apply a hot spunge, in order to relax them, and bring them to the external part, when they are in view, to cut off each of them with a knife, and renew the ulcers; then to lay on soft lint, and over it honey spread upon a linen cloth; and to fill up the part with soft wool, and thus bind it up; on the next and following days, to dress with mild medicines, which I have elsewhere prescribed for the same disorders when recent; and in the first days to diet the patient with gruels, after that gradually to add to the food, but something of that kind, which I have directed in the same place. If at any time, from an inflammation, pus arises in them, as soon as that appears, an incision must be made to prevent the anus itself from suppurating. But we must not be in a hurry to do it before; for if it be cut while crude, the inflammation is much increased, and a greater quantity of pus is generated. In these wounds too, there is a necessity for mild food, and the same kind of medicines.

But the tubercles called condylomata, when they have grown hard, are cured in this manner. First of all, a clyster must be given. Then the tubercle being laid hold of by a vulsella, must be cut out near its roots. When this is done, the same course must be followed, that I prescribed after the preceding operation; only if there is any fungus, it must be kept under by copper scales.

The mouths of the hæmorrhoidal veins, discharging blood, are taken off thus. When there is a discharge of sanies besides blood, an acrid clyster must be administered, that the mouths of the veins may be pushed the farther outward; which causes all the vessels to appear like small heads. Then if a head be very little, and have a small base, it must be tied with a thread a little above the point, where it joins the anus; and a spunge squeezed out of hot water must be laid over it, till it grow livid; then above the knot it must be scarified either by the nail or the knife. If this is not done, violent pains ensue, and a difficulty in making water. If it be pretty big, and the base broad, it must be taken hold of with a small hook or two, and an incision made round the tumour, a little above the base; and neither any part of the head must be left, nor any thing taken off the anus: which a person may accomplish, if he neither draws the hooks too much nor too little. Where the incision has been made, a needle should be put in, and below that the head tied with a thread. If there be two or three of them, the inmost must be cured first; if more than that number, not all at once, lest there be[(35)] sore places all round the part at the same time. If there is a discharge of blood, it must be received in a spunge; then lint must be applied; the thighs, groin, and what lies contiguous to the ulcer, be anointed, and cerate laid over it, and the part filled with warm barley meal, and thus bound up. The day following, the patient ought to sit down in warm water, and be dressed with the same cataplasm. And twice in the day, both before and after the dressing, the ischia and thighs must be anointed with liquid cerate, and the patient kept in a warm place. After an interval of five or six days, the lint is to be taken out with a specillum oricularium; and if these heads have not dropped off at the same time, they must be pushed off by the finger. Afterwards, the ulcer must be brought to heal by mild medicines, such as I have prescribed before. The proper treatment, when the disease is cured, I have already mentioned elsewhere.

CHAP. XXXI. OF VARICES IN THE LEGS.

From these disorders we go on to the legs. Varices in these are not difficult to remove. To this place I have deferred the cure of those small veins, which hurt in the head, as also the varices in the belly, because it is the same in them all. Therefore any vein that is troublesome, either is cauterized, and so decays, or is cut out. If it be straight, or though transverse, yet simple, it is better to cauterize it. If it be crooked, and as it were twisted into orbs, or several of them are involved within each other, it is more convenient to cut them out.

The method of cauterizing is this. An incision is made in the skin over it; then the vein being laid bare, is moderately pressed by a small and blunt iron instrument red hot: and we must avoid burning the lips of the wound itself, which it is easy to draw back with small hooks. This is repeated over the whole varix, at the distance of about four fingers breadth; and after that a medicine for healing burns is laid on.

But it is cut out in this manner. An incision being made in the same way in the skin over the vein, the lips are taken up with a small hook; and the vein is separated all round from the flesh by a knife, but in this great care is taken not to wound the vein itself; and a blunt hook is put under it; and generally, at the same distance mentioned before, in the same vein, the same operation is repeated. The course of it is easily discovered by extending it with the hook.

When this has been done, as far as the varices go, the vein, being brought forward in one part by the hook, is cut through, then where the next hook is, it is drawn up and pulled away, and is cut off there again. And in this manner the leg being entirely freed from the varices, the lips of the wounds are then brought together, and an agglutinating plaister is laid over them.

CHAP. XXXII. OPERATIONS REQUIRED IN COHERING AND CROOKED FINGERS.

If the fingers, either from the birth, or by an ulceration in their opposite sides, have afterwards adhered together, they are separated by the knife; round each of them a plaister, not greasy, is put on, and thus they heal separately.

But if there has been an ulcer in a finger, and afterwards a cicatrix injudiciously brought on, has rendered it crooked; in the first place a malagma must be tried. If that does no good (which generally happens both in an old cicatrix, and where the tendons are hurt) then we ought to see whether the fault be in the tendon or the skin. If in the tendon, it ought not to be touched, for it is not curable: if in the skin, the whole cicatrix must be cut off, which being generally callous, prevents the fingers from being extended. Then being kept extended, it must be brought to cicatrize afresh.

CHAP. XXXIII. OF THE OPERATION REQUIRED IN A GANGRENE.

I have elsewhere observed, that a gangrene comes about the nails, armpits or groin; and that if it does not yield to medicines, the member ought to be cut off.

But even this is attended with very great danger: for the patients often die in the operation, either by a hæmorrhage, or faintings. But in this, as well as other cases, it is not to be considered, whether the remedy is very safe, which is the only one we have. Between the sound and corrupted part then, an incision must be made with a knife in the flesh, as far as the bone. But this must not be done over a joint; and some of the sound part must rather be cut off, than any of the corrupt left. When we come to the bone, the sound flesh must be drawn back from it, and cut below round the bone, that some part of the bone may also be laid bare under it; then the bone must be cut off with a saw, as close as we can to the sound flesh, that still adheres to it; and then the fore part of the bone, that has been roughened with the saw, must be smoothed, and the skin brought over it; which in a cure of this kind ought to be lax, that it may cover the bone as much as possible all round. The part, which the skin does not reach, must be covered with lint, and above that a spunge squeezed out of vinegar must be tied on the place. The remaining part of the cure must be the same, as I have directed in wounds which are brought to digestion[(36)].

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A. CORNELIUS CELSUS

OF

MEDICINE.

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BOOK VIII.

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CHAP. I. OF THE SITUATION AND FIGURE OF THE BONES OF THE HUMAN BODY.

It now remains, that I speak of what relates to the bones: for the easier understanding of which, I shall first describe their situations and forms. The first then is the skull, which is concave on the internal side, externally gibbous, and on each side smooth, both where it covers the membrane of the brain, and where itself is covered by the skin, from which the hair grows. In the occiput and temples it is simple; but double from the forehead to the vertex. And the bones of it in their external part are hard; on the inside, where they are connected with each other, softer. And veins are distributed between them, which probably supply them with nourishment.

Now the skull is rarely entire without sutures; but in hot countries it is more frequently found so. And such a head is strongest, and the most safe from pain; of others, the fewer sutures there are, so much the freer is the head from complaints; for their number is not certain, nor indeed their situation. However, for the most part two above the ears divide the temples from the upper part of the head; the third running to each side through the vertex, separates the occiput from the top of the head; the fourth goes from the vertex along the middle of the head to the forehead; and this ends in some at the point, to which the hair extends, in others between the eye-brows, dividing the forehead itself[(1)]. The other sutures are exactly fitted to each other upon the same level. But the transverse ones above the ears, grow gradually thinner to their edges; and thus the inferior bones slightly overtop the superior ones. The bone behind the ear is the thickest in the head; for which reason, probably hair does not grow there. Over these muscles too[(2)], that cover the temples, a bone is situated in the middle, which is inclined to the external part. But the face has the largest suture; which beginning from the one temple runs transversely through the middle of the eyes, and the nose, to the other temple; from which two short ones point downward under the internal angles. The cheek-bones also have each of them a transverse suture in the upper part. And from the middle of the nose, or the sockets of the upper teeth, proceeds one through the middle of the palate; and another also divides the palate transversely. These then are the sutures found in most people.

The largest foramina of the head are those of the eyes; next the foramina of the nose; then those we have at the ears. The foramina of the eyes run straight and undivided to the brain. Two foramina are observed in the nose, divided by a bone in the middle: for these about the eye-brows and angles of the eyes begin osseous, and so proceed near the third part of the way; then turning cartilaginous, the nearer they approach to the mouth, so much the softer and more fleshy they become. But these foramina, which from the beginning of the nostrils to the internal part are simple, are there again divided each into two courses; the branches opening into the fauces both emit and receive the breath; the others go to the brain; in the end they are branched into many small openings, which afford the sense of smelling. In the ear too the passage at first is straight, and simple, but farther in, it becomes winding; the part next the brain is separated into many and small openings, from which we have the faculty of hearing. Near these there are as it were two small sinuses; and above them, that bone terminates, which going in a transverse direction from the cheeks is sustained by the inferior bones. It may be called jugale from the same resemblance, which gave it the Greek name of Zygodes[ HW ]. The maxilla is a soft bone[(3)], and only one in number: the middle and lowest part of which compose the chin; from whence it proceeds on both sides to the temples; and this only moves: for the malæ with the whole bone, that contains the upper teeth, are immoveable: but the extremities of the maxilla shoot as it were into two horns. One of these processes is broader below[(4)], and is narrowed at the vertex, and being extended forward enters below the os jugale, and over that is tied down by the muscles of the temples. The other is shorter and rounder, and is lodged like a hinge in that cavity, which is near the foramina of the ear; and there turning itself different ways, gives the maxilla a power of moving.

The teeth are harder than bone; part of them are fixed in the lower jaw-bone, and part in the upper. The four first from their cutting are by the Greeks called tomici[ HX ]. On each side of these above and below stand the four canine teeth; beyond which there are commonly five maxillary teeth, except in those, in whom the genuine (dentes sapientiae) which generally grow late, have not come out. The fore teeth adhere each by one root, the maxillary by two at least, some by three or four. And a longer root commonly emits a shorter tooth; and the root of a straight tooth is straight, that of a crooked one bent. From this root in children, a new tooth springs, which most frequently forces out the former; sometimes however it appears above or below it.

Next to the head is the spine, which consists of twenty-four Vertebræ. There are seven in the neck, twelve by the ribs, and the other five are below the ribs. These are round and short, and send out two processes on each side; in the middle they are perforated, where the spinal marrow, connected with the brain, descends. The sides also between the two processes are perforated by small holes, through which, from the membrane of the brain similar small membranes proceed. And all the Vertebræ[(5)] (except the three uppermost) at the superior part in the processes themselves have small depressions; at the lower, on the contrary, they send out processes pointing downwards. The first then immediately sustains the head, by receiving small processes of it into two depressions; which is the reason that the surface of the head below is rendered unequal by two prominences. The second is inserted into the under part of the first, and the superior part of the second is round and narrow (processus dentatus) in order to admit of a circular motion, so that the first surrounding the second allows the head to move towards each side. The third receives the second in the same manner; whence the neck has great facility of motion. And indeed it would not be able to sustain the head, if straight and strong nerves on each side did not secure the neck; these the Greeks call Carotæ. For one of them in every flexure, being always stretched, prevents the upper parts from slipping further. The third Vertebra has prominences, which are inserted into that below it. All the rest are inserted each into its inferior one by processes pointing downwards; and by depressions, which they have on each side, they receive the superior, and are secured by many ligaments, and a great quantity of cartilage. And thus one moderate flexure forward being allowed, a man both stands erect for some kinds of employment, and at other times bends himself as the actions he is engaged in require.

Below the neck, the first rib is situated opposite to the shoulders. After that the six inferior ones[(6)] reach the bottom of the breast: and these at their origin being round, and furnished with something like small heads, are fixed to the transverse processes of the vertebræ, which are in that part a little depressed; then they grow broader, and bending outward, degenerate gradually into cartilage; and in that part being again turned gently inward, are joined to the pectoral bone: which begins strong and hard at the fauces, being excavated on each side, and terminates at the præcordia, where it is softened into a cartilage. And under the superior ribs there are five, which the Greeks call Nothæ (spurious) shorter, and thinner, which also gradually turn to cartilage, and adhere to the external parts of the abdomen; the lowest of these in the greatest part of it is nothing else but a cartilage.

From the neck two broad bones, one on either side, go to the shoulders, by us called scutula operta, by the Greeks Omoplatæ. These have cavities at their vertices; from the vertices they become triangular, and growing gradually broader tend to the spine; and the broader they are in any part, so much the duller is their sensation. These too at their extremity are cartilaginous, and in their back part lie as it were loose, because, unless at the top, they are fixed to no bone, but are there tied down by strong muscles and nerves.

But at the first rib[(7)] a little within the middle of it, a bone grows out, in that part indeed slender; but going forward, the nearer it comes to the broad bone of the scapula, it becomes thicker, and broader, bending a little inwards, which being a little enlarged at its other vertex, sustains the clavicle. This bone is crooked, and is to be reckoned amongst the hardest bones; the one end of it is joined to the bone I just mentioned before, and by the other it is fixed in a small depression of the pectoral bone, and is moved a little in the motion of the arm; and its lower head is connected by ligaments and a cartilage with the broad bone of the shoulders.

Here the humerus begins, which at both its ends is enlarged, soft, without marrow, and cartilaginous; in the middle round and hard, and containing marrow; is a little concave[(8)] in its fore and internal part; and convex in its posterior and external part. Now the fore part is next the breast; the posterior is toward the scapulæ; the internal next the side; and the external at the greatest distance from the side: which distinctions will afterwards appear applicable to all joints in the extremities. The upper end of the humerus is rounder than the other bones, which I have yet mentioned, and a small part of it is inserted into the vertex of the broad bone of the shoulder; the greatest part, standing out of it, is secured by ligaments. But the inferior head has two processes; the intermediate space between which, is even more depressed than its extremities.

This affords a reception to the fore-arm; which consists of two bones. The Radius, which the Greeks call cercis[ HY ], is the superior one and shorter, and at first being more slender, with its ends round, and a little concave, receives the small tubercle of the humerus, which is secured there by ligaments and a cartilage. The cubitus is the inferior and longer; it is at first larger in its upper end, and by two vertices, as it were, standing out, fixes itself into the sinus of the humerus, which I mentioned, betwixt its two processes. The two bones of the fore arm at first[(9)] are close together, then separate by degrees, and meet again at the hand, their former proportions being reversed: for there the radius is pretty large, and the cubitus very small. After that the radius rising to a cartilaginous head is inserted into its neck. The cubitus is round at its extremity, and projects a little on one part. And to save frequent repetition, this ought to be known, that most bones end in a cartilage, and that every articulation is thus terminated: for it could neither be moved, unless it pressed upon something smooth, nor be joined with flesh and ligaments, unless these were connected by some matter of a middle nature.

In the hand, the first part of the palm consists of many and small bones, the number of which is uncertain. But all of them are oblong and triangular, and connected together by a peculiar kind of structure, the plain of each one being higher than another alternately; whence it happens, that the whole makes up the appearance of one bone a little concave on the internal part. But from the hand two small processes are lodged in the cavity of the radius. Then at the other end five straight bones going to the fingers, compleat the palm; from which the fingers themselves have their origin. These consist each of three bones. The conformation of them all is the same. The more internal bone has a depression in its vertex, and receives the small tubercle of the external, and these are secured by ligaments. From them arise the nails, which grow hard: and thus they adhere by their roots, not to bone, but rather to flesh. This then is the construction of the superior parts.

But the lower part of the spine ends in the hip-bone, which is transverse, and far the strongest, and defends the womb, bladder, and intestine Rectum. And this in the external part is convex; at the spine inclined backward; on the sides, that is, at the hips themselves, it has round cavities; from whence arises the bone, which is called pecten; and that being situated transversely over the intestines under the pubes, strengthens the belly; it is straighter in men, but in women more bent externally, that it may not prevent the birth.

From these proceed the thigh bones; the heads of which are still rounder than those of the humeri; though the latter have more rotundity, than is found in any of the rest. A little lower they have two processes on the fore and posterior part. From that they descend hard and full of marrow, externally convex, and are again enlarged at the inferior heads. The superior ones are inserted into the cavities of the hip-bone, as the humeri into the bones of the scapulæ; then, lower down, they slope gently inward, that they may more equally sustain the superior parts. And their inferior heads have also depressions between them, that they may be the more easily received by the bones of the leg: which articulation is covered by a small, soft, and cartilaginous bone, which is called Patella. This floating above, and not being fixed to any bone, but bound down by flesh and tendons, and a little more inclined to the thigh bone, defends the joint in all flexures of the legs.

The leg consists of two bones; for in every thing the thigh resembles the arm, and the leg the fore-arm; so that the shape and elegance of the one may be known from the other; which beginning with the bones, answers also in the flesh. One of these bones is situated on the external part of the calf of the leg, and from that properly enough takes the name of Sura[(10)]. This is shorter and more slender above, but is enlarged at the ancles. The other, which is placed in the fore part, and has the name of Tibia, is longer and larger in the upper part, and is alone connected with the lower end of the thigh-bone, as the cubitus is with the humerus: and these bones too, being joined both below and above, separate in the middle, as those of the fore arm.

The leg bones are received below by a transverse bone in the ancle; and that is situated above the heel bone; which in one part has a depression and in another prominences, and it both receives the processes from the ancle-bone, and is inserted into its cavity. And this is hard, without marrow, and projecting more to the posterior part makes a round figure there. The other bones of the foot are constructed in a similar manner to those of the hand. The soles answer to the palms, the toes to the fingers, and the nails to the nails.

CHAP. II. GENERAL DIVISION OF DISORDERS IN THE BONES. OF A BLACKNESS AND CARIES, AND THEIR TREATMENT.

Whenever a bone is injured, it is either corrupted, or fissured, or fractured, or perforated, or contused, or dislocated. A corrupted bone generally turns first oily, and afterwards either black or carious. These cases happen from large ulcers, or fistulas over them, when they have either grown antient, or have been seized with a gangrene. First of all it is necessary to lay bare the bone, cutting out the ulcer, and if the disorder extends farther than the ulcer was, to pare away the flesh below, till the sound part of the bone be exposed all round; then it is sufficient to cauterize the part that is oily, once or twice, by the application of an iron instrument, that so a scale may cast off; or to scrape it, till some blood appear, which is the mark of a sound bone: for whatever is vitiated must necessarily be dry. The same method must also be pursued in a cartilage that is injured; for that too must be scraped by a knife, till what remains be sound. And then what is thus scraped, whether bone or cartilage, must be sprinkled with nitre well powdered. And nothing else is to be done, where a caries or blackness is in the surface of the bone: for in that case, the cautery or the scraping must only be continued a little longer. A person, that scrapes these, ought to press the instrument boldly, that he may both do it effectually, and have the sooner done. The operation is finished, when we come to the white or firm bone. It is evident, that when the defect is a blackness, it ends in the white, and that where there is a certain degree of solidity, there the caries terminates. We have already observed, that there is also some blood in a sound bone: But when either of these happen to go in pretty deep, it is uncertain where they end.

It is easy to form a judgment in a caries, if a small probe is introduced into the foramina, which by penetrating more or less, shews that the caries is either in the surface, or of greater depth. The same may be collected[(11)] even from the pain and fever; for when these are moderate, it cannot have penetrated deep. A greater certainty is obtained however by the application of the perforator: for the disease ends, where the dust of the bone ceases to be black. Therefore if the caries has gone deep, several holes must be made in it by the perforator, as deep as the disease goes; then into these holes must be put hot irons, till the bone become entirely dry. For the consequences of this operation will be, that whatever is spoilt will be separated from the bone below; and the cavity will be filled up with flesh; and afterwards either no humour at all, or a small quantity will be discharged.

But if the blackness goes through[(12)] to the other side of the bone, it ought to be cut out. The same may be done also in a caries, that penetrates to the other side of the bone. But where the whole is spoilt, the whole must be taken away. If the inferior part is sound, so far as is corrupted, ought to be cut out. Likewise if the skull or pectoral bone, or a rib be carious, the actual cautery is needless, but there is a necessity for excision. Neither does the opinion of these people deserve our attention, who defer the excision to the third day after the bone is laid bare, before they cut it out; for in all cases it is safer to perform an operation, before an inflammation come on. Therefore both the skin is to be cut, and the bone laid bare, and freed from every fault, as far as possible, in the same moment. Now a disease in the pectoral bone is far the most pernicious of any; because though the operation have succeeded well, it hardly ever restores a perfect soundness.

CHAP. III. OF THE USE OF THE MODIOLUS AND PERFORATOR, AND OTHER INSTRUMENTS, ESPECIALLY FOR THE BONES OF THE HEAD.

There are two ways of cutting out a bone; if the part injured be very small, by a modiolus, which the Greeks call chœnicion[ HZ ], if larger by terebræ. I shall explain the method of each. The modiolus is a concave and round iron instrument with serrated edges in its lowest extremity; through the middle of which is put a pin, surrounded also by an interior circle. Of perforators there are two kinds: one of them resembling that, which carpenters use; the other with a longer head, which begins from a sharp point, and then turns quickly broader; and again from another beginning goes upward with thickness pretty near equal.

If the disease be confined to a small space, so that the modiolus can cover it, that must be used preferably. But if a caries appear below, the pin in the middle is put into the opening. If there be a blackness, a small hole is made by the angle of a chisel[(13)] to receive the pin, that the modiolus resting upon that, by being turned round may not slip, and then it is turned like the perforator by a strap. And there is a certain degree of pressure required, that both a perforation may be made, and it may go round; because if it be lightly impressed, it does not produce the effect; if too much, it has no motion. And it is not improper to drop in a little rose oil or milk, the smoothness of which may make it turn with the greater ease; yet too much of the liquid blunts the edge of the instrument. But when the modiolus has marked out a way for itself, the middle pin is taken out, and it is worked about by itself. And then, when the soundness of the inferior part is discovered by the dust, the modiolus is taken away.

But if the disease is more extended than to be covered by that, we must make use of the perforator. By this a hole is made in the limit, that divides the injured from the sound part of the bone; and not far from that a second, and a third, till the part, that is to be cut out, be surrounded with these holes. And in this case too the dust indicates how deep the perforator is to go. Then a chisel being drove by a mallet from one hole to another, cuts out the intermediate space between them; and thus a circumference is formed like to that, which is imprinted in a smaller circle by the modiolus. In whichever way the circle has been made, let the same chisel, laid flat on the corrupted bone, smooth each superior lamina, till the bone be left entirely sound.

A blackness hardly ever goes quite through a bone, but a caries does, especially where the skull is faulty. There also the disorder is discovered by the probe, which being introduced into the hole, that terminates at the sound part of the bone, both finds some resistance, and comes out moist. If it prove pervious, the probe going in deeper between the bone and the membrane, meets with no resistance, and comes out dry: not because there is no corrupt sanies within, but because it is there diffused, as being in a larger cavity.

Now whether a blackness, which the perforator has discovered, or a caries, which the probe has shewn, pass through the bone, the use of the modiolus is generally fruitless: because, where the disease has penetrated so deep, it must also necessarily be largely extended in breadth. Here then we must use the second kind of perforator above described; and to prevent its growing too hot, it must be dipped now and then in cold water. But then we must proceed with greater caution, when we have perforated either half through in a simple bone, or the superior lamina in a double one. The space itself guides us in the first case; and in the other, the blood. Therefore at that time the strap must be drawn slower, the left hand should press more gently, and be taken off pretty frequently: also the depth of the perforation is to be considered, that we may be sensible whenever the bone is broke through, and run no risque of wounding the membrane of the brain by its point, from which proceed violent inflammations, with danger of death.

When the holes are made, the intermediate spaces must be cut out in the same manner, but with much more circumspection; lest the angle of the chisel chance to wound the same membrane; till a passage be made, through which the instrument to protect the membrane may be introduced. The Greeks call it meningo-phylax[ IA ]. It is a copper plate, firm, bent a little upward towards the end, and externally smooth: which being introduced in such a manner, that its external surface be next the brain, is put under that part, which is to be separated by the chisel; and if it receives its angles, it stops its progress; and upon this account the physician repeats his strokes upon the chisel both more boldly, and more safely, till the bone being cut out all round is raised by this plate, and may be taken away without any hurt to the brain. When the whole bone is taken out, the edges must be scraped round and smoothed, and if any dust has fallen upon the membrane, it must be gathered up. When the superior part is taken away, and the inferior left, not only the edges, but the whole bone must be smoothed, that the skin may afterwards generate upon it without being hurt, which growing upon a rough bone, does not immediately become sound, but produces new pains.

The steps to be taken after the brain is uncovered, I shall mention, when I come to fractured bones. If any base is preserved, medicines not greasy, that are calculated for recent wounds, must be applied, and over them must be laid sordid wool moistened with oil and vinegar. In process of time flesh grows from the bone itself, which fills up the cavity made by the operation. And when any bone is cauterized, it separates from the sound part, and granulations sprout up between the sound and mortified part, which expel what has separated. And this, because it is a thin and small lamina, by the Greeks is called lepis[ IB ], that is, a scale.

It may happen too, that from a blow, a bone may be neither fissured, nor broke through, but the surface of it only contused, and rendered rough. When this occurs, it is sufficient to scrape and smooth it. Though these methods are most commonly practised in the head, yet they are common to the other bones too; so that wherever the like case shall occur, the same remedy must be used. But as they are fractured, fissured, perforated, and contused, they require some particular methods of cure in each kind, and in most of them, some general ones also. Of these I shall proceed to treat, beginning with the head.

CHAP. IV. OF FRACTURES OF THE SKULL.

When a blow has been received upon the skull, we must immediately enquire, whether the person has vomited bile; whether he have lost his sight, or his speech; whether blood has issued by his nostrils, or ears; whether he has immediately fallen down; whether he has lain insensible, as if asleep: for these do not happen without a fracture of the bone. And when they occur, we may be assured, that an operation is necessary, but of uncertain success. If besides, a torpor has come on; if he is delirious, if either a palsy, or a convulsion has followed, it is probable that the membrane of the brane too is wounded; and of such patients there is still less hope. But if none of these have ensued, and it may be doubted, whether the bone be fractured, it is first to be considered, whether the blow was given by a stone or a stick, or iron, or any other weapon, and whether the instrument was smooth, or rough, small or large, whether struck with force, or more lightly; because the more gentle the stroke was, so much the more easily we may suppose the bone to have resisted it. But it is best to examine that by a more certain mark. Therefore a probe ought to be introduced where the wound is, neither too small nor sharp, lest if it should light upon any of the natural sinuses, it mislead us into an opinion of a fracture, where there is none; and not too thick, lest small fissures escape it. When the probe comes to the bone, if nothing but what is smooth and slippery occur, one may judge it to be sound; if there is an asperity, especially where there are no sutures, that is an evidence the bone is fractured.

Hippocrates has recorded, that he was himself deceived by the sutures. This is the custom of great men, who have a just consciousness of their own superior abilities: for little minds, because they are deficient in every thing, never allow themselves to be deficient in any. An ingenuous confession of an error is worthy of a great genius, who will have enough besides to entitle him to esteem; and it is especially laudable in a practical art, which is handed down to posterity for their benefit; that they may not be deceived in the same way another was deceived before them. A regard to the memory of a professor, in other respects so great a man, led us into this digression.

Now a suture may deceive for this reason, because it is equal in asperity to the other; so that though there be a fissure, one may readily take it for a suture, in a place, where it is likely one lies below. Therefore it is not fit to be thus deceived; but the safest method is to lay bare the bone: for, as I observed before, the place of the sutures is not certain; and the same part may both have this natural junction, and be fissured by a blow, or may have some fissure near it. Nay sometimes, when the blow has been violent, though nothing be found by the probe, yet it is better to open it. And if even then the fissure is not manifest, writing ink must be drawn over the bone, and then scraped off with a chisel, for if there be any fissure it retains the blackness.

Sometimes it even happens, that the blow has been given on one side, and the bone fissured on the other. For that reason, if upon receiving a violent blow, bad symptoms have followed, and no fissure be found in that part, where the skin is lacerated; it is not improper to consider, whether any part on the opposite side be softer, and swelled; and to open that; for there a fissure in the bone will be found. Nor is it very troublesome to heal the skin again, though nothing has been discovered by the incision. A fractured bone, unless help be seasonably administered, brings on violent inflammations, and is treated with more difficulty afterwards.

Rarely, but sometimes it happens, that the whole bone remains sound; but from the blow some internal vein in the membrane of the brain is broke, and discharges blood, which being coagulated there, raises violent pains, and deprives some people of their sight. But there is generally a pain in the part that covers it, and an incision being made in the skin there, the bone is found pale; and therefore this must also be cut out. Upon whatever account this operation is necessary, if the opening of the skin is too small, it must be enlarged, till all the injured part be in view. In this great care must be taken to leave upon the bone no part of that fine membrane that covers the skull below the skin; because when this is lacerated by the chisel, or perforators, it excites violent fevers with inflammations. Therefore it is better to separate it entirely from the bone. If the external wound be made by the blow, we cannot alter the form of it. If we are to make one, the best is that made by two transverse lines in the shape of the letter X, that afterwards the skin may be cut below, beginning at each of the prominent angles.

If blood is discharged in the time of doing this, it must be frequently restrained by a spunge dipped in vinegar, and taken up by lint applied upon it, and the head raised high. This accident is attended with no danger except among the muscles, which secure the temples; but even in that place there is no safer method.

In almost every fissure, or fracture of the bone, the ancient physicians had immediate recourse to instruments to cut it. But it is far the best method, first to try plaisters that are composed for the skull. Some one of these, it is proper to soften with vinegar, and apply alone upon the fissured or fractured bone; then over that, somewhat broader than the wound, a piece of linen spread with the same medicine, and besides that, sordid wool dipped in vinegar; then to bind up the wound, and open it again every day; and dress it in this manner for five days; from the sixth, to foment it also with the vapour of hot water by a spunge, continuing all the former treatment. And if granulations begin to grow, if the febricula is either gone, or abated, if the appetite has returned, and the patient gets sufficient sleep, we must continue the same dressings. Some time after, the plaister must be softened, with the addition of a cerate made of rose oil, to promote the growth of flesh: for, by itself, it has a repellent quality. By this method often the fissures are filled with a kind of callus, which is as it were a cicatrix in a bone. And in large fractures, if the bones do not cohere together in any part, they are united by the same callus; and this is a far better covering to the brain, than the flesh that grows, when the bone is cut out. If, under the first treatment, the fever increases, the sleeps are short and disturbed by dreams, the ulcer is moist and does not fill, small glandular swellings rise in the neck; the pains are violent; and with all these the loathing of food increases; then, and only in that case, recourse must be had to the hand and the chisel.

There are two dangers attending a blow upon the skull; that it be either split, or depressed in the middle. If it is fissured, the lips of it may be compressed; either because one of them rises above the other, or even because they have run together again with force: whence it happens, that a humour descends upon the membrane, and has no vent, and thus irritates it, and brings on violent inflammations.

When the bone is depressed in the middle, it presses upon that same membrane of the brain; and sometimes also some sharp points from the fracture, prick it. In the cure of these cases as little as possible must be taken off the bone. Therefore, if one edge rests upon the other, it is sufficient to cut off the prominence with a plain chisel. After that is removed, if the fissure gapes a little, it is enough for the cure. But if the edges are compressed together, an opening must be made with the perforator, at a finger’s breadth distance on one side, and from that the chisel must be carried in two lines, to the fissure, in the form of the letter Λ: so that the vertex of it may be at the opening, and the base at the fissure.

But if the fissure extends to a great length, it will be proper to repeat the operation from another foramen; and thus nothing that is broke off can be concealed under the bone, and a large opening is procured for whatever is hurtful within. Nor is it necessary to cut out the whole of a fractured bone, though it be depressed; but if it be either entirely broke through, and has separated wholly from the cranium, or if it adhere to the surrounding skull in a small part, it must be divided from the sound bone by the chisel. Then in the depressed bone, near the fissure we have made, holes must be bored; if the injured part be small, two; if larger, three; and the spaces betwixt these must be cut out; and then the chisel must be drove on both sides to the fissure, in such a manner as to make a semicircular cavity, and let the middle part be toward the fracture, and the horns point to the sound bone. Then if any pieces be loose, and can be easily taken away, they must be removed by the forceps, which is made for that purpose, especially those sharp pieces, which irritate the membrane. If this cannot be easily done, the plate, which I called meningo-phylax, must be put below it; and above that whatever is prickly, and stands inward, must be cut off; and whatever is depressed inward must be raised by the same plate. The effect of such treatment is, that the fractured bones, if they adhere together in any part, may be consolidated; and wherever they are broke away, in time they may be separated by medicines without any pain; and at the same time a space may be left sufficiently large between them, to evacuate the sanies; and the brain may have a better protection from the bone than it would have had, if that were cut out.

After these things are done, the membrane must be sprinkled with sharp vinegar; that, if there be a discharge of blood from it, it may be restrained, or if any blood remain coagulated within, it may be discussed; then the same medicine must be applied, softened in the manner above prescribed, to the membrane itself; the other directions, which relate to the linen spread, and the sordid wool, must be observed in the same manner, and the patient must be kept in a warm place, and the wound dressed every day; and in summer even twice.

But if, by reason of an inflammation, the membrane has swelled, warm rose oil must be infused upon it. If it shall swell to such a height as to rise above the bones, it will be restrained by lentils well powdered, or vine leaves powdered, and mixed with either fresh butter, or recent goose fat; and the neck will require to be mollified by liquid cerate made of iris ointment. But if the membrane shall appear not to be clean, equal quantities of the plaister and honey must be mixed; which must be infused upon it; and to keep that on, a piece of lint or two must be clapped on, and that again covered with a linen cloth spread with a plaister. When the membrane is sufficiently clean, cerate must be added in the same manner to the plaister to promote the growth of flesh.

As to abstinence, and the food, and drink, in the first and more advanced stages of the cure, the same rules must be observed which I prescribed in wounds, and with the greater exactness, by how much a hurt in this part is more dangerous. Nay even when it shall be fit to allow such a quantity of food as not barely to sustain the patient, but to nourish him, yet every thing that requires chewing must be avoided; also smoke, and whatever excites sneezing. The membrane being moveable, and of its natural colour, granulations of ruddy flesh, and an easy motion of the lower jaw and neck, afford certain hopes of recovery. The bad signs are, the membrane immoveable, black, livid, or of any other vitiated colour; a delirium, acrid vomiting, a palsy, or convulsion, livid flesh, or rigor of the jaws and neck. The other symptoms that relate to sleep, appetite, fever, and the colour of the pus, are either salutary or mortal, as in other wounds.

When the case succeeds well, the growth of flesh begins from the membrane itself; or if the bone in that part be double, it sprouts from thence too, and fills up the void space between the bones; sometimes it even rises higher than the surface of the skull. If that happens, copper scales must be sprinkled on to keep it down; and medicines applied to bring a cicatrix over it, which is easily obtained in every place, except the part of the forehead, which is a little above the space that lies between the eyebrows (sinus frontalis): for there, an ulceration for the whole life after, can hardly be prevented; this must be covered with a linen cloth spread with a medicine. And the following directions must be always observed in a fractured skull, that till the cicatrix be strong, the sun, wind, frequent bathing, and excess in wine be avoided.

CHAP. V. OF FRACTURES OF THE NOSE.

In the nose, both the bone and the cartilage are liable to be fractured; and that sometimes happens in the fore part, sometimes on one side. If either both, or one of them be fractured in the fore part, the nostrils fall in, and the breath is drawn with difficulty. If the bone is fractured on one side, that part is hollow; if the cartilage, the nostrils are turned to the opposite side.

Any part of the cartilage, that has given way, must be gently raised, either by a probe put under it, or two fingers compressing it on both sides; then lint platted of a due length, sewed up in soft leather, must be put within; or some part of a dry penecillum composed in the same manner; or a large quill dipped in gum or joiner’s glue, and covered with soft leather, which prevent the cartilage from sinking in. But if the fracture be in the fore part, both nostrils are to be equally filled. If on one side, what is put in ought to be thicker in that part where the nose falls in, and smaller on the other; and externally, a soft strap must be carried round, the middle of which is spread with fine flour and soot of frankincense mixed together; and this must be drawn beyond the ears, and the two ends being crossed there and returned, are to be glued to the forehead: for it sticks to the skin like glue, and when it has grown hard, it keeps the nostrils firm. But if what is put within gives pain, which happens chiefly where the interior part of the cartilage is broke through, the nostrils being raised in the same[(14)] manner, must be only held firm by the strap abovementioned; then, after fourteen days, that must be removed; it is to be separated by hot water, with which also the swelled part[(15)] must be fomented every day.

But if the bone be fractured, that must also be reduced into its place by the fingers; and when the fracture is in the fore part, both nostrils must be filled; when on the side, that to which the bone has been forced; cerate also must be applied, and it is to be bound down a little more tightly; because in that part, there not only grows callus enough to make it sound, but even to form an eminence. From the third day, it must be fomented with hot water, and the more so, the nearer it may be expected to approach a sound state. And if there be several small pieces in the fracture, nevertheless each of them that are beat in, must be forced into its place by the fingers: also the strap must be applied externally, as before directed; and over that a cerate, without any other bandage.

But if any fragment be separated all round, and will not be united with the rest, as may be known from the humour, which will be discharged in great quantity from the wound, it must be extracted by a vulsella; and when the inflammation is gone, some one of those medicines that are gently repellent, must be applied. The case is worse, when besides a fracture of the bone, or cartilage, there is also a wound in the skin. This very seldom occurs. When it does happen, they must nevertheless be raised to their place in the same manner; and upon the skin must be laid some one of these plaisters, that are adapted to recent wounds: but no bandage must be applied over it.

CHAP. VI. OF FRACTURES OF THE EARS.

Sometimes the cartilage of the ear is broke. When this happens, an agglutinating medicine must be applied, before a suppuration begins; for that often prevents it, and heals the ear. Both here and in the nose, it should be understood, that the cartilage itself is not re-united, but that the flesh growing round it consolidates the part; and therefore, if, together with the skin the cartilage is broke, the skin is sewed on both sides; but I now speak of the cartilage fractured, when the skin is entire. If pus then is already formed, the skin must be opened on one side, and over against the incision, the cartilage itself must be cut in a lunated form; then a gentle styptic must be used; such as lycium diluted with water, till the bleeding be stopped; after that a plaister that is not greasy, spread upon linen, must be laid on, and soft wool put behind the ear, to fill up the space between that and the head; then it must be fastened by a gentle bandage; and from the third day fomented with warm water, as I directed for the nostrils; and in these kinds of accidents, at first abstinence is necessary, till the inflammation be gone.

CHAP. VII. OF A FRACTURED MAXILLA, TOGETHER WITH SOME GENERAL OBSERVATIONS RELATING TO FRACTURES.

As I am to proceed from these parts to the lower jaw, I think it proper to insert some observations relating to all the bones in general, to prevent a frequent repetition of them. Every bone then is sometimes split longitudinally, like wood, sometimes is fractured transversely, sometimes obliquely; and in this last species the ends are sometimes blunt, sometimes acute, which last is of the worst kind; because they are not easily united, where they do not rest upon something obtuse, then they also wound the flesh, and sometimes a nerve or a muscle: moreover, one fragment sometimes happens to be divided into several. In fractures of the other bones, one end often recedes entirely from the other; but the broken ends of a jaw-bone remain always in contact in some one part.

Therefore, first the bones are to be forced into their place, by two fingers pressing on each side, both within the mouth and upon the chin; then if the fracture of the jaw-bone be transverse, (in which case one tooth generally stands out beyond that next to it) when it is reduced, the two contiguous teeth, or if they are loose, those next to them, must be tied together by a horse-hair. In a different kind of fracture this is needless. All the other steps are the same as in the above-described fractures; for a double linen cloth dipped in wine and oil must be laid upon it, and with that fine flour, and the soot of frankincense; then a roller or soft strap, with a longitudinal opening in the middle, that it may take in the chin both above and below; and lastly, the ends of it must be brought over the head and tied there.

With regard to the bones in general, it may further be remarked once for all, that fasting at first is necessary; then from the third day moist food; when the inflammation is removed a little fuller diet and such as promotes the growth of flesh; wine is hurtful through the whole time. On the third day, they ought to be opened, and fomented with the vapour of hot water by a spunge, and the same dressings, as at first, are to be put on; this to be repeated on the fifth day, and so on, till the inflammation is gone, which ceases, either on the ninth day, or generally on the seventh: when that is removed, the bones must be examined again, that if any fragment is not in its place, it may be reduced, and the bandage must not be taken away, till two thirds of the time have elapsed, in which the several bones unite.

Now, generally between the fourteenth and twenty-first day, the following bones heal: the lower jaw, cheek-bone, clavicle, breast-bone, scapula, ribs, the spine at the hips, the ancle-bone, heel, hand, and foot; between the twentieth and thirtieth, the bones of the leg and fore arm; between the twenty-seventh and fortieth, the arm and thigh bones.

But concerning the lower jaw-bone I must add, that the case requires the long use of a liquid diet. Also far a considerable time pancakes and such like must be continued, and nothing be chewed, till the callus has perfectly restored the strength of the bone: and for some days, at first, the patient must not speak at all.

CHAP. VIII. OF A FRACTURED CLAVICLE.

The clavicle, if it be fractured transversely, sometimes unites very well of itself, and if it be not moved, may do well without a bandage; but sometimes, and especially when it is moved, it slides away; and generally the part next the breast lies over, and behind that next the humerus. The reason of which is, that it does not move by itself; but complies with the motion of the humerus: therefore, this standing still, the humerus is moved upon it. That part of the clavicle, next the breast, very seldom lies on the forepart; insomuch that men of great character in the profession have told us they never met with it; but the authority of Hippocrates is sufficient to put the fact beyond dispute.

However, as these cases are dissimilar, so each requires a treatment somewhat different from the other. When the clavicle flies back towards the scapulæ, the humerus must be pushed backward by the palm of the right hand, and at the same time the clavicle itself be brought forward. When turned to the breast, this must be forced backward, and the humerus brought forward; and if the humerus fall below the other, that part of the bone next the breast must not be depressed, because it is immoveable; but the humerus itself must be raised; but if it rise higher, the part next the breast must be filled with wool, and the arm bound down to the breast. If there be sharp pieces in the fracture, an incision must be made in the skin over it; and any parts of the bone, that wound the flesh, must be cut off; then the blunted bones must be brought together; and if there be a prominence any where, it must be kept down by a linen cloth, three times folded, dipped in wine and oil: if there be several fragments, they are to be covered with a splint, the inside of which is to be smeared with wax, lest the roller should slip on one side. The roller must be bound over the clavicle, when reduced, rather often than tight: and this rule holds in all fractures. In a fracture of the right clavicle, the bandage ought to pass from it to the left arm-pit; if, of the left clavicle, to the right; and again under the arm-pit of the affected bone: this done, if the clavicle be inclined toward the scapula, the fore-arm must be tied to the side; if forward, to the neck; and the patient laid on his back. All the other directions given before must be observed.

Now there are several bones that have very little motion, and are either hard, or cartilaginous, which are liable to be fractured, or pierced, or bruised, or fissured, as the malae, the breast-bone, scapula, ribs, spine of the hips, ancle-bone, heel, hand, and foot. The method of cure is the same in all these. If there is an external wound, that must be dressed with the medicines proper for it. While the wound is healing, a callus also fills up the fissures of the bone, or any vacuity that may be in it. If the skin is entire, and from the pain we infer that the bone is injured, there is nothing else to do but rest; and cerate must be applied, and tied on gently, till the pain is removed by the bone becoming sound.

CHAP. IX. OF FRACTURES OF THE RIBS AND SPINE.

But there are some peculiarities to be observed relating to the ribs; because they are near the viscera, and that part is exposed to great dangers. A rib then is sometimes fissured in such a manner, that not the exterior surface of the bone, but the interior part of it, which is thin, is hurt; sometimes it is broke entirely through. If the whole is not fractured, there rarely follows either a spitting of blood, or a febricula, or any suppuration; and the pain is not great; however the place is slightly pained upon being touched. But this case requires no more than to do what is above directed; and in binding it up to begin at the middle of the roller (a double-headed roller) lest it draw the skin to either side. After the twenty-first day, when the bone ought to be united, we must endeavour, by a more plentiful diet, to render the body as plump as possible, that it may cover the bone the better; which being yet tender is in that part exposed to injuries under a thin skin. And through the whole time of the cure, vociferation must be avoided, and even speaking, hurrying, anger, all violence of motion, smoke, dust, and whatever excites either coughing or sneezing; and it is not even proper to hold in the breath much.

But if a rib be entirely broke through, the case is more troublesome: for both violent inflammations, and a fever and suppuration, and often a danger of death ensue; and a spitting of blood. Therefore, if the strength admits, blood must be taken from the arm of the same side with the rib; if it does not allow this, a clyster must be given, but without any thing acrid; and the patient must fast a considerable time. He must not eat bread before the seventh day, but live upon gruel alone; and upon the part must be applied cerate made of lycium, with an addition of boiled resin; or the malagma of Polyarchus; or cloths squeezed out of wine, rose oil, and common oil; and over these soft sordid wool, and two double-headed rollers, but not tight. What I mentioned before as hurtful, are in this case to be avoided with greater caution; so that even the breath must not be too often fetched. But if a cough be troublesome, a potion must be taken for it, either of germander, or rue, or the herb staechas, or of cummin and pepper. When there are severe pains, it is proper to lay on a cataplasm either of darnel or barley, with an addition of a third part of mellow figs. And this must lie on in the day time; but in the night, either cerate, or a malagma, or cloths; because the cataplasm may drop off. Therefore it must be opened every day, till such time as we may be content with the cerate or malagma. And for ten days the body must be reduced by fasting; from the eleventh we must begin to nourish it; and therefore the bandage about it must be more lax than at first; and generally this method is continued to the fortieth day.

In the course of which, if there be any fear of a suppuration, the malagma will be more effectual to discuss it than cerate. If, notwithstanding, the suppuration take place, and cannot be discussed by the medicines prescribed before, no time must be lost, lest the bone below be affected; but in the part where it shall swell most, a hot iron must be introduced, till it reach the pus, which must be evacuated. If a tumour does not appear any where, we may discover where the pus is principally lodged in this manner. We must rub all the part with Cimolian chalk, and suffer it to dry; and wherever the moisture shall penetrate deepest, there the pus is nearest to the skin; and here the actual cautery is to be used. If there shall be a pretty large abscess, it will require two or three perforations; and lint to be put into them, or some part of a penecillum; which may be tied by a thread at the top, that it may be easily drawn out. What remains to be done is the same as in other burns. When the ulcer shall be clean, the body must be nourished, lest a consumption follow, which would be fatal. Sometimes too, when the bone is more slightly affected, and neglected at first, not pus, but a certain humour like mucus is collected within, and the skin over it grows soft; in which case, we must use the cautery in the same manner.

Fracture of the spine.

There is also something peculiar to be noted in the spine: for if any part has separated from a vertebra, or is any way broken[(16)], the part becomes hollow; prickings are felt there, because these fragments must necessarily be jagged: whence it happens, that the patient now and then leans forward. These are indications of the case; and the same medicines are necessary, which have been mentioned in the first part of this chapter.

CHAP. X. OF FRACTURES OF THE HUMERUS, FORE-ARM, THIGH, LEG, FINGERS, AND TOES.

The cases which occur in the arms and thighs, and their methods of cure, are in a great measure similar. There are also some general things that belong equally to the arms, fore-arms, thighs, legs, fingers, and toes; for a fracture in the middle of these is least dangerous; but the nearer the fracture is, either to the superior or inferior head, so much the worse: for it both creates greater pain, and is more difficult to cure. Of fractures, the most innocent is a simple transverse one; worse, where it is oblique, and where there are fragments; worst of all, when these are sharp. Sometimes the bones in these parts being fractured, continue in their places: but they much more frequently give way, and one part lies over the other. This circumstance ought to be first of all considered; and there are certain marks for knowing it. If they are displaced, they are bent, and cause the sensation of pricking, and are unequal to the touch. But if they meet one another, not directly, but obliquely (which happens, when they are not in their place) that limb is shorter than the other, and the muscles of it swell.

Therefore, if this is found to be the case, it is proper to extend the limb immediately: for the tendons and muscles being in a natural state kept stretched by the bones, are in this case contracted; neither do they return to their place, unless they be extended by force. Again, if that is neglected for some days at first, an inflammation comes on, during which, it is both difficult and dangerous to use violence to the tendons; for there follows a convulsion or gangrene; or at least, which is the mildest of the bad consequences, a suppuration; therefore, if the bones have not been replaced before the inflammation, they must not be reduced till after it is gone. Now one person alone may extend a finger, also any other member, if it be of a child, by taking hold of one part with his right hand, and the other with his left. A stronger limb requires two to pull different ways. If the tendons are very firm, as is the case in robust men, and chiefly in their thighs and legs, the ends of the joints on both sides must be tied with straps, or linen rollers, and pulled contrary ways by several persons; and when this force has stretched the limb a little beyond its natural length, then the bones must be pressed by the hands into their place; and the sign of a bone’s being reduced, is the removal of the pain. The limb being made equal with the other, must be wrapt up in cloths two or three times doubled, dipped in wine and oil; for which purpose linen is best.

Six bandages are generally required. The first to be applied is the shortest; which should be rolled about the fracture[(17)], and ascend spirally like a screw; and it is sufficient for it to go round in this manner thrice. The second is one half longer than this; which, if the bone project in any part, must begin there; if it be every where equal, it may begin any where upon the fracture, and go in an opposite direction to the former, tending downwards, and returning again to the fracture, end in the upper part beyond the former bandage. Over these must be laid cerate, upon a broad piece of linen, to keep them on. And if the bone is prominent in any part, a cloth, three times doubled, moistened in the wine and oil before mentioned, must be laid upon it. These are to be secured by a third and a fourth bandage, in such a manner, that the following move always in a contrary direction to the former, the third alone must end in the lower part, and the other three in the superior; because it is better to make several convolutions, than to bind it tight; for a strict bandage disorders a part, and makes it liable to a gangrene. We ought to bind an articulation as little as possible; but if the fracture of the bone is near the joint, there is a necessity for it.

When the limb is bound up, it must be kept so to the third day, and the bandage should be such, as on the first day not to hurt by its stricture, and yet not to seem lax; on the second it should be a little laxer; the third almost loosened. Therefore, the limb must then be bound up again, and a fifth roller must be added to the former; after which it must be again opened on the fifth day, and then secured by six rollers, in such a manner, that the third and fifth may end below, and the rest above. As often as the limb is opened, it must be fomented with hot water. But if the fracture be near a joint, wine, with the addition of a small proportion of oil, must be dropped upon it for a long time, and all the other directions observed, till the inflammation leave it, or the limb become smaller than ordinary: which, if it does not happen on the seventh day, will certainly be effected by the ninth. Then the bones are handled with great ease.

Therefore, if they are not well joined to each other, they must be set again; and if any fragments rise above the rest, they must be reduced into their places, and then the limb must be rolled up in the same manner, and splints be fitted round it, to keep the bones in their places. And on that side, to which the fracture inclines, a broader and stronger splint must be applied. About a joint all these should turn outward, that they may not hurt it, and be bound no tighter than is necessary to secure the bone: as they grow laxer in time, they must be a little tightened every third day by their straps; and if there be no itching nor pain, continue so, till two-thirds of the time be compleated, in which each of these bones unites; afterwards, it is to be bathed more gently with hot water; for at first it is necessary to dissipate the humours, and afterwards to make them transpire. Therefore it must also be anointed lightly with liquid cerate, and the surface of the skin rubbed; and the fracture be bound up more loosely. It must be opened every third day, and all the applications be repeated, except the hot water; only one of the rollers, as often as it is loosed, must be withdrawn.

Of a fractured humerus.

The foregoing rules are general; the following peculiar to each bone. If the humerus be fractured, the extension must not be made as in another limb; but the patient is placed in a high seat, and the physician in a lower one opposite to him. Then the patient’s fore-arm is to be supported by a bandage passed round it, and fastened behind the neck. This done, a second bandage, with two heads, is to be rolled round the upper part of the humerus, and have its two ends tied into a knot above the head. Lastly, a third bandage of the like kind is to be fastened to the lower part of the humerus, and carried downwards, its two ends being also tied together. Then, from behind the patient’s head, an assistant stretching his own arm through the loop of the second mentioned roller, his right, if the right humerus is to be extended, his left, if the left humerus, takes hold of a stick placed between the patient’s thighs; the physician also sets his right foot, if he be to operate upon the left humerus, his left, if upon the right, on the third of these rollers; and at the same time the assistant raises the one roller, and the physician depresses the other; by which means, the humerus is gently extended. If the fracture be in the middle or lower part of the bone, shorter rollers are required; if in the superior, longer; so that they may be extended from thence over the breast, under the other arm-pit to the shoulders. In binding it up, the fore-arm must be so inclined, and the affected part put into such a position by the bandages, that the suspending of the forearm afterwards, do not turn the humerus any other way, than when it was bound up. And the fore-arm being hung, the humerus is to be also gently tied down to the side; by which means it will be prevented from moving, and therefore the bones continue as they have been set. When we come to the application of splints, these ought to be longest on the external side, shorter on the fore-part, but shortest of all under the arm-pit. And when the humerus is fractured near the cubitus, they must be pretty often removed, lest the tendons there grow rigid, and the fore-arm be rendered useless. Whenever they are removed, the fracture must be held in the hand; and the cubitus fomented with hot water, and rubbed over with soft cerate; and splints must either not be put upon the processes of the cubitus at all, or they must be somewhat shorter than the others.

Of a fracture of the fore-arm.

But if there is a fracture in the fore-arm, it must be first of all considered, whether one bone or both be broken: not that there is any different method of cure to be used; but first that the extension may be the stronger, if both bones be fractured, because the tendons must necessarily be less contracted, when one of the bones is entire, and keeps them upon the stretch; in the next place, that every thing which relates to securing the bones, may be done with the greater accuracy, if one of them does not help the other: for where one is unhurt, it helps more than rollers and splints. The fore-arm ought to be tied up with the thumb turned a little toward the breast; for that is the most natural posture of the fore-arm: and after the bandages are put on, it is best held in a scarf, the full breadth of which is under the fore-arm, with its ends, which are very narrow, fixed over the neck; thus the arm is conveniently suspended from the neck, and ought to hang a little higher than the other elbow.

But if any part of the top of the cubitus be fractured, it is improper to secure it by bandages, because the fore-arm becomes immoveable. And if means only are found[(18)] to remove the pain, it remains as useful as before.

Fractures of the thighs and legs.

It is of equal importance in the leg for one of the bones to continue entire. Both in this and the thigh it is fit after binding it up to put it in a box. This box ought to have holes below, through which any humour that is discharged, may descend; and at the foot a prop, which may both sustain, and not suffer it to slip; and holes in the sides, through which straps being past, some bars[ IC ] may keep the leg and thigh in their position. If it be a fracture of the leg, this ought to reach from the foot to the ham; if of the thigh, as far as the hip; if near the head of the thigh-bone, so as that the hip likewise may be within it. We ought not to be ignorant, however, that a fractured thigh becomes shorter, because it never entirely returns to its former state; and that the person ever after supports himself upon his toes in that foot, which occasions great weakness; however it is much worse, where the misfortune has been encreased by neglect.

Fractures of the fingers.

It is sufficient to bind a finger to one small twig, after the inflammation is gone.

General rules.

The foregoing directions are confined to the cases relating to particular limbs; the following are general: fasting for some days at first; then when the callus is growing, a pretty full diet; long abstinence from wine; plentiful fomentations of hot water, while the inflammation continues; when that has ceased, they must be more sparing; lastly, a pretty long but gentle rubbing of liquid cerate into the more remote parts. Nor must the limb be immediately put upon exercise, but by degrees returned to its former motions.

The case is a good deal worse, when, besides the fracture of the bone, there is also a wound in the flesh; and particularly if that happen in the muscles of the thigh or arm: for the inflammations there are much greater, and they are more liable to gangrenes. And generally, where the bones of the thigh have slipped past each other, it is necessary to cut it off. The arm is also endangered in the same circumstances, but is more easily preserved. And these dangers are still more to be apprehended, if the fracture be near the joints: therefore, such a case must be treated with more care, and the muscle must be cut through transversely over the middle of the wound; and if the hæmorrhage has been but small, the patient must be bled, and extenuated by fasting for ten days. And though the other limbs may be extended slowly, and the bones reduced gently to their place; yet in these it is not quite expedient either to extend the tendons, or handle the bones. And the patient must be allowed to keep them in the position that is easiest to him. To all such wounds must be applied, at first, lint dipped in wine, with an addition of a very little rose oil: the other management is the same as above recommended. They are to be bound up with rollers broader[(19)] than the wound; which must be applied looser, than if there was not a wound there; and as the wound is more liable to corruption and a gangrene, we are by a number of rollers to manage it so, that though they are slack, they may keep the bones firm.

This method may be followed in the thigh or arm, provided the bones have chanced to return to their proper place; but if they be in any different situation, they must only have such a bandage, as will keep on the medicine that is applied. The other directions I gave before must be observed: except that neither splints nor boxes be used, with which the wound cannot heal; but only more and broader rollers are necessary; and both hot oil and wine must be poured upon them now and then; more frequently the latter. At the beginning the patient must fast; the wound must be bathed with hot water; he must avoid the cold; and recourse must be had to medicines for promoting digestion of the wound, and more care must be taken of the wound than the bone: for that reason it must be opened every day and dressed.

In the mean time, should any small fragment of the bone project, if it be blunt, it must be reduced into its place; if sharp, its point, when long, must first be cut off, when short, filed, and in either case smoothed with a chisel; and then it must be returned in again. And if that cannot be done by the hand, a vulsella, such as workmen make use of, must be applied with that part[(20)] which turns inward to the sharp point of the bone, that by its convex part the prominent bone may be thrust into its place. If it be too large, and covered by small membranes, we should allow these to be dissolved by medicines, and when the bone is laid bare, cut it off; which is to be done pretty early, and afterwards, in this method we may let the bone unite and the wound heal; the first in its proper time, and the other as the circumstances admit.

Sometimes too it happens in a large wound, that some fragments as it were mortify, and do not unite with the rest. This may be discovered from the quantity of discharge; which makes it necessary to open the ulcer oftener than it is dressed; and the consequence generally is, that this bone, after some days, of itself falls off; otherwise, though the condition of the wound is miserable enough before, that often encreases it, and makes it more tedious of cure. The bone too is often broken away, when the skin is entire, and immediately an itching and pain come on. Wherefore, if that happens it is proper to open it the sooner, and bathe it in the summer time with cold water; and in the winter with water just warm; and then apply myrtle cerate.

Sometimes, the fracture, by some points like prickles, irritates the flesh: which being discovered by the itching and prickings, the physician must open it, and cut off these points. The other part of the cure is the same in both these cases as in a recent wound. When the ulcer is clean, nourishing food must be taken. If the limb is still too short, and the bones are not in their places, a wedge of the smallest and smoothest kind must be put in between them with its head standing out a little, and the thick part of it must be driven farther in every day, till that limb be equal to the other. Then the wedge must be taken out, and the wound healed up. When a cicatrix is brought on, it must be bathed with a decoction of myrtle, ivy, and other like vervains, cold, and a drying medicine applied upon it; and in this case, there is a greater necessity for rest, till the limb recover its strength.

When the bones happen not to unite, because they have been often opened, and often moved, the method of cure is obvious; for they may unite. If the fracture be of long standing, the limb must be extended, to create a fresh injury; the bones must be separated from one another by the hand, that their surfaces may be roughened by rubbing against each other, and if there be any fat substance, it may be abraded, and the whole of it become as it were recent: great care, however, must be taken not to wound tendons or muscles. Then it must be bathed with a decoction of pomegranate bark in wine; and the same mixed with the white of eggs, must be applied to it; on the third day it must be opened, and bathed with a decoction of the vervains abovementioned: which must be repeated on the fifth day, and splints put round it; the other steps, both before and after, which I directed already, must be taken in the same manner. However, sometimes the bones unite obliquely[(21)]; and thus the limb becomes both shorter and deformed, and if the ends are pretty sharp, continual prickings are felt: for this reason the bones ought to be fractured again, and put in a proper direction. It is done in this manner. The limb is fomented with plenty of hot water, and rubbed over with liquid cerate and extended; in the mean time, the physician handling the bones, the callus being yet tended, separates them by his hands, and forces the part that projects, into its place: and if that is not effectual, on that side, to which the bone inclines, he puts a regula wrapped up in wool; and by thus binding it up brings it to a habit of lodging in its former place.

Sometimes also, though the bones have united as they should do, too large a callus grows upon them; and therefore the part is swelled. When this happens, the limb must be rubbed gently for a long time, with oil, salt and nitre, and bathed with plenty of salt water; a discutient malagma must be applied; and a tight bandage put on; and the patient must eat herbage, and take vomits; by which course, the callus is reduced together with the flesh. Some good is done by an application of mustard and a fig upon another limb, till it corrode a little, and derive the matter to that part. When the tumour is lessened by these means, the person may return to his ordinary course of life.

CHAP. XI. OF LUXATIONS.

Thus far then we have treated of fractures. Now the bones are dislocated in two ways. For sometimes those that are joined together, separate from each other, as when the broad bone of the scapula recedes from the humerus[(22)], and in the fore-arm the radius from the cubitus, and in the leg, the tibia from the fibula, and sometimes in leaping the heel-bone from the ancle; which last, however, seldom happens. Sometimes the articulations are displaced. I shall speak first of the former.

When such an accident happens, the part is immediately hollow, and by pressing upon it with the finger one feels a cavity. After that, a violent inflammation comes on; and particularly in the ancle; for generally it occasions fevers and gangrenes, and either convulsions, or contractions, which draw the head down upon the shoulders. To avoid which, the same method must be followed here, as in injuries of the moveable bones. And whenever it happens, the medicines prescribed before must be laid on these parts to remove the pain and tumour: for bones once separated in this manner never come together again; and though some degree of comeliness be attainable in the part, yet it is of no use[(23)].

But the lower jaw and the vertebræ, and all the joints, though they be secured by strong ligaments, are luxated by the force of a blow, or when the ligaments are either ruptured, or some way weakened; and more easily in children or lads, than in those that are more robust. And they slip out forward and backward, and inward and outward; some of them in all these ways, others in particular ways. And there are some general signs belonging to all, others peculiar to each one: for there is always a tumour in that part, to which the bone is propelled, and a cavity in that from whence it recedes. Now these marks are common to them all; the others peculiar to the several bones will be mentioned, when I speak of each case distinctly.

But though all the articulations may be dislocated, they cannot be all replaced; for the head is never reduced, nor a vertebra in the spine, nor a jaw-bone, which being out on both sides, has raised an inflammation before it could be returned. Again, those that slip out from the fault of the ligaments, when they are forced into their places, give way again. And those that have been dislocated in childhood, and have not been reduced, grow less than the rest: and the flesh of all these that are not in their place, is decayed, and more so in the member nearest to it, than in one beyond it. For instance, if the humerus is not in its place, the arm wastes more than the fore-arm, and that more than the hand. Then according to the situations, and the nature of the accidents, there is left either more or less use of the limb; and the more use remains of it, the less it is wasted.

Now whatever is dislocated should be reduced before an inflammation begin. If that has already seized it, till it cease, it must not be meddled with; after its removal, trial must be made in such limbs as are reducible. A great deal depends upon the habit both of the body and the ligaments: for if the body be slender, or humid, or if the ligaments be weak, the bone is more quickly reduced; but it is both more liable to dislocation, and is less firmly held after it is reduced[(24)]. Bodies of the contrary qualities hold it faster in its place; but when once forced out, admit of its return with difficulty. It is proper to alleviate the inflammation by applying sordid wool squeezed out of vinegar; and if the misfortune be in a strong articulation, to abstain from food for three, and sometimes even five days; to drink warm water till the thirst be gone; to observe these rules more strictly in luxations of those bones, that are held by strong large muscles; and much more so if a fever has ensued; on the fifth day to foment with hot water; and taking away the wool, to apply cerate made of Cyprine oil, with the addition of nitre, till the inflammation be entirely removed. Then it is proper to use friction to the limb; to take food of good juices, wine in moderate quantity; and by this time, to make some use of the limb: because motion, as it is extremely hurtful in pain, so it is very salutary when the pain is removed. These observations are general; I shall now treat of the particular cases.

CHAP. XII. OF A LUXATED MAXILLA.

In a dislocation of the lower jaw it is pushed forward, but sometimes on one side, sometimes on both. If on one side, it inclines together with the chin to the contrary side, the teeth do not answer to each other, but the canine teeth below are opposite to the incisores: if on both sides, the chin leaves its place, and is protruded to the external part; and the lower teeth come farther out than the upper; and the muscles of the temples appear tense. The patient, as soon as possible, must be placed in a seat in such a manner, that an assistant may secure his head behind; or he may be seated near a wall, putting a hard leather cushion between the wall and his head, and let his head be pressed upon the cushion by an assistant, that it may be kept the steadier; then the thumbs of the physician being wrapped up with linen cloths, or rollers, that they may not slip, must be introduced into his mouth; and the fingers must be applied externally. When the maxilla is firmly grasped, if the luxation be on one side, the chin must be shaken, and brought towards the throat; then at the same time his head must be held, and the chin being raised, the maxilla forced into its place, and the mouth shut; and all this must be done almost in the same instant. But if the luxation be on both sides, the same method must be taken; but the jaw-bone must be forced back equally on both sides. When the bone is replaced, if the case was attended with a pain of the eyes and neck, blood must be taken from the arm. And as liquid food at first is proper for all persons, whose bones have been dislocated, so particularly in this circumstance; where even frequent speaking, by the motion of the mouth, hurts the nerves of the temples[(25)].

CHAP. XIII. OF A LUXATION OF THE HEAD.

In the first part of this book, I have already observed, that the head is secured upon the neck by two processes received into two depressions of the upper vertebra. These processes are sometimes dislocated toward the posterior part; the consequence of which is, that the nerves below the occiput are extended, the chin is fixed upon the breast, and the patient can neither drink, nor speak, and sometimes discharges his semen involuntarily. Such patients die very quickly. I judged it necessary to mention this case, not because there is any cure for it; but that it might be known by its symptoms, and if any should lose a friend in this way, they might not think it was for want of a physician.

CHAP. XIV. OF A LUXATION IN THE SPINE.

The same misfortune attends those, whose vertebræ of the spine are luxated. For this cannot happen, unless both the medulla, which passes through the middle, and the two membranes, that go through the two processes on the sides, as also the ligaments, that secure them, be ruptured. They are dislocated both backward, and forward; both above and below the transverse septum. As they slip the one way or the other, there will be either a swelling or a cavity behind. If this happens above the septum, the hands become paralytick, a vomiting or convulsions follow, the breath is oppressed, and a violent pain and deafness ensue. If below the septum, the thighs are paralytick, the urine is suppressed, and sometimes it even flows involuntarily. Though a person does not in such cases die so quickly as where the head is luxated, yet it commonly happens within three days; for what Hippocrates has directed in a vertebra luxated externally, that the patient must be laid prone, and extended, and then a person ought to stand upon him with his heel and force it in, must be understood of those, that are but partially displaced, not of these, that are entirely luxated; for sometimes a weakness of the ligaments causes a vertebra to protuberate forwards, though it be not dislocated: this is not mortal. But it is not possible to force it back from the internal part. If any vertebra be reduced from the external side, it generally returns again, unless, which is very rare, the tone of the nerves be restored[(26)].

CHAP. XV. OF A LUXATION OF THE HUMERUS.

The humerus slips sometimes into the axilla, sometimes forward. If it has fallen into the arm-pit, the cubitus recedes from the body, and cannot be brought upward with the humerus to the ear of the same side; also that arm is longer than the other: if forward, the upper part of the fore-arm is extended, but not to its full length; and the cubitus is moved with more difficulty forward than backward.

Therefore if the humerus has fallen into the arm-pit, and the patient be young, or of a lax habit, so that the ligaments are weak, it is sufficient to place him in a seat; and to order one assistant to draw back gently the head of the broad bone of the scapula, and another to extend the fore-arm; while the physician himself sitting behind, with his knee under the patient’s arm-pit, forces the humerus upwards, and at the same time presses the scapula with one hand, while he pushes the cubit to the side with the other.

But if the patient be of a large stature, or the ligaments more robust, a wooden spatha is necessary of the thickness of two fingers, and so long as to reach from the arm-pit to the fingers. In the top of it, is a small round head a little hollowed; that it may receive some part of the head of the humerus; and in three places at due distances there are two holes made for the admission of soft straps. This spatha being wrapt up in a roller, that it may hurt the less, is applied from the fore-arm to the arm pit, in such a manner, that the head of it is put under the axilla; then it is tied to the arm by its straps, in one place a little below the head of the humerus, another a little above the elbow, and the third above the hand; to which purpose the distances of the holes are then also to be adapted. The arm being thus tied up is put over a step of a ladder, so high, that the patient cannot stand upon the ground; and at the same time his body is suffered to sink on one side, and his arm kept extended on the other; the effect is, that the head of the humerus, being impelled by the head of the spatha, is forced into its place, sometimes with a crack, sometimes without it. It appears from Hippocrates alone, that there are many other methods; but none of them has been more approved by experience than this.

But if the humerus is luxated forward, the patient must be laid on his back, and a roller, or strap put round the middle of the arm-pit, and the ends of it delivered to one assistant behind the patient’s head, and his fore-arm to another; then the first must be ordered to extend the strap, and the other the fore-arm; and the physician must thrust back the patient’s head with his left hand, and with his right raise the cubitus together with the humerus, and force the bone into its place; which in this case is more easily reduced than in the former.

When the humerus is replaced, wool must be put under the arm-pit; that if the bone was in the interior part, it may prevent its returning; if forward, that it may however be more conveniently rolled up. Then the roller being first carried under the arm-pit, ought to surround the head of the bone, and passing over the breast to the other arm-pit, and from that to the scapulæ, and back again to the head of the luxated humerus, it must be carried round in this manner several times, till the head of the humerus be well secured. The humerus being thus bound up is better fixed, if it be drawn close to the side, and tied down to it with a roller.

CHAP. XVI. OF A LUXATION OF THE CUBITUS.

From what has been said in the first part of this book, it may be understood, that three bones meet together at the elbow, the humerus, radius, and cubitus. If the cubitus, which is fixed to the humerus, separates from it, the radius, which is contiguous to it, is sometimes dislocated, and sometimes remains firm. Now the cubitus may be luxated in all the four different ways. If it be displaced forward, the fore-arm is extended, and cannot be bent; if backward, the fore-arm is bent, cannot be extended, and is shorter than the other; sometimes it brings on a fever and bilious vomiting; if externally, or internally, the fore-arm is stretched, but is a little bent to that part, from whence the bone has receded.

Whatever species it be, the method of reduction is the same (and not only in the cubitus, but in all the larger limbs, which are joined in the articulation by a long process) to extend both limbs different ways, till there be a void space between the bones; and then to thrust the luxated bone from that side, into which it has prolapsed, to the contrary. However the methods of extension are various according to the strength of the ligaments, and the position of the luxated bones. And sometimes the hands alone are used, sometimes other means.

Therefore if the cubitus is displaced forward, it is sufficient for it to be extended by two hands, sometimes assisted by two straps; then some round body must be put into the bend of the elbow, and upon that, the cubitus is to be suddenly forced towards the humerus. But in the other cases the best method is so extend the fore-arm in the same manner, as was directed in a fractured humerus, and then to reduce the bones.

The remaining part of the cure is the same as in the other luxations; only this must be sooner, and more frequently opened, also more plentifully fomented with hot water, and rubbed longer with oil, and nitre, and salt. For the cubitus, whether it remain displaced, or be reduced, is more quickly surrounded by a callus than another joint, and if this grows, while the arm is at rest, it afterwards prevents its flexure.

CHAP. XVII. OF A LUXATED HAND.

The hand too may be displaced in all the four directions. If it slips backward, the fingers cannot be extended; if forward, they cannot be bent; if on either side, the hand is turned to the opposite, that is, either toward the thumb, or the little finger, and may be replaced without much difficulty. The hand and fore-arm should be extended on something, that is hard and will not give way, the hand being prone, if the luxation was to the posterior part; and supine, if forward; if internally, or externally, it should be laid on one side. When the ligaments are sufficiently stretched, if the luxation was lateral, it must be repelled to the contrary side by the hands: but where it was forward, or backward, some hard body is to be put upon it, and pressed upon the prominent bone by the hand, which additional force pushes it more easily into its place.

CHAP. XVIII. OF LUXATIONS IN THE PALM.

The bones also in the palm are sometimes dislocated, and that either forward, or backward. For they cannot be luxated laterally by reason of the resistance from the parallel bones on each side. There is only one indication of it, which is common to them all: a tumour in that part, to which the bone comes, and a cavity in the other, from which it recedes. But the bone being well pressed by a finger, returns without extension to its place.

CHAP. XIX. OF LUXATED FINGERS.

In the fingers there are as many different cases, and the same signs, as in the hands. But an equal degree of force is not necessary in their extension; because the several bones are shorter, and the ligaments less strong. They ought only to be extended upon a table, when the luxation is forward or backward; and then compressed with the palm of the hand that thus the finger may be[(27)] restored to the place from whence it slipped.

CHAP. XX. OF A LUXATION OF THE FEMUR.

Having treated of the humerus[(28)], what I said there may seem to suffice for the lower extremities; for there is some similitude in this case between the femur, and humerus, the tibia, and cubitus, the foot and hand. However something must be said in particular about these.

The femur is protruded in all the four ways; most frequently to the internal part, next externally, very rarely forward, or backward. If it be luxated internally, the leg is longer and turned round externally more than the other; for the toes point outward. If to the external part, it is shorter and bowed inward, and the foot turns the same way; the heel in walking does not touch the ground, but the person rests upon the extremity of the sole of the foot; and in this case, the leg sustains the superior part of the body better than in the former, and less needs the help of a staff. If forward, the leg cannot be bent, and being extended is as long at the heel as the other: but the toes are turned less inward; also the pain is most violent in this case; and the urine very liable to be suppressed: when the inflammation together with the pain have ceased, such patients walk pretty well, and their foot is straight. If the luxation be backward, the leg cannot be extended; and is shorter; also in standing, the heel does not reach the ground.

But there is a great danger attending the femur, that it be either difficult to reduce, or slip out again after it is replaced: some affirm it always comes out again; but Hippocrates, and Diocles, and Philotimus, and Nileus, and Heraclides the Tarentine, very celebrated authors, have affirmed, that they have made a perfect cure. Neither would Hippocrates, Andreas, Nileus, Nymphodorus, Protarchus, Heraclides, and a certain artificer too, have contrived so great a variety of machines for extending the femur in this case, if it were to no purpose. But as this is a false opinion, so on the other hand it is true, that the ligaments and muscles there being very strong, if they retain their natural firmness, they will hardly admit of a reduction; if they do not, they do not hold it fast, when reduced.

Therefore trial must be made, and if the limb be but tender, it is sufficient to make an extension by one strap at the groin, and another at the knee; if it be muscular, the extension will be better made by tying these straps to strong sticks; and then putting the lower ends of the sticks against a fulcrum, and pulling the upper ends with both hands. The extension of the limb is still more strong upon a bench, that has axes at both ends, to which these straps are tied; which being turned as in a wine-press, by persevering, they will not only extend, but even break the ligaments and muscles. Now the patient must be laid upon this bench, either prone or supine, or on one side, so that the part, into which the bone has slipped, be always uppermost, and that, from which it has receded, lowermost. When the ligaments are extended, if the bone is luxated forward, some round body must be put upon the groin; and the knee must suddenly be drawn towards the body, in the same manner, and for the same reason, as is done in the arm; and if the femur gives way to the flexion, it is reduced.

But in the other cases, where the bones have receded a little from each other, the physician ought to force back the prominent part; and an assistant to push the hip in a contrary direction. When the bone is reduced, there is nothing different required in the treatment, except confining the patient longer to his bed; lest if the femur be moved, while the ligaments are too lax, it may slip out again. However it may be secured by keeping the middle or upper part of the joint in some canaliculus[(29)].

CHAP. XXI. OF A LUXATION OF THE KNEE.

It is very well known, that the knee slips inward, outward, and backward. Most authors have written, that it is not displaced forward. And that may appear very probable; as in that place the patella is opposed to it, and likewise keeps in the head of the tibia. But Meges has given an instance of a person cured by him, where the luxation was forward.

In these cases the ligaments may be extended by the same means, which I recited in the femur. And where the bone is luxated backward, it is reduced in the same manner, by some round body applied to the ham, and drawing up the leg. In the other cases the hands are only to be used, and then the bones are at the same time forced different ways.

CHAP. XXII. OF A LUXATED ANCLE.

The ancle is luxated in all directions. When it is inward, the sole of the foot is turned outward. When the contrary case to this happens, there is also the contrary symptom. But if it be luxated forward, the broad tendon behind is hard, and tense; and the foot turns downward. If backward, the heel is almost hid, and the sole of the foot is enlarged. This luxation is reduced by the hands; the foot and leg being first extended different ways. And in this case also the patient must be kept longer in bed; lest the ancle, which sustains the whole body, yield beneath its load, and be forced out again before the ligaments have recovered their strength. And at first low shoes must be used, lest the binding hurt the ancle.

CHAP. XXIII. OF LUXATIONS IN THE SOLES OF THE FEET.

The bones in the soles of the feet are luxated in the same manner as those in the hands; and are reduced by the same methods; only it is necessary to put a roller round the heel; lest as the middle part and extremity of the sole require to be bound, the ancle being left free, may receive the redundant matter, and thus come to suppuration.

CHAP. XXIV. OF LUXATED TOES.

In the toes there is nothing else required, than what has been directed before in the fingers.

CHAP. XXV. OF LUXATIONS ATTENDED WITH A WOUND.

These are the methods to be taken, when the bones have been displaced without a wound; but they are often dislocated, and the part wounded at the same time; and here the danger is great, and so much the greater, as the limb is larger, and the ligaments, or muscles that hold it, stronger; and therefore, from the arm and thigh bones there is danger of death: and if the bones are reduced, there is no hope; and yet when they are not replaced, there is also some danger. In both, the event is the more to be feared, the nearer the wound is to the articulation. For Hippocrates has asserted, that no bone could in this case be safely reduced, except the fingers and toes, and the bones of the feet and hands; and that even here great caution must be used, lest it suddenly destroy the patient. Some have reduced both arms and legs; and to prevent gangrenes and convulsions (which in such cases often terminate in speedy death) they let blood from the arm. But not even a finger (where, as the malady, so also the danger is least) ought to be reduced, either while there is an inflammation, or afterwards, when the bones have continued long luxated. And farther, if after the reduction of the bone, convulsions come on, it must be immediately put out again.

Now every member that is at once wounded and dislocated, and continues unreduced, ought to lie in the posture easiest to the patient; provided it neither be moved nor hang down. In every case of this kind the cure is much promoted by long fasting; and then the use of those methods prescribed before. In fractured bones, where there is a wound, if the naked bone project, it will always prevent its healing; therefore, the prominent part must be cut away, and dry lint applied, and medicines not greasy; till the greatest degree of soundness attainable in such a case be restored; for it both leaves a weakness behind it, and the part is covered with a thin cicatrix, which must of necessity be ever after greatly exposed to injuries.

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NOTES TO BOOK I.

[1.] Their gods. Though Æsculapius lived so near to the time of the Trojan war, yet the Greeks knew very little about him. The superstition of those times gave him a place among the gods: and as he was adored under the character of the genius of physick, it came at last to be doubted whether he was ever a mortal. This blind devotion, however, produced one happy consequence: his priests were obliged, for their own interest, to make themselves masters of all the physic that was known in that country, that they might be qualified to give advice to the people, who applied to them. Their prescriptions passed for the suggestions of the god; their cures for miraculous. But both diseases and remedies were carefully recorded.——Strabo tells us, that from these registers in the temple of Æsculapius at Cos, Hippocrates formed his plan for a proper diet.——Strabon. Geograph. lib. 14. p. 657. Edit. Casaub.

[2.] Immortal gods.) That this was really the opinion of the ancients, may be seen by many passages in Homer’s poems, where he mentions Jupiter punishing wicked nations by diseases, as well as famine, wars, and other calamities.

[3.] Principles.) Some of the ancient philosophers maintained, that the human body, as well as the whole material system, was composed of four principles or elements, viz. fire, air, earth, and water.

[4.] Vessels, in the original, vena; which is used by our author as a general term for arteries and veins. In this place it is evident he means arteries; for mentioning the same opinion again, page 16, he says, At si sanguis in arterias transfusus; and he often speaks of the motion of the veins, where, it is plain, he intends the pulsation of the arteries. Arteria he uses to signify the wind-pipe, and likewise the sanguiferous arteries, as in chap. 1. of book 4. Circa guttur venae grandes, quae sphagitides nominantur; item arteriæ, quas carotidas vocant.

[5.] Distribution of the same.) The word in the original is digero, which, by the modern physicians, is generally applied to the digestion of the aliment in the stomach. But that is what our author never intends by it. Digero he uses in three different senses; 1st, for the distribution of the aliment from the stomach (after its concoction) to all the other parts of the body, which appears to be his meaning here: 2dly, for any evacuation made by the pores of the skin, as sudore digerit in the end of the ninth chapter of this book: 3dly, for discussing any collection of humour, so as to prevent its coming to suppuration; vel avertenda concurrens eo materia, vel digerenda, vel ad maturitatem perducenda est: si priora contigerunt, nihil praeterea necessarium est. Lib. vii. c. 2. ad fin. p. 408. Unless we restrain the meaning of this last passage to discussing by the skin, which would bring it under the second sense.

[6.] Asperity.) Ten of the most ancient editions mentioned by Morgagni[ ID ] read contactum; but as that seems to convey no convenient sense, others prefer contractum, which is found in one of the manuscripts, and suppose it to mean asperity, a sense which it is not found to bear elsewhere; and therefore, Constantine boldly enough substitutes confractum, which he thinks agreeable to this interpretation. The same reason may, perhaps, have led him to that alteration, as induced the others to explain contractum by asperity, that it might stand in opposition to smoothness. For my own part, though confractus is not found in any other classic, yet I have given this translation, because I can find no other sense of the place, as it now stands. If I durst offer my own conjecture, ἀπόζυμος γαστὴρI would rather chuse to read anfractum, which, I think, is applicable to the windings of some of the internal parts.

[7.] Lippitudo is used by Celsus, and the more ancient Latins in the same sense as the Greek term Ophthalmia.

[8.] Abdomen.) The word in the original is uterus, which our author generally uses for the cavity of the abdomen.

[9.] Indeed may be opened.) The text in Almeloveen and Linden runs thus, Nam ne uterum quidem ut nihilominus aerem contineat, &c. The particle ne is not in the older copies or the MS. of Morgagni[ IE ], and as it spoils the sense, I have omitted it. The same older copies read qui minus ad rem pertineat, instead of ut nihilominus aerem contineat; but as the first can bear no sense at all in this place, and the other has not the elegance of Celsus, I have taken no notice of either; and as the connection is perfect without any addition, I suspect both to have crept in from the margin.

[10.] Praecordia.) This word frequently occurs in Celsus; and he seems to use it in two senses: 1st, For the cavity of the thorax, as lib. 4. c. 1. At sub corde atque pulmone transversum ex valida membrana est septum, quod è praecordiis uterum diducit. 2dly, For the hypochondria; for which see several passages in the first eight chapters of the second book, where he considers the symptoms of distempers from the external appearance of the præcordia; by which word, in those passages, he translates the Greek term ὑποχονδρίον in Hippocrates; the derivation of which demonstrates it to be below the Cartilago Xiphoides.

[11.] Quantity of flesh.) I shall not trouble the reader with several various and opposite opinions of this case, by different commentators; it will be sufficient to recite the opinion of Morgagni[ IF ] (which appears the only probable one) and the reasons with which he supports it. In his anatomical lectures he explained it as an inverted uterus, which he says resembles nothing more than flesh, and is quickly seized with a gangrene, for the reasons given by Ruysch. Observ. Anat. Chir. 10. and thus[ IG ] Celsus, in the description of a gangrene, mentions siccam et aridam carnem; and Boerhaave says, an inverted uterus is seized with a gangrene in three hours after its inversion, which agrees with intra paueas horas in this place.——The ingenious author, first mentioned, confirms this explanation by a case that occurred to a surgeon, who, struck with the novelty of it, came immediately to ask his opinion: upon his shewing the surgeon Ruysch’s delineation of an inverted uterus, he confessed it to be perfectly similar.——Morgagni advised him to run back and replace it immediately, which he did in an hour after its inversion, and the lady was cured.

[12.] Nervus.) Though it might be doubted, whether the ancients comprehended under this word, what is now properly called a nerve, yet, it is certain they used it for a tendon, or ligament; which so evidently appears in many passages of Celsus, particularly the eighth book, that it is quite superfluous to instance any single example. And this is agreeable to the signification of the Greek word νευ̃ρον, a chord or string; and thus Hippocrates says, “The nerves are dry and void of any cavity, and grow to the bone, and have most of their nourishment from thence; they are nourished also from the flesh, and their colour and strength is in a middle degree between bone and flesh.” Hippocrat. Opera, sect. 4: lib. de loc. in homin. p. 409. ad finem. That I might not seem to determine, what may be thought doubtful, I have generally retained the author’s term nerve, and left the application to the reader’s judgment; but in some places, particularly in the eighth book, where the meaning was very evident, and the word νευ̃ρονnerve would have been harsh to an English reader, I have rendered it tendon, or ligament, as the connection appeared to require.

[13.] Another loose.) The word in the original is fluens, that is a disorder attended with some discharge.

[14.] Our author means here the ἀχμὴ of a disease, after which it increases no more.

[15.] A dinner also.) Mercurialis conjectures that the custom among the Romans of making but one set meal in the day, arose from their spending so much time in cleaning their bodies, and going through the several processes at the baths, that they had hardly time left even for one meal; considering that besides all these operations, they had each his own private business to transact, and their bathing was too sacred to be omitted. Hieron. Mercurial. de Art. Gymnast. lib. i. cap. 11.

[16.] Iatroalipta.) This is a Greek word, and signifies a physician that anoints. There was always one or more of these attending a gymnasium, to whose province belonged every thing that related to unction. To their care was committed the strength and complexion of the body; thus Cicero in an epistle to Lentulus, says, Sed vellem non solum salutis meae, quemadmodum medici, sed etiam ut aliptae, virium et coloris rationem babere voluissent. It is probable, that at their first institution, they were acquainted with the nature and effects of their operations on human bodies; and according to Plato, de Legibus, lib. xi. they were either physicians, or in many things equal to them. But Galen complains, that in his time they were ignorant. For a more particular account, see Mercurial. de Art. Gymnast. lib. i. cap. 12.

[17.] Sometimes the warm bath, &c.) No practice was ever more universally followed, than that of bathing among the ancients. The first design of it was certainly the preservation of health; but, as riches and luxury increased among both Greeks and Romans, the edifices for this purpose grew proportionably more elegant and sumptuous. The construction of baths and their several appurtenances must have been so well known, when in use, that it is not to be wondered we have so imperfect accounts of them transmitted to us. Without entering into any of the disputes about the form or use of several of their parts, I shall subjoin what seems to be generally agreed to by all, and may serve to explain any passages in our author which have relation to them.

In the baths there were five apartments—One, called Tepidarium, was a room close all round, and rendered tepid by dry vapours from a fire. Persons staid here so long as to rarify their humours, that they might not go unprepared into the hotter rooms. The Calidarium, or Laconicum, was in all things similar to the foregoing, only the heat was greater. Some affirm, that in both these apartments there were vessels of water, of the same temperature with their air. Next followed the Solium, where was the hot bath. People sat here, sometimes, without going into the bath, and had water poured over them, as Celsus in several places prescribes. The Baptisterium, or Piscina, was the receptacle for cold water, for bathing and swimming in. There was also an apartment called Frigidarium, concerning which there is a dispute, whether it contained water or not; Mercurialis says, ‘Some have imagined there was water here for those who were fond of swimming; but there is no mention of water in authors.’—He adds, ‘that it was contrived for those that came immediately from the Tepidarium and Calidarium, and wanted to enjoy a cool air.’ Pliny[ IH ] the younger mentions a Frigidarium in a bath at his villa, where there was water for swimming in; but this may have been a new mode, and not known in Celsus’s time. Whether this apartment contained water or not, I shall not determine; but it would appear from authors, that either the air or water here was of a mild temperature, not quite cold, nor yet so warm as the Tepidarium. To[ II ] these several parts were subservient; the Aquarium, in which a large reservoir was built for holding water brought from the aqueducts and elsewhere.—The Vasarium, where the necessary vessels were placed, and where the water was heated; this stood above the Hypocaustum, or stove.

Seneca[ IJ ] has shown us of how great importance the Romans esteemed the baths in the time of the republic, when he observes, ‘What pleasure there would be in going into the baths, which a person knew to be tempered by the hand of Cato in his edileship, or Fabius Maximus, or one of the Cornelii—for, says he, this function the most noble ediles performed, of inspecting those places frequented by the people, and requiring cleanliness and a convenient and salutary temperature; not such as has been lately brought into use, in which the heat is so violent, that one would imagine a slave convicted of some crime were condemned to that punishment.’

These several parts of the baths were variously used, according to the case of the person, and the intention pursued. Where no epithet is added to the bath in the text, it will appear from the connection, generally, that the hot bath is to be understood. For any further particulars relating to the baths, see Mercurial. de Art. Gymnast. lib. i. c. 10.

[18.] Gravedoes.) I have here retained the original word, because we have no one English term which will answer to it. See its symptoms enumerated, lib. iv. c. 4.

[19.] In one that has laboured little.) According to the reading of Almeloveen and Linden, which is, In eo, qui minus laboravit, et bene concoxit, remissior: in eo, qui assuetus est, et minus concoxit, amplior, Celsus gives a precept contrary to what he had directed before, p. 22. l. 2. Qui parum concoxit, quiescere debet. In justice, therefore, to our author, I restore with Morgagni[ IK ] the old reading, In eo, qui minus laboravit, et bene concoxit, amplior: in eo, qui fatigatus est, et minus concoxit, remissior.

[20.] Salt fish, salsamentum.) By this is generally understood fish salted and dried (resembling our dried ling), for in several ancient authors it is ordered to be macerated before boiling; and it is often mentioned as made of fish: but it would appear from Strabo[ IL ], that the same name was also given to flesh cured in like manner; for he mentions a ταρχεία, or salsamentum, made of pork, amongst the Sequani, which was brought to the Roman market.

[21.] Sexes.) Our author here proposes the difference arising from the sexes, as one of the subjects to be treated of, but no notice is taken of it in the subsequent part of the chapter: so that this word must either have been interpolated, or, as Constantine observes, Celsus must have forgot it, (which is not probable,) or his observations upon that article may be lost, by the carelessness of transcribers.

[22.] Frequent yawning.) As this whole paragraph relates to people that are fatigued, it renders the old reading more probable, fatigatio, instead of oscitatio, especially as it follows, that a change of labour relieves from fatigue; unless we reckon yawning as one of the symptoms of lassitude; Morgagni[ IM ] prefers fatigatio: but as the difference is of small importance, I have not departed from Almeloveen.

[23.] Warm water.) It appears a little doubtful, why our author should mention this, as he adds the bath immediately after: unless by balneum he means all the processes at the bath; and by the other, bathing in warm water alone.

[24.] Mulse was made of two parts of wine, and one of honey. Dios. lib. v. cap. 790. But from Celsus, it would appear that the proportions were arbitrary: for he says, Mulse is more nourishing the more honey it contains. Lib. ii. cap. 18.

[25.] Hyssop.) Hippocrates thus prescribes it for a vomit to corpulent men; let about a gill of powdered hyssop be given to drink in a gallon of water, adding a little vinegar and salt, to make it as pleasant as possible; and let this be drunk at first gradually, and afterwards more quickly. Lib. de Salub. Vict. Rat. p. 338. Edit. Gen. 1657.

[26.] Lotus.) There are several species of this mentioned by ancient authors; but the particular kind intended here seems to be the lotus Ægyptius, growing in the water, with a stalk resembling the cyamus. It has a root like a quince, and is eaten both raw and boiled, and in the last way, in quality, it is like the white of an egg. The Egyptians make bread of its head, which resembles poppy.—See Dioscorid. lib. iv. cap. 696. and Plin. Hist. Nat. lib. xiii. cap. 17 and 18.

[27.] The body is rendered humid.) Lommius asserts the copies to be every one corrupted in this place. From the moisteners he strikes out the following,—continuing awake, long and brisk walking, morning exercise without eating after it,—as unworthy of our author. And for the same reason, in the list of dryers, inserts watching and unction, without bathing in cold water. This I thought proper to mention in a note, but did not chuse to take so great liberties with the text against the authority of all the other copies, but leave it to the judgment of the learned reader, though I rather incline to the alteration proposed. Vide Lomm. Comment. de Sanitat. tuend. p. 218 and 219.

[28.] Apples, Poma.) Under this Celsus includes all the apple-kind; and he elsewhere comprehends in this genus, cherries, mulberries, &c. so that he seems to take in all the pulpy fruits, whether they have stones or not. Wherever he intends what we particularly call apples, he makes a distinction, as Quæque propriè poma nominantur, lib. ii. cap. 18.

[29.] Salt wine.) “Wines are prepared with sea water in different ways; for some, immediately after gleaning the grapes, mix sea-water with them; others expose them to the sun, and thus tread them, adding sea-water. Others again, make the grapes into raisins, and macerate them in vessels with sea-water, and thus tread and press them. Wine made in this way is sweet: but there are others prepared of a more austere taste[ IN ].”

Pliny tells us, That the properties of this wine were first accidentally discovered by a servant stealing some wine, and filling up the vessel with sea-water[ IO ].

[30.] Defrutum is sweet must, boiled to one half its quantity, done to imitate honey. Plin. lib. xiv. cap. 9. Columella says to one-third, which Pliny calls sapa. Ibid.

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NOTES TO BOOK II.

[1.] Not but in any weather.) Morgagni observes, that in the original, it should be read, Non quod non omni tempore, omni tempestatum genere; so that the translation should run, Not but in any season, and in any weather. What renders this correction more probable is, that a few lines before, Celsus had said, Quæ tempora anni, quæ tempestatum genera.—These two words, though omitted by Juntas and Cæsar, and after them by Linden and Almeloveen, are nevertheless extant in the MS. and the other editions he perused. Ep. 6. p. 142.

[2.] To be most apprehended in the spring.) The words in the original are, Vere tamen maxime, &c.—As there is no opposition between this observation and any going before, if the reading be right, there must be a chasm in the text.—But I suspect tamen ought to be quam, and have rendered it accordingly.

[3.] Dropsical disorders. Aqua inter cutem.) This is a term used by our author, to signify a slight species of the leucophlegmatia, or the first appearances of a dropsy. See the beginning of the 21st chapter of lib. iii.

[4.] Braces a sound body. Spissat sanum corpus.) Literally, it thickens, or compacts a sound body.—The interpretation here given is confirmed by opposite effects of the south wind, a few lines after, Corpus efficit hebes, humidum, languidum.

[5.] If the temples be strait bound.) This happens, when there is no perspiration from them.

[6.] And pubes be full.) Linden and Almeloveen here have plana—But I chose rather with Constantine to read plena; both because the appearance is then exactly opposed to what follows in the IV. chapter, as a bad symptom in those parts, and because it corresponds better with Hippocrat. aphor. 35. sect. 2.

[7.] At the end of a distemper.) Celsus takes this from Coac. Prænot. 601. which if he had translated literally, he would have said, instead of Sub fine morbi, ad crisim; which shows his great care to avoid the Greek terms of art, and render the knowledge of medicine as easy as possible to his countrymen.

[8.] Betwixt the fourth hour.) The Romans divided the day from sun-rise to sun-set into twelve equal parts, or hours; the measure of which therefore differed in proportion to the length of the day. The sixth hour was our twelve; it is easy to reckon all the rest by their distance from that middle point. When they mention hours as a general measure of time, they mean equinoctial hours, as Plin. lib. xviii. cap. 25.

[9.] Strigments, Strigmenta.) I find the moderns differ about the signification of this word; some taking it for the sordes absterged from the skin at the baths or palestræ, other for abraded fibres from the guts. It is agreed on all hands, that Celsus by this word translates ξύσματα in Hippocrates, and so it is rendered by Foesius.—Though ξύσμα will bear either of these interpretations, yet it seems to favour the first, that not only Erotianus explains it so in his lexicon to Hippocrates; but Celsus himself, in the sixth book, c. 6. orders a composition to be brought to the consistence of strigmentum.

[10.] Many ways.) Instead of pluribus modis, most editions have pluribus morbis. However, either of them will agree with what goes before and follows.

[11.] And if there is not a discharge of blood from the nose, &c.) In Almeloveen and Linden the reading is thus, Ac si inter ipsa initia sanguis è naribus non fluit, circa aures erumpit.—Morgagni[ IP ] here observes, that this does not agree with the prænotion, no. 6. whence this whole context is taken; and also that these words, Sanguis è naribus, are not in the margin, nor in any of his editions; and that Constantine and Ronsseus have in the margin Initia aut viscera, while all of them write in the text Ipsa ulcera, some Non fluit, others Non fuit; which the most ancient editions and the MS. have, and besides viscera.—So that, upon the whole, he would incline to read Ac si inter ipsa viscera non fit, circa aures erumpit, viz. And if it is not formed amongst the viscera, it breaks out about the ears.

[12.] If it grow less.) I have chosen to follow the older reading, which omits the negative particle, because it seems plain, that our author is here speaking not of the body, but the belly, in this and the two preceding articles; the sense determines itself.—If the belly yields to purging medicines or spontaneously discharges soft and figured excrements, and the effect of one or both appears in the diminution of its bulk.

[13.] Is hysteric.) The original is, Quæ locis laborat; which by itself is pretty obscure, but the sense here given appears just, from comparing it with aphorism 35. sect. 5: Γυναικὶ ὑπὸ ὑστερικω̃ν ἐνοχλουμένη, ἢ δυστοκούση, πταρμὸς ἐπιγινόμενος ἀγαθόν.—Mulieri uteri strangulatu vexatæ, aut difficultate partus laboranti, sternutatio succedens bono est.

[14.] Of that kind that breaks outward.) The text in this place in Almeloveen and Linden appears to be corrupt, who read, At ex suppurationibus hæ pessimæ sunt, quæ intus tendunt, sic ut exteriorem quoque cutem decolorent: ex his deinde, quæ in exteriorem partem prorumpit; tum quæ maximæ, quæque planissimæ sunt. I own I could make no sense of it, that I thought tolerable. The plural number is used both in the first and last members of the period; and the nature of the distributor seems to require the same number to be used here. For this reason I have made but two members, and read the latter thus: Ex his deinde quæ in exteriorem partem prorumpunt, quæ maximæ, quæque planissimæ sunt. By which small alteration we have an observation worthy of our author, and consonant to the parallel place in Hippocrat. Coac. Prænot. no. 281. where Foesius quotes this passage as here proposed.

[15.] In the middle of the body.) An ascites.

[16.] Puffed up as it were by fermentation, &c.) Foesius observes in a note upon lib. ii. prædictor. 31. from whence this context is closely copied, that ἀπόζυμος γαστὴρ, fermentatus venter, is an unusual kind of expression, which makes him suspect the reading should be ὑποξήρους, which he thinks is supported by Galen in his Exegesis, who says that ὑποξήρους περὶ γαστέρων signifies ταπεινοτέρας aut προεσταλμένας, that is dried up, extenuated, contracted. Foesius thinks too, that Celsus by mistake has read λιπαράς for ῥυπαρὰς, fat for sordid. But as this is only conjecture, it is much more natural to suppose, that λιπαρὰς was the true reading, and that ῥυπαρὰς had crept in since the time of Celsus.

[17.] Therefore an intermission, &c.) In Almeloveen the reading is thus, Expectanda ergo intermissio est: si non decedit, cum crescere desiit: si neque remissio speratur, tunc quoque, &c.—[ IQ ] Morgagni observed this reading to be suspicious, as it was not probable our author would have mentioned its stop before its remission; and upon examining his editions, he found this reading in them all, Expectanda ergo remissio est. Si non decrescit; sed crescere desiit, tunc quoque, &c. i. e. therefore a remission is to be waited for. If it does not remit, but has ceased to increase, in that case the only, &c.

[18.] Already hurt.) I have here rejected the word quam upon the authority of the marginal reading; because it appears to me to spoil the sense, which without it is very proper.

[19.] Penecillum.) [ IR ] Fabricius ab Aquapendente makes penecillum a tent made of scraped lint. I think he is right as to its form and materials; but it often occurs in Celsus, where it is used as a pledgit, and not introduced into any cavity, as in this place. Notwithstanding, in other places, it exactly corresponds to a tent, as lib. vii. cap. 4. when used to a fistula.—For this reason I have chosen to retain the original word.

[20.] Scales of copper.) These are scales that fly off in hammering red-hot copper. They were washed and rubbed in a mortar, to free them from any adhering sordes, and when cleaned and dried, put by for use. Dioscorid. lib. v. cap. 863.

Celsus added here, called by the Greeks λεπὶς χαλκου̃, which he had literally translated by squama æris.

[21.] Sea spurge, Lactuca marina.) Our author elsewhere says, that this herb by the Greeks is called tithymalus—of which Dioscorides enumerates seven species, all similar in their virtues, amongst which is the παράλιος or maritime kind here mentioned. Dioscorid. lib. iv. cap. 747.

[22.] Hydromel was made of two parts of water to one of honey. Dioscorid. lib. v. cap. 791.

[23.] Ptisan was made by steeping barley in water, till it swelled; then drying it in the sun; afterwards beating it, till the husk came off; then grinding it; the meal was boiled in water, dried in the sun, and then set by. When used, it was boiled up again with water; and this was what they called the cremor or succus ptisanæ.

[24.] A decoction of vervains.) What herbs our author means by vervains, he shows in chapter 33d of this book.

[25.] Concerning friction, &c.) In the text, De frictione et gestatione adeo multa Asclepiades, &c. which, though it be the reading in most copies, must necessarily appear erroneous by considering what follows; and therefore I have taken no notice of these words et gestatione.

[26.] Digestion.) See note at lib. i. p. 6.

[27.] A prop is to be put under one foot, &c.) In Linden and Almeloveen the reading is, At certe uni pedi lecti fulcimentum subjiciendum est.—But all the editions in the possession of Morgagni[ IS ] and the MS. have Funiculus subjiciendus est. A cord is to be put under one foot, &c. And in this way Mercurialis reads it, when he quotes this passage de Art. Gymnast. lib. iii. cap. 12.

[28.] Clibanum was the name of a particular kind of oven among the Romans. As it is here mentioned, beside the laconicum or hot-room at the bath, he probably intends by it a stove placed in a common room so as to heat it.

[29.] Fever.) Our author here means, either an acute continued fever, or the paroxysm of an intermitting one; as will appear by the following paragraph.

[30.] Bottles filled with hot oil, Utriculi.) Their bottles were made of leather. The nearest to this kind of practice among the moderns are the tin cases made in different shapes, and adapted to the abdomen, breast, or joints, filled with hot water.

[31.] Lentils.

[32.] The Cetus.) Cetus is generally translated whale in English; but it cannot be understood of what we call a whale, but is a general name for all the larger fishes that are viviparous.

[33.] Particular kind of bread, Opus pistorium.) The English reader will perceive, by the ingredients mentioned, that there is no such bread in modern use, and consequently no proper name for it. Pliny mentions the same composition. lib. xviii. cap. 11.

[34.] Phœnicopter.) This signifies a bird with purple wings; its tongue was of a delicious taste. Plin. lib. x. cap. 48.

[35.] Snails.) Cochlea, without distinction, is used to signify a snail and periwinkle, which last is only the marine snail. The Romans were at prodigious expence and trouble, to feed their snails to an almost incredible size.

[36.] Conchylia, according to Pliny, in different places, a delicate shell-fish, the greatest plenty of which came from the river Indus, of the same nature and properties with the purple fish.

[37.] Siligo was a kind of wheat, very delicious to the taste, extremely white, growing best in moist ground. Plin. lib. xviii. cap. 8.—The same author says it never grows so ripe as the other kinds; for when it is suffered to stand too long, it drops its grains, Id. ibid. cap. 10. Columella says that all wheat in a watery soil, after the third sowing, turns into siligo. Lib. ii. cap. 9.

[38.] Than the mealy, Fragilia.) Which translation appears to be just, from its opposition to succosa.

[39.] Thrush, Turdus.) The Romans included several birds under this name.

[40.] Salsamenta, which are salted and dried. Vide [note] at chap. 2. book i.

[41.] Lacertus et aurata.) I have chosen rather to retain the Latin appellations of these fish, and several more, than to follow the conjectures of the moderns, where they are not agreed. Aurata is taken for the gilt-head, corvus, a cabot, oculata, eye-fish, resembling a lizard, plani, flat fish, or the turbot kind, lupus some will have the pike, others sturgeon. Mullus, barbett, or mullet.—See Pliny who describes them.

[42.] Four footed animal.) I have here rejected the particle vel, according to the older reading; because our author would never say, A quadruped or any animal that is sucking, &c. since no other sucking animals are used for food but quadrupeds.

[43.] Soft or sorbile.) The first by Dioscorides is called ἀπαλὸν, and the second ῥοφητὸν. Humelbergius in his notes upon Apicius de re Coquinar. takes the first to be eggs boiled soft without their shell, by us called poached eggs.

[44.] Alica is reckoned among the vernal seeds. It is a species of wheat which degenerates after being sown in soils not proper for it, as in Africa, where it has the name of zea. It is ground to meal, and the husks taken from it, and then chalk is added to it, which renders it exceedingly white and soft. The best chalk for this purpose is found between Puteoli and Naples. A common way of counterfeiting it is to take the largest and whitest grains of wheat, and after parboiling these, and drying them in the sun, to sprinkle them, and after drying a second time, to grind them. Plin. lib. xviii. cap. 7. and 11. The same author says, this is an invention of the Romans, and not very old, unknown to the Greeks, otherwise they would not have bestowed so many encomiums upon their ptisan; because it was not mentioned by any of the followers of Asclepiades, he believed it was not used in the time of Pompey the Great. Id. lib. xxii. cap. 25.

[45.] Pulse.) Pulticula is a diminutive of puls, which was a very ancient kind of food, made of meal, water, honey, or with cheese and eggs boiled, which, according to Pliny, the Romans used for many years, before they knew bread.

[46.] Passum.) Columella’s method of making passum (from Mago) is this—Gather the early grapes thoroughly ripe, and throw away what stones are either dry or rotten. Expose them to the sun in the daytime, and cover them at night from the dew. When they are dried, take out the stones—then put them into a cask, and add as much of the best must as to cover them; when the grapes are macerated and filled, on the sixth day take them out and press them, and thus draw off the passum. Columell. lib. xii. cap. 39. This resembles nothing in modern use so much as raisin wine. Other inferior kinds were also prepared, for which see Columella in the same chapter, and Pliny, lib. xiv. cap. 9.

[47.] Starch, amylum, so called from its being prepared without a mill. Though the process among the ancients differed a little from the present, yet the effect of the operation is the same.—See Dioscorid. lib. ii. cap. 311.

[48.] Tragum was made from wheat in the same manner as ptisan from barley. Plin. lib. xviii. cap. 7.

[49.] Wombs of hogs.) This amongst the ancients was accounted a delicate dish; it is now entirely disused. The butchers give that part the name of the bearing bag.

[50.] Garum was a liquor made of the intestines of fish macerated with salt. So that it was a kind of sanies of them in their putrescent state. It was formerly made of the fish, which the Greeks called garos; afterwards it was prepared from a great many more, so that the kinds of it are almost infinite. It bore a higher price than any thing, except unguents. One kind was of the colour of old mulse, and so sweet and thin, that it might be drunk. Plin. lib. xxxi, cap. 7 and 8.

[51.] Bulbusses.) The ancients had several kinds of bulbusses. [ IT ]Dioscorides mentions the bulbus esculentus, which he says is known to every body; it is good for the stomach and belly, of a reddish colour, and brought from Africa. But the bitter and squillaceous kind is fitter for the stomach, and helps concoction. All of them are acrid and heating. Pliny, lib. xix. cap. 5. reckons up many species. Most naturalists agree that they are not known now.

[52.] Pancake, Laganum.) This differed a little from our pancake, as they added to it cheese, pepper, saffron, cinnamon, &c.

[53.] Those called crustumina, &c.) Pliny observes that such fruits as these have taken their names, either from their planters, countries, or the persons whose taste they pleased. All these pears and apples are reckoned among the best kinds by him, lib. xv. cap. 14. and 15. as also by Columella, lib. v. cap. 10.

[54.] Wormwood.) In Linden and Almeloveen the word absinthium is followed by murices, purpuræ, cochleæ, which are omitted in all [ IU ]Morgagni’s editions, except Ruellius and the MS. And as they appear redundant here, the same words occurring a few lines after, I have taken no notice of them.

[55.] Resinated.) This is made in different countries. It was very common in Gaul, where the grapes not thoroughly ripening by reason of the cold, the wines turned sharp, unless mixed with resin. The resin, together with the bark of the tree, was either cut small, or powdered, and mixed with the wine. Some separated the resin from it by straining, others let it stand. Such wines become sweet by age. Vide Plin. Nat. Hist. lib. xiv. cap. 20. Columella, lib. xii. cap. 23. et Dioscorid. lib. v. cap. 817.

[56.] Pecten was a name for shell fish striated like cockles.

[57.] Murex and purpura.) These fishes afforded the purple dye, and their difference was not considerable according to ancient authors, but they are not known now.

[58.] Sweet bread mentioned before, viz. chap. 18.

[59.] Scarus, taken for the scar or char, lolligo calamary, or sleeve-fish, locustus lobster, polypus pourcountrel.

[60.] Pelorides.) This was a sort of shell fish, so called from Pelorus, a promontory in Sicily, supposed by some to be cockles.

[61.] Soft water, &c.) The reading in Linden is Aqua, omnia tenera, tepida, &c. but it is not probable our author would have expressed himself so loosely as to say aqua, without any epithet. By making a small change in the order of the words, we find this properly opposed to aqua dura, said in chap. XXX. to bind the belly; I have therefore read with Constantine, Cæsar, Stephens, and several others, Aqua tenera, omnia tepida, dulcia.

[62.] Torminalia.) These, says Pliny, are the fourth species of the service fruit, and probably called so from being used as a remedy; that is, for the dysentery, as appears by the name. Lib. xv. c. 21.

[63.] Sordid wool, Lana succida, by Dioscorides called εἰρίον οἰσυπηρὸν. The more oily sordes it contained, it was reckoned so much the better and more emollient, upon account of its œsypum, the preparation of which will be mentioned in its proper place. The wool about the neck and inside of the thighs was most esteemed. Dioscorid. lib. ii. cap. 720.

[64.] Cimolian chalk.) This had its name from Cimolus an island in the Cretan sea. There are two kinds of it, one white, and the other inclining to purple. The first by Dale, is thought to resemble tobacco-pipe-clay; and the second fullers earth. Vide Plin. lib. xxxv. cap. 17. et Dioscorid. lib. v. cap. 950.

[65.] Tarras, gypsum, is a-kin to lime; for it is procured by burning a stone, which ought to resemble the alabaster, or marble. The best kind is made from lapis specularis. Plin. lib. xxxvi. cap. 24. Amongst the moderns some take this to be the calx of alabaster, others of Muscovy glass, others of the selenites.

[66.] Oil of quinces.) Oleum vel unguentum melinum, according to Dioscorides, was prepared by infusing and boiling some aromatics in oil, and afterwards macerating quinces in it, and thus letting them stand till the oil had imbibed the strength of the quinces. Others made it with quinces alone. Dioscorid. lib. i. cap. 56.

[67.] Or myrtles.) This is prepared by bruising and pressing the tender leaves of the black myrtle, and mixing their juice with an equal quantity of the oil of unripe olives, then boiling them together, and taking off whatever swims upon the top. Some thicken the oil first with pomegranate bark, cypress, &c. Dioscorid. lib. i. cap. 49.

[68.] Of roses.) This is made by boiling the juncus odoratus with water and oil, and after straining, fresh roses are infused in the oil: they are stirred frequently with the hands rubbed with honey, and squeezed. When they have stood for a night, they are pressed out. A second and third kind of rose oil is prepared, by infusing the same roses in fresh quantities of oil. Dioscorid. lib. i. cap. 54.

[69.] Bitter oil.) This has probably been prepared from the wild olive; for Pliny says, such is thin, and much more bitter than what is made from the olive. Lib. xv. cap. 7.

[70.] Made of far.) Far is a species of wheat.—Columella reckons four kinds of it. Pliny says it is the hardest of all, and firmest against winter. It was called also semen adoreum. It was the first grain the Romans used. Pliny, lib. xvii. cap. 8, et Columella, lib. ii. cap. 6.

[71.] Cyprine oil was made from the tree called cyprus in Egypt, according to Pliny—And in his time some conjectured it to be the same with the ligustrum of Italy. Plin. Nat. Hist. lib. xii. c. 24.

[72.] Oil of iris.) The oil is first inspissated by boiling it with water, and the involucrum of the fruit of the palm tree (called by Dioscorides, spatha). When this is done, an equal quantity of bruised iris is infused with this inspissated and aromatized oil, which stands for two days and two nights, and then is strongly expressed. A more fragrant kind is prepared by inspissating the oil with balsam-wood and calamus. After expression, a fresh quantity of iris may be added, if it be desired stronger. Dioscorid. lib. i. cap. 67.

[73.] Nitre.) So much has been said by modern authors concerning the nitre of the ancients, that it would be impertinent to give a particular account of it here. The greatest plenty was produced in Egypt, in the lands which the Nile had overflowed. Most naturalists believe it to have been a native alkaline salt. Pliny says, it was adulterated in Egypt by lime, but that trick was easily discovered by putting it in water, when the true nitre would dissolve, and the lime not. Plin. lib. xxxi. cap. 10. where a long account of it may be seen.

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NOTES TO BOOK III.

[1.] Those things, &c.) [See] book ii. chap. 2.

[2.] Digested.) See note lib. i. p. 6.

[3.] From the inguen.) Almeloveen would rather read ingluvie, or sanguine, than inguine. But these cannot be reckoned among the external causes. There is no reason to question the authority of the text, if we remember what Hippocrates has said, aph. 55. sect. 4. ‘All fevers proceeding from buboes are bad, except a diary.’

[4.] For these reasons others defer it.) The translation is agreeable to the reading of Linden and Almeloveen. But Morgagni[ IV ] informs us, that all the editions in his possession, and the MS. too, read thus: Ob hæc ad mediam noctem decurro, id est, finito jam gravissimo tempore, eodemque longissime distante, secuturis vero antelucanis horis, quibus onmes fere maxime dormiunt, deinde matutino tempore, quod sua natura levissima est. That is, ‘for these reasons I defer it till midnight, that is, when the most severe time is over, and the return of it is at the greatest distance, this being succeeded by the hours before day-light, when every body generally sleeps most quietly, and these followed by the morning, which is naturally the easiest period of all.’—He adds, beside the impropriety of the prescription, as it now stands in Almeloveen, when Celsus meant quite otherwise; the place is the more worthy of notice, that it shews Celsus, although not for common, yet to have practised medicine.

[5.] Apply his hand to his wrist, ejus carpo manum admovere.) The word carpus appears suspicious, as it no where else occurs in Celsus. On the contrary, in describing this part he says, In manu vero, prima palmæ[ IW ] pars, &c. and Morgagni[ IX ] observes the old reading was corpori, and carpo only Constantine’s explication.

[6.] Intrita.) We have no particular description of this food in any of the ancients, as far as I remember. By comparing their several applications of this word, I take it to be a general term for several species of compositions, the ingredients of which were rubbed small in a mortar, or softer materials macerated in liquids, as bread in wine, mentioned by Pliny, Intrita panis e vino, lib. ix. cap. 8.—By our author’s use of it here, it plainly appears to be something light, soft, and simple, probably very like, if not the same with our panada.

[7.] But if one in such a fever coughs gently, &c.) Siquis autem in hujus modi febre leniter tussit, is neque vehmenti siti conflictari, neque bibere aquam frigidam debet; sed eo modo curandus est, quo in cæteris febribus præcipitur.—All this is omitted in Morgagni’s MS.—Ronsseus suspected it to be interpolated, and it is not to be found in the Pinzian edition, nor the Juntine, nor Florentine.—Ronsseus’s suspicion arose from considering aph. 54. sect. 4.—‘Those that are troubled with dry and gentle coughs in ardent fevers, are not very thirsty.’ Morgagni, Ep. 5. p. 140.—But perhaps this objection might be removed by only reading conflictatur, instead of conflictari.

[8.] To twenty-four hours.) Linden and after him Almeloveen have followed Constantine in rejecting the preposition inter. But the old reading seems preferable, which was this,—Inter horas viginti quatuor et triginta sex: that is, The fit takes up between twenty-four hours and thirty-six.

[9.] Cleanse his belly, vomendo ventrem purgaret.) It is probable by venter here our author means the stomach.

[10.] And apply that, et id ingerere.) I cannot help agreeing with Scaliger, that these words are interpolated. For supposing them to mean the application of the medicine here mentioned, yet that is particularly directed a few lines after. Besides I do not remember any instance of ingero bearing a sense that would answer in this place.

[11.] Greeks call zesis. Et jactationem, fervoremque corporis, quem ζέσιν Græci vocant.)—All Morgagni’s[ IY ] editions and his MS. agree in reading thus, Fætoremque quendam odoris, quem ὄζην Græci vocant. Which word from this single passage of Celsus has a place in Stephens’s Thesaur. Ling. Græc. But as the sense, according to this last reading, is not near so proper, and as Linden, no doubt, had some authority for his reading, I have abode by it.

[12.] Former regimen strictly.) After the words, to which these answer in the original, there follows in Linden and Almeloveen, Et aqua tantummodo calida, si sitis est, uti: ac tum ita nono die balneo frigus prævenire, et. Which must appear manifestly corrupt; for this would be making the paroxysm of a quartan fever return after one day’s interval: so that though the other words were retained, yet nono should be undoubtedly changed into decimo. But I have chosen rather to follow the reading of Pinzi and Junta, which is perfectly consonant with the context. Septimo die balneo frigus prævenire, abstinere, continere se debet; si febris redierit, ducere alvum; ubi ex eo corpus conquieverit, inunctione vehementer perfricari, eodem modo sumere cibum et vinum, biduo proximo se abstinere, frictione servata. Decimo die rursus balneum experiri, &c. This makes the directions which follow nono die, to belong to the seventh; and decimo die for decimo tertio die still preserves the regular succession of the fits. This reading is confirmed by what our author adds in the next paragraph, where he prescribes a new method to be pursued, if the fever should return upon the thirteenth day. ‘Wherefore, if the distemper shall continue upon the thirteenth day, the bath must neither be tried before the fever nor after it, &c.’ For if we allow the reading of Linden, &c. decimo tertio die, in the first paragraph, he orders bathing on this day; and in the next he absolutely forbids it.

[13.] Laser.) This was the juice or gum of a plant like the ferula, by the Latins called laserpitium, by the Greeks silphium. That kind, which was most esteemed, came from Cyrene, where it seems it was worn out in Pliny’s time, for he tells us only one stalk was found in his memory, which was sent to Nero; he adds, that for a long time they had no other imported to them, but what came from Persia, Media, and Armenia, where it grew in abundance, but much inferior to the Cyrenean, and adulterated with gum, sagapenum, or bean-meal.—See Plin. Nat. Hist. lib. xix. cap. 3.—Some of the moderns take this for assa-fœtida; others, among whom is Dr Lister, think it a different thing, and absolutely unknown now. I have therefore chosen to retain the original word.—See the description of it Dioscorid. lib. iii. cap. 500.

[14.] Happened in the beginning.) Cum id initio inciderit; thus Linden and Almeloveen read it; some older editions have vitio, when that has happened by some mismanagement; which agrees with what our author says in the end of the 15th chapter. Perhaps it might be Initio, cum id inciderit, that is, upon its first appearance, &c.

[15.] That cannot be assigned. Certis partibus assignari possunt.) Constantine, and after him Linden and Almeloveen, have thought fit to omit non, which will appear to any, who considers the sense to be manifestly wrong. Our author himself determines it in the beginning of the fourth book, where with reference to this part of his work he says, Hactenus reperiuntur ea genera morborum, quæ in totis corporibus ita sunt, ut iis certæ sedes assignari non possint. See Morgagni, Ep. 1. p. 25.

[16.] There may be the same reason, &c. Nec minus dubitari potest, an alvus ducenda sit.) The connection of this sentence with the context has an obscurity very uncommon in our author. We must observe that he is here maintaining the necessity of taking blood in phrenitic cases against Asclepiades: and after general reasons drawn from the nature of the disease, he adds an argument from the practice of that physician. He prescribed clysters in this distemper, though, as Cælius Aurelianus[ IZ ] observes, that was directly contrary to a principle of his own. Celsus therefore insists, that there is no reason against bleeding, that is not equally strong against clysters, which are however approved by Asclepiades. According to the exact method every where observed by our author, this argument would naturally have followed what he said of friction ordered by Asclepiades: and as it now stands after the conclusion drawn, it seems to be an after-thought. If this explication be thought unnatural, it may be otherwise paraphrased, and connected with the following paragraph thus: The doubt is the same with regard to clysters, as to the letting of blood, and the resolution is also the same. But after either of these, intermitting a day, &c.

[17.] Ointment of saffron.) In preparing this they first inspissated the oil by boiling it with calamus and myrrh, and then infusing saffron in it for five days, and stirring it frequently; and on the sixth the oil was poured off clear. Others added the myrrh in powder, after the oil was poured off the other ingredients.

[18.] Ajax or Orestes.) These cases are best illustrated by the tragedies of Sophocles and Euripides, which our author seems to have had in view. Ajax enraged to see Ulysses preferred to him in the competition for the arms of Achilles, falls into madness. He resolved to revenge this affront upon the whole army. And in the night ran into the fields, where their flocks and herds were grazing, murdered the shepherds and laid about him among the cattle, taking them for men; slew numbers of them, which he imagined to be Agamemnon, Menelaus, and others, that were accessary to his dishonour. Then bound and led prisoners to his tent many more oxen and sheep to be reserved for tortures, and flogged unmercifully a great ram for his adversary Ulysses, before he put him to death. Orestes was affected in the same manner. After the murder of his mother, he fancied himself haunted by the furies, and her amongst them. He is represented as terrified by their frightful looks, sometimes reasoning, sometimes beseeching, and at other times drawing his sword to fight them. In one of these fits, like Ajax, he falls upon the cattle. See Sophocl. Ajax flagell. et Euripid. Orest. et Iphigen. in Taur. Such are the figures presented to the imagination in this species of madness.

[19.] Purged in the inferior parts.) The whole sentence, which runs thus, Ubi ab inferiore parte purgandus aliquis est, ventrem ejus ante solvendum esse: ubi à superiore, comprimendum esse, is taken from aph. 66. sect. 7. And after comparing them together, I conceive our author’s meaning to be, that when the intention is to purge, the belly should first be moistened by diluent liquors taken inwardly, or perhaps a laxative clyster administered to facilitate the operation. On the contrary, when a vomit is intended, the belly should be bound.

[20.] Polenta is made from barley in several ways. The Greeks pour warm water upon the grain, dry it for one night, and the day following, toast it, and then grind it. Others toast it more, and sprinkle it again with a little water, and dry it before they grind it. Others again shaking out the recent barley from the green ears, bruise it, while moist, in a mortar, and wash it in baskets, dry it in the sun, beat it again, and after it is cleansed, grind it. In whatever way it is prepared, they first of all toast three pounds of lintseed, and half a pound of coriander, with an acetabulum of salt, and mix it in the mill, with twenty pounds of barley. Those that have a mind to preserve it for a longer time, put it into earthen vessels with its own flour and bran. In Italy it is ground fine after toasting, without pouring any water upon it, and mixed up with the ingredients abovenamed and millet. Plin. b. xviii. cap. 7.

[21.] Vomit spontaneously. Sponte vomere.) That is, vomit without any emetic medicine being given.

[22.] Bulbous roots.) Aretæus mentions nothing of rubbing these over the whole body; but he recommends the small red kind, crude with pepper, and the powdered lees of vinegar, as the best cataplasm for the feet in this disorder. To which he adds this caution, that they must be frequently removed, for fear of ulcerating the parts. Lib. ii. de Curat. Acut. Morb. cap. 3.

[23.] Inject by way of clyster.) Celsus here shews that he knew it was possible to nourish by clysters, and that it was sometimes practised—Cælius Aurelianus mentions the use of clysters in this disorder, particularly acrid ones, as prescribed by the followers of Serapion, Heraclides, and Herophilus, and also by Asclepiades and Themison. But he does not give the least hint, as if any of these authors directed an injection with a view to nourishment, but only to make a derivation of the humour from the skin to the belly. Cæl. Aurelian. de Acut. Morb. lib. ii. cap. 38.

[24.] Malagmas.) These cannot according to the present division of compositions admit of a literal translation, and therefore the original word is retained. By turning to the fifth book, chap. 17. and 18. will be seen their difference from plaisters, &c. and that they consist of various ingredients, but compounded without any heat.

[25.] Catapotia.) Most of the moderns translate this word pills. But our author does not limit their consistence nor form; for we find him sometimes ordering them to be diluted, sometimes of the consistence of sordes, and sometimes swallowed about the bigness of a bean, and at other times dry powders given in some kind of liquor. See lib. v. cap. 25.—Scribonius Largus defines a catapotium as a medicine, that is swallowed without being diluted, cap. 22. comp. 87. Upon which Rhodius will have them to be much the same with the bolusses now in use.

[26.] Attempt that by diet.) The reading in Almeloveen and Linden is Alvum moliri cibo melius est, &c. But as there was no mention of the belly before, and no proper sense can be assigned to molior, as it there stands, I have followed the old reading, Sed id ipsum moliri cibo melius est, and the rather, as Celsus immediately subjoins proper medicines for that purpose. This reading is approved by Morgagni, Ep. 6. p. 149.

[27.] Nard.) It is generally agreed, that what we now have under the name of nard, is not the ancient kind. Dioscorides says, it resembles the cyperus in its smell, has a small head, is bitter to the taste, and drying to the tongue, retaining its fragrancy for a long time. There were two species of it, one called Indian, and the other Syrian. Dioscorid. lib. i. cap. 6.

[28.] Balsam.) Our author does not distinguish what part of the balsam-tree he intends. The ancients called the juice opobalsam, the wood xylobalsam, and the fruit carpobalsam; which distinction Celsus himself elsewhere uses. Dioscorid. lib. i. cap. 18.

[29.] Panaces, or panax.) Dioscorides mentions three kinds of this, which are still retained by modern botanists. Considering the virtues he ascribes to each, I think it probable our author intends the panax Heracleum, or Hercules’s all heal, from whence the opopanax is produced. Though it is to be observed, that Pliny affirms the opopanax to be obtained from the panax Asdepium. Lib. xxv. cap. 4. P. Ægineta from the Heracleum lib. vii.

[30.] Cardamom.) It neither appears from Celsus nor Dioscorides, that the seed was in use among the ancients. Some affirm it to be the same with the modern greater cardamom. Dioscorides[ JA ] says, the best comes from Comagene, Armenia and Bosphorus. It grows also in Arabia and India. The best is firm, large, compact, and pungent to the smell, acrid and bitterish to the taste; it has a heating quality. By this it would seem they made use of the root.

[31.] Acorum according to Dioscorides has leaves likes the iris, but narrower, and roots not unlike to it, not growing straight, but oblique and creeping on the surface of the earth, whitish, divided by joints, acrid to the taste, and smelling not unpleasant. Lib. i. cap. 2.

[32.] The flower of long and round cyperus.) In the original Juncus quadratus et juncus rotundus. I shall not determine, whether what we now call cyperus longus, et rotundus, are the same as here mentioned. However, they certainly belong to the same class, and the virtues ascribed to the present, agree pretty nearly with those attributed to the ancient by Dioscorid. lib. i. cap. 4. and 16.—See also Dale and Schroder.

[33.] Bound upon the skin.) This seems a very odd way of using squils; the old reading appears much more just. Utiliter etiam scilla cocta delinitur cutis. It does good also to rub boiled squils over the skin. The same variety recurs at the end of the following paragraph, Sicut supra dixi delinitur, instead of Simul super ventrem deligatur.

[34.] Frequent pimples.) That is the smoothness or continuity of the skin is interrupted by pimples and ulcers.

[35.] Takes its rise from the head.) From a catarrh, which the ancients imagined to be a discharge from the brain through the os ethmoides.

[36.] Mild as gruel.) I have here departed from Linden and Almeloveen, who have it thus, Deinde lenis sorbitio, &c. Afterwards mild gruel, because the more ancient reading, Dein lenis, ut sorbitio, besides being more elegant, is confirmed by the following words of our author.

[37.] And especially brains.) I have taken no notice of the words ex prima in the reading of Linden and Almeloveen, which manifestly spoil the sense, otherwise complete without them. [ JB ]Morgagni observes, that all the other editions read, either ex pruna, or ex aprugna; but this last is not probable, because he said, that a boar was of the strongest class of food, lib. ii. but the whole head of a lamb or kid in the middle kind; and the former seems to be superfluous.

[38.] Comitial, so called from the comitia or assemblies of the people being adjourned, when any person was taken with one of these fits.

[39.] Arquatus.) The obscurity of this name gives room to the conjectures of critics. Some tell us it was so called, because the colour in the jaundice resembles the greenness of the rainbow; others because it bends the bodies of those afflicted with it like a bow.

[40.] Suppurations.) Ronsseus think this paragraph wrong placed here, as having no connection with what goes before; and suspects its proper place to be at the end of the twenty second chapter of this same book; because the author there treats of consumptive people, and suppurations of the lungs. Morgagni also believes it to be improperly placed, Ep. 1. p. 32.

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NOTES TO BOOK IV.

[1.] Sometimes like a small tongue, viz. the epiglottis.

[2.] Below the last ribs, &c.) I have here translated, according to an emendation proposed by Morgagni[ JC ], who would read, Qui lumbis sub imis costis inhærent, a parte earum rotundi, ab altera resimi. Where a small alteration renders the description just: whereas in the way it stands in all the editions, Qui lumbis sub imis coxis inhærent, a parte earum resimi, ab altera rotundi, it plainly contradicts truth, as will be very obvious to any person the least conversant in anatomy.

[3.] They are stocked with vessels, and covered with coats.) In Almeloveen, Et venosi sunt, et tunicis super conteguntur. Morgagni[ JD ] informs us, that after the three first words, all his editions agree in inserting Et ventriculos habent, and they have ventricles; and it is not probable our author would take no notice of these; and to the same purpose speaks Hippocrates de Ossium Natur. no. 8.

[4.] Relaxation of the nerves.) Resolutio nervorum he commonly uses for a palsy, yet he cannot intend that here, but a langour or slight relaxation of the solids.

[5.] Cervicalia.) Cervicale was used in a double sense by the Romans, either for a bolster, or a piece of dress resembling the neckcloth.

[6.] And venery, A venere.) It is probable that Almeloveen is wrong in omitting after this a vino, which is in Morgagni’s[ JE ] MS and all his editions especially as a few lines after, our author mentions the condition of allowing wine.

[7.] Nostrils are more open.) In Almeloveen magis pallent. Though the MS and Cæsar and Ruellius read thus, yet it is plain from the text itself that the other editions are right, which have it magis patent; for our author presently adds, in a worse state of the disorder, the contrary symptom: Si nares æque clausæ videntur. Morgagni, Ep, 6. p. 140.

[8.] Aminean wine.) This, says Pliny, has the preference of all other wines, upon account of its strength, and its growing better by age. Plin. Nat. Hist. lib. xiv. cap. 2. And thus Virgil says, Georg. 2. line 97.—Sunt et Amineæ vites, fortissima vina.

[9.] Liquid cerate, says Ægineta, such as is used for fractures, is prepared from two parts of oil and one of wax. Lib. vii. cap. 17.

[10.] Syrian oil.) I suppose our author must here mean what was called from its sweetness elæomeli—which Pliny says is produced spontaneously in the maritime parts of Syria. It flows from the trees, fat, thicker than honey, thinner than resin, of a sweet flavour, and is used by the physicians. Plin. Nat. Hist. lib. xv. cap. 7.—And to the same purpose Dioscorid. lib i. cap. 37.—To this account P. Ægineta adds, that about two cyathi of this taken in a hemina of water discharge crude and bilious humours by stool; but that this draught is apt to stupefy a person, which, however, is not dangerous, but he would require to be excited. P. Æginet. lib. vii. cap. 3.

[11.] Synanche, or Cynanche.) According to Aretæus, the latter of these names was given to the distemper, either because it was common to dogs, or because these animals, even in health, hang out their tongues. Lib. i. de Caus. et Sign. Morb. Acut. cap. 7.

[12.] His belly must be opened. Si non febrit, venter solvendus est.) This I take to be the general direction; if he has no fever, the intestinal discharge must be promoted—Liquenda alvus, by which I understand the accomplishment of this by diet or medicines, and Interdum etiam ducenda, the use of clysters.

[13.] Lycium or puxacantha, box-thorn, a tree of the thorn-kind. The branches, with the leaves, are bruised and macerated for some days in water, then boiled, and after straining it, is boiled again to the consistence of honey. The best lycium is what will burn. It has an astringent quality. They adulterate it by mixing lees of oil, or the inspissated juice of wormwood or ox-gall in the boiling. Dioscorid. lib. i. cap. 133.

[14.] Frankincense, thus.) It is generally allowed, that what the ancients called thus, goes now under the name of olibanum.

[15.] Stomach.) When our author mentions the gullet and stomach together, as in the first chapter of this book, he calls the former stomachus, and the latter ventriculus; but he often comprehends both under the name of stomachus, as in this place, which appears by the disorders mentioned.

[16.] A powder with oil.) This word is pulvis—Our author does not say what powder. He had mentioned rose-oil just before: can he intend the powder of rose-leaves? or any of those powders he prescribes in the cardiac disorder, the last of which is quilibet ex via pulvis, any common dust? Or has the word, denoting the kind, been omitted by the copiers?

[17.] Sulphurated wool.) I suppose he means wool impregnated with the fumes of sulphur.

[18.] Cutiliæ, &c.) The waters of Cutiliæ in the country of the Sabines, Pliny says, are extremely cold, and by a kind of suction excite a sensation in the body like a bite; they are very useful to the stomach, nerves, and the whole body. Lib. xxxi. cap. 2. Our industrious critics and collectors have not been able hitherto to find any such place as Subruinæ or Sumbruinæ, and therefore to cut the knot they cannot loose, propose to read here, as well as in the forecited place of Pliny, Subcutiliæ.

[19.] Rhetic or Allobrogic.) These wines, whose qualities are here described, had their names from the countries where they were produced; the first was the Grisons, and the latter Savoy.

[20.] Signine.) This wine by reason of its great austerity was used as an astringent medicine in fluxes. It had its name from the town of Signia in Latium. Plin. Nat. Hist. lib. xiv. cap. 6.

[21.] Sesanum.) Dioscorides gives no description of this, but says, it is bad for the stomach, and produces a bad smell in the mouth. Lib. ii. cap. 369. Pliny tells us it is brought from India, and the colour of it is white, and it resembles the erysimum or hedge mustard in Greece and Asia. Lib. xviii. cap. 10. The moderns give this name to the oily purging grain.

[22.] Over it.) That is, through the teguments, so as to bring the part affected into view. I have here followed the old reading contra id, which Constantine upon the authority of an ancient MS. changed into ultra id; which I think does not afford so good a sense, though followed by Linden.

[23.] Cytisus is a shrub, all white like the buckthorn, sending out branches of a cubit’s length or more, about which are the leaves, resembling fenugreek; which being rubbed between the fingers smell like rocket. Dioscorid. lib. iv. cap. 695.

[24.] Acorns.) Dioscorides calls this βάλανος μυρεψική. It is the fruit of a tree like the myrica.—It resembles the Pontic nut: upon being squeezed like bitter almonds, it emits a moisture, which is used for ointments instead of oil.—It grows in Ethiopia, Egypt, and Arabia. Lib, iv. cap. 742.

[25.] Ferula answered to narthex among the Greeks, and was a general name for several herbs of the same genus, from whence some of the fetid gums are obtained, as sagapenum, and galbanum.—The ancients made use of the stalks of these herbs, in the same manner as paste-boards are now used for fractures, as will be seen in the eighth book.

[26.] Refreshing to nature.) I have given a sense of the phrase secundum naturam (which is the reading of Linden and Almeloveen) very near to that, in which the philosophers use it, because I can find no other.—Pinzius, Junta, and the Manutii read vel mentha secundum naturam est. As the books vary, and none of them make the meaning quite clear, it might perhaps be plainer, if it be read, vel quod secundum eam naturam est, that is, Or mint, or something of the same nature.

[27.] Regimen for such patients I have already mentioned.) Vid. book i. chap. 7.

[28.] Minium.) Pliny complains that minium, which was used by the painters, was of a poisonous nature, and through ignorance often given in medicine instead of the Indian cinnabar. This last, he says, is believed to be the gore of a dragon crushed by the weight of a dying elephant, with the mixture of the blood of these animals. Minium was found in the silver mines in both the Spains, but hard and sandy; also at Colchos in a certain inaccessible rock, but this was a spurious kind: the best was got near Ephesus.——Minium some of the Greeks call cinnabar, others miltos. Plin. lib. xxix. c. i. & lib. xxxiii. c. 7. Cinnabar, says Dioscorides, some mistake for what is called ammion: for this last is prepared from a certain stone mixed with the silver sand in Spain, and no where else. In the melting pot it changes into a very florid and flame colour: it has a suffocating steam in the mines: the painters make use of it. But cinnabar is brought from Libya, and sold at a great price, in so much that painters can hardly have it for their use: the colour of it is deep, whence some have imagined it to be the blood of a dragon: it has the same virtues as the hæmatites stone. Lib. v. c. 883.—Miltos Sinopica, the best is solid and heavy, of a liver colour, not stony, very thin when melted. It is gathered in Cappadocia in certain caves; it is strained and brought to Sinope, and sold there, whence its name. It possesses a drying quality, and agglutinating, for which reason it is mixed with vulnerary plaisters, and drying and styptick troches. It binds the belly if taken with an egg, and is given in clysters to hepatick patients, Lib. v. c. 885.——Our author elsewhere prescribes minium from Sinope, which makes it probable, that he intended the miltos of Dioscorides. But upon comparing these several descriptions, which it is needless to enlarge upon, the learned reader may determine for himself.

[29.] Tetrapharmacum, or compounded of four medicines. Vid. lib. v. c. 19.

[30.] Myrrhapia.) So called, according to Pliny, from the likeness of their flavour to that of myrrh. Lib. xxv. c. 15.

[31.] If the hardness continue.) Si durities manet. This appears suspicious, as our author had mentioned no hardness before. In this chapter he first describes hysterick fits, then prescribes the proper treatment both during the paroxysms, and after they are over. We have very great reason to believe the whole chapter to be corrupted, for reasons which will be mentioned in a following note. With regard to this particular place, my opinion is, that after Celsus had finished what he had to say concerning hysterick fits, he next proceeded to treat of a hardness of the uterus; and after directing some remedies, in case of their failing, and the hardness continuing, he orders other medicines to be tried.—What renders this conjecture the more probable, is, that Aretæus, amongst the chronick diseases of the uterus, mentions σκληριη, a hardness. “There is,” says he, “another species of cancer, where there is no ulcer, but a hard and resisting tumour. The whole uterus is stretched, violent pains distress, and all the other symptoms are the same as in a cancerous ulcer of this part.” Lib. ii. de caus. et sig. morb. chron. c. 2.

[32.] Restringents must be used.) Si maligna purgatio est, subjicienda sunt coërcentia: thus Linden and Almeloveen.—Morgagni observes, that the MS. copy of Alex. Paduan, after the words subjicienda sunt, not only has a great vacuity to the end of the page, but in the beginning of the next coëuntia, and in the margin opposite to this chasm are written these words, Desunt in vetustissimo exemplari duo folia. Two leaves are wanting in the oldest copy. In this also, where the indexes were prefixed to each book, he found the following in the fourth—Vulva exulcerata est—De vesica—De calculis in vesica—In omni dolore vesicæ. And in the margin of the book, he found, Vulva ulcerata est, written opposite to Si vero vulva exulcerata est. Then should have followed the two other—And the last, namely, In omni dolore vesicæ, was set over against Præter hæc in omni dolore vesicæ, and not vulvae, as Linden and Almeloveen read it.

In the MS. in the library of St Anthony at Venice, he found the preceding chasm much larger, 42 large pages, the same observation in the margin, and the correspondent numbers in the contents of the book.—Morgagn. ep. ii. p. 45.—ep. iii. p. 50. So that it is probable our author had first finished the diseases of the uterus, as being peculiar to women, and then proceeded to those of the urinary bladder, as common to both sexes.

[33.] And especially rue with vinegar, &c.) Almeloveen and Linden read, praecipueque ex aceto; vitare autem oportet rutam, et ne supinus dormiat. This is making Celsus condemn what all physicians almost have approved, and therefore with Constantine and Ronsseus, I read praecipueque ex aceto rutam: vitare etiam oportet ne supinus dormiat: which Morgagni prefers. Ep. i. p. 27.

[34.] At such seasons as it returns.) I have here followed the correction offered by Morgagni his for hi which last would manifestly destroy our author’s meaning, as may appear from the general sense of the whole sentence—Instead of the present translation it would be, by those upon whom it returns.

[35.] Sarcophagus, or flesh-eating.) This is found at Assos, a city of Troas. Dead bodies interred in it are said to be consumed in forty days, bones and every thing, except the teeth. Plin. l. xxxvi. c. 17.

[36.] Asian stone.) Dioscorides says this ought to be of the colour of the pumice, spongy, light, and easily friable. Lib. v. c. 916.

[37.] Acopon, according to the derivation of the word, signifies something that relieves lassitude, which was rubbed upon the joints.—Our author exhibits some forms of them lib. v. cap. 24. where their consistence varies.—P. Ægineta for acopa orders four parts of oil to one of wax, lib. vii. cap. 17.—In later ages the word was used in a more extensive sense, for compositions of the consistence of oil, or as a liniment even when the intention was not to relieve fatigue.

[38.] Most agreeable to his humour.) That is, Celsus supposes a man in good health, who is his own master, to be confined to no laws, lib. i. cap. i. but upon account of a preceding illness he must return to that gradually.

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NOTES TO BOOK V.

[1.] Chalcitis.) Pliny lib. xxxiv. cap. 2. says, this was an ore of copper, and found in Cyprus. Dioscorides describes the best chalcitis as resembling copper, easily friable, having shining veins. Lib. v. cap. 889.

[2.] Gum, when mentioned alone in any of the ancient authors, is understood to be the same with what now bears the name of gum Arabic.

[3.] Calcined lead. Plumbum combustum.) The process of this is mentioned by Dioscorides under the correspondent Greek name—It was prepared by putting very thin laminæ of lead, with sulphur strewed upon each of them, into an earthen pot, and keeping them on the fire, stirred with an iron rod, till the lead was converted into ashes. It was afterwards rubbed in a mortar, and washed by repeated affusions of water, till no dross swam at top. Dioscorid. lib. cap. 870.

[4.] Misy.) This hath the same virtues as the chalcitis, and they only differ in the degree of strength. The best comes from Cyprus, of a gold colour, hard, and when broken, shining and stellated. Dioscorid. lib. v. cap. 891.

[5.] Allum.) There are several kinds of this mentioned by the ancients. Dioscorides says, the scissile, round and liquid, were applied to medicinal purposes, and that the scissile was the best. Lib. v. cap. 897.

[6.] Melinum.) As our author in this place mentions only simples, he cannot intend by this word, oil of quinces; so that it must either be a kind of colour that came from Melos, or else the Melian allum; in which last sense the comma ought to be expunged betwixt alumen, and Melinum.—But it is necessary to observe, that our author mentioning this species of allum in the sixth book, calls it Alumen Melium, which in other editions is Alumen Melinum.

[7.] Iron scales are reckoned to have the same virtue as its rust, but not so efficacious.

[8.] White vine.) Paul Ægineta mentions the Ampelos leuce, or white vine, which he said was also called bryonia. Lib. vii.

[9.] Propolis is a gluey matter, of a fetid smell, found in the honey-combs, which Pliny says serves to keep out the cold.—Dale calls it bee-bread.—Others call it bee-glue.

[10.] Soot of frankincense.) Dioscorides orders it to be made thus,—“With a pair of small tongs light a bit of thus at a lamp, and put it into a new hollow earthen vessel, which is covered with a concave copper one, with an opening in the middle, and carefully anoint it over; on one side or both, put small stones to the height of four fingers, to show if it burns, and that there may be room to put in other bits, before the first be entirely extinguished; and continue this, till you observe a sufficient quantity of soot collected; always wetting the external side of the copper with a sponge dipped in cold water. For thus all the soot will be fixed, when this is not too much heated: otherwise it would fly off again by reason of its lightness, and be mixed with the ashes of the thus.” Lib. i. cap. 85.

[11.] Sandarach.) This is the mineral sandarach, or red arsenic.

[12.] Gnidian berry.) Modern botanists are not agreed, what this berry of the ancients was; some taking it for the mezereon, or spurge olive, others for the spurge flax.

[13.] Omphacium.) Of this there were two kinds, the one the juice of unripe olives, and the other the juice of unripe grapes. Plin. lib. xii. cap. 27.

[14.] Copper-scales.) This must be an interpolation, as in this same chapter, which mentions only the class of cleansers, it occurred before.

[15.] Calcined copper.) The metal was calcined by being put into a pot, stratum super stratum, with sulphur and salt.—Or else the copper was kept for several days in the fire in a pot by itself.—Others again added allum to it, or sulphur alone, which last gave it a sooty colour.—It was washed in a mortar, and the water changed four times a day, till no froth arose in it. Dioscorid. lib. v. cap. 861.

[16.] Apronitre.) The spume or froth of nitre was of a purplish colour, and the lighter the better. It had the same virtues with nitre.—Id. lib. v. cap. 905.

[17.] Chrysocolla.) I have here retained the original word, because naturalists are not agreed, that it was the modern borax. Dioscorides says the Armenian is the best, and in colour it resembles leeks.—What is full of earth and stones is to be rejected. Lib. v. c. 878.

[18.] Cyprus ashes. Cinis Cyprius.) I do not remember that this is mentioned by any other ancient author; but it has probably been the ashes of the tree or plant of this name, or perhaps some particular kind of ashes brought from the island of Cyprus.

[19.] Cadmia.) The best is the Cyprian, called botryitis, solid, moderately heavy, being clustered like a bunch of grapes, of the colour of spodium, and being broken it appears cineritious and eruginous within. There are other kinds of it inferior, known by the names onychitis, zonitis, and ostracitis. For burning cadmia it is hid in live coals, till it grows diaphanous, and runs into bubbles like the scoria of iron; afterwards it is extinguished in Aminæan wine. Some burn it thus three times, till it be perfectly converted into ashes; and then they use it instead of spodium. It is washed in a mortar, and the water changed, till no dross appears on the top. Dioscorid. lib. v. cap. 858.—I have here mentioned particularly the burning and washing of cadmia, because it may serve to shew the nature of this process in other minerals, when our author prescribes such; and Dioscorides in mentioning them often refers to cadmia as the general example.

[20.] Hypocistis grows near the roots of cistus. The juice of it is inspissated like the acacia; and it has the same qualities. Dioscorid. lib. i. cap. 128.

[21.] Diphryges.) This is not known in medicine at present. Dioscorides says ‘there are three species of it. One of the metallic kind found only in Cyprus, which is first dried in the sun, and then burnt by laying sticks all round it. Whence its name from being twice torrified. A second kind is found at the bottom of the copper furnaces after smelting. The third is the pyrites stone calcined for several days in a furnace, till it have the colour of cinnabar. The taste of diphryges is eruginous, astringent, and vehemently drying upon the tongue.’ Lib. v. cap. 894.

[22.] Salamander.) Our author here intends the animal so called, and Dioscorides ascribes to it this virtue. It was burnt and the ashes made use of. Lib. ii. cap. 255.

[23.] Flower of copper.) Flos æris is obtained, when the melted copper runs from the furnace, by pouring cold water upon it to refrigerate it. For by the sudden check, this substance is as it were spued out, and concretes into flowers. Id. lib. v. cap. 862.

[24.] Spodium was scraped off the walls of furnaces mixed with sparks, and sometimes coals; that, which was generated in the gold furnaces, was reckoned best for the eyes. Plin. lib. xxxiv. cap. 13.

[25.] Phrygian.) This was made use of by the dyers in Phrygia, whence its name. The best is pale-coloured and moderately ponderous, not firm in its concretions, and having white veins. Diosc. lib. v. cap. 915.

[26.] Scissile.) This is produced in the western Iberia. The best is of a saffron colour; easily broken and split; in its contexture it resembles the sal ammoniac. Dioscorid. lib. v. cap. 919.

[27.] Vinegar is superfluous, because mentioned before in the same chapter.

[28.] Burned paper.) It must be observed the paper of the ancients was made from the papyrus or paper-reed.

[29.] Sansucus.) Dioscorides says this is the same with the amaracus, or sweet marjoram, which is the name given to sansucus by the Sicilians and people of Cyzicum. Lib. iii. cap. 452.

[30.] Asteriace.) I do not find that this word occurs any where else.

[31.] Eretrian earth is very white, or of an ash-colour: this last, and the soft is best. Dioscorid. lib. v. cap. 945.

[32.] Poppy-tears.) Dioscorides after describing the papaver sativum and its virtues, says, ‘It is not improper to subjoin the method in which the opos or juice of it is collected. Some then cutting the poppy heads with the leaves, squeeze them through a press, and rubbing them in a mortar, form them into troches. This is called meconium, and is weaker than the opos. But whoever desires to gather the juice, must proceed thus. After the heads are moistened with dew, let him cut round the asterisk with a knife, but not penetrate through them, and from the sides, cut straight lines in the surface, and draw off the tear that flows, with his finger, into a shell; and come again not long after, for it will be found standing upon it; and the day following, it will be found in the same manner. It is proper to rub it in a mortar, and forming it up, to set it by.’ Dioscorid. lib. iv. cap. 647.—Pliny says, that the meconium is prepared from a decoction of the heads and leaves; but is much weaker than opion. Lib. xx. cap. 18.

From this account it seems plain, that our author means the genuine tear, or the opos of Dioscorides.

[33.] Antimony. Stimmi, and in other places of our author stibium.) Dioscorides’s description of this shews it to be the modern antimony, lib. v. cap. 873.

[34.] Dross of lead.) This is glassy, and has the same virtues as calcined lead. If is washed in a mortar like other minerals. Dioscorid. lib. v. cap. 878.

[35.] Matter. Materia.) This is not meant here of pus, as will appear by what the author immediately adds; but any humour, that is the proximate cause of a disease.

[36.] Struthium.) This was an herb used by dyers. Dioscorides says it was well known. The wool-washers make use of it for cleansing wool: the root of it is pungent and diuretic, and relieves in disorders of the liver, &c. Lib. ii. cap. 381.—This herb is not known now, at least by the same name. Some take it for the luteola, others for the imperatoria, others for red valerian, others for saponaria.

[37.] Nard ointment.) For making this, oil is inspissated with cyperus, and for the fragrancy is added costus, amomum, nard, myrrh, balsam. Dioscorid. lib. i. cap. 76.

[38.] Cachrys is the fruit of the libanotis fructifera, which is by some called zea or campsanema, and has leaves like fennel, but thicker and broader, roundish, and creeping on the ground; the stalk, about a cubit or more in length; the fruit has a heating quality, very drying, whence it is good mixed with ointments against rheums of the eyes. Dioscorid. lib. iii. cap. 492. et 93.

[39.] Viscum, bird-lime.

[40.] Ammoniacum thymiama.) According to Constantine, this is nothing else than gum ammoniac. I forbear to mention the conjectures of others, that seem to be not well founded. Paulus Ægineta says, it is an opos, or juice, endued with such an emollient virtue as to discuss schirri and tophi. Lib. vii.

[41.] Crocomagma.) This was the refuse left after the expression of the oil in making the crocine ointment; which, besides retaining some of the virtues of saffron, would also be in some measure impregnated, with the aromatics used in the composition of that ointment. Vide Plin. lib. xxi. cap. 20. et Dioscorid. lib. i. cap. 26.

[42.] Thapsia.) According to Dioscorides’s description and account of its virtues, it seems to be the modern thapsia, or turpethum garganicum, deadly carrot. Vide Dioscorid. lib. iv. cap. 739.

[43.] Washed lead was thus prepared.—Put water into a leaden mortar, and rub it with a lead pestle, till the water becomes black and feculent; then strain it through a linen cloth, pouring water upon it, that all that is dissolved may be strained; and repeat this till you have a sufficient quantity. Then suffer it to settle, pouring water upon it several times, till no more blackness stand upon the top; then work it up into a troches and set it by. Dioscorid. lib. v. cap. 869.

[44.] Cedria is what distils from the cedar-tree; the best is thick, pellucid, and of a strong smell, and not diffusing itself when poured out. Dioscorid. lib. i. cap. 106.

[45.] Laurel oil.) This was made in different ways. One method was boiling the berries in water when they fall off the tree, which causes them to emit their oil, which is separated by the hands into shells. Others impregnate the oil of unripe olives with cyperus, calamus, and afterwards putting in the tender leaves of the laurel, boil them together. Others add to these bay-berries, till the oil smell sufficiently of them. Others mix with it storax and myrrh. Dioscorides, lib. i. cap. 50.

[46.] Rasile verdigrease is made by suspending a copper vessel, or plate, over the steam of vinegar for ten days; then the verdigrease produced is scraped off. Or else by putting one or more lumps or plates of copper into husks of grapes grown sour. Dioscorid. lib. v. cap. 865.

[47.] Oesypum is the oily part collected from sordid wool thus: the wool was washed in warm water, and all its sordes expressed, the fat swimmed a-top, with a froth, and upon throwing in some sea water, it subsided to the bottom, and when all the œsypum was obtained from it in this manner, it was purified by repeated affusions of water. When pure it has no sharp taste, but is in some degree astringent, and appears white. It has a heating quality, fills up ulcers, and is emollient. Dioscorid. lib. ii. cap. 272.

[48.] Boiled copperas.) Dioscorides mentions a species prepared in Spain that had the name of χάλκανθον ἑφθὸν—atramentum sutorium coctum. Lib. v. cap. 888.

[49.] Cicine.) A proper quantity of κροτωνὼν, of the Ricinus, is dried in the sun, till their exterior coat break and fall off. Then the pulp is collected, put into a mortar, and pounded well, and afterwards removed into a tinned kettle containing water, and boiled over a fire. When all the juice is obtained from them, remove the vessel from the fire, and take up the oil that swims a-top, and set it by. In Egypt, where great use is made of this oil, they obtain it by first grinding the seed, and then pressing it. Dioscorid. lib. i. cap. 38.

[50.] Burnt ceruss.) Put powdered ceruss into a deep vessel; set it on the fire, stirring it with a ferula, till it has the colour of sandaracha, (red arsenick). Dioscorides also mentions a toasted or roasted ceruss, but the process is of the same nature, and only stopped, when the ceruss acquires a lemon colour. Dioscorid. lib. v. c. 877.

[51.] Polybus.) I have chosen to read this name with the older editions, because our author afterwards mentions the sphragis of Polybus, which can have no other place to refer to but this.

[52.] Cauneæ.) Mentioned by Cicero, De Divinatione, lib. 2.

[53.] Susine ointment.) For making this, oil was first boiled with wine, calamus, and myrrh, and after being strained, cardamom was infused in it, til it gave a proper flavour, After this, to three and an half pound of this oil were added the leaves of a thousand lilies, and the whole was stirred with hands anointed with honey. After standing a day and a night, the lilies were squeezed out. Dioscorid. lib. i. c. 63.

[54.] If a woman does not conceive.) Si non comprehendit. This sentence has, in some copies, been joined with the former, si concidere vitio locorum, &c. as if comprehendit related to the consistence of the pessus obtained by the honey. There are several other explanations offered, but none of them with any appearance of truth. I thought it capable of no other sense than what I have given in the translation; and was pleased to find this supported by the opinion of Morgagni, Ep. i. p. 18.

[55.] Sprinkled on dry.) The words as they stand in the text, seem capable of no proper sense. Misy quoque et galla, si paribus portionibus misceantur, corpus consumunt: eaque vel arida inspergere licet, vel excepta cadmia, illinere. I have therefore taken the liberty to transpose cadmia, and place it after galla for the cadmia is as dry as the other two, and therefore could not serve to bring them to any consistence; but still there seems to be a word wanting after excepta, to denote the substance for uniting them.

[56.] Marmor coctum.) I suppose this to be burnt marble; for Dioscorides mentions a lapis alabastrites, which was burnt, and mixed with resin or pitch, and thus used to discuss hardnesses. Lib. v. c. 927.

[57.] Ignis sacer.) Some, among whom is Heister[ JF ], believes, that Celsus calls an erysipelas ignis sacer, whereas he has erysipelas under its own name, cap. 26. of this book.—Fabricius[ JG ] ab Aquapendente, and Wiseman[ JH ], by his ignis sacer understand the miliary herpes. See our author’s description of it, cap. 28.

[58.] Malabathrum.) It is a question, whether the modern malabathrum, or Indian leaf, is the same with the ancient. Dioscorides says, some will have it to be the leaf of Indian nard being deceived by the similarity of its smell. But that is not true; for it is a vegetable of a peculiar nature, growing in the fens of India, without any root, the leaves swimming on the surface of the water. Lib. i. cap. 11.

[59.] Black cassia is the second species mentioned by Dioscorides, who says it is preferable to the first, and fittest for medicinal use; the natives of Arabia call it zigir; it is thick, and smells like roses. Lib. i. cap. 12.

[60.] Myrrh called stacte was the oily part expressed from particular kinds of myrrh, and was very fragrant. Dioscorid. lib. i. c. 78.

[61.] Pontic root.) Dale, with Alpinus, believes the rhapontic of the ancients to be the same with the true rhapontic of the moderns.

[62.] See note at chap. 24. book iv.

[63.] Sil.) Rhodius, together with Constantine and Ronsseus, are for reading seselis instead of silis, for sil is a species of ochre; and they take it for the seseli Creticum, or tordylium, hartwort of Candy.

[63a.] Between the fingers. Vel inter digitos.) Morgagni observes, that, instead of these words, his MS. and all his editions read In articulis which the reader, he says, cannot wonder at, if he considers what follows concerning the difficulty of curing wounds in the joints, p. 297. of the original. Ep. 6. p. 144.

[64.] Fibulæ.) The word fibula, in other classical authors is translated by a buckle; which from its connection in such places appears very proper. But upon comparing the several passages in our author, where the use of them is directed, it seems very difficult to give any account of them. The variety of opinions may very well be reduced to two, those of Guido de Cauliaco and Fallopius. The first believed them to be hooks, whose size was adapted to that of the wounded member, curved at both ends in the form of the letter S, that they might be fixed to both lips of the wound. According to Fallopius the fibula was nothing else but the interrupted suture now commonly used in wounds.

Fabricius was at first of opinion, that the fibula was not made of thread, but copper or iron, not hard, as Guido would have it, but softer and flexible, that it might be fixed through the lips of the wound and then twisted. But after mature consideration, he says he found Fallopius’s opinion to be most agreeable to truth.

Rhodius in his treatise de Acia, where his design is only to clear up the fibula and acia of Celsus, has been at immense pains to collect every thing extant in any of the ancients about their fibulæ; but as there is nothing which occurs in any of the old physicians more particular than in our author, it is not to be wondered, that every thing in his treatise of real importance to the scope of his enquiry, is contained in Fabric. ab Aquapendente, lib. ii. de Vulnerib. cap. 5. et de Chirurgic. Operation. cap. 108.

The principal places, in which our author mentions fibulæ, are lib. v. cap. 26. p. 292. in the original, p. 293.—Lib. 7. cap. 4. p. 412.—Cap. 19. p. 462. et 464.—Cap. 22. p. 469.—Cap. 25. p. 473.

The difficulty seems to rest here, that our author should use the term fibula, which in other classical authors is always taken for a buckle, or something of that kind made of metal, without distinguishing it from the ordinary fibula, as one should imagine he would have done, had he intended thread. Could it be a metal wire with a loop at one end, and the other first put through the wound, then passed into the loop, and twisted; which it would be easier to cut than pull out? This seems to obviate the strongest objection against its being of metal, drawn from the verb incido, which some moderns would have only applicable to thread.

Rhodius de Acia, cap. 6. will have the fibula used to the prepuce of boys (mentioned by our author lib. vii. cap. 25.) to be of metal; and according to Joann. Britannicus a small ring either of silver, gold, or copper.

I have only to add, that instead of paulatim according to Linden and Almeloveen, I have read paulum with Pinzi, Junta, Aldus, and others.

[65.] Soft thread, acia molli.) Acia occurs no where else but in this single place of Celsus; the translation is agreeable to the sentiments of Rhodius de Acia, cap. 14. and I think it capable of no other sense. It may not be improper however to observe, that in some copies, though they are not of the best authority, acu is read instead of acia, but with no apparent meaning.

[66.] After applying.) I read with Constantine imposito for impositum, which last has no place in the construction with a proper sense.

[67.] And the flesh within is corrupted.) Malique odoris est, et caro intus corrupta. All the editions of Morgagni[ JI ] have carunculæ corruptae, and the MS, carunculaeque corruptae, which Morgagni likes better; because it would have been to no purpose to have repeated caro ejus corrupta, which had occurred only a few lines before; whereas with the other reading, we expunge the colon, and make carunculae relate to the verb resolvuntur.

[68.] The skin a little farther off.) I have here followed the reading of the older editions, ulterior instead of deterior in Linden, which agrees much better with the sense of the whole passage. Vide Morg. ep. 6. p. 149.

[69.] The skin is entire, but the flesh within.) Linden omits integra cute, which is in the older editions, and Morgagni’s MS[ JJ ].—As the sense seems to require it, I have taken it into the translation.

[70.] Almost all bites.) I read here, omnis fere morsus, with Nicolaus Junta and the Manutii, and not feræ, as Linden and Almeloveen have it. For Celsus himself makes no distinction between venenatos et non venenatos morsus.

[71.] Psylli.) Pliny, from the authority of Agatharchides, says, there was a nation called Psylli, in whose bodies there was some humour destructive to serpents, by the odour of which they stupified them. They had a custom among them of exposing their children to the fiercest of these creatures, that they might try the chastity of their wives, the serpents not flying from those, that were not of their blood. Plin. lib. vii. c. 2. This account of Pliny’s has no better foundation than other vulgar errors: but we may observe, our author was too curious an enquirer into nature to give credit to such fables.

[72.] Especially in Gaul.) The Gauls tinged their arrows in hunting with hellebore, and cutting out the wound they made all round, they pretended it made the flesh more tender. Plin. lib. xxv. c. 5.

[73.] Cerastes, from κερας, a horn, is a serpent of one or two cubits in length, of a sandy colour in the body, and near the tail void of scales; upon its head something rises like horns, and the parts about the belly are covered with scales, orderly disposed, which as it creeps along makes a rustling noise like hissing. Æt. Tetrab. 4. Serm. 1. cap. 28.

[74.] Dipsas, a serpent called by that name, from the immoderate thirst, which is caused by its bite. It is found in maritime places, is about a cubit in length, thick, and becoming gradually smaller towards the tail. Id. cap. 22.

[75.] Hæmorrhois.) Paulus Ægineta tells us, persons bit by an hæmorrhois are tormented with pains, their bodies become short and small, there is a violent hæmorrhage from the wound, and if there is a cicatrix in any part of the body, it bursts and bleeds: the stools are bloody, the blood discharged is grumous, blood is brought up from the lungs by coughing; and being seized with a vomiting of blood they die immediately. He adds, that remedies must be applied before the symptoms appear; for after they come on, all means are vain.

[76.] Chersydrus.) The name of this imports it to be an amphibious animal, from χέρσος terra, and ὕδωρ aqua.

[77.] The Phalangium is unknown to Italy, and is of several kinds; one like an ant, but much larger, with a red head, the rest of its body black and variegated with white spots. The bite of this is worse than that of a wasp. The Greeks gave this name also to two species of spiders, the lupus, and another downy with a large head. Plin. Nat. Hist. lib. xxix. cap. 4.

[78.] Pastinaca fish was of the plani kind, and had a cartilage instead of a spine. The aculeus, or κεντρὸν of this fish is a remedy for the tooth-ach, as Dioscorides informs us, and Celsus himself mentions, lib. vi. cap 9. Dale calls it the poison fish, fire, or fierce flaw. The liver is said to be good against itching; in oil it removes lichens and lepras.—This cleansing quality attributed to it, makes it probable our author intends it here, for no such virtue is attributed to the water, or sea-parsnip.

[79.] Now this is a very bad kind.) One of the great sources of corruption is a false punctuation; and as I could make no sense of this sentence as it now stands, I have translated it agreeably to the following; Namque pessimum id genus est. Fereque primum id fit, quod cacoethes à Græcis nominatur. As it stood before, the cacoethes was called the worst kind, which our author contradicts immediately, by saying that no other species but that can be cured. Some of the older editions read ob quæ for namque, that is, ‘Upon these accounts this is a very bad kind.’ Which appears to agree better with the context.

[80.] None of these can be removed but the cacoethes.) Here again the sense of the author is manifestly corrupted by the punctuation in Linden and Almeloveen; but Morgagni[ JK ] has set it to right in this manner:—Tolli nihil nisi cacoethes potest: reliqua curationibus irritantur; et quo major vis adhibita est, eo magis. Quidam usi sunt, &c. The translation is conformable to this. Which reading is almost the same with Constantine’s.

[81.] Of a good juice.) See book ii. chap. 20.

[82.] Probe.) One kind of the probe or specillum of the ancients was broad at one extremity for the purpose, which Celsus here mentions. Vide Scultet. Armament. Chirurg. tab. 8. fig. 6.

[83.] Chironian.) So called, says Paulus Ægineta, because it requires a very great physician, such as Chiron. Lib. iv. cap. 46.

[84.] These are the methods prescribed by physicians.) This translation is agreeable to the reading of the most ancient editions, particularly Nicolaus, Pinzi, Junta, and Aldus. Quæ cum medici doceant, quorundam rusticorum, &c. In Linden and Almeloveen the passage has a quite different turn: Quæ cum medici doceant, ab iis requirenda. Quorundam, &c.—That is, ‘These being the methods prescribed by physicians, they will be best practised under their direction.’

[85.] Leaven.) The common leaven for bread among the Romans was paste worked up without salt, and boiled after the manner of pulticula, then suffered to stand till it turned sour. Plin. lib. xviii. cap. 11.

[86.] From its figure, our authors call it panus.) Panus, a clue or ball of wool or yarn; πη̃νος, or πα̃νος the Greeks used in the same sense, but did not apply it, as the Romans did, to this tumour.

[87.] The same applications.) I have here followed the reading of Pinzi Manut. Ruell. Stephens and Morgagni’s MS. autem for aut, and tantum modo for tantummodo. Morgagni, Ep. vi. p. 156.

[88.] If it does not slip out, &c.) Almeloveen and Linden read, si non dilabitur sede, qua innititur; whereas the prior editions wrote, si non labitur, sede quale innititur; i. e. ‘if it does not slide, but rests upon a smooth surface.’ This Morgagni[ JL ] likes much better, as agreeable to Celsus himself, who adds, si inæquale quoque et asperum, &c, that is, in the first case where the probe rested, but upon a plain surface, the caries was but little advanced; whereas under the following appearances it was more considerable.

[89.] Collyrium.) This name, at present, is appropriated to medicines designed for the eyes; in which sense the ancients also used it. But they gave it a greater latitude, to denote likewise a composition of powders brought to a consistence by some liquid, and formed into something like a tent, of various sizes, according to the cavities it was designed for. Thus Scribonius Largus orders a collyrium of the bigness of a pine kernel, to be introduced into the anus, Cap. xxxvii. comp. 142.

[90.] Which is more ulcerated. Quæ magis exulcerata est.) Several of the ancient editions read quia for quæ, that is, ‘Because it is more ulcerated.’

[91.] Spreads wide.) This whole passage was very much corrupted in the old editions. We are obliged to Linden for several corrections in it; but he reads this part Proceditque et latet, that is, It spreads and conceals itself. As this can hardly be the meaning of the author, I read Procedit latè, which is in Pinzi, Junta, Aldus, and others; only I take the liberty of expunging et.

[92.] Cimolian chalk.) I have here kept close to the author’s term subcærulea. Pliny and Dioscorides describe this kind as inclining to purple. See note book ii. chap. 33.

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NOTES TO BOOK VI.

[2.] Gum.) Our author here manifestly distinguishes between lachryma and pituita. The ancients imagined the pituita to be concreted tears, whereas it is the sebaceous matter secreted from the glands of Meibomius. To translate it in one word I have therefore given it the vulgar English name.

[3.] Phlegm.) Vid. lib. ii. cap. 23.

[4.] Diet ought to be somewhat fuller than formerly.) In Almeloveen and Linden, Post hæc cibo pleniore, quam ex operum consuetudine. The reading in the older editions was ex eorum dierum consuetudine, which Morgagni prefers, Ep. vi. p. 153. and is the reading I have followed.

[5.] Burnt antimony.) The antimony is rubbed over with suet, and hid in the fire till the suet is burnt, and then being taken out, it is extinguished in the milk of a woman, that has had a male child, or in old wine. Dioscorid. lib. v. c. 873.

[6.] Specillum asperatum.) Paulus Ægineta, treating of the same disorder, mentions this instrument by the name of blepharoxyston, that is, an instrument for scraping the eye-lids. It is delineated by Heister, p. 2. tab. 16. fig. 5.

[7.] Psoricum.) Dioscorides gives the same process for making of psoricum: only he orders the vessel to be buried in dung for forty days, about the heats of the dog star. Lib. v. cap. 890.

[8.] Hot waters.) By our author’s using the plural number here, it may be doubted, whether he does not intend mineral hot waters.

[9.] Strigil.) This is used by other authors to signify a currycomb, or that instrument, with which the sordes were scraped off the skin at the baths; but in this place it can be taken for nothing else but a tube or syringe.

[10.] The specillum oricularium, from its use here, as well as in other places, must have been some kind of forceps.

[11.] A board is laid down.) I could make no proper sense of this sentence according to the present pointing, and therefore have altered the punctuation in this manner; tabula quoque collocatur, media inhærens, capitibus utrinque pendentibus, &c.

[12.] The teda is a tree very like the pine, abounding with resin. Pliny says, that all the trees, that afford resin, by an excess of fat are changed into the teda. Hence teda is often used for a torch in Latin authors. Vid. Plin. Nat. Hist. lib. xvi. c. 10. & lib. xvii. c. 24.

[13.] Sory was a mineral of much the same virtues as misy and chalcitis: it is strong scented, and creates a nausea. It is produced in Egypt, Africa, Spain, and Cyprus. Dioscorid. lib. v. c. 893.

[14.] Rhus is a shrub growing in rocky places, of about two cubits in length; it has long leaves, and reddish, the fruit of it is like a grape stone. The bark about is very useful: it has a styptick quality, and is used for the same purposes as acacia. It was used by the tanners. Dioscorid. lib. i. c. 138. It is supposed to be rhus obsoniorum, or sumach of the moderns.

[15.] In the inner part.) For ulteriore in Almeloveen, I chuse to read with Constantine interiore.

[16.] In nine cyathi.) There is no liquid mentioned in Linden’s or Almeloveen’s edition, but most of the others have Ex novem cyathis vini.

[17.] That the skin be kept from falling in contact, &c.) This is agreeable to the reading of Linden and Almeloveen, Illam esse servandam ne considat, ulcerique agglutinetur. But [ JM ] Morgagni would here restore the reading of his editions and the MS. Illam non esse servandam ne considat, &c. that is, ‘It must always be cut off in such a case;’ which indeed is rendered probable by our author’s first ordering circumcision, when there is a loss of substance in the penis; and then his adding Perpetuumque est, as if that were a general rule for the same operation in like circumstances.

[18.] Vulsella.) This instrument is delineated by Scultet. Arm. Chirurg. tab. 4. fig. 1.

[19.] Cicatrix is formed. Fit cicatrix.) I find no variety in any of the copies, which I have seen. The sense however seems to require crusta instead of cicatrix; because the caustic medicines would produce an eschar, whereas no cicatrix would be formed, till the eschar cast off, and the ulcer was deterged and incarned.

[20.] Consumed either by stronger medicines, &c.) This is agreeable to the reading of the older editions—Si hac ratione non tollitur: vel medicamentis vehementioribus, vel ferro adurendum est.—Linden and Almeloveen have it thus: Si hac ratione non tollitur, vel aliis medicamentis similibus, vel vehementioribus: ferro adurendum est. That is, ‘If it is not removed by this method, or like medicines, or stronger, it must be burnt by the actual cautery.’ Which, Morgagni[ JN ] justly observes, besides the incongruity of recommending similar medicines after the first have failed, alters the sense much for the worse.

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NOTES TO BOOK VII.

[1.] Physician makes a wound.) An English reader may naturally suppose that the term should be surgeon; but as our author here uses the word medicus, I did not think myself at liberty to depart from it; especially as his not using chirurgus was from choice, since this word occurred in the preceding paragraph. Celsus supposes an accomplished physician acquainted with all the branches.

[2.] Nevertheless, it is not right to trust, &c.) In this translation I have followed Linden and Almeloveen. But the reading in most of the old editions, as Nicolaus, Pinzi, Junta, Aldus, Gryphius, &c. is Neque tamen fas non est nihil cucurbitula agere; that is, ‘Yet it is not an inviolable rule always to employ the cupping-vessel.’ Which I must own, appears most agreeable to the sense of this place; because our author immediately proceeds to consider a case, in which cupping can be of no service. See Morg. Ep. vi. p. 151.

[3.] Even before the suppuration is formed.) I have here followed the old reading, tum pure quoque maturior hæc interdum esse consuevit, which seems to agree better with our author’s reasoning; for as he had just blamed Meges for introducing the new term callus instead of tunica, without necessity; so he adds, that he was mistaken also in believing that it was never found but inclosing an old collection of matter. He on the contrary says, that it sometimes appears before the generation of pus. Linden and Almeloveen read tum, pure quoque maturiore, hæc interdum esse consuevit; that is, ‘And this is found, even when the suppuration is more ripened.’ Whether the connexion of this with what went before be natural, the reader may judge for himself. I do not know but these learned editors may have put another sense upon maturiore, when the suppuration is sooner ripened: which would be pretty much the same with the old reading. However the first is preferred by Morgagni, Ep. vi. p. 152.

[4.] Lest convulsions follow, which may debilitate, &c.) This translation is agreeable to the reading in Linden and Almeloveen; but all the older editions read thus, ne vel distendantur hi, vel membrum debilitent; i. e. ‘Lest either convulsions follow, or the limb be disabled.’ And this appears the more probable, as one of them might happen without the other following. And so it is quoted by Fabricius ab Aquapendente.

[5.] And some again require a wound, &c.) Jamque alia rectam plagam desiderant, ut in carne: alia vero vehementer cutem extenuant, in quibus tota ea super pus excidenda est. There are several variations in the reading of the copies of this paragraph, but they do not remove the difficulty. Morgagni[ JO ] very ingeniously conjectures, that after Celsus had considered such as were quite mature, he next mentioned such as were not quite ripe; and did not talk here of cutting off the whole skin, because he afterwards says, Est etiam in rerum natura, ut cutis latius excidenda sit; and that what is here said of the skin being extenuated, was repeated from above by carelessness. All the old editions and MSS. have itemque for jamque; none of them ut; the MS. tuto for tota. Upon the whole, he seems inclined to read it thus: Itemque alia rectam plagam desiderant in carne; in quibus tuto ea super pus incidenda sit; i. e. ‘Others again require a wound in a straight direction in the flesh, in which it may be proper and safe to make an incision above the pus.’

[6.] Crude lint.) Fabricius ab Aquapendente and Rhodius take this crude lint to be such as has not been boiled in a lixivium.

[7.] Loosing this knot. Soluto nodo.) Morgagni[ JP ] here prefers the old reading, salvo nodo, without loosing the knot, for this reason, that our author immediately orders the knot to be loosed every third day, for changing the string. And thus also it is quoted by Aquapendente, De chirurg. operation. cap. 93.—Celsus has here followed Hippocrates, Lib. de fistul. where he orders the string to be drawn and twisted every day, as much as it is loosened by the putrefaction of the fistula; but he says nothing of untying the knot every day. The difference is not material; for if salvo nodo be the reading, the string must be made tighter in the manner Hippocrates directs. According to the reading of Linden, the method is plain, nor does it seem to be attended with any difficulty; for it is untied twice a day to move the ligature; and also untied every third day, for the sake of introducing a fresh ligature, because the old one must not be suffered to rot.

[8.] A very small habenula may be cut out.) Linden and Almeloveen read here, habenula tenuis admodum injiciatur, which I think has no proper connection either with what goes before or follows. It is true, Aquapendente has given two explications of this passage, according to the same reading, De chirurg. operat. cap. 93. Neither of which appears to me consistent with the reasons Celsus gives for this method: I have therefore chosen to follow Nicolaus, Pachel, Pinzi, Junta, Aldus, and others, who have ejiciatur for injiciatur, which seems to clear up the difficulties of this place.—Our author uses habena often for a strap; but by habenula here he must understand a small slip or stripe of flesh.

[9.] Gum in this place (pituita) must signify a purulent fluid.

[10.] Like a spatha.) A knife was said to resemble a spatha, when it ended in an acute point with sharp edges on both sides, which our author mentions chap. x. for the excision of a polypus in the nose.—The needle here described is thin and broad, so that it was more like this instrument than a common needle. Vid. Fabric. ab. Aquapend. de Oper. Chirurg. cap. 107.

[11.] Of the colour of wax.) I have here departed from the reading of all the copies, and instead of it admit the correction of Mercurialis cereus for cæruleus, which is approved by the best judges, and seems to be confirmed by its affinity to the gold colour immediately following. Vid. Mercurial. Var. Lect. lib. v. cap. 5. & Le Clerc. Hist. de la Medicine, p. 2. liv. 4. sect. 2. chap. 5.

[12.] The needle sharp pointed, but not too slender.) The reading in Almeloveen is Tum acus admovenda est, aut acuta, aut certe non nimium tenuis. As I could find no sense from this reading, or any other that is proposed, I have taken the liberty to read thus, Tum acus admovenda est acuta, at certe non nimium tenuis.

[13.] With timidity. Timide.) Though this reading may be defended, yet as what our author adds of the needle finding no resistance should make an operator more cautious, it is possible he wrote temere.

[14.] Below the bone.) I have here followed the old reading sub osse, and not as Almeloveen has it ab osse, which plainly appears to be erroneous by what our author says, when he mentions this species again, Manifestum sub osse descendere.

[15.] Humour still flows.) Here is a manifest error in Linden and Almeloveen, who read tumor instead of humor, which all the old copies have. Morgagni, ep. 5. p. 150.

[16.] And therefore cannot be separated.) In the original Ideoque legi non possunt. Our author here barely mentions the lectio venarum, and a little below speaks of it as a distinct operation in these words, Sed nihil melius est, quam quod in Gallia quoque comata sit, ubi venas in temporibus, et in superiore capitis parte legunt. In the conclusion of the chapter he promises a full explanation of it, when he comes to the varices of the legs. The place he refers to is the 31st chapter of this book, where the reader will find, he does not once use the word lego through the whole: not that he forgot it, for he puts us in mind of this very passage in the beginning: Huc autem et earum venularum, quæ in capite nocent,—curationem distuli; he then proceeds to describe two methods of cure by the actual cautery, and excision. In the first process I find nothing applicable to lego, there as well as here, cauterizing being quite a different thing; but in the second, namely the excision, the veins are separated from the contiguous parts, and are taken up by several blunt hooks, at the distance of four fingers breadth from each other, then, one of these hooks being raised, the vein is cut through and pulled away: so in all the rest (the terms are Excipitur, diducitur, attrahitur, evellitur, rursus abscinditur.) Now from the various senses, which lego bears in the classics, it seems without a strain capable of signifying any step of this operation. And as it is not uncommon among the ancients to include several known consequences under one term, I must own it appears to me our author intends them all, when he uses the word lego in this chapter.

[17.] Through what remains.) Instead of super est in Linden and Almeloveen, which seems to be directly contrary to our author’s meaning, I read in one word superest, with the older editions.

[18.] Defects in these three parts, if they be small, &c.) Linden and Almeloveen read Curta igitur in his tribus, ac si qua parte parva sunt, &c. The more ancient editions have Ac si qua parva paria sunt; neither of which seem to give the author’s meaning. I cannot help thinking the whole passage should run thus. Curta igitur in his tribus, si qua parva sunt, curari possunt: si qua majora sunt, aut non accipiunt curationem, &c. For neither paria nor parte appear to be at all proper after what was said in the conclusion of the last chapter, where he expressly confined these defects to the three parts abovementioned. I have therefore ventured to translate according to that reading; a liberty however I durst not take without advertising the reader.

[19.] Sometimes however the skin—left deformed.) I have here translated according to the reading of Linden and Almeloveen, from which I find no other variety than that of autem for tamen. But this observation by no means agrees with the general rule contained in the next words, Hujusmodi loci altera pars incidenda, altera intacta habenda est. If we are allowed to reject haud, it will run thus: Sometimes however it happens, that to draw forward the skin on one of the sides, would effectually disfigure the part it has left. This sense appears quite consistent both with the general rule, Hujusmodi loci, &c. and its application, Ergo ex imis auribus, &c.

[20.] Two regulæ.) Regula is commonly taken for a ruler. Our author himself directs a single regula to be applied to a fractured bone, where there is a protuberance, to keep that down, Lib. viii. cap. 10. In this place he mentions the end proposed by them. It seems probable that they were two pieces of wood fixed together by a hinge, and used in the same manner as farriers use the instrument by them called barnacles.

[21.] In two lines.) Instead of duæ tunicæ, I read here with Nicolaus, Aldus, Stephens, and others, duæ lineæ.

[22.] Small glands, Glandulis.) Most of the old copies have instead of this word, medullis. But Aquapendente in quoting this place, follows the same reading with Linden and Almeloveen.

[23.] The coats however, &c.) I have here followed the old reading tunicæ, for tunicarum in Linden and Almeloveen. According to which the translation would run, ‘They (the testicles) are pained however in wounds and inflammation of the coats, which contain them.’—Which must appear quite inconsistent with what our author had said the line before, so that Morgagni[ JQ ] very properly asks how they can be void of all sensation, and yet be pained in diseases of their coats?

[24.] By an assistant.) I read ministro instead of sinistro, which is in Linden.—See Morgagni, Ep. vi. p. 147.

[25.] Sometimes upon account of their health. Interdum valetudinis causa.) Some of the older editions insert before this, Interdum vocis, Sometimes on account of their voice. I do not know how this came to be dropped afterwards: for it is certain this was one very common reason for infibulating.

[26.] Sticks where that grows narrower.) In Almeloveen and Linden, Nonnunquam etiam prolapsus in ipsam fistulam calculus, qui subinde ea extenuatur.——-Which I think is capable of no sense, and have therefore taken the liberty to follow Morgagni’s conjecture qua for qui. Ep. i. p. 38.

[27.] Being first slightly anointed with oil, &c. Leniter prius unctos oleo simul in anum ejus demittit.) The old editions, without any mention of the oil, have, Leniter prius unum deinde alterum in anum ejus demittit; that is, Introduces gently the fore and middle fingers, first the one and then the other.

[28.] Come out prone, that is, with its end foremost, ut pronus exeat.) This Constantine changed in the margin into Ut ne pronus exeat, which Linden received into the text. Constantine explains prone by lying on its side, and says it is hardly possible to extract an oblong stone in that posture, supposing, no doubt, that it must necessarily lie across the orifice. See Morgagni, Ep. v. p. 128.

[29.] Then in that part where the bottom of the wound is straiter, &c. Deinde ea parte qua strictior ima plaga est.) Thus all the printed copies read. This passage has given rise to a variety of opinions on the nature of the first and second wound: some imagining that the first, which is called the lunated incision, was concave towards the rectum; others, on the contrary, from the word coxæ being used for the ilia as well as the ischia, believed it was concave towards the scrotum.

Then, with respect to the transverse incision made through the neck of the bladder, some have thought that the word transverse was used as it regarded the first wound, so that the second incision was nearly perpendicular to the first, and the urethra was divided longitudinally; others again have supposed, that the incision was made transverse, with regard to the course of the urethra, that is, the neck of the bladder was opened transversely.

Though all the printed copies agree in the above reading, yet Morgagni informs us that instead of Qua strictior ima plaga est, his ancient MS has Qua resima plaga est, which would determine the convexity of the lunated incision to be towards the rectum; because in that case the cornua of the lunated incision would point to the superior part of the body. But this reading does not fix the direction of the plaga transversa, whether it was called so in respect of the parts, or the first incision: nor does that ingenious author favour us with his own opinion, but seems to prefer this to the common reading. Ep. vii. p. 189.

Now it should seem almost certain, that the lunated incision was meant to be concave towards the rectum; because when made in that direction, it would probably render the rectum much more loose and supple, than it is in its natural state, and thereby greatly facilitate the operation, by allowing the surgeon a much freer use of the two fingers, which are introduced into the rectum, and consequently admitting him to bring the stone more easily forwards into the neck of the bladder. One would suppose, however, that the benefit here suggested to arise from this lunated incision, was not extremely evident, or it would not have been dropped so early by succeeding surgeons: Ægineta makes not the least mention of this process, nor do we know when it was first discontinued. Perhaps, even in Celsus’s time, there were different methods of performing this operation; for does not he himself, when describing Meges’s manner of cutting upon a rough stone, omit the lunated incision? And does he not imply that there were different methods by saying, Quocunque autem modo cervix ea parte secta est, &c.?

With regard to the transversa plaga, it should seem by the use of that term, when he describes the manner of cutting women, that it was transverse with respect to the perineum; and indeed, it is natural to suppose, when the stone was brought forward by the fingers, and the neck only of the bladder was to be cut, that the incision should be made in that direction. But those, who contend that the transversa plaga was made transverse with respect only to the first incision, may urge, that Celsus in this very passage orders the incision of the neck of the bladder to be made so large, that the opening in the iter urinæ may exceed the dimensions of the stone. If, therefore, Celsus in this place intends that the urethra should be opened, one would suppose the incision must be made according to the length of that canal; but I believe it may be questioned, whether Celsus is sufficiently accurate in his notions of the anatomy of these parts, to determine his meaning by that expression.

It is very remarkable, that how much soever this operation of Celsus’s may have engaged the attention of later ages, neither Galen, Oribasius, nor Ægineta make the least mention of his method: nay Ægineta (lib. vi. cap. 60.) describes the cutting on the gripe nearly as it has been practised in our own age.

[30.] A crotchet, in the original uncus.) Our author here describes the instrument he mentions, and as the use is the same, and the form not very different from that once employed by modern surgeons, I have taken the liberty to use their term. But the reader will please to observe, that this uncus is different from that mentioned in chapter xxix. used in extracting a dead fœtus.

[31.] On the external part smooth.) As the ancient editions have exteriori, which is made extremely clear by our author’s description, Qua corpori jungitur, it is hardly worth while to observe that interiori in Linden must be an error of the press.

[32.] Knees.) Other copies have inguinibus, instead of in genibus.

[33.] Which by pressing upon the bladder.) Instead of Atque vesicam urgendo, in Linden and Almeloveen, I read Quæ vesicam urgendo, with Nicolaus, Pachel, Pinzi, and several other old editions.

[34.] Into the anus. In anum.) This is the reading of all the copies, which I have seen; but it is highly probable our author wrote colem for anum. For as I see no propriety in introducing a pipe into the anus, so in the very case before us, a catheter in the urethra, is at present esteemed the best method of cure.

[35.] Sore places.) It appears that in this place, Celsus uses the word cicatrix for a wound as well as a scar, of which I do not remember another instance in his work.

[36.] Which are brought to digestion.) I have here followed the old reading, in quibus pus moveri debet, because I think it more agreeable to our author’s practice.——Constantine had inserted non, in which he was followed by Linden and Almeloveen; he supported his correction by referring to p. 290. lib. 5. in the original, where Celsus gives directions about a hæmorrhage from wounds; but I own I can see nothing there to incline me to his opinion.

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NOTES TO BOOK VIII.

[1.] Morgagni[ JR ], with Paaw, thinks it probable, that there is some chasm in the text, because Celsus does not describe the coronal suture, which he could not be ignorant of.

[2.] Over these muscles too, &c. Super bos quoque musculos, qui tempora contegunt, os medium, in exteriorem partem inclinatam, positum est.) Thus Linden and Almeloveen. All the other copies have, sub his musculis, qui tempora connectunt; in the following words they differ, which Ronsseus would read thus, os medium in interiorem partem inclinatam; in this he was followed by Paaw, who was of opinion, that Celsus intended here the processus petrosus; which Morgagni thinks quite foreign to the question. It is probable, says the same author, that Linden changed sub his musculis into super hos musculos, to make the description answer to the processus zygomaticus, which our author describes a little after, under the name of jugale. His own conjecture is, that Celsus wrote sub his musculis, qui tempora continent, and that he meant that part of the temporal bone which is covered by the crotaphite muscle. Morgag. Ep. 7. p. 212. 214. But as this description of a bone is inserted in the midst of the sutures, there is some foundation to suspect the whole to be an interpolation.

[3.] The maxilla is a soft bone. Maxilla vero est molle os.) Thus all the editions read, but Morgagni[ JS ] suspects molle should be mobile, a moveable bone; for Celsus himself calls the sternum a strong and hard bone, which is not to be compared in that respect with the maxilla.—It is no objection to this reading, that the author adds, solaque ea movetur, for that is to exclude the upper jaw-bone. The reader will please to observe, that maxilla, by our author, is applied only to the lower jaw-bone, for he includes the upper jaw-bones under the malæ.

[4.] Is broader below.) I have here followed the proposed emendation of Morgagni, infra for intra. Ep. 1. p. 40.

[5.] And all the vertebræ.) What follows relating to the structure and connection of the vertebræ, appears to be very much corrupted, in so much, that the reading in all the copies makes our author contradict himself. I shall be content with mentioning some observations of Morgagni’s upon the reading of Linden. The words in the parenthesis (says he) exceptis tribus summis, except the three uppermost, were surely never wrote by Celsus, at least not as they stand; for if the three first vertebræ want depressions in their superior surfaces, how comes the first to receive into its depressions the two small processes of the head, as our author immediately adds?

The adding of parvis to tuberibus he judges to be superfluous, because Celsus had said just before exiguis ejus processibus. He conjectures that secunda superioris parti inferiori inseritur is interpolated, because the connection is more natural without these words. A little after follows tertia eodem modo secundam excipit, as if a process stood out from the inferior part of the second vertebra, to be surrounded by the third in the same manner, that its processus dentatus is surrounded by the first; so that all these five words he seems with justice inclined to expunge.

After these Linden adds, Jamque vertebra tertia tubercula, quæ inferiori inserantur, excipit; which at first view must appear highly absurd. I therefore have followed, in the translation, the reading of Nicolaus, Pachel, Pinzi, Stephens, and Morgagni’s manuscript, exigit for excipit.—See Morgagni Ep. vii. from 173 to 177.

[6.] The six inferior ones.) Almeloveen and Linden read here septem inferiores, others write undecim, as if the following description related to all the ribs. But that is false, as appears by the sequel, and it is plain, from the whole passage, our author could write nothing else than sex.

[7.] But at the first rib, &c.) This whole paragraph is extremely obscure. The variation of reading in the older copies does not in the least lessen the difficulty. If we were allowed to understand by jugulum, the neck, the whole description, lame as it is, could then answer no bone but the clavicle; but jugulum in no other place of this work seems to be used for any thing else but the clavicle, so that id ipsum, &c. would appear to be the beginning of the description of that bone.—Morgagni thinks, that though the description is far from just, yet that most of the words, as they now stand, relate to the spine of the scapula, which may be said to sustain the clavicle; and it is observable, that if our author does not intend the spina scapulæ here, he makes no mention of it at all. Vide Morgagni, Ep. vii. p. 177. I must own the reading appears to me so much depraved, that it is impossible to determine, precisely, what our author has had in view.

[8.] Is a little concave, &c.) This translation follows Linden and Almeloveen. In all the other copies the reading is leniter gibbus, et in priorem et posteriorem, interiorem et exteriorem partem, as if the bone was concave on no side. Morgagni[ JT ] therefore proposes a reading agreeable to truth. Leniter gibbus in priorem et posteriorem et interiorem, cavus in exteriorem; i. e. gently convex in its fore and posterior, and internal part; concave externally.

[9.] The two bones of the fore arm at first, &c.) The reading in Linden and Almeloveen is primo vero duo radii et brachii ossa, &c. which at once appears to be wrong, because Celsus had said before, quæ res sedem brachio præstat, quod constat ex duobus ossibus, to which two he immediately gives the names of Radius and Cubitus, so that it would be sufficient, as Morgagni observes, to have wrote duo brachii ossa, or if they must be named duo radii et cubiti ossa according to the first of which I have translated. The other editions have primo vero duobus radiis brachii ossa. See Morgagni, Ep. i. p. 28.

[10.] Properly enough, &c.) Sura was the Roman name for the calf of the leg, whence our author says, that name is properly enough given to the fibula.

[11.] The same may be collected.) Colligi idem potest. Morgagni[ JU ] would have the old reading restored here, nigrities colligi quidem potest. A blackness may be discovered, &c. because these words in the next chapter, sive autem nigrities quam terebra detexit, &c. make it plain the terebra was only used in sounding the blackness.

[12.] But if the blackness goes thorough.) Sin autem nigrities, and then there follows est aut si caries, which appears a manifest error by reason of what follows. With Constantine and Ronsseus, I therefore judge these words should be expunged, and have taken no notice of them in the translation.

[13.] Is made by the angle of a chisel.) I here take the reading of the older editions, angulo scalpri sinus exiguus fit. I suppose sit in Linden and the later copies has been a typographical error. See Morgagni, Ep. vi. p. 162.

[14.] Being raised in the same.) I have here translated agreeably to the old reading excitatæ nares, instead of which, by a palpable error, Linden and Almeloveen had exercitatæ nares. Morgagni, Ep. i. p. 29.

[15.] The swelled part.) In Almeloveen and Linden it is tumens locus, instead of which the old reading was better, tum is locus, then this part; because our author had not mentioned any swelling before. Vid. Morgagni, Ep. v. p. 140.

[16.] For if any part is separated from a vertebra, or is any way broken.) This is according to the reading of Linden and Almeloveen; but several of the older copies have Si id, quod ex vertebra excedit, aliquo modo fractum est; that is, If the part, that stands out from a vertebra (the spinal process) is any way fractured. This agrees very well with what is said afterwards of the fragments being spinous.

[17.] Which should be rolled about the fracture. Quæ circa fracturam ter voluta.) I find no various reading in any of the editions, but I think I can produce one from our author himself, who is far from a profusion of words and repetitions, and thinks this circumstance of importance enough to make a rule bcsy itself in the following words; Satisque est eam ter hoc quoque modo circuere. Upon his authority I have therefore ventured to omit the first ter.

[18.] And if means only are found, &c.) The period in Linden and Almeloveen runs thus, Ac, si nihil aliud quam dolori occurrendum est, idem, qui fuit, ejus usus est; that is, ‘And if nothing else is to be done but to remove the pain, its use continues the same as before.’ As it is evident this cannot be our author’s meaning, I have followed in the translation the old reading occursum for occurrendum.

[19.] Broader than the wound.) I follow here the old reading latioribus for laxioribus in Linden, of which I could find no proper sense. In the following words I have also removed the point at vulnus potest as the ancient editions have it, and the connection seems to require.

[20.] Must be applied with that part, &c.) This is according to Linden’s edition.—None of the more ancient seem to give the true reading of this whole passage taken together, but some of them afford hints. Instead of Acutæ ossis prominentis cuspidi, Pinzi has Recte se habendi capiti; others Recte se habenti capiti. Upon the whole I think Morgagni’s[ JV ] reflections upon this passage extremely probable; our author had before ordered a sharp point of a fragment to be either cut off or filed down and smoothed: he is now considering how the fragment itself is to be replaced. If we read it thus, the sense seems to be pretty clear: Vulsella, quali fabri utuntur, injicienda est capiti ossis recte habenti, ab ea parte, qua sima est, &c. that is, ‘A workman’s vulsella should be applied with that part, which turns inward, to the sound end of the bone, that by its convex part the prominent bone may be thrust into its place.’

[21.] Unite obliquely. Solent tamen interdum adversa inter se ossa confervere.) Thus Linden and Almeloveen.—But by what follows it is plain adversa was never wrote by our author in this place. Many editions have transversa; others diversa, which I think is the only probable reading, and have taken it in the same sense as Morgagni does.—Ep. vi. p. 164.

[22.] Of the scapula recedes from the humerus. Os scapularum ab humero recedit.) Morgagni very ingeniously suspects that instead of ab humero our author wrote ab jugulo, because the clavicle is joined with the scapula, as the tibia with the fibula. Ep. vii. p. 209. As it now stands ab humero, it would come under the second head; Modo articuli suis sedibus excidunt.

[23.] Yet it is of no use. Et ut aliquid decoris eo loco, sic nihil usus admittitur.) Thus Linden and Almeloveen, and I find no other variation in any of the copies, except sit for sic, which does not alter the sense. Our author had said immediately before, ‘That bones thus separated never come together again,’ which makes it improbable he would add, ‘That some comeliness would remain.’ For this reason I suspect we should read amittitur for admittitur, and then the meaning will be quite opposite, thus, ‘And though their comeliness is impaired, yet their use continues the same as before.’

[24.] Is less firmly held after it is reduced.) In a luxation of the humerus from a lax habit Hippocrates advises the use of the actual cautery, but with great caution, for fear of injuring the blood vessels or tendons; and when the ulcers are clean and fit for cicatrizing, to bind the arm close down to the side, and allow no motion, that the cicatrix may contract the part the more, and strengthen the joint. He censures the practice of his predecessors, who cauterized on the external and anterior side, which ever way the bone had been luxated, and observes that when the humerus is liable to slip into the arm-pit, this would rather push it downward, than prevent its luxation. He proposed therefore the new method of applying the cautery to that part, toward which the bone is liable to be protruded. Hippocrat. de Articul. p. 787, 788, and 789.

[25.] That even frequent speaking, by the motion of the mouth, hurts the nerves of the temples.) This is according to the reading of Linden and Almeloveen. The old editions have adeo ut sermo quoque frequens motu oris per nervos lædat; that is, that even frequent speaking, by the motion of the mouth by the nerves, hurts. See Morgagni, ep. v. p. 130.

[26.] Tone of the nerves be restored.) I follow here the old editions in reading restituta for destituta.

[27.] That the finger may be restored, &c.) In Linden and Almeloveen, ut ita in locum, unde lapsus est digitus, restituatur. [ JW ]Morgagni observes, that our author had said, there were as many different cases and the same signs as in the hands; but according to this reading he takes no notice of the cure of lateral luxations. Whereas the whole is set right by restoring the old reading, which was, instead of these words, that are quoted from the original, Atque id, quod in latus elapsum est, digitis restitui, i. e. “and that which is luxated laterally ought to be reduced by the fingers.”

[28.] Having treated of the humerus.) Cum de humeris dixerim. We might here (says Morgagni) have taken humeris for the superior extremities as cruribus for the inferior, but the MS. and all my editions have cum de his dixerim: de his quoque (or as Stephens has it de iis quoque) quæ in cruribus, &c. Ep. vi. p. 167.

[29.] By keeping the middle or upper part of the joint in some canaliculus.) This whole sentence Potest tamen conditus articulus medius aut summus canaliculo aliquo contineri, in all the old editions is placed at the end of the 24th chap. and not here.—But [ JX ]Morgagni suspects, and as it appears to me, very justly, it should be rather referred to luxated fingers than toes, and that Linden guided by some MS. had transferred it from the 24th to the 19th, from whence it was transposed to this place by the carelessness of the copiers, where it stands very improperly.

---

THE
I N D E X.

N.B.—n. refers to the notes.

alpha-table

[A]

[B]

[C]

[D]

[E]

[F]

[G]

[H]

[I]

J

K

[L]

[M]

[N]

[O]

[P]

Q

[R]

[S]

[T]

[U]

[V]

[W]

X

Y

Z

[A.]
Abstinence, too great, hurtful, [18]
── of two kinds, [71]
Acopon what, n., [26]
Acorum, n., [21]
Actions, natural what, [4]
Æsculapius, why deified, [1]
── register kept at his temple, its use, n., [1]
Ages, the proper regimen for each, [25]
── what reasons favourable or hurtful to each, [36]
── the peculiar disorders of each, [37]
Alica, n., [12]
Allum, n., [27]
Alopecia, [263]
Ammoniacum thymiama, n., [31]
Ammonius Alexandrinus, an improver of surgery, [309]
Andreas, [186]
Antimony, n., [30]
── washed, n., [38]
Aphronitre, n., [28]
Apollonius, an empiric, [3]
Apollonius Mus, [186]
Apollonii, two surgeons, [309]
Apples (poma) what, n., [6]
Asclepiades alters the method of practice, [3]
── finds a man carried to burial alive, [45]
── his book upon general remedies, [68]
── account of the duty of a physician, [91]
── practice in a tertian, [111]
Autumn the most dangerous season, and why, [34]
── its usual distempers, [35]
[B.]
Balsam, n., [20]
Baths, ancient described, n., [4]
── their use, [72]
── cautions concerning them, [72]
── whether proper in fevers, [72]
Beef sometimes most easily concocted, [160]
Berry gnidian, n., [28]
Bleeding, the proper subjects for it, [60-61]
── how to be performed, and where, [62]
── dangers attending the operation, [63]
Boys to be differently treated from men in distempers, [103]
[C.]
Cachexia, its causes, [129]
Cachrys, n., [31]
Cadmia, n., [29]
Cardamomum, n., [20]
Caries, its depth how known, [389]
Cassia black, n., [33]
Cassius an ingenious physician in Celsus’s time, [14-172]
Catapotia what, n., [20]
Causes of diseases occult and evident, [3]
Cedria, n., [31]
Celsus his opinion in the controversy between the rationalists and empiricks, [9-11]
── of the methodists, [12]
── use of dissections, [15]
── his complaints of the conduct of patients, [71]
── says one physician cannot attend many patients, [93]
── his practice with regard to food in continued fevers, n., [16]
── in a tertian, [111]
── opinion of the paracentesis, [128]
── practice in a jaundice, [136]
── whether the drink should be cold or hot in a purging, [177]
Cerastes, n., [35]
Ceruss burnt, n., [32]
Chalk Cimolian, n., [14]
Chalcitis, n., [27]
Changes in the way of life to be gradual, [19]
── of place, [19]
Changing a disease, sometimes useful, [106]
Chersydrus, [239]
Chirurgery the most ancient branch of medicine, [2]
── its effects the most evident, [308]
── its province, [309]
Chrysippus a physician, [2]
Chrysocolla, n., [28]
Cleophantus his practice in a tertian, [111]
Clibanum, n., [10]
Clysters, when proper, [65]
── their kinds and management, [66]
── for nourishing, [122]
Coition, when to be used, [16]
Cold, to whom useful, and hurtful, [30]
Coldness what, [90]
Collyrium what, and how used, n., [37]
── of Nileus the best of all, [271]
Colour, what portends an approaching illness, [38]
Conchylia, n., [11]
Concoction, various opinions about it, [5]
Copper, scales of, n., [10]
── calcined, n., [28]
── flower of, n., [29]
Crocomagma what, n., [31]
Cupping, its uses, [64]
Cutiliæ, n., [24]
Cyperus long and round, n., [21]
Cytisus, n., [24]
[D.]
Days critical, [94]
Defrutum, n., [7]
Delirium, in the paroxysm of an intermittent, not dangerous, [114]
Democritus skilled in medicine, [2]
── declared the marks of death fallacious, [45]
Dietetice a part of physic, [3]
── differently treated by the rationalists and empirics, [4]
Digestion what, n., [2]
Diocles the Carystian, [2]
── his graphiscus for extracting weapons, [318]
Diphryges, n., [29]
Dipsas, n., [35]
Diseases attributed to the anger of the gods, [1]
── unknown, instance of one, [10]
── increasing and declining, their marks, [87]
Diuretics not good in disorders of the fauces, [154]
Drink, astringent, what, [178]
Dropsy, more easily cured in slaves than free men, [124]
[E.]
Ears, the danger of their disorders, [281]
Earth, Eretrian, n., [30]
Empedocles, skilled in medicine, [2]
Empirics, their doctrine and arguments, [6-11]
Erasistratus, a physician, [2]
── dissected living bodies, [5]
── his opinion about drinking in fevers, [92]
Euelpistus, an improver of surgery, [309]
Excess, small, less dangerous in drinking than eating, [18]
Exercises proper for the valetudinary after employment, [17]
── what and how long, [18]
[F.]
Far, what, n., [15]
Fatigue, management after, [19-21]
Ferula, n., [24]
Fevers, what not dangerous, [39]
── bad, [40]
── prognostics of their continuance, [41]
── not easily known from the pulse, or heat, [100]
Fevers, marks of their presence, [101]
── what discharges necessary in them, and when, [102]
Fibula, n., [34]
Fistula, opposite to the intestines, dangerous, [315]
Fomentations, warm, what their effects, [74]
Food, when given in fevers by the ancients, [92]
── a variety of it when useful, [101]
Foramina, in the head, how many, [382]
Frankincense, n., [23]
── soot of, n., [28]
Fractures of the skull how discovered, [393-394]
Friction, its various effects all depending on one principle, [68]
── the proper times for using it, and its degrees, [69]
[G.]
Garum, n., [13]
Gestation, when proper, [70]
── its various kinds, [70]
Glaucias, an empiric, [3]
Gorgias, an improver of surgery, [309]
Gum, n., [27]
── in the eyes, n., [38]
Gypsum, what, n., [15]
[H.]
Habits of body, different regimen for them, [22]
── corpulent and slender, diseases of, [38]
Heat, to whom useful and hurtful, [31]
Hæmorrhois, n., [35]
Hellebore, white, when properly used for purging, [65]
Heraclides of Tarentum, an empiric, [3]
── his practice in a quartan condemned, [112]
Heron, two of that name improvers of surgery, [309]
Herophilus an empiric, [2]
── dissected living bodies, [5]
Hippocrates, the first that separated medicine from philosophy, [2]
── said to be the disciple of Democritus, [2]
── delivers the best prognostics, [33]
── gives short and full directions for friction, [68]
── his doctrine of critical days refuted by Celsus, [94]
── deceived by the sutures, [394]
Hours, the Roman, n., [8]
Hydromel, how made, n., [10]
Hypocistis, n., [29]
Hyssop, how used for a vomit, by Hippocrates, n., [6]
[I.]
Iatrolipta, what, n., [4]
Ignis sacer, n., [33]
Infibulating boys, the method, [361]
Inflammation, its marks, [107]
Incisions, general rules for them, [312]
Intrita, what, n., [16]
Intestines, their wounds, whether curable, [345]
Issues, general rule about them, [181]
[L.]
Laser, what, n., [17]
Lead, calcined, n., [27]
── dross of, n., [30]
── washed, n., [31]
Lithotomy, the proper age, &c. for it, [363]
── patient’s posture, [363]
Lithotomy, the transverse wound, n., [44]
── Meges’s improvement in the operation, [366]
Lotus, n., [6]
Lycium, n., [23]
[M.]
Machaon, [1]
Madness of Ajax and Orestes, what, n., [18]
Malabathrum, n., [33]
Malagma, n., [20]
Matter, n., [30]
Medicine, its design and rise, [1]
── by whom improved, &c., [2]
── how divided, [2]
── a conjectural art, [10-46]
Meges, the most learned surgeon, [309]
── his account of the coat of an abscess censured, [311]
Melinum, n., [27]
Methodists, their doctrine, [11]
Metrodorus, his management under a dropsy, [125]
Milk, when hurtful and where proper, [131]
Mind, to be kept easy in sickness, [99]
Minium, what, n., [25]
Misy, n., [27]
Mulse, n., [6]
Myrrh, called stacte, n., [33]
[N.]
Nard, n., [20]
── ointment of, n., [31]
Nature, its great power, [55]
Navel, a tumour of, its causes, [342]
Nitre, n., [15]
[O.]
Oesypum, n., [32]
Oil, cicine, n., [32]
── cyprine, n., [15]
── of iris, n., [15]
── of laurel, n., [31]
── of myrtle, n., [14]
── of quinces, [14]
── of roses, [14]
── Syrian, n., [23]
Ointment, Susine, n., [32]
Omphacium, n., [28]
Operations, chirurgical, the proper season for them, [324]
Ophiasis, [263]
[P.]
Palate, to be often consulted in medicines, [175]
Panaces, n., [20]
Panus, [248]
Passum, how prepared, n., [12]
Paper, burnt, n., [30]
Pastinaca fish, [239]
Pestilence, [2-31]
Petron, remarkable for using contrary methods, [106]
Phacia, [264]
Phalangium, n., [36]
Philosophers studied physic, and why, [2]
Philoxenus, an improver of surgery, [309]
Phrenitic patients, whether to be kept in the light or in the dark, [116]
── whether to be bled, [116]
Phymosis, its chirurgical cure, [360]
Podalirius, [1]
Polenta, what, n., [19]
Poppy tears, n., [30]
Poison swallowed, more dangerous than a venomous bite or sting, [240]
Praxagoras, [2]
Prepuce, the operation for bringing that over the glans, [360]
Preserves, hurtful, [19]
Prognostics, certain, [44]
Propolis, n., [28]
Psoricum, n., [38]
Psylli, [237]
Pthisis, incident to the strongest age, [131]
Ptisan, how prepared, n., [10]
Pulse, pulticula, n., [12]
Purging, when useful, [24-66]
── when improper, [41]-66
Pythagoras, skilled in physic, [2]
[R.]
Rationalists, their doctrine and arguments, [3]-6
Remedies, their operation, [59]
── contrary, sometimes successful, [105]
── but rash, [105]
Rhus, Syrian, n., [39]
Root, Pontic, n., [43]
[S.]
Salamander, n., [29]
Salsamentum, n., [11]
Sansucus, n., [30]
Seasons, the regimen for each, [25]
── considered with regard to health, [34]
Serapion, author of the empiric sect, [3]
Sesamum, n., [24]
Shuddering, a common cause of it, [109]
Siligo, what, n., [11]
Sleep, a good or bad sign, [38]
Sory, n., [39]
Sostratus, an improver of surgery, [309]
Specillum asperatum, [276]
── oricularium, [286]
Spitting, what it indicates, [55]
Spleen, contracted by smith’s forge water, how discovered, [165]
Spodium, n., [29]
Spring, its distempers, [34]
Strigil, n., [38]
Struthium, n., [30]
Stone in the bladder, symptoms of, [48]
── sarcophagus, n., [26]
── Asian, [26]
── Phrygian, n., [29]
── scissile, [30]
Stools good, [40]
── bad, [42]-46
Subruinæ, n., [24]
Summer, its diseases, [34]
Suppurations, their several causes, [50]
── not yet visible how known, [51]
── good and bad kinds, [55]
Surgeon, qualifications of, [309]
Sutures in the head, [382]
── how they may deceive, [394]
Sweats, what they indicate, [39]
── how procured, [72]
[T.]
Teda, n., [39]
Thapsia, n., [31]
Tharrias, his opinion and practice in a lethargy, [123]
── practice in an ascites, [128]
Themison a follower of Asclepiades, [3]
── departs from him in his old age, [3]
Tragum, n., [12]
Tryphon, the father, an improver of surgery, [309]
[U.]
Urine in sickness good, [40]
── bad, [42]
── its appearances, if a fever is to be tedious, [42]
── various indications from it, [48]
── how discharged by a catheter, [362]
[V.]
Veins cauterized, their treatment after, [334]
Verdigrease rasile, n., [32]
Vervains what, [85]
Vomits rejected by Asclepiades, [20]
── when useful, [20]
Vulsella, n., [39]
[W.]
Water, its trial, [77]
── cold, useful to the head, [27]
Weather more or less healthful, [34]
── the effects of the several kinds, [35]
Winds, their effects upon the body, [35]
── what most healthful, [35]
Wine Aminæan, n., [22]
── Allobrogic, n., [24]
── Rhetic, [24]
── Signine, [24]
── salt, n., [6]
── resinated, n., [13]

FINIS.

Printed by C. Stewart.

---

Just Published by DICKINSON & Co.
Infirmary Street, Edinburgh.

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COLLOQUIA ANATOMICA, PHYSIOLOGICA,
atque CHEMICA,
Quæstionibus et Responsis;
Ad usum Ingenuae Juventutis accommodata.
Auctore
ARCHIBALDO ROBERTSON, M.D.
Et apud Edinenses Sermonum Practicorum de Arte
Medicinali Praelectore.
Editio Secunda.

---

LEXICON LINGUAE LATINAE
COMPENDIARIUM;

Or, a Compendious Dictionary of the Latin Tongue,
BY THE LATE
ALEXANDER ADAM, LL. D.
Rector of the High School of Edinburgh.
SECOND EDITION.
To which is added,
An ENGLISH AND LATIN DICTIONARY,
With an Index of Proper Names,
BY
ADAM DICKINSON.

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