Of Medicine, in Eight Books

by Aulus Cornelius Celsus

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.