Past exam of the medicine course of the University of Oxford / 1866 / Second examination / Medical translations (No. VI.)

Original volume: Examination papers for the Degree of Bachelor of Medicine by the University of Oxford (1864–1867). PDF volume pages 73–74; Oxford, December 1866, No. VI. Open the original paper in the scanned volume.

Original questions are transcribed from the public-domain edition. Credit: Wellcome Collection; original supplied by Royal College of Physicians, London. Source and public-domain rights statement.

The original paper is untitled. The two headings below identify its unnumbered medical translations in their source order.

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Ξυνεχὴς μὲν οὖν ποδάγρη οὐ ῥηϊδίως γίγνεται, διαλείπει δὲ ἔσθ᾽ ὅπῃ χρόνου μακρόν. λεπτὴ γάρ· καὶ Ὀλυμπίασι ἐνίκησε ποδαγρὸς ἐπ᾽ ἀνέσει δρόμου. ἀλλ᾽ ἄνδρες μὲν παθεῖν ῥηΐτεροι, γυναικῶν δὲ ἐλαφρότερον· γυναῖκες δὲ ἀραιότερον μὲν ἀνδρῶν, χαλεπώτερον δέ. τὸ γὰρ μὴ ἐν ἔθεϊ μηδὲ οἰκεῖον, ἢν ὑπὸ ἀνάγκης κρέσσον γένηται, βιαστὴν μέζονα τίκτει τὴν ξυμφορήν· ἡλικίῃ τὰ πολλὰ μὲν ἀπὸ ἐτέων πέντε καὶ τριήκοντα. θᾶσσον δὲ καὶ βράδιον ἐκ τῆς ἑκάστου φύσιος καὶ διαίτης. δεινοὶ μὲν οὖν οἱ πόνοι, καὶ τὰ παριόντα πόνων μέζονα· λειποθυμίη, ἐπὶ τῇσι ψαύσεσι ἀκινησίη, ἀποσιτίη, δίψος, ἀγρυπνίη· ἢν δὲ ἐπανέλθωσι, τοῦτο μὲν ὅκως ἐκ θανάτου πεφευγότες, ἄνετοι τὸν βίον, ἀκρατέες, ἁπλοί, εὔθυμοι, δωροδόκοι καὶ ἐς τὴν δίαιταν ἁβροί· τοῦτο δὲ ὡς ἐκ θανάτου αὖθις ἐσόμενοι ἅδην χρέονται τῇ παρούσῃ ζωῇ. ἀπέσκηψε πολλοῖσι ἐς ὕδρωπα ἡ ποδάγρη, ἄλλοτε δὲ ἐς ἄσθμα· καὶ τῶνδε ἄφυκτος ἡ διαδοχή.

Aretæus. Χρονιων Παθων Σημειωτικον Βιβλ. Β.

Translation. Gout, then, does not readily become continuous, but sometimes leaves a long interval; for it is slight. Indeed, a man suffering from gout won a footrace at the Olympic games during a remission. Men are more readily affected, but less severely than women; women are affected less frequently than men, but more severely. For what is neither customary nor natural to a person, if it gains the upper hand through compulsion, produces a more violently oppressive affliction. As regards age, it generally begins from thirty-five years onwards, but earlier or later according to each person's constitution and way of life. The pains are terrible, and their accompaniments worse than the pains: faintness, inability to move when touched, loss of appetite, thirst and sleeplessness. But if they recover, on the one hand, as though they had escaped death, they live without restraint: uncontrolled, frank, cheerful, receptive to gifts and luxurious in their way of life; on the other, as though they would escape death once again, they make abundant use of the life they presently have. In many people gout has settled into dropsy, and sometimes into asthma; and there is no escaping the succession of these conditions.

The passage describes an ancient conception of gout, not a modern diagnostic definition. Its source is Aretaeus of Cappadocia's On the Causes and Signs of Chronic Diseases by Aretaeus of Cappadocia, II.12, on arthritic and sciatic affections. Here ποδάγρη is rendered gout, with the more specific name podagra referring to the foot. The conspicuous clinical observation is intermittency: the account contrasts severe attacks with intervals in which someone might run competitively. The Olympic story is the author's illustration, not an independently verified case history. ^[ref]

Several details matter for a faithful rendering. λεπτὴ γάρ says “for it is slight”, despite the later description of severe pain; it should be understood in the context of the preceding intermittent course, rather than turned into a claim that every attack is mild. δίαιτα includes the whole way of life, not simply food. ἁπλοί means frank or straightforward here. The printed δωροδόκοι literally concerns receiving gifts, which is why the translation says “receptive to gifts”; silently replacing that with “generous” would reverse the ordinary direction of the word. The closing ὡς ἐκ θανάτου αὖθις ἐσόμενοι is rendered as an expectation of escaping death again: the printed clause contains no negative. The comparison edition punctuates the symptom list so that touch provokes faintness; the Oxford punctuation instead leaves “when touched” next to immobility, as reflected above. ^{[ref] [ref]}

The assertions about women's greater severity, unusual conditions necessarily being more violent, and the patient's moral character are historical claims, not established consequences of gout. Modern gout is an inflammatory arthritis caused by deposits of urate crystals in anatomical joints. It is more common in men, and risk in women increases after menopause; that does not establish the text's proposed universal severity rule or its portrait of indulgent behaviour. Diagnosis concerns clinical findings and, where needed, examination of a synovial fluid sample, rather than moral judgements about the sufferer. ^[ref]

Likewise, dropsy is a historical term for abnormal fluid accumulation, overlapping with oedema; it does not name one specific modern disease. The ancient ἄσθμα can describe difficult breathing and should not automatically be equated with present-day asthma. The translation retains the historical word, but the closing progression from gout to dropsy or asthma, with no escape, is the author's prognosis, not a current inevitable natural history. Modern diagnostic categories must therefore be kept separate from the ancient list. ^[ref]

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Ut haec vasorum, in ejusmodi praesertim corpore, magna angustia initium fortasse fuerat morborum omnium, ita pancreatis, magisque Duodeni intestini duritiem vomitionum fuisse causam, non dubito. Sive enim id intestinum a compressione stringatur, ut olim animadvertit Riolanus, quem hic in Sepulchreto laudatum videbis, sive ob scirrhosas tunicas se minime possit constringere, oppositas hasce causas idem effectus sequitur, ut illapsura ex ventriculo cum minus facile aut excipiantur, aut ulterius promoveantur, nempe in ventriculo restent pleraque, ibique corrupta, aut mora ipsa gravia, et molesta impellant ad vomitum : cujus rei luculentum exemplum etiam protulit Cl. Molinellius. Idem contingat, necesse est, cum pylorus vitiis afficitur ejusdemmodi. Plurima autem hic in Sepulchreto habes exempla, ut Observatione XI. et XVII. et plerisque aliis insequentibus ferme usque ad XXVI. et rursus in LVI. § 13 in Additamentis autem Observatione I. et VIII. quin etiam alibi, ut libro I. Sect. IX. Observatione non solum XXXIV. sed insuper, si subversiones illas attendas, XXXIII. Inter illas autem quas Sectione VIII. hac leges, cum ad Observationem perveneris XXI. non ita dissimilem alterius quae a Joanne Bohnio est, in illaque vomitionem ciborum omnium, et mortem denique intra decimum diem consecutas invenies pylori occlusionem a nummo devorato exiguo argenteo; veniet procul dubio in mentem nummi illius argentei tanto majoris quem solers Chirurgus du Luc inde, atque adeo extra corpus cum aliis auxiliis, tum hydrargyri praesertim et pondere urgentis, et amalgamatione, ut Chymici loquuntur, imminuentis feliciter deturbavit, cum jam laevi ad pylorum dolores incepissent cum vomendi voluntate.

Morgagni de Sed. Morb. Lib. iii.

Translation. Just as this great narrowness of the blood vessels, particularly in a body of this kind, had perhaps been the beginning of all the diseases, so I do not doubt that the hardness of the pancreas, and still more that of the duodenum, was the cause of the vomiting. For whether that portion of the intestine is constricted by compression, as Riolan long ago observed, whom you will see cited here in the Sepulchretum by Théophile Bonet, or whether, because its coats are scirrhous, it is quite unable to contract, these opposite causes are followed by the same effect: since the contents about to descend from the stomach are either less readily received or less readily propelled onwards, most of them remain in the stomach, and there, either becoming corrupted or simply troublesome and oppressive through their delay, provoke vomiting. The distinguished Molinelli has also published a clear example of this. The same thing must happen when the pylorus is affected by defects of the same kind.

You have very many examples here in the Sepulchretum by Théophile Bonet, as in Observations XI and XVII and most of the others following almost as far as XXVI, and again in LVI, §13; in the Additions, in Observations I and VIII; and indeed elsewhere, as in Book I, Section IX, not only in Observation XXXIV but also, if you attend to those “upturnings”, in XXXIII. Among those which you will read in this Section VIII, when you come to Observation XXI, not very unlike another supplied by Johannes Bohn, and find there that vomiting of all food and finally death within ten days followed blockage of the pylorus by a small silver coin which had been swallowed, you will undoubtedly recall that much larger silver coin which the skilful surgeon du Luc successfully dislodged from that place and indeed out of the body. He did so with other aids, but especially with mercury: pressing it onwards by its gravitational weight and reducing it by amalgamation, as the chemists call it, when pains near the pylorus had already begun, with an urge to vomit (the printed laevi at this point is unclear).

The central inference is that different impairments of passage can produce the same vomiting. The author is Giovanni Battista Morgagni; the extract corresponds to Book III, Letter XXX, article 13 of The Seats and Causes of Diseases Investigated by Anatomy by Giovanni Battista Morgagni. The opening haec, “this”, points back to an anatomical case preceding the selected extract. The translation preserves the difference between the tentative claim fortasse, “perhaps”, about the narrow blood vessels and the stronger non dubito, “I do not doubt”, about the cause of vomiting. It does not convert either level of historical confidence into a present-day demonstrated diagnosis. ^{[ref] [ref]}

The two mechanisms are not contradictory observations. Compression can narrow the entrance to the duodenum; hard, poorly contracting intestinal coats can fail to propel their contents onwards. Both impede gastric emptying, allowing retained material to provoke vomiting. This is an early example of connecting clinical observation with pathological anatomy. Nevertheless, gross hardness, described as scirrhous, does not by itself supply a modern microscopic diagnosis of scirrhous carcinoma. The descriptive term scirrhous hardening is therefore kept distinct from that modern category. The separate assertion about the pancreas likewise cannot identify its precise disease from this extract alone.

The Sepulchretum by Théophile Bonet is an earlier compilation of anatomical observations. Its cited observation numbers are retained because they are part of the argument's trail of evidence, including the distinction between Section VIII and the additional cross-reference to Book I, Section IX. Subversiones literally means “upturnings”; in this context the reference concerns disturbances or upheavals of the stomach, not a political meaning. Ventriculus here is the stomach, not a cardiac heart ventricle. The printed word laevi near the end is grammatically unclear in its context; the translation gives the secure surrounding sense and does not silently assign it a patient's identity, an anatomical side, or a new causal claim. ^{[ref] [ref]}

The coin episode reports an attempted mechanical and chemical remedy, not a modern recommended treatment. In the text, mercury is supposed both to press the coin onwards through its gravitational weight and to reduce it by amalgamation with its silver. The report does not establish the contribution of each mechanism, the extent of the coin's alteration, or therapeutic safety. Its purported success should not be generalized from a historical anecdote. Modern toxicological information distinguishes the chemical forms of mercury and their routes of exposure: swallowed liquid metal is poorly absorbed, whereas vapour is readily absorbed and can cause serious harm. This distinction neither validates the historical intervention nor warrants the false correction that any swallowed metallic mercury must immediately produce systemic poisoning. ^[ref]

Modern investigation also separates obstruction from impaired movement. Endoscopy uses a flexible instrument with a camera to inspect the upper digestive passage for structural abnormalities; a gastric emptying scintigraphy test instead follows a meal containing a small radioactive tracer with an external camera. These examinations illustrate how the proposed impediment to passage can now be tested rather than inferred from vomiting alone. They are later developments, not techniques available to the author of this passage. ^[ref]