Of Medicine, in Eight Books

by Aulus Cornelius Celsus

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.