Hippocrates of Cos, Fistulas

LCL 482: 386-387

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VI 448 Littré

1. Σύριγγες δὲ γίνονται μὲν ὑπὸ φλασμάτων καὶ φυμάτων, γίνονται δὲ καὶ ὑπὸ εἰρεσίης, καὶ ἱππασίης, ὅταν ἀθροισθῇ ἐν τῷ γλουτῷ αἷμα πλησίον τῆς ἕδρης· σηπόμενον γὰρ νέμεται ἐς τὰ μαλθακά, ἅτε ὑγροῦ ἐόντος τοῦ τε ἀρχοῦ, καὶ τῆς σαρκὸς μαλθακῆς, ἐν ᾗ νέμεται, ἔστ᾿ ἂν τὸ φῦμα ῥήξῃ καὶ κάτω ἐς τὸν ἀρχὸν διασήψῃ. ἐπὴν δὲ τοῦτο γένηται, συριγγοῦται, καὶ ἰχὼρ ῥέει, καὶ κόπρος ῥεῖ δι᾿ αὐτῆς1 καὶ φῦσα καὶ βδελυγμίη πολλή. 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 εἰρεσίης, ἢ ὅσα τοιουτότροπά ἐστι· ξυνίσταται γὰρ αἷμα· σηπόμενον δὲ ἐκπυΐσκεται· ὑπὸ δὲ τοῦ ἐκπυϊσκομένου πάσχει ἅπερ ἐπὶ τῶν φυμάτων εἴρηται.

2. Πρῶτον μὲν οὖν ὅταν τι τοιοῦτον αἴσθῃ φυόμενον φῦμα, τάμνειν ὡς τάχιστα ὠμὸν πρὶν ἢ διαπυῆσαι ἐς τὸν ἀρχόν.

3. Ἢν δὲ νοσέοντα ἤδη τὴν σύριγγα παραλάβῃς, λαβὼν σκορόδου φύσιγγα νεαρήν, ἀνακλίνας τὸν ἄνθρωπον ὕπτιον, τὰ σκέλεα διαγαγὼν τὸ μὲν ἔνθα, τὸ

  • 1Littré: ἑωυτῆς I.



1. Fistulas arise from contusions and tubercles, and also from rowing and horse-back riding, when blood collects in the buttock near the anus; for on putrefying, this blood migrates through the soft parts, the rectum being moist, and the intervening tissue soft, until the tubercle ruptures and suppurates its way down through into the rectum. When this happens, a fistula is formed and serum flows out through it, as well as faeces, wind and copious filth. Now a fistula arises from contusions when part of the area about the rectum is contused as the result of a blow, fall or wound, or from horse-back riding, or rowing, or things like these: for the blood collects, putrefies and suppurates, and from the suppuration of the blood the person suffers the same things that were described for tubercles.

2. In the first place, then, whenever you observe any such tubercle forming, incise it as soon as possible during the unconcocted stage before suppuration through into the rectum occurs.

3. But if you take on someone who already has a fistula, take a fresh stalk of garlic, lay the person down on his back, spread his legs one in each direction, insert the stalk until it

DOI: 10.4159/DLCL.hippocrates_cos-fistulas.1995