Of Medicine, in Eight Books

by Aulus Cornelius Celsus

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.