§1## ΠΕΡΙ ΣΥΡΙΓΓΩΝ.
1.
ΠΕΡΙ ΣΥΡΙΓΓΩΝ. 1.
Σύριγγες γίνονται μὲν ὑπὸ φλασμάτων καὶ φυμάτων, γίνονται δὲ καὶ ὑπὸ ἐρεσίης, καὶ ἱππασίης, ὅταν ἀθροισθῇ ἐν τῷ γλουτῷ αἷμα πλησίον τῆς ἕδρης·
Fistulae are produced by contusions and tubercles, and they are also produced by rowing or horse-riding, when blood accumulates in the buttock near the anus.
σηπόμενον γὰρ νέμεται ἐς τὰ μαλθακὰ, ἅτε ὑγροῦ ἐόντος τοῦ τε ἀρχοῦ, καὶ τῆς σαρκὸς μαλθακῆς, ἐν ᾗ νέμεται, ἔστ’ ἂν τὸ φῦμα ῥήξῃ καὶ κάτω ἐς τὸν ἀρχὸν διασήψῃ.
For, when corrupted, it spreads into the soft parts, since the rectum is moist and the flesh in which it spreads is soft, until the tubercle breaks and corrupts downwards into the rectum.
Ἐπὴν δὲ τοῦτο γένηται, συριγγοῦται, καὶ ἰχὼρ ῥέει, καὶ κόπρος ῥεῖ δι’ αὐτῆς καὶ φῦσα καὶ βδελυγμίη πολλή.
When this occurs, a fistula is formed, and ichor flows, and feces flow through it, and flatus and much fetor.
Ὑπὸ μὲν οὖν τῶν φλασμάτων γίνεται, ὁκόταν τι τῶν περὶ τὸν ἀρχὸν χωρίων φλασθῇ ὑπὸ πληγῆς, ἢ ὑπὸ πτώματος, ἢ ὑπὸ τρώματος, ἢ ἱππασίης, ἢ ἐρεσίης, ἢ ὅσα τοιουτότροπά ἐστι· ξυνίσταται γὰρ αἷμα· σηπόμενον δὲ ἐκπυΐσκεται· ὑπὸ δὲ τοῦ ἐκπυϊσκομένου πάσχει ἅπερ ἐπὶ τῶν φυμάτων εἴρηται.
It is produced, then, by contusions when any of the parts about the rectum are contused by a blow, or by a fall, or by a wound, or by horse-riding, or by rowing, or whatever is of such a kind; for the blood congests, and when corrupted, it suppurates; and by the suppurating matter, it suffers the same things as have been described in the case of tubercles.
§22.
2.
Πρῶτον μὲν οὖν ὅταν τι τοιοῦτον αἴσθῃ φυόμενον φῦμα, τάμνειν ὡς τάχιστα ὠμὸν πρὶν ἢ διαπυῆσαι ἐς τὸν ἀρχόν.
First, then, whenever you perceive any such tubercle forming, you must cut it as quickly as possible while raw, before it suppurates into the rectum.
§33.
3.
Ἢν δὲ νοσέοντα ἤδη τὴν σύριγγα παραλάβῃς, λαβὼν σκορόδου φύσιγγα νεαρὴν, ἀνακλίνας τὸν ἄνθρωπον ὕπτιον, τὰ σκέλεα διαγαγὼν τὸ μὲν ἔνθα, τὸ δὲ ἔνθα, τὴν φύσιγγα καθιέναι ἔστ’ ἂν προσκόψῃ, μετρῆσαί τε τὸ βάθος τῆς συρίγγος τῇ φύσιγγι, καὶ σεσέλιος δὲ ῥίζαν κόψας ὡς λεπτοτάτην, ὕδωρ ἐπιχέας, βρέχειν τέσσαρας ἡμέρας·
But if you receive a patient who already has a fistula, take a fresh clove of garlic, lay the man on his back, separate his legs, one this way and one that way, and introduce the clove until it meets an obstacle, and measure the depth of the fistula with the clove; and having cut the root of seseli as fine as possible, pour water over it, and let it soak for four days.
καὶ προνηστεύσας πινέτω μέλιτι παραμίσγων τὸ ὕδωρ κατὰ τρεῖς κυάθους· ἐν τούτῳ κάθαιρε καὶ τὰς ἀσκαρίδας.
And after a previous fast, let him drink the water mixed with honey, three cyathi at a time; during this time, also clear out the roundworms.
Ὁκόσοι δ’ ἂν καταλείφθωσιν ἀθεράπευτοι, θνήσκουσιν.
Those who are left untreated die.
Ἔπειτα ὀθόνιον βύσσινον τιθυμάλλου ὀπῷ τοῦ μεγάλου δεύσας, καταπάσσων ἄνθος χαλκοῦ ὀπτὸν τετριμμένον, στροβίλην ποιήσας ἴσην τῇ σύριγγι τὸ μῆκος, ῥάμμα διεὶς δι’ ἄκρας τῆς στροβίλης καὶ αὖθις διὰ τῆς φύσιγγος, ὕπτιον κατακλίνας τὸν ἄνθρωπον, κατοπτῆρι κατιδὼν τὸ διαβεβρωμένον τοῦ ἀρχοῦ, ταύτῃ τὴν φύσιγγα διεῖναι·
Then, having moistened a piece of fine linen with the juice of the great tithymallus, and sprinkling upon it ground roasted copper flower, make a tent equal in length to the fistula, pass a thread through the tip of the tent and again through the clove, lay the man on his back, inspect the eroded part of the rectum with a speculum, and pass the clove through there.
καὶ ὁκόταν παρακύψῃ ἐς τὸν ἀοχὸν, ἐπιλαμβανόμενος ἕλκειν, ἄχρις οὗ ἡ στροβίλη διωσθῇ καὶ ἰσωθῇ τῷ τε ἄνω καὶ τῷ κάτω·
And when it appears in the rectum, take hold of it and pull, until the tent is pushed through and made equal both above and below.
ἐπὴν δὲ ἐσωσθῇ, βάλανον ἐνθεὶς κερατίνην ἐς τὸν ἀρχὸν, γῆ διαχρίσας σμηκτρίδι, τὸν ἀρχὸν ἐᾷν·
When it is equalized, place a horn suppository into the rectum, smear it with cleansing earth, and leave the rectum alone.
ἐπὴν δὲ ἀποπατέη, ἐξαιρέειν, καὶ αὖθις προστιθέναι, ἕως ἂν πεμπταίη γένηται·
When he evacuates, take it out, and put it back again, until it becomes the fifth day.
ἕκτῃ δὲ ἡμέρῃ ἐξαιρέειν, ἕλκων τὴν στροβίλην ἔξω τῆς σαρκός·
On the sixth day, take it out, pulling the tent out of the flesh.
καὶ τρίψαι στυπτηρίην μετὰ ταῦτα, καὶ πλήσας τὴν βάλανον καὶ ἐς τὸν ἀρχὸν ἐμβαλὼν, ἐᾷν ἄχρις οὗ ἡ στυπτηρίη ὑγρὴ γένηται·
And grind alum after this, and having filled the suppository and inserted it into the rectum, leave it until the alum becomes liquid.
τὸν δὲ ἀρχὸν σμύρνῃ ἀλείφειν, ἄχρις οὗ ἂν δοκέῃ ξυμπεφυκέναι·
And anoint the rectum with myrrh, until it seems to have consolidated.
§44.
4.
Ἑτέρη θεραπείη· ὠμόλινον λαβὼν ὡς λεπτότατον, συμβάλλειν ὅσον σπιθαμιαῖον πεντάπλουν, καὶ ξυμπεριλαβεῖν ἱππείην τρίχα·
Another treatment: taking raw flax as fine as possible, double it to about a span's length, fivefold, and wrap a horse-hair with it.
ἔπειτα ποιησάμενος μήλην κασσιτερίνην ἐπ’ ἄκρου τετρημένην, ἐνείρας ἐς τὴν μήλην τὴν ἀρχὴν τοῦ ὠμολίνου συμβεβλημένου, καθιέναι τὴν μήλην ἐς τὴν σύριγγα, καὶ ἅμα τῆς ἀριστερῆς χειρὸς τὸν δάκτυλον τὸν λιχανὸν καθιέναι ἐς τὴν ἕδρην·
Then, having made a tin probe perforated at the tip, thread the end of the bundled flax into the probe, lower the probe into the fistula, and at the same time lower the index finger of the left hand into the anus.
ἐπὴν δὲ ψαύσῃ ἡ μήλη τοῦ δακτύλου, ἄγειν ἕξω τῷ δακτύλῳ, ἀποκάμψας τῆς μήλης τὸ ἄκρον καὶ τὴν ἀρχὴν τὴν ἐν τῇ μήλῃ·
When the probe touches the finger, bring it out with the finger, bending the tip of the probe and the end that is in the probe.
καὶ τὴν μὲν μήλην πάλιν ἐξαιρέειν, τοῦ δὲ ὠμολίνου τὰς ἀρχὰς ἀφάψαι δὶς ἢ τρίς· καὶ τὸ λοιπὸν τοῦ ὠμολίνου ἐπιστρέψας, ἐπιδῆσαι πρὸς τὸ ἄμμα· ἔπειτα κελεύειν ἀπελθόντα διαπρήσσεσθαι τὰ ἑωυτοῦ.
And take out the probe again, and tie the ends of the flax twice or thrice; and twist the rest of the flax, and bind it to the knot; then bid him go away and attend to his own business.
Ὁκόσον δὴ, σηπομένης τῆς σύριγγος, χαλᾶται τοῦ ὠμολίνου, τοῦτο ἐπιτείνειν καὶ ἐπιστρέφειν αἰεὶ καθ’ ἑκάστην ἡμέρην·
As much of the flax as becomes loose daily as the fistula rots, tighten and twist this always every day.
ἢν δέ σοι τὸ ὠμόλινον διασαπῇ πρόσθεν ἢ τὴν σύριγγα διαβρωθῆναι, πρὸς τὴν τρίχα προσάψας ἕτερον ὠμόλινον διεῖναι καὶ ἀφάψαι (ἡ γὰρ θρὶξ διὰ τοῦτο παραβάλλεται τῷ ὠμολίνῳ ὅτι ἄσηπτός ἐστιν)·
If your flax rots before the fistula is eaten through, attach another flax to the hair, pass it through, and tie it (for the hair is added to the flax for this reason, because it does not rot).
ἐπὴν δὲ διασαπῇ ἡ σύριγξ, τάμνεσθαι χρὴ σπόγγον μαλακὸν ὡς λεπτότατον προστεθέντα·
When the fistula has rotted through, a soft sponge cut as thin as possible should be applied.
ἔπειτα ἐς μὲν τὴν σύριγγα ἄνθος χαλκοῦ ὀπτὸν συχνὸν τῇ μήλῃ ἐνθεῖναι, τὸν δὲ σπόγγον ἀλεῖψαι μέλιτι, καὶ ὑποβαλὼν μέσον τῷ λιχανῷ δακτύλῳ τῆς ἀριστερῆς χειρὸς ὦσαι πρόσω, καὶ προσθεὶς ἕτερον σπόγγον ἀναδῆσαι τὸν αὐτὸν τρόπον, ὅν περ καὶ ἐπὶ τῇσιν αἱμοῤῥοΐσιν·
Then, put plenty of ground roasted copper flower into the fistula with the probe, and anoint the sponge with honey, and having placed it on the middle of the index finger of the left hand, push it forward, and having applied another sponge, bind it up in the same manner as for hemorrhoids.
τῇ δὲ αὔριον ἀπολύσας, περινίψαι ὕδατι θερμῷ, καὶ σπόγγῳ τῷ δακτύλῳ τῆς ἀριστερῆς χειρὸς πειρᾷν διακαθαίρειν τὴν σύριγγα, καὶ αὖθις πάλιν τὸ ἄνθος ἐπιδῆσαι·
On the next day, loose it, wash around with warm water, and try to clean out the fistula with a sponge on the finger of the left hand, and bind up the copper flower again.
ταῦτα ποιέειν ἑπτὰ ἡμέρας, ἐν ταύτῃσι γὰρ μάλιστα ὁ χιτὼν τῆς σύριγγος ἐκσήπεται·
Do this for seven days, for in these days especially the membrane of the fistula rots away.
τὸ δὲ λοιπὸν, ἔστ’ ἂν ὑγιανθῇ, τουτέῳ ἐπιδεῖν·
For the rest, until it is healed, bind it up in this way.
κατὰ γὰρ τοῦτον τὸν τρόπον ὑπὸ τοῦ σπόγγου διαναγκαζομένη καὶ ἀναπτυσσομένη ἡ σύριγξ οὔτε πάλιν ξυμπέσοι ἂν, οὔτε τὸ μὲν αὐτῆς ὑγιανθείη ἂν, τὸ δὲ πάλιν ξυμπληρωθείη, ἀλλ’ ἐν ἑωυτῇ πᾶσα ὑγιὴς ἔσται.
For in this way, being forced open and unfolded by the sponge, the fistula will neither close up again, nor will one part of it heal while another part is filled up again, but it will all become healthy in itself.
Ἐν τῇ θεραπείῃ δὲ προσαιονᾷν ὕδατι πολλῷ θερμῷ, καὶ λιμοκτονέειν.
During the treatment, apply fomentations of much warm water, and starve the patient.