De Medicina

Celsus, Aulus Cornelius

Celsus, Aulus Cornelius. De Medicina. Spencer, Walter George, translator. Cambridge, MA: Harvard University; London, England: W. Heinemann Ltd, 1935-1938.

10 Again, if the tonsils owing to the inflammation

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are swollen but not ulcerated, the head is to be kept covered; externally the painful part should be fomented by steam; the patient is to take walking exercise freely; when in bed his head should be raised repressive gargles should be used. Also that root which they call sweet, crushed and boiled in raisin wine or honey wine, has the same beneficial effect. It is useful to anoint them gently with certain medicaments prepared as follows: the juice is squeezed out of sweet pomegranates, and of this half a litre is boiled over a slow fire until of the consistency of honey; then saffron, myrrh, and shredded alum 8 grams each are pounded together, and to this is added a little at a time 85 cc. of mild wine and 42 cc. of honey; next these latter are mixed with the pomegranate juice aforesaid, and all gently boiled again. Or half a litre of the pomegranate juice is boiled in the same way, and the following after being pounded in like manner are added: nard 0.33 gram; omphacium 4 grams; cinnamon, myrrh and casia 0.33 gram each; these same compositions are also appropriate both for purulent ears and nostrils. Food too in this affection should be bland that it may not irritate. If the inflammation is so severe that breathing is hindered, the patient should keep in bed, abstaining from food, and take nothing else except hot water; the bowels should be moved by a clyster, and the gargle of fig and honey wine used; the tonsils are to be smeared with honey and omphacium; internally steam is to be inhaled somewhat longer until the tonsils suppurate and spontaneously open. If after pus has formed these swellings do not burst, they are to be cut into; then the patient must gargle with warm honeyed wine.

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But if with only moderate swelling there is ulceration as well, the throat is to be gargled with bran gruel to which a little honey should be added; and the ulcers smeared with the following composition: 750 cc. of the sweetest raisin wine are boiled down to one-third, then are added: frankincense 4 grams; garlic 4 grams; saffron and myrrh 0.66 gram each; and all are then gently heated together. When the ulcers have cleaned, the throat is gargled with bran gruel or milk. And here also bland food is necessary, and in addition sweet wine can be taken.

11 Now ulcerations of the mouth if accompanied by inflammation, and if they are foul and reddish, are best treated by the medicaments made from pomegranates mentioned above. And, as a repressant, pearl barley gruel to which a little honey has been added is to be often held in the mouth; the patient must walk and not take acrid food. As soon as the ulcerations begin to clean, a bland liquid, at times even the purest water, is held in the mouth. It is then beneficial to eat a pear of the softer sort, and more food along with sharp vinegar; then the ulcers should be dusted over with split alum, to which about half as much again of unripe oak-galls has been added. If the ulcers are alar encrusted, as happens after cauterization, those compositions are to be applied which the Greeks call antherae: equal portions of galingale, myrrh, sandarach, and alum. Or saffron and myrrh 4 grams each; iris, split alum and sandarach 16 grams each; galingale 32 grams. Or oak-galls and myrrh 4 grams each; split alum 8 grams; rose leaves 16 grams. But some mix saffron 0.66 gram; split alum and myrrh 4 grams each; sandarach 8 grams; galingale 16 grams.

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The first compositions are dried and then dusted on; the last one is smeared on with honey added, and used not only for ulcerations of the mouth, but also of the tonsils.

But by far the most dangerous are those ulcers which the Greeks call aphtae, certainly in children; in them they often cause death, but there is not the same danger for men and women. These ulcers begin from the gums: next they invade the palate and the whole mouth; then they pass downwards to the uvula and throat, and if these are involved, it is not easy for the child to recover. But the disease is even worse in a suckling, for there is then less possibility of its conquest by any remedy. But it is most important that the nurse should be made to take exercise both by walking and by doing work which moves her arms; she should be sent to the bath, and ordered when there to have hot water poured over her breasts; moreover, she should have bland, easily digestible food; and for drink, if the infant is feverish, water; if free from fever, diluted wine. And if the nurse is constipated, her bowels are to be moved by a clyster. If there is clotted phlegm in her mouth, she must vomit. Then the child's ulcers are to be anointed with honey, to which is added sumach, which they call Syrian, or bitter almonds; or a mixture of dried rose leaves, pinecone seeds, mint, young stalks, and honey, or that medicament which is made of mulberries, the juice of which is concentrated in the same way as pomegranate juice to the consistency of honey; similarly too there is mixed with it saffron, myrrh, alum, wine and honey; nothing should be given which can provoke spittle. If it is an older child he should

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generally gargle as described above. If the milder medicaments do little good, the caustic materials which induce crusts upon the ulcers should be applied, such as split alum or copper ore or blacking. Even hunger is beneficial and the greatest possible abstinence is to be ordered. The food ought to be bland; for cleansing the ulcers, however, sometimes cheese with honey is appropriately given.

12 Ulcerations of the tongue need no other treatment than that noted in the first part of the previous chapter. But those which arise at the side of the tongue last the longest; and it should be looked to, whether some tooth opposite the ulcer is too pointed, which often keeps an ulceration in that position from healing, in which case the tooth must be smoothed down.

13 There often occur on the gums adjacent to the teeth certain painful swellings: the Greeks call them parulides. These at first should be gently rubbed over with powdered slat; or with a mixture of powdered rock-salt, cyprus oil and catmint; then the mouth is washed out with lentil gruel, and the mouth is held open at intervals until there has been a sufficient flow of phlegm.

When there is still more severe inflammation, the same medicaments are to be used as noted above for ulcerations of the mouth: and between the tooth and gum should be inserted a little roll of soft lint soaked in one of the compositions which I said are called antherae. If the hardness of the gum prevents this, then hot steam by means of a sponge

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is to be applied outside, followed by a cerate. If suppuration shows itself, the steaming is continued longer, and hot honey wine in which a fig has been boiled down is held in the mouth; and before the abscess is quite mature it should be cut into, for fear that the bone may suffer if the pus should be retained longer. But if there is greater swelling, it is better to cut all away so as to free the tooth on both sides. When the pus is let out, if the incision is small it will suffice to hold hot water in the mouth and to foment externally with its steam; if it is larger, lentil gruel should be used, and the same medicaments as for the treatment of ulcerations of the mouth in general. There are also other ulcerations, mostly arising in the gums, for which the same remedies are beneficial; in particular, however, privet should be chewed and the juice held in the mouth. It happens now and then, whether following a gumboil or not, that a discharge of pus persists from an ulcer on the gum; this is due to either a decayed tooth or to bone that is broken or injured and diseased in some other way, and it most commonly occurs through a fissure in the bone. When this is the case, the place must be laid open, the tooth extracted; any projecting scale of bone is to be removed; and any carious bone scraped away. What ought to be done after this has been included in the treatment of other ulcerations. If the gums have retracted from the teeth, the same antherae are of service. It is also useful to chew pears and apples which are not too ripe, and to hold their juice in the mouth. Vinegar that is not too sharp can also be held in the mouth with similar advantage.

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14 Inflammation of the uvula should also cause anxiety when severe. In this case, as before, abstinence is necessary, and it is right to let blood; and if anything prevents this, it is useful to clyster the bowel; and also the head must be kept covered and raised; and the patient must gargle with a decoction of blackberries and lentils. But the uvula its is to be smeared either with omphacium or oak-galls or split alum to any one of which honey has been added; it is also good to smear the uvula with chelidonium juice by means of a spoon, and especially with honey. For this purpose also the composition called Andronium is suitable; it consists of: split alum, red copper scales, blacking, oak-galls, myrrh and antimony sulphide; these are pounded separately and again pounded when mixed together, a dry wine being gradually added till the ingredients have the consistency of honey. After the uvula has been smeared with one of these compounds there is, as a rule, a free flow of phlegm; when this has subsided, hot wine should be gargled. But if there is less severe inflammation, it is sufficient to pound up assafoetida and add cold water to it, and to put the fluid into a spoon and apply it under the uvula itself. When there is only moderate swelling, even cold water held in the same way under the uvula subdues it. Also the same cold water is to be used as a gargle which, with or without the addition of assafoetida, has been applied in this manner to the uvula.

15 If at any time gangrene has attacked ulcers of the mouth, the first thing to consider is whether the general health is bad, and if so to obviate it; next the actual ulcers are to be treated. But if the

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disease is superficial, it is sufficient to use a powdered anthera to dust on the ulcer if moist; if the ulcer is rather dry, to smear it on mixed with a little honey: for somewhat deeper ulcerations, apply burnt papyrus two parts, and orpiment one part; if the mischief penetrates very deeply, burnt papyrus three parts, orpiment one part, or equal parts of rock salt and roasted iris, or copper ore, quick-lime and orpiment, likewise equal parts. But in order that neighbouring spots may not be injured, it is necessary to apply lint dipped in rose oil over these caustic medicaments. Some also put the roasted salt into 250 cc. of strong vinegar until it ceases to dissolve; then the vinegar is boiled to dryness, and the salt pounded up and dusted on. But whenever this medicament is applied, the mouth should be washed out both before and after, either with lentil gruel, or with a decoction of vetches or of olives or of vervains, to any one of which a little honey is added.

Also vinegar of squills held sufficiently long in the mouth is beneficial for such ulceration, so too the salt after evaporation as described above dissolved again in vinegar. But whilst the affection continues to be severe it is necessary both to hold one or other of the remedies in the mouth for some time and to use them two or three times a day, If it is a child who is attacked, a probe wrapped round with wool is dipped in the medicament and held to the ulcer, lest by accident he should swallow the caustic. If it is the gums which are involved, and some teeth are loose, they should be extracted, for they greatly hinder treatment. If these medicaments do no good, the ulcers are to be cauterized. But this procedure is not necessary for any ulcer on

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the lips since excision is more convenient. Indeed such an ulcer, except by adopting surgical measures, whether cauterizing or excising, cannot be replenished with new flesh. But the bones of the bums, which are inert, continue bare after the cauterization; for no flesh grows up afterwards. A lentil dressing, however, is to be applied to the parts cauterized until it is rendered as healthy as possible.

16 Such are the disorders in the head which generally require medicaments. But just below the ears parotid swellings are inclined to occur, sometimes during health when inflammation occurs there, some after prolonged fevers when the force of the disease has been turned in that direction. It is of the nature of an abscession; and so no novel treatment is called for, only what follows must be attended to: if there is swelling without previous disease, repressants are to be tried first; if there has been illness, repressives are objectionable, and it is more convenient that the abscess should mature and be opened as soon as may be.

17 For prominent navels, in order that surgical measures need not be used, abstinence should first be tried, a clyster to induce a motion, and the following applications to the umbilicus: hemlock and soot 4 grams each; washed white lead 24 grams; washed lead 32 grams; 2 eggs; to these nightshade juice also is added. This ought to be kept on for a long time, the patient meanwhile lying up, and taking food in such moderation that all flatulence

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is avoided.

18 Next come subjects relating to the privy parts, for which the terms employed by the Greeks are the most tolerable, and are now accepted for use, since they are met with in almost every medical book and discourse. Not even the common use has commended our coarser words for those who would speak with modesty. Hence it is more difficult to set forth these matters and at the same time to observe both propriety and the precepts of the art. Nevertheless, this ought not to deter me from writing, firstly in order that I may include everything which I have heard of as salutary, secondly because their treatment ought above all things to be generally understood, since every one is most unwilling to show such a complaint to another person.

So then when the penis swells up owing to inflammation, and the foreskin cannot be drawn back, or conversely drawn forwards, the place should be fomented freely with hot water. But when the glans is covered up, hot water should be injected, between it and the foreskin, by means of an ear syringe. If the foreskin is thus softened and rendered thinner, and yields when drawn upon, the rest of the treatment is more speedy. If the swelling goes on, either lentil meal or horehound or olive leaves, boiled in wine, is to be laid on, to each of which, whilst being pounded up, a little honey is to be added; and the penis is to be bandaged upwards to the belly. That is required in the treatment of all its disorders; and the patient ought to keep quiet and abstain from food, and drink water just so much as is justified by thirst. On the next day fomentations with water must again be applied in the same way, and even force should be tried as to

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whether the foreskin will yield; if it does not give way, the foreskin is to be notched at its margin with a scalpel. For when sanies has flowed out this part will become thinner, and the foreskin the more easily drawn upon. But whether the foreskin is made to yield by this procedure, or whether it has at no time proved resistant, ulcerations will be found, either in the ulterior part of the foreskin, or in the glans, or behind this in the penis, and these ulcerations must of necessity be either clean or dry or moist and purulent. If they are dry, they must in the first place be fomented with hot water; then apply either buckthorn in wine, or olive lees in the same, or butter with rose oil. If there is a thin humour, the ulcerations should be bathed with wine, and then to butter and rose oil a little honey and a fourth part of turpentine resin is to be added and this dressing put on. But when pus runs from the ulcers, first they are to be bathed with hot honey wine; than there is put on: pepper 4 grams; myrrh 0.66 gram; saffron and boiled antimony sulphide 8 grams each; these are heated in dry wine to the consistency of honey. Moreover, the same composition is suitable for the tonsils, a dripping uvula, and ulcerations of the mouth and nostrils. Another for the same purpose consists of pepper and myrrh 0.66 gram each; saffron 1.33 gram; cooked antimony sulphide 4 grams; roasted copper 8 grams; these are first pounded together in dry wine, then, when they are dry, are again pounded up in 125 cc. of raisin wine and heated to the consistency of birdlime. Verdigris too mixed with boiled honey, also those compositions noted above for ulcerations of the mouth, or the compositions of Erasistratus or of

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Craton are suitable for applying to suppurating genitals. Also . . . olive leaves are boiled in 375 cc. of wine, to which is added split alum 16 grams, lycium 32 grams; and 250 cc. of honey; and if there is more pus, this medicament is made up with honey; if less, with wine. After treatment, the general procedure, so lon as the inflammation persists, is to apply a poultice such as was mentioned above, and to dress the ulcers daily in the same way. If a free discharge of foul pus begins, the ulcers should be bathed with lentil gruel to c a little honey has been added. Or a decoction is made of olive or of mastich leaves, or of horehound, and the liquid used with honey in the same way; and the same remedies are to be laid on of even omphacium with honey, or that prescription used for the ears containing verdigris and honey, or Andron's composition, or an anthera, as long as a little honey is added to it. Some treat all ulcerations of the kind here spoken of with lycium and wine. If the ulceration spreads more widely and deeply, it should be bathed in the same way, and then there should be applied either verdigris or omphacium with honey or Andron's composition or that containing horehound, myrrh or saffron, split alum boiled, dried rose leaves and oak-galls, 4 grams each; Sinopic minium 8 grams. These are pounded up first separately, then together again, with honey added, until of the consistency of a liquid cerate; then gently heated in a bronze pot but not allowed to boil over. When drops from it begin to solidify, the pot is taken off the fire; and this composition when it is to be

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used is dissolved in honey or wine. But the same by itself is also good for fistulae. The ulceration at times even penetrates to fibrous tissues; there is a running discharge, then sanies, thin and foul, coloured or like water in which fresh meat has been soaked; and the place is painful and has a pricking sensation. This kind, although purulent, is none the less to be treated by bland applications, such as the tetrapharmacum plaster dissolved in rose oil with the addition of a little frankincense; or the composition made of butter, rose oil, resin and honey noted by me above. In particular this ulcer should be fomented freely with hot water, and should be kept covered, not exposed to cold. Sometimes through such an ulceration the penis is so eaten away underneath the foreskin that the glans falls off; in which case the foreskin itself must be cut away all round. It is the rule, whenever the glans of any part of the penis has fallen off, or has been cut away, that the foreskin should not be preserved, lest it come into contact, and adhere to the ulceration, so that afterwards it cannot be drawn back, and further perhaps may choke the urethra. Again, little tumours, which the Greeks call phymata, spring up around the glans; they are burnt away by caustic or the cautery; when the crusts fall off, copper scales are dusted that no more may grow there.

The foregoing ulcerations stop short of canker, which in other parts, but here the more especially, attacks ulcerations. It begins in a black patch. If it invades the foreskin, at once a probe should be passed underneath, upon which the foreskin is to be incised and the margins seized with forceps; then

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what is corrupted is cut away, a little of the sound tissue being also removed; this is followed by cauterization. Whenever there is any cauterization, it follows too that here lentil meal is to be applied; next when the crusts have separated the ulcers are treated like others. But if the canker invades the penis itself, some one of the caustics is dusted on, and especially that composed of quick-lime, copper ore and orpiment. If medicaments fail, in this case also whatever is corrupted should be cut away with a scalpel, so far that some sound tissue is also removed. It is likewise the rule here that after the canker has been cut out, the wound is to be cauterized. But if hard scabs form, whether after caustics or the cautery, there is a great danger that haemorrhage from the penis will follow upon their separation. Therefore there is need for prolonged rest with the body almost immobile until the scabs gently separate from the penis. But if the patient, either purposely or accidentally, from moving about too soon, has detached the scabs and haemorrhage has occurred, cold water should be applied. If this has little effect, recourse must be had to medicaments which suppress haemorrhage. If these do not succeed either, the spot should be carefully and cautiously cauterized, and no opportunity afterwards given for the same risk by any sort of movement.

Occasionally on this part there arises that kind of canker which the Greeks call phagedaena. In such a case there must be no delay whatever: the treatment is immediate cauterization, whether with medicaments as above, or, if these have little effect, with the cautery. There is also a sort of blackness, which is insensitive, but spreads and, if we leave it

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alone, extends even to the bladder, after which nothing can avail If it is situated at the lip of the glans around the urethra, a fine probe should be inserted into the urethra first that it may not be closed up; then the black patch burnt with the cautery. If it has gone deep, whatever is involved is to be cut away. The rest of the treatment is the same as for other kinds of canker.

Again, now and then a callosity forms in the penis; and it is almost entirely without feeling; this also should be excised. But if a carbuncle occurs here, it is first to be irrigated with water through an ear syringe; next the growth is to be cauterized with medicaments, especially copper ore with honey or verdigris with boiled honey, or fried sheep's dung pounded up similarly with honey. When the carbuncle falls off, use the fluid medicaments prepared for ulcers of the mouth.

But if any inflammation occurs in the testicles, not due to injury, blood is to be let from the ankle; there must be abstinence from food and bean meal boiled in honey wine must be applied, always cumin rubbed up in boiled honey; of pounded cumin with the rose oil cerate; or parched linseed, pounded up and boiled in honey wine; or wheat flour in honey wine boiled with cyprus shoots; or pounded lily root. If the testicles have become indurated, apply linseed or fenugreek seed boiled in honey wine; or the cyprus oil cerate; or fine wheat flour pounded up in wine to which a little saffron has been added. If the induration is already of long standing, the most efficacious something is wild cucumber root boiled in honey wine, then pounded up. If the testicles swell as the result of an injury, it is necessary

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to let blood, especially if they are livid as well. Then one of the compositions containing cumin mentioned above should be put on; or the composition which contains: fused soda 4 grams; pine resin and cumin, 8 grams each; black bryony berries without the seeds 16 grams; along with sufficient honey to combine them. If, as the result of an injury, the testicle lacks nutrition, generally pus develops; then the only thing to be done is of cut into the scrotum, and let out the pus, and to excise the testicle itself.

The anus also is subject to many most tedious maladies, which do not require much variation in their treatment. In the first place, the skin of the anus is often fissured at several places; the Greeks call these ragadia. If this is recent, the patient should keep quiet and sit in hot water. Further, pigeon's eggs are to be boiled until hard, shelled, and then one should be covered completely in very hot water, the other is applied hot to the place, the eggs being used thus turn and turn about. Then the tetrapharmacum or the rhypodes is to be diluted for use with rose oil; or fresh wool-grease is mixed with the liquid cerate made up with rose oil; or washed lead with the same cerate; or a little myrrh to turpentine resin; or old oil to litharge; with any one of which the anus is smeared. If the lesion is external, not hidden inside, lint may be soaked in the same medicament and applied; whatever is put on is to be covered by a cerate. In such a case also neither acrid nor coarse food is to be taken nor such as constipates; dry food is not satisfactory

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unless in very small amount; liquid, mild, fatty and glutinous nutriment is better. There is nothing to prevent the use of mild wine.

A condyloma is a small tumour due to inflammation of some kind. When it appears the same prescriptions apply regarding rest, food and drink as have just been set out. Also the tumour itself may be properly treated by fomenting similarly with eggs. But the patient should first sit in a repressant decoction of vervains. Then we may properly apply lentil meal with a little honey, also mellilot boiled in wine, bramble leaves pounded up with the rose oil cerate or a quince, or the inner rind of a pomegranate boiled in wine, pounded up in the same cerate; or copper ore boiled and pounded, then taken up in wool-grease and rose oil; and the composition containing: frankincense 4 grams, split alum 8 grams, white lead 12 grams, litharge 20 grams, into which whilst it is being pounded up rose oil and wine are dropped by turns. But the binder for this part is a square of linen or woollen cloth, which has a loop at each of two adjacent angles and a tape at each of the two opposite ones. The square having been applied underneath with the two loops upon the abdominal wall, the pes are brought round from behind and passed through the loop on its corresponding side. Each tape being drawn tight, that on the right side is carried round the back to the left, and the left tape back and round to the right side. Finally, the ends of the tapes are tied together in front of the abdomen. But if a long-standing condyloma is already indurated and does not yield to the foregoing measures, it can be burnt with a caustic consisting of: verdigris 4

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grams; myrrh 16 grams; cumin 32 grams; frankincense 48 grams; antimony sulphide, poppy juice, and acacia juice, 64 grams each, and by this medicament some also produce a fresh surface on the ulcers, which I have described above. If this has little effect upon the condyloma it is possible to apply strong caustics. When the tumour has been eaten away, a change is made to mild medicaments.

There is also a third lesion, in which vein mouths rise up as from little heads, which at frequent intervals pour out blood: the Greeks call them haemorrhoids. In women they may even appear at the vulvar orifice. There are some in whom it is hardly safe to suppress such a flux of blood, those who are not the weaker for it; for to these it is a purgation, not a disease. Hence some, after being cured, since the blood had no way out, and diseased matter was diverted towards the praecordia and viscera, have been carried off by sudden diseases of the gravest kind. But if the bleeding is doing harm to anyone, he should sit in a decoction of vervains, and the best thing to apply is pomegranate rind pounded up with dried rose leaves, or anything else that stops bleeding. But inflammation especially tends to occur when first a rather violent evacuation of the bowels has ruptured the epidermis, and later a hard stool has injured this spot. Then the patient should sit in soft water and foment with eggs; yolk of egg which has been stirred up with rose leaves and boiled in raisin wine is to be applied; if the haemorrhoids are internal, by the finger, if external, spread upon linen. The medicaments described above for recent fissures are suitable here also. In this case the diet

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should be the same as in the preceding one. But if the above treatment has little effect, it is usual to apply caustics to destroy these small heads. If they are already of long standing, then, on the authority of Dionysius, sandarach should be dusted on, and after that the composition should be applied containing copper scales and orpiment 20 grams, limestone 32 grams; the next day the haemorrhoids are to be punctured with a needle. The small heads having been cauterized, a scab is produced which prevents blood from running out. But whenever haemorrhage is thus suppressed, the diseased matter is to be dispersed by free exercise that no danger may ensue. And besides, in men and in women who are not menstruating, blood should be let from the arm now and then.

If the anus itself, or, as sometimes happens, the mouth of the womb, prolapses, examination should be made to see whether what is protruding is clean, or is covered with a mucous humour. If it is clean, the patient should sit in water; either in salt water or in water boiled with vervains or pomegranate rind. If it is moist, it should be bathed with dry wine and smeared with roasted wine lees. After being treated in one of these ways, it is to be replaced, and pounded plantain or willow leaves boiled in vinegar applied, next lint, and wool over it: and these must be bandaged on, whilst the legs are kept tied together.

In the same place an ulceration like a fungus may arise, which must be bathed with lukewarm water in winter, at other seasons in cold water; then copper scales are dusted on, and over that is applied a cerate made with myrtle oil to which has been

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added a little of copper scales, soot, and lime. If this treatment gives no relief, it is to be cauterized, either with more active medicaments or with the cautery.