On Hemorrhoids — First Draft Translation

ON HEMORRHOIDS. 1. The disease of hemorrhoids comes about in this way: when bile or phlegm settles into the veins in the rectum, it heats the blood in the small vessels; the small vessels, being heated, draw blood from the nearest small vessels, and filling up, they swell outward into the interior of the rectum. The heads of the small vessels protrude, and being chafed at the same time by the passing of the stool, and pressed at the same time by the blood gathering within, they shoot out blood — most often together with the stool, but sometimes apart from the stool. 2. The treatment should be as follows. First, it must be known in what place they occur. For in the rectum, cutting and excising and suturing and splitting and causing to rot — these seem the most fearful things — you will do no harm. I instruct that seven or eight iron instruments be prepared, a span in length, in thickness like a thick probe; bent at the tip, with the flat end sized like a small obol. Having first cleansed with a purging drug beforehand, and on the very day you intend to cauterize, lay the man on his back with a cushion placed under his loins, and use the fingers to push the anus outward as far as possible. Heat the irons until they glow, and burn until you have dried out the hemorrhoids, taking care not to smear them over. Burn so as to leave none of the hemorrhoids unburnt, but cauterize all of them. You will recognize the hemorrhoids without difficulty: they project into the interior of the rectum like livid grapes, and when the rectum is pushed out they shoot blood. Let attendants hold the patient's head and hands while he is being burnt, so that he does not move — let him shout while being burnt, for the rectum protrudes more. When you have cauterized, boil lentils and bitter vetches in water, grind them smooth, and dust the area for five or six days. On the seventh day, cut a soft sponge as thin as possible, the sponge being six fingers' breadth in all directions; then place upon the sponge a piece of linen equal in size to the sponge, thin and smooth, smeared with honey; then, placing the middle of the sponge under the index finger of the left hand, push it down under the anus as far in as possible; then put wool over the sponge, so that it stays in place in the anus. Bandage around the flanks, and passing a bandage strip from behind, bring the dressing up from between the legs and fasten it to the waist-band beside the navel. Apply the drug I mentioned, which causes flesh to grow thick and strong. This dressing must be kept on for no fewer than twenty days. Drink once a day a gruel of meal, or millet, or bran-water, and drink water; if the patient sits to pass stool, wash with warm water; bathe every third day. Another treatment: push out the anus as far as possible, foment with warm water, then cut off the tips of the hemorrhoids. Prepare beforehand the following drug for use after the cutting: urinate into a bronze vessel, then sprinkle over the urine roasted and finely ground copper bloom, stir and agitate the vessel, then dry in the sun; when dry, scrape together and grind fine. 3. Apply to the anal ring, and apply linen pledgets smeared with oil, and bind a sponge on top. Another method: attached to the blood-vessel is something like a mulberry fruit, forming a condyloma; and if the condyloma protrudes far outward, the fleshy covering has grown around it. 4. Seat the patient squatting on two mortars and examine; for you will find the parts between the buttocks near the anus swollen, with blood coming out from inside. If it yields under the covering, remove the condyloma with the finger — for it is no harder than to pass the finger between the skin and flesh of a sheep being flayed; and do this while talking with him so that he does not notice what you are doing. When you have removed the condyloma, streams of blood will necessarily flow from the whole of the removed part; wash these away with astringent wine in which gall-nuts have been soaked. The blood-vessel will go along with the condyloma, and the covering will be restored; and the longer-standing the condition, the more readily the healing will proceed. If the condyloma is located higher up, inspect with the rectal speculum, and do not be deceived by the speculum: for when opened it smooths out the condyloma, and when closed again it shows it correctly. 5. The removal should be done after smearing the anal ring with black hellebore; then on the third day wash out with astringent wine. As for the blood — when you remove the condyloma, do not be surprised that it does not flow; for neither will blood flow if you cut at the joint level in the hands or legs, but if you cut above or below the joints you will find hollow, blood-filled veins, and you will with difficulty be able to stop them readily. So also with the hemorrhoid in the anus: if you cut above or below the site of condyloma removal, blood will flow; but if you remove the condyloma itself at its point of attachment, it will not flow. If, then, it settles thus, all will be well; if not, cauterize — taking care not to touch with the iron, but bringing the instruments near so as to dry the area out, and apply the copper bloom in the urine. Another method of healing hemorrhoids: make a cauterizing instrument like a small marsh-reed; fit an iron piece into it that fits well; then insert the tube into the anus and pass the glowing iron down through it, drawing it out frequently so that the heated area tolerates it better. There will be no wound from the heat, and the small vessels, dried out, will become healthy. 7. If you wish neither to burn nor to cut, foment first with much warm water and turn the anus outward, then grind myrrh fine and gall-nut, and burn Egyptian alum — one and a half parts relative to the others — and an equal quantity of melantery; use these in dry form. The hemorrhoid with these drugs will slough away like burnt leather; continue doing this until you have caused all of them to disappear. Burnt chalcitis at half the quantity accomplishes the same effect. If you wish to treat with suppositories: cuttlefish bone, one third part of lead ore, asphalt, alum, a little copper bloom, gall-nut, a little verdigris — pour boiled honey over these, form into an elongated suppository, and apply until you have caused them to disappear. 9. Treat a woman's hemorrhoid as follows: foment with much warm water — boil some fragrant herbs in the warm water — grind tamarisk, roasted litharge, and gall-nut, pour in white wine and olive oil and goose fat, grind all together, and when the patient has been fomented, apply. Also foment the anus, pushing it out as far as possible.