Kitap 2
9
The dejections and the circumstances attendant on the ulcers are different in different cases; for, if superficial, when from above, the discharges are thin, bilious, devoid of odour except that which they derive from the intestines; those from the jejunum are rather more coloured, saffron-like, and fetid. Those dejections which contain the food in a dissolved state but rough, are sometimes fetid in smell when the ulcers are gangrenous, and sometimes have the smell as if from scybala. But in the ulcerations from the parts below, the discharges are watery, thin, and devoid of smell. But if deeper they are like ichor, reddish, of the colour of dark wine, or like the washings of flesh; and these are sometimes by themselves and sometimes with the fæces, these being dissolved in the surrounding fluid, devoid of bile and of smell; or they are evacuated in a consistent and dry state, lubricated with the surrounding fluid. But if the ulcers be larger and smoother, in those above they are bilious, and pinch the parts from which they come and through which they pass (they even pinch the anus), for the bile is acrid, more especially if from an ulcer; and the bile is fatty, like grease. In the deeper ulcers below, a thick clot of blood with phlegm, like flesh not very fat, or like the scrapings of the bowels: nay, even entire portions are mixed up with them; they are discharged white, thick, mucous, like chopped tallow, along with the humour in which they float: these proceed from the rectum: but sometimes they are merely mucous, prurient, small, round, pungent, causing frequent dejections and a desire not without a pleasurable sensation, but with very scanty evacuations: this complaint gets the appellation of tenesmus. But from the colon there are discharged pieces of flesh, which are red, large, and have a much larger circumference. If the ulcers become deep, and the blood thick and feculent, these are more fetid than the former; but if the ulcers spread and are phagedænic, and if nothing will stop them, above, in addition to being intensely bilious, the dejections become saffron-like, frothy, feculent, blackish, like woad or like leeks, thicker than the former, fetid like a mortification; food now undigested, as if only masticated by voracious teeth. But if the under parts are also corroded, black clots of blood, thick, fleshy, very red, clotted, sometimes, indeed, black, but at other times of all various colours, fetid, intolerable; involuntary discharges of fluids. And sometimes a substance of considerable length, in many respects not to be distinguished from a sound piece of intestine, has been discharged, and, to those ignorant of the matter, has caused apprehension about the intestine: but the fact is this,—the intestines, like the stomach, consist of two coats, which lie close to one another in an oblique manner; when, therefore, the connection between them is dissolved, the inner coat, being separated to some length, protrudes externally, while the outer one remains alone, incarnates, and gets cicatrised, and the patients recover and live unharmed. It is the lower gut alone which suffers thus, owing to its fleshy nature. And, if blood be discharged from any vessel, it runs of a bright red or black colour, pure, and unmixed with food or scybala; and if a concretion is spread over it like broad spiders’ webs, it coagulates when cold, and no longer would be taken for a secretion of blood; but being discharged with much flatulence and noise, it has the appearance of being much larger than its actual amount. Sometimes, also, a purulent abscess forms in the colon, nowise different from the other internal ulcers; for the symptoms, the pus, and the mode of recovery are the same. But if there be hard secretions of matters resembling flesh, as if pounded, and like rough bodies, the abscess is not of a mild nature. Sometimes a copious discharge of water takes place from the colon in the form of dysentery, which has freed many patients from dropsy. In a word, such are the ulcers in the intestines; and their forms and the secretions from them as I have described.
