The general subject of fistulae is treated at considerable length on
folio 205b, and fistula lachrymalis and fistulae of the jaw receive
special attention in their appropriate places. As a rule, the fistula
is dilated by a tent of alder-pith, mandragora, briony or gentian,
the lining membrane destroyed by an ointment of quick-lime or even the
actual cautery, and the wound then dressed with egg-albumen followed
by the _unguentum viride_. Necrosed bone is to be removed, if
necessary, by deep incisions, and decayed teeth are to be extracted.
The elongated uvula is to be snipped off, and abscesses of the tonsils
opened _tout comme chez nous_.
An elaborate discussion of the subject of hernia is given under the
title "_De relaxatione siphac et ruptura_" (f. 280c)--siphac being
the Arabian name for the peritoneum. Gilbert tells us the siphac is
sometimes relaxed, sometimes ruptured (_crepatur_?) and sometimes
inflated. He had seen a large rupture (_crepatura_) in which it was
impossible to restore the intestines to the cavity of the abdomen
in consequence of the presence in them of large hard masses of fecal
matter, which no treatment proved adequate to remove, and which
finally occasioned the death of the patient. Rupture of the siphac is
most frequently the result of accident, jumping, straining in lifting
or carrying heavy weights, or in efforts at defecation, or of shouting
in boys or persons of advanced age, or even in excessive weeping,
etc. It is distinguished from hernia by the fact that in hernia pain
is felt in the testicle, radiating to the kidneys, while in rupture
of the siphac a swelling on one side of the pubes extends into the
scrotum, where it produces a tumor not involving the testicle. Rupture
of the siphac, he says, is a lesion of the organs of nutrition, hernia
a disease of the organs of generation. Accordingly, in the pathology
of Gilbert, the term hernia is applied to hydrocele, orchitis and
other diseases of the testicle, and not, as with us to protrusions of
the viscera through the walls of their cavities.
Public-domain text, read in full here on John Shaqi.
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