§9Λεκτέον δὲ ἐφεξῆς τὰ χολώδη ῥεύματα.
Next, we must speak of the bilious fluxes.
νενίκηκε γὰρ οὐκ οἶδ’ ὅπως τὸ τῶν ἰατρῶν ἔθος, ἄν τε χολὴν ὀνομάσωμεν ἁπλῶς ἄν τε χολώδη χυμὸν, ἀκούειν ἡμᾶς τὴν ὠχρὰν καὶ πικρὰν, οὐ τὴν ὀξεῖαν καὶ μέλαιναν.
For, I know not how, the custom of physicians has prevailed that, whether we simply name "bile" or "bilious humor," we understand the yellow and bitter one, not the acid and black one.
ἐκείνην γὰρ ἀεὶ μετὰ προσθήκης ὀνομάζουσι, συνάπτοντες τῇ προσηγορίᾳ τοῦ χυμοῦ τὴν χρόαν.
For they always name the latter with an addition, joining the color to the appellation of the humor.
ὅταν οὖν κατασκήψῃ χολῶδες ῥεῦμα, τὸ μὲν ἀκριβὲς ἑλκοῖ τὸ δέρμα, τὸ δὲ ὑδατώδεσιν ἰχῶρσιν ἢ αἵματι συμμιγὲς ἧττόν ἐστι δριμὺ καὶ μᾶλλον εἰς ὄγκον αἴρει τὸ μέρος ἢ ἑλκοῖ.
Therefore, when a bilious flux attacks, that which is pure ulcerates the skin, while that which is mixed with watery ichors or blood is less acrid and rather raises the part into a tumor than ulcerates it.
τουτὶ μὲν οὖν ἐρυσίπελας ὀνομάζεται, θάτερος δὲ ἕρπης.
The latter indeed is named erysipelas, and the former herpes.
ἐνδείκνυται δὲ τὸν ἐργασάμενον χυμὸν ἥ τε χρόα καὶ ἡ θερμότης τῶν παθῶν.
And both the color and the heat of the affections indicate the humor that produced them.
ἐπεὶ δὲ αὖ καὶ τοῦ δριμέος ὁ μὲν ἧττον, ὁ δὲ μᾶλλον ὑπάρχει τοιοῦτος, ἰστέον ἐπὶ μὲν τοῦ δριμυτέρου τὸν ἐσθιόμενον ἕρπητα συνίστασθαι, οὕτω γὰρ αὐτὸν ὠνόμασεν Ἱπποκράτης, ὑπὸ δὲ θατέρου τὸν ἕτερον, ᾧ καὶ κεγχρίαν ἔνιοι τῶν μεθ’ Ἱπποκράτην τοὔνομα ἔθεντο, διότι κέγχροις ὁμοίας ἐξοχὰς ἀποτελεῖ κατὰ τὸ δέρμα.
But since, moreover, of the acrid humor, one is less and another is more so, it must be known that upon the more acrid is constituted the eating herpes (for so Hippocrates named it), and by the other is constituted the other herpes, which some of those after Hippocrates named "cenchrias," because it produces eminences on the skin resembling millet seeds.
φλέγματι μὲν οὖν μοι δοκεῖ μεμῖχθαι τὸ τοιοῦτον ῥεῦμα· τὸ δὲ ἕτερον ἀκριβοῦς εἶναι χολῆς.
Indeed, such a flux seems to me to be mixed with phlegm, while the other is of pure bile.
διὰ τοῦτο καὶ μετὰ ἀναβρώσεως γίγνεται, τὸ συνεχὲς ἀεὶ τοῦ δέρματος ἐπιλαμβάνοντος τοῦ πάθους, ὅθεν αὐτῷ καὶ τοὔνομα.
For this reason, it also occurs with erosion, the affection always seizing the contiguous skin, whence also it has its name.
μιχθέντος δὲ αἵματος ἴσου τῇ χολῇ, τὸ πάθος ἀμφοῖν ἐν μέσῳ τὴν ἰδέαν ἐστὶ καὶ τὴν φύσιν ἐρυσιπέλατός τε καὶ φλεγμονῆς.
And when blood is mixed equally with bile, the affection is in the middle between erysipelas and inflammation in its appearance and nature.
εἰ δὲ πολὺ ἐπικρατοίη τὸ ἕτερον, ἀπὸ τοῦ κρατοῦντος ἡ προσηγορία τῷ πάθει, κατηγορεῖται δὲ αὐτῷ τὸ μιχθέν.
But if one should greatly prevail, the appellation of the affection is from that which prevails, and that which is mixed is predicated of it.
ἐρυσίπελας μὲν οὖν φλεγμονῶδες ἐπὶ τῇ ξανθῇ κρατούσῃ, φλεγμονὴ δὲ ἐρυσιπελατώδης ἐπὶ τῷ κρατοῦντι αἵματι λέγεται.
Thus, it is called a "phlegmonous erysipelas" when the yellow bile prevails, and an "erysipelatous phlegmon" when the blood prevails.
παραπλήσιος δὲ καὶ ἡ τῶν ἄλλων μίξεων ἑρμηνεία, φλεγμονὴ σκιῤῥώδης, καὶ σκίῤῥος φλεγμονώδης, οἴδημά τε φλεγμονῶδες καὶ οἰδηματώδης φλεγμονή. τέτταρα γὰρ ταῦτ’ ἔστι συνεχῶς γινόμενα πάθη δι’ ἐπιῤῥοὴν ὑγρῶν, ἐρυσίπελας καὶ οἴδημα καὶ φλεγμονὴ καὶ σκίῤῥος.
And the designation of the other mixtures is similar: "scirrhous phlegmon" and "phlegmonous scirrhus," "phlegmonous edema" and "edematous phlegmon." For these are four affections occurring continually through the influx of fluids: erysipelas, edema, inflammation, and scirrhus.
ἐρυσίπελας μὲν οὖν, ὡς εἴρηται, χολώδους ῥεύματος κρατήσαντος· φλεγμονὴ δὲ, αἱματώδους· οἴδημα δὲ λεπτοῦ τὴν σύστασιν φλέγματος, ὥσπέρ γε παχέος καὶ γλίσχρου τὸ ἕτερον εἶδος τῶν σκίῤῥων· τὸν γὰρ ἕτερον ἡ ἰλὺς τοῦ αἵματος ἀπεργάζεται.
Now erysipelas, as has been said, is when the bilious flux prevails; inflammation, when the bloody; edema, when it is of phlegm thin in its constitution, just as indeed the other kind of scirrhous tumors is of thick and viscid phlegm; for the other scirrhus is produced by the dregs of the blood.
ἔστι δὲ δήπου καὶ αὐτὴ διττὴ, τὸ μὲν ἕτερον εἶδος, ὅπερ Ἱπποκράτης ὀνομάζει μέλαιναν· τὸ δ’ ἕτερόν ἐστι μὲν καὶ τοῦτο μέλαν, ἰδίαν δὲ ἔχει τὴν προσηγορίαν· ὀνομάζεται γὰρ μέλαινα χολή. ταύτης μὲν οἱ καρκῖνοι, θατέρου δὲ τοῦ μέλανος ἕν τι τῶν σκίῤῥων εἶδος ἔγγονον ὑπάρχει.
And this is indeed also twofold, the one kind being that which Hippo- crates names "black [bile]"; the other is indeed also black, but has its own appellation, for it is named "black bile." From the latter indeed cancers arise, while from the other black [matter] arises a certain kind of scirrhus.
διορίζεται δὲ ἀπὸ θατέρου τοῦ φλεγματικοῦ τῇ χρόᾳ.
And it is distinguished from the other, the phlegmatic one, by its color.
κοινὰ δ’ ἀμφοῖν ὁ μείζων τοῦ κατὰ φύσιν ὄγκος ἀνώδυνός τε καὶ σκληρὸς, ἥ τε γένεσις ἀμφοτέρων ἐνίοτε μὲν ἐξ ἀρχῆς, ἔστιν ὅτε δὲ ἐκ μεταπτώσεως ἤτοι φλεγμονῆς, ἢ ἐρυσιπελάτων, ἢ οἰδήματος, ἐμψυχθέντων ἀμετρότερον.
Common to both is a tumor larger than natural, painless and hard, and the generation of both is sometimes from the beginning, and sometimes from a transition either of inflammation, or of erysipelas, or of edema, when they are immoderately cooled.
§10Ἐγγὺς δ’ ἐστὶ σκίῤῥου τά τε ἐκχυμώματα καλούμενα καὶ τὰ μελάσματα, πρεσβύταις μάλιστα συμβαίνοντα θλασθεισῶν τῶν φλεβῶν.
Close to scirrhus are what are called ecchymoses and melasmas, occurring especially in the elderly when the veins are bruised.
ἔστι δὲ καὶ τούτων ἔνια μὲν, ὡς εἴρηται, μέλανα, καὶ μάλιστα γέρουσι γίγνεται ταῦτα, διὰ σμικρὰς προφάσεις· ἔνιοι δὲ καὶ ἐρυθροὶ καὶ μέλανες ἐν τῷ μεταξὺ, τὰ καλούμενα πελιδνά.
And some of these, as has been said, are black, and these occur especially in old men from small causes; some indeed are between red and black, what are called livid.
γίγνεται δ’ ἅπαντα τὰ τοιαῦτα ἐκ τῶν φλεβῶν αἵματος ἐκχεομένου, ποτὲ μὲν διὰ τῶν χιτώνων θλασθέντων, ἔστι δ’ ὅτε ἀναστομωθέντων κατὰ τὸ πέρας.
All such things occur when blood is poured out from the veins, sometimes because the tunics are bruised, and sometimes because they are anastomosed at the end.
§11Ἀρτηρίας δ’ ἀναστομωθείσης τὸ πάθος ἀνεύρυσμα καλεῖται.
When an artery is anastomosed, the affection is called an aneurysm.
γίγνεται δὲ τρωθείσης αὐτῆς, ἐπειδὰν εἰς οὐλὴν μὲν ἀφίκηται τὸ προσκείμενον αὐτῇ δέρμα, μένῃ δὲ τῆς ἀρτηρίας ἕλκος μήτε συμφυθείσης μήτε συνουλωθείσης μήτε σαρκὶ φραχθείσης.
It occurs when it is wounded, whenever the skin adjacent to it arrives at a scar, but the ulcer of the artery remains, neither being united, nor scarred over, nor obstructed by flesh.
διαγινώσκεται δὲ τὰ τοιαῦτα παθήματα τῶν σφυγμῶν τῶν ἐργασαμένων ἀρτηριῶν, ἀλλὰ καὶ θλιβομένων ἀφανίζεται πᾶς ὁ ὄγκος, παλινδρομούσης εἰς τὰς ἀρτηρίας τῆς ἐργαζομένης αὐτὸν οὐσίας, ἣν ἐδείξαμεν ἐν ἄλλοις ἅμα λεπτὸν καὶ ξανθὸν εἶναι αἷμά τι πνεύματι λεπτῷ καὶ πολλῷ συμμιγές.
And such affections are diagnosed from the pulsations of the arteries that produced them; but also, when pressed, the whole tumor disappears, the substance producing it running back into the arteries, which substance we have shown in other works to be at once a thin and yellow blood mixed with thin and abundant pneuma.
εὐθὺς δὲ καὶ θερμότερόν ἐστι τὸ αἷμα τοῦτο τοῦ κατὰ τὰς φλέβας καὶ τρωθέντος τοῦ ἀνευρύσματος ἐξακοντίζεται δυσεπισχέτως.
And immediately this blood is warmer than that in the veins, and when the aneurysm is wounded, it spurts out difficulty to restrain.
ὑποχωρεῖ μὲν οὖν κᾀν τοῖς οἰδήμασιν ἡ ὕλη θλιψάντων τῶν δακτύλων, καὶ βοθροῦται τὸ μέρος, ἀλλ’ οὔτε σφυγμός ἐστιν ἐν τούτῳ τῷ πάθει, καὶ ἡ χροιὰ λευκοτέρα, καὶ τὸ οἴδημα πολλῷ πλατύτερόν τε καὶ μεῖζον ἀνευρύσματος, πλὴν εἴποτε θρόμβος τις ἐγγενόμενος ἐξ ἀνευρύσματος σφάκελον ἐργάζοιτο.
Now, also in edemas the matter recedes when the fingers press, and the part is pitted; but there is no pulsation in this affection, and the color is whiter, and the edema is much broader and larger than an aneurysm, except if ever some thrombus arising from an aneurysm should produce a sphacelus.
καλῶ δ’ οὕτω τὴν φθορὰν τῶν στερεῶν σωμάτων ἅπασαν, ὡς καὶ τοῖς ὀστοῖς ἐγγίνεσθαι, μήτοι γε δὴ σαρξὶν, ἢ ἀγγείοις.
And I call thus (sphacelus) all corruption of the solid bodies, such as occurs even in bones, not to mention indeed in flesh or vessels.
ἡ δὲ γάγγραινα νέκρωσις καὶ αὕτη τῶν στερεῶν σωμάτων, ἀλλ’ οὔτ’ ὀστοῖς ἐπιγίγνεται καὶ ταῖς μεγίσταις ἕπεται φλεγμοναῖς, εἶδος μέν τι τῶν σφακελῶν ὑπάρχουσα, προσηγορίαν δὲ ἰδίαν ἐξαίρετον ἐπὶ τῇ κοινῇ κεκτημένη.
But gangrene is also a mortification of the solid bodies, but it does not happen to bones, and it follows the greatest inflammations, being a certain species of sphacelus, but having its own special appellation in addition to the common one.
ταῦτ’ οὖν αὐτάρκως διώρισται, καὶ λέγειν ἤδη καιρὸς περὶ τῶν μελαγχολικῶν ῥευμάτων.
These things, then, have been sufficiently distinguished, and it is now time to speak of the melancholic fluxes.