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                                                            400 BC
                                 ON HEMORRHOIDS

                                 by Hippocrates

                          translated by Francis Adams


  The disease of the hemorrhoids is formed in this way: if bile or
phlegm be determined to the veins in the rectum; it heats the blood in
the veins; and these veins becoming heated attract blood from the
nearest veins; and being gorged the inside of the gut swells
outwardly; and the heads of the veins are raised up; and being at
the same time bruised by the faeces passing out; and injured by the
blood collected in them; they squirt out blood; most frequently
along with the faeces; but sometimes without faeces。 It is to be cured
thus:

  2。 In the first place it should be known in what sort of a place
they are formed。 For cutting; excising; sewing; binding; applying
putrefacient means to the anus;…all these appear to be very formidable
things; and yet; after all; they are not attended with mischief。 I
recommend seven or eight small pieces of iron to be prepared; a fathom
in size; in thickness like a thick specillum; and bent at the
extremity; and a broad piece should be on the extremity; like a
small obolus。 Having on the preceding day first purged the man with
medicine; on the day of the operation apply the cautery。 Having laid
him on his back; and placed a pillow below the breech; force out the
anus as much as possible with the fingers; and make the irons red…hot;
and burn the pile until it be dried up; and so as that no part may
be left behind。 And burn so as to leave none of the hemorrhoids
unburnt; for you should burn them all up。 You will recognize the
hemorrhoids without difficulty; for they project on the inside of
the gut like dark…colored grapes; and when the anus is forced out they
spurt blood。 When the cautery is applied the patient's head and
hands should be held so that he may not stir; but he himself should
cry out; for this will make the rectum project the more。 When you have
performed the burning; boil lentils and tares; finely triturated in
water; and apply as a cataplasm for five or six days。 But on the
seventh; cut a soft sponge into a very slender slice; its width should
be about six inches square。 Then a thin smooth piece of cloth; of
the same size as the sponge; is to be smeared with honey and
applied; and with the index finger of the left hand the middle of
the sponge is to be pushed as far up as possible; and afterward wool
is to be placed upon the sponge so that it may remain in the anus。 And
having girded the patient about the loins and fastened a shawl to
the girdle; bring up this band from behind between the legs and attach
it to the girdle at the navel。 Then let the medicine which I
formerly said is calculated to render the skin thick and strong; be
bound on。 These things should be kept on for not less than twenty
days。 The patient should once a day take a draught from flour or
millet; or bran; and drink water。 When the patient goes to stool the
part should be washed with hot water。 Every third day he should take
the bath。

  3。 Another method of cure:…Having got the anus to protrude as much
as possible; foment with hot water; and then cut off the extremities
of the hemorrhoids。 But this medicine should be prepared beforehand;
as an application to the wound:…Having put urine into a bronze vessel;
sprinkle upon the urine the flower of bronze calcined and finely
triturated; then; when it is moistened; shake the vessel and dry in
the sun。 When it becomes dry; let it be scraped down and levigated;
and apply with the finger to the part; and having oiled compresses;
apply them; and bind a sponge above。

  4。 Another method:…There grows upon the bleeding condyloma; a
protuberance like the fruit of the mulberry; and if the condyloma be
far without; an envelope of flesh is adherent to it。 Having placed the
man over two round stones upon his knees; examine; for you will find
the parts near the anus between the buttocks inflated; and blood
proceeding from within。 If; then; the condyloma below the cover be
of a soft nature; bring it away with the finger; for there is no
more difficulty in this than in skinning a sheep; to pass the finger
between the hide and the flesh。 And this should be accomplished
without the patient's knowledge; while he is kept in conversation。
When the condyloma is taken off; streaks of blood necessarily flow
from the whole of the torn part。 It must be speedily washed with a
decoction of galls; in a dry wine; and the bleeding vein will
disappear along with the condyloma; and its cover will be replaced。
The older it is; the more easy the cure。

  5。 But if the condyloma be higher up; you must examine it with the
speculum; and you should take care not to be deceived by the speculum;
for when expanded; it renders the condyloma level with the surrounding
parts; but when contracted; it shows the tumor right again。 It is to
be removed by smearing it with black hellebore on the finger。 Then; on
the third day; wash it out with a dry wine。 You need not be
surprised that there is no discharge of blood when you remove the
condyloma; for neither; if you cut off the hands or legs at the
articulations will there be any flow of blood; but if you cut them off
above or below the joints; you will find there hollow veins which pour
out blood; and you will have difficulty in stopping the bleeding。 In
the same manner; the bleeding vein in the anus; if you cut it above or
below the point of separation of the condyloma; will pour forth blood;
but if you take away the condyloma at its junction (with the natural
parts?) there will be no flow of blood。 If matters then be thus put to
rights; it will be well; but otherwise burn it; taking care not to
touch the place with the iron; but bringing it close so as to dry it
up; and apply the flos aeris in the urine。

  6。 Another method of curing hemorrhoids:…You must prepare a
cautery like the arundo phragmites; and an iron that exactly fits is
to be adapted to it; then the tube being introduced into the anus; the
iron; red hot; is to be passed down it; and frequently drawn out; so
that the part may bear the more heat; and no sore may result from
the heating; and the dried veins may heal up。 But if you are neither
disposed to burn nor excise; having first fomented with plenty hot
water and turned out the anus; levigate myrrh; and having burnt
galls and Egyptian alum; in the proportion of one and a half to the
other things; and as much of melanteria; these things are all to be
used in a dry state。 The hemorrhoid will separate under the use of
these medicines; like a piece of burnt hide。 You are to proceed thus
until the whole are removed; and a half part of burnt chalcitis does
the same thing。 But if you wish to effect the cure by suppositories;
take the shell of the part fish a third part of plumbago; bitumen;
alum; a little of the flos aeris; galls; a little verdigris; having
poured a small quantity of boiled honey on these; and formed an oblong
suppository; apply until you remove them。

  7。 An hemorrhoid in a woman may be thus cured。 Having fomented
with plenty of hot water; boil in the water certain of the fragrant
medicines; add pounded tamarisk; roasted litharge and galls; and
pour on them white wine; and oil; and the grease of a goose;
pounding all together。 Give to use after fomenting。 In fomenting the
anus is to be made to protrude as much as possible。



                                    THE END


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