400 BC

ON HEMORRHOIDS

by Hippocrates

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

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Original file name: On Hemorrhoids -400 BC - converted on Monday, 21 July 2003, 13:44