De Medicina

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3.18.7
Rarely, yet now and then, however, delirium is the produce of fright; this class of insanity, has similar sub-divisions, and is to be treated by the same species of dietetic regimen, except that, in this form of insaneness alone, wine is properly given.
3.19.1
19 That kind of affection which the Greeks call cardiac is a complete contrast to the foregoing diseases, although insane persons often pass over into it; in those the mind gives way, in this it holds firm. Indeed the illness is nothing other than excessive weakness of the body, which, while the stomach is languid, wastes away through immoderate sweating. And it may be recognized at once by the exiguous and weak pulsation of the blood vessels, while sweat, at once unaccustomed and excessive and untimely, breaks out all over the chest and neck, and even over the head, the feet and legs remaining more dry and cold; and it is a form of acute disease.
3.19.2
The primary treatment is the application over the chest of repressant plasters; the secondary, to stop sweating. The latter is accomplished by bitter olive oil, or rose or quince or myrtle oil, with any of which the body is to be lightly anointed, then a salve made up of any of them is to be applied. If the sweating wins, the patient is to be smeared over with gypsum or litharge or cimolian chalk, or even powdered over with the same at intervals. A powder consisting of the pounded leaves of dried myrtle or of blackberry, or of the dried lees of dry and good wine, attains the same end; there are many simple materials, and if these are not at hand, it is useful enough to scatter on any dust from the road. In addition to this, moreover, in order that he may sweat less, the patient should be lightly covered and lie in a cool room, with the windows open, so that some breeze reaches him.
3.19.3
A third aid is to help his weakness whilst in bed by food and wine. The food, whilst not much in quantity, should be given often, as well by night as by day, so as to nourish without becoming onerous. It should consist of the weakest class of materials and should be suitable to the stomach. Unless there is necessity, it is not well to hurry on to wine. But when fainting is apprehended, then there is given both bread crumbled into the wine and wine by itself dry indeed yet thin, undiluted, lukewarm, at intervals liberally, and if the patient is taking but little food, polenta may be scattered into the wine; and that wine should not be lacking in strength, yet not over-strong the patient may properly drink three quarters of a litre, and even more if of large build, in the course of a day and night: if he does not take his food, the patient should be anointed, should have cold water poured over him, and after that be given food. But if the stomach has become relaxed and retains but little, let the patient vomit as he will, whether before or after food, and after vomiting take food again. If even after that food is not retained, he should sip a cupful of wine, and another after the interval of an hour. If the stomach returns this wine also, he should be rubbed all over with pounded onions, which as they dry cause the stomach to retain the wine, and as a result, cause heat to return throughout the body, and a forceful pulsation to the blood vessels. The last resource is the introduction into the bowel from below of barley or spelt gruel, since that too supports the patient's strength. Should he feel hot, it is not inappropriate to hold to his nostrils a restorative such as rose oil in wine; if he has cold extremities, they should be rubbed by hands anointed and warmed. If we can by these measures obtain a diminution in the severity of the sweating, and a prolongation of life, time itself now begins to come to our aid. When the patient appears to have reached safety, rapid release into the same state of weakness is still to be feared; hence along with a gradual withdrawal of wine, the patient ought each day to take stronger food, until a sufficiency of bodily strength is gained.
3.20.1
20 There is also another disease, a contrast in a different way to the phrenetic. In the latter sleep is got with great difficulty, and the mind is disposed to any foolhardiness; in this disease there is a pining away, and an almost insurmountable need of sleep. The Greeks name it lethargy. And it also is an acute sort, and unless remedied, quickly kills. Some strive to excite these patients by applying at intervals medicaments to promote sneezing, and those which stimulate by their offensive odour, such as burning pitch, unscoured wool, pepper, hellebore, castoreum, vinegar, garlic, onion. Moreover, they burn near them galbanum, hair or hartshorn, or when that is not at hand, some other kind of horn, for these when burnt give out an offensive odour. One Tharrias said, indeed, that this affection is a sort of feverish paroxysm, and that the patient is relieved when that remits, hence those without keep on irritating such patients do harm uselessly. But the important point is whether the patient wakes up with the remission; or whether the fever is either not relieved, or else it is relieved and yet sleep still oppresses him. For if the patient wakes up, it is needless to treat him as if in a stupor; for he is not made better by keep in him awake, but if he is better he keeps awake of himself. If the sleepiness in us interrupted the patient must certainly be aroused, but only at those times when the fever is of the slightest, in order that he may both make a natural evacuation and take food. Now a most powerful excitant is cold water poured suddenly over him; therefore when the fever has remitted, and he has been anointed freely, he should have three or four jarfuls poured over his head. But this measure should be employed only when the patient's breathing is regular, and the parts below the ribs soft: otherwise those are to be preferred which have been mentioned above. Such is the most suitable procedure, so far as concerns sleeplessness.
3.20.2
But in order to cure, the head is to be shaved, and then fomented with vinegar and water in which laurel or rue leaves have been boiled. On the following day castoreum may be applied, or rue pounded up in vinegar, or laurel berries or ivy with rose oil and vinegar; mustard put to the nostrils is particularly efficacious both for arousing the patient, and when put on the head or forehead for driving out the disease itself. Rocking is also advantageous in this malady; and most of all food given opportunely, that is in the greatest degree of remission that can be found. Now gruel is most fitting until the disease begins to decrease; so if there is a severe paroxysm every day, it is given daily; if every other day, after a more severe paroxysm, gruel, and after a slighter paroxysm, hydromel. Wine is also of no mean service, when given at the proper time all with suitable food. But if this kind of torpor attacks the body after prolonged fevers, all the other measures are to be carried out, in the same way, and in addition three or four hours before the paroxysm castoreum is administered, mixed with scammony if the bowels are costive, if not, then by itself in water. If the parts below the ribs are soft, food should be given more freely; if hard, the patient must subsist on the gruel mentioned above, whilst something is to be applied to the parts below the ribs to repress and mollify at the same time.
3.21.1
21 Now the foregoing is indeed an acute disease. But a chronic malady may develop in those patients who suffer from a collection of water under the skin, unless this is dispersed within the first days. The Greeks call this hydrops. And of this there are three species: sometimes the belly being very tense, there is within a frequent noise from the movement of wind; sometimes the body is rendered uneven by swellings rising up here and there all over; sometimes the water is drawn all together within, and is moved with the movement of the body, so that its movement can be observed. The Greeks call the first tympanites, the second leukophlegmasia or hyposarka, the third ascites. The characteristic common to all three species is an excessive abundance of humour, owing to which in these patients ulcerations even do not readily heal. This is a malady which often begins of itself, often it supervenes upon a disease of long standing, upon quartan fever especially (III.15, 16). It is relieved more easily in slaves than in freemen, for since it demands hunger, thirst, and a thousand other troublesome treatments and prolonged endurance, it is easier to help those who are easily constrained than those who have an unserviceable freedom. But even those who are in subjection, if they cannot exercise complete self-control, are not brought back to health. Hence a not undistinguished physician, a pupil of Chrysippus, at the court of King Antigonus, held that a certain friend of the king, noted for intemperance, could not be cured, although but moderately affected by that malady; and when another physician, Philip of Epirus, promised that he would cure him, the pupil of Chrysippus replied that Philip was regarding the disease, he the patient's spirit. Nor was he mistaken. For although the patient was watched with the greatest diligence, not only by his physician but by the king as well, by devouring his poultices and by drinking his own urine, he hurried himself headlong to his end. At the beginning, however, cure is not difficult, if there is imposed upon the body thirst, rest, and abstinence; but if the malady has become of long standing, it is not dispersed except with great trouble. They say, however, that Metrodorus, a pupil of Epicurus, when afflicted with this disease, and unable to bear with equanimity necessary thirst, after abstaining for a long while, was accustomed to drink and then to vomit. Now if what has been drunk is then returned, distress is much reduced; but if retained in the stomach, it increases the disorder; and so it must not be tried in every case. But if there is also fever, this is first of all to be overcome by the methods which have been prescribed concerning possible relief in such cases (III.4‑17). If the patient has become free from fever, then at length we must go on to those measures by which the disorder itself is usually treated. And here, whatever the species, so long as the disease has not taken too firm a hold, the same remedies are required. The patient should walk much, run a little, and his upper parts in particular are to be rubbed while he holds his breath. Sweating is also to be procured, not only by exercise, but also by heated sand, or in the Laconicum, or with a clibanus and such-like; especially serviceable are the natural and dry sweating places, such as we have in the myrtle groves above Baiae. The bath and moisture of every kind is wrong. Pills composed of wormwood two parts, myrrh one part, are given on an empty stomach. Food should be of the middle class indeed, but, of the harder kind; no more of drink is to be given than to sustain life, and the best is that which stimulates urine. But that, however, is better brought about by diet than by medicament. If, nevertheless, the matter is urgent, one of those drugs which are efficacious is to be made into a decoction, and that given as a draught. Now this faculty seems to belong to iris root, spikenard, saffron, cinnamon, cassia, myrrh, balsam, galbanum, ladanum, oenanthe, opopanax, cardamomum, ebony, cypress seeds, the Taminian berry which the Greeks call staphis agria, southernwood, rose leaves, sweet flag root, bitter almonds, goat's marjoram, styrax, costmary, seeds of rush, square and round (the Greeks call the former cyperon, the latter schoinon): whenever I use these terms I refer, not to native plants, but to such as are imported among spices. The mildest of these, however, are to be tried first, such as rose leaves or spikenard. A dry wine is beneficial, but it must be very thin. It is good besides to measure every day with string the circumference of the abdomen, and to put a mark where it surrounds the belly, then the day following to see whether the body is fuller or thinner, for the thinning shows a yielding to the treatment. Nor is it unserviceable to take the measure of his drink, and of his urine; for if more humour is evacuated than taken in, then at least there is hope of recovery. Asclepiades has put it on record that for a patient who had lapsed from a quartan into dropsy, he employed for two days abstinence and rubbing, on the third day, the patient having all become freed from both the fever and the water, he gave food and wine.
3.21.2
So far the prescription can be common to all the species; if the disease is more severe, the method of treatment must be different. For instance, if there is flatulence and owing to that pain is frequent, a vomit is beneficial, either daily or on alternate days, after food; hot and dry foments are to be applied. If the pain is not ended by these, dry cuppings are needed, but if the torment is not relieved even by these, skin incisions are made and then the cups applied. If cupping does no good, the last resource is to infuse hot water copiously into the rectum and draw it out again. Nay even vigorous rubbing with oil and any one of the heating agents should be carried out three or four times a day, but in this rubbing the abdomen is to be left out; but to this mustard should be applied repeatedly until the skin is excoriated; and ulcerations are to be set up in many places upon the abdominal wall by means of the red hot cautery, and the ulcers to be kept open for some time. It is useful also to suck a boiled squill bulb; but for a long while after such attacks of flatulence the patient should abstain from everything that causes it.
3.21.3
But if the affection is that named leukophlegmasia, the swollen parts should be exposed to the sun, but not too much lest feverishness ensue. If the sun is over-strong, the head is to be covered, and rubbing is to be used with hands just moistened with water to which salt and soda and a little oil is added, taking care that the hands of children or of women are employed, for theirs is a softer touch; and this ought to be done, should the patient's strength allow of it, for a whole hour before noon, or for half an hour after noon. Repressing poultices are of benefit, especially for the more delicate. Also an incision should be made our fingers' breadth above the ankle on the inner side through which humour may discharge freely for some days, and the actual swellings ought to be incised by deep cuts; the body also is to be shaken up by much rocking (II.15); then after the incisions have formed a scab, both exercises and food must be increased, until the patient is restored to his former state of health. The food should be nutritious and glutinous, mostly meat. The wine, when the stomach permits of it, should be rather sweet, but should be drunk alternately with water every two or three days. The seeds of the wolf's-milk plant, which grows to a large size on the seacoast, may be advantageously administered in a draught with water. If the patient is strong enough, he should suck a boiled squill bulb as noted above. There are many authorities who would have the swelling beaten with inflated ox-bladders.
3.21.4
But if the form of the affection is that in which much water is drawn into the belly, the patient should take walks, but with much more moderation, and have applied a dispersive poultice, covered with three folds of linen, bandaged on not too tightly; a practice begun by Tharrias, which I see many have followed. If the liver or spleen is plainly affected, a fatty fig bruised with honey should be put on over it: if the belly is not dried up by such remedies, and in spite of them the humour is in large amount, aid must be given in a quicker way, by giving issue to it through the belly itself (VII.15). I am quite aware that such a way of treatment was disapproved of by Erasistratus, for he deemed the disease to be one of the liver, that therefore it was the liver which had to be rendered sound, and that it was of no use to let out water which, if that organ is diseased, will continually be reproduced. But firstly, the disease is not primarily one of that organ alone; for it occurs when the spleen is affected, and there is a general diseased condition of the body; further, granted that it begins from the liver, the water unnaturally collected there, unless evacuated, injures both the liver and all the rest of the internal organs. And it is agreed, nevertheless, that the body generally has to be treated; for the mere evacuation of the humour does not restore health, but it affords an opportunity for medicaments which the accumulation within impedes. And indeed it is not in dispute that not everybody with this affection can be so treated, but only the young and robust, in whom fever is wholly absent, or who have sufficiently long intermissions. For those are unfitted for this treatment whose stomach is corrupted, or who have lapsed into the malady owing to black bile, or who have a diseased condition of body. But food on the day the humour is first let out is not needed unless strength fails. On the days following, both food and wine, undiluted indeed, but not overmuch in quantity, should be given; little by little the patient should be submitted to exercise, rubbing, sun-heat, sweating, a sea voyage, along with a suitable diet, until he has completely recovered. Such a case requires a bath seldom, more often an emetic on an empty stomach; in summer a swim in the sea is beneficial. For a long while after his recovery, however, the practice of venery is unsuitable.
3.22.1
22 Longer and more dangerous is the illness which follows when wasting disease attacks a patient. This also has several species. There is one in which the body is not nourished enough, and as there is some natural loss going on all the time without replacement, extreme emaciation ensues, which unless countered, kills. The Greeks call it atrophia. It proceeds commonly from two causes: for either from excessive dread the patient consumes less, or from excessive greed more, than he ought: thus either the deficiency weakens, or the superfluity undergoes decomposition. There is another species which the Greeks call cachexia, in which owing to bad habit of body all the aliments undergo decomposition. This occurs generally in those whose bodies have become vitiated by prolonged disease, and even if they have rid themselves of this, yet they do not regain health; or when the system has become affected by bad medicaments; or for a long while necessaries of life have been deficient; or unusual or unserviceable food has been consumed; or something similar has happened. In this case besides the wasting, it not unfrequently occurs that the skin surface undergoes irritation by persistent pustulation or ulceration, or else some parts of the body become swollen. The third species, which the Greeks call phthisis, is the most dangerous by far. The malady usually arises in the head, thence it drips into the lung; there ulceration supervenes, from this a slight feverishness is produced, which even after it has become quiescent nevertheless returns; there is frequent cough, pus is expectorated, sometimes blood-stained. When the sputum is thrown upon a fire, there is a bad odour, hence those who are in doubt as to the disease employ this as a test.
3.22.2
As these are the species of wasting, the first consideration should be, which the patient is suffering from: next, if it is only that the body is not being sufficiently nourished, we must look to the cause of this, and if the patient has been consuming less food than he ought, addition is to be made, but only a little at a time, lest if the system becomes overloaded suddenly by an unaccustomed quantity, it may hinder digestion. On the other hand, if the patient has been consuming more than he ought, he should first fast for a day, then begin with a scanty amount of food, increasing daily until he reaches the proper amount. Further, he should walk in places as little cold as possible, whilst avoiding the sun; he should also use the hand exercises; if he is weaker, he should be rocked, anointed and then rubbed, doing as much as possible of this himself, several times each day, before and after meals, until he sweats — sometimes adding heating agents to the oil. It is advantageous on an empty stomach to pinch up and pull on the skin in a number of places, in order to relax it, or to do the same by applying a pitch plaster and at once pulling it off. The bath also is sometimes beneficial, but only after a scanty meal. And whilst actually in the solium, some food may properly be taken, also immediately after a rubbing, when applied without the bath. The food too should be of the kinds easily digested, which are most nutritious. Hence also the use of wine is necessary, but it should be dry; urination is to be stimulated.
3.22.3
But if there is a bad habit of body, the patient should abstain at first, next have the bowels moved by a clyster, then take food a little at a time, with exercise, anointing and rubbing. A frequent bath is useful for these cases, but on an empty stomach, prolonged till there is sweating. Abundant and varied and succulent food is necessary, such as will less readily decompose, and dry wine. If there is no relief from anything else, blood should be let, but only a little each day for several days; with this proviso, that the other remedies also should be employed as described.
3.22.4
But if there is more serious illness and a true phthisis, it is necessary to counter it forthwith at the very commencement; for when of long standing it is not readily overcome. If the strength allows of it a long sea voyage is requisite with a change of air, of such a kind that a denser climate should be sought than that which the patient quits; hence the most suitable is the voyage to Alexandria from Italy. And the body ought generally to be able to bear this in the early stages, since this disease arises especially during the most stable part of life, namely between eighteen and thirty-five years of age. If the patient's weak state does not allow of the above, the best thing for him is to be rocked in a ship without going far away. If anything prevents a sea voyage, the body is to be rocked in a litter, or in some other way. Further, the patient should keep away from business, and everything disturbing to his spirit; he should indulge in sleep; he is to be warned against catarrh, lest that should make worse what the treatment is relieving; indigestion should be avoided, also the sun and cold; the mouth should be covered, the neck wrapped up, any cough put a stop to by its appropriate remedies; and whenever there is an intercurrent fever, it is countered, sometimes by abstinence, sometimes by timely meals, at which water is to be drunk. Milk also, which in headaches, in acute fevers and for the excessive thirst they occasion, also when the chest swells, or there is bilious urine, or a flux of blood, is as bad as a poison, can nevertheless be given appropriately in phthisis, as also in all prolonged feverishness. But if there has either been no intercurrent fever yet, or if it has already remitted, recourse should be had to moderate exercise, walking in particular, also to gentle rubbing. The bath is unsuitable. The food should at first be acrid, such as garlic and leeks, also this latter or endive, basil or lettuce after soaking in vinegar; later the food should be bland, such as a gruel made with pearl barley, or spelt flour, or starch to which milk is added. Rice also, and if there is nothing else, parched groats of spelt answer. Subsequently use is to be made of the above foods in turn, with some additions from food of the middle class, especially grilled brains, small fish and such like. Flour mixed with mutton- or goat-fat and then boiled serves for a medicament. The wine taken ought to be light and dry. So far there is no great difficulty in countering the disease. But if it is more severe, and the body is evidently wasting, stronger remedies are required. Ulceration is to be set up by cautery, at one spot under the chin, at another on the neck, two upon each breast, and the same below the shoulder-blades which the Greeks call omoplatae. The ulcerations are not to be allowed to heal until the cough has stopped, and for this there must clearly be a special treatment also. Then three or four times a day the extremities should be rubbed vigorously, the chest being merely stroked with the hands; an hour after food both legs and arms are to be rubbed. At intervals of ten days the patient should be immersed in the solium contain in oil with the hot water. On other days he should drink first water, then wine; if there is no cough, the drink should be cold, if there is cough lukewarm. It is also of advantage to give food every day during the remission; rubbing and rocking should be employed likewise. On the fourth or fifth day he should take the above mentioned acrid food, now and then polygonum or plantain juice in vinegar. A further remedy is either plantain juice by itself, or horehound juice cooked with honey; of the former a cupful may be sipped, of the latter a spoonful, a little at a time, put upon the tongue, or one half part of turpentine resin, and another part of butter and honey may be mixed together and cooked. But of all these measures the principal ones are the diet, rocking in a litter or on a ship, and the gruel. Loose motions must be especially obviated. Frequent vomiting in this affection is a sign of danger, especially when blood is vomited. A patient who is beginning to improve a little should resume exercises, rubbing, and increase of food, next rub himself while holding his breath, but for a long while abstain from wine, the bath and venery.
3.23.1
23 That malady which is called comitialis, or the greater, is one of the best known. The man suddenly falls down and foam issues out of his mouth; after an interval he returns to himself, and actually gets up by himself. This kind affects men oftener than women. And usually it persists even until the day of death without danger to life; nevertheless occasionally, whilst still recent, it is fatal to the man. And often if remedies have been ineffectual, in boys the commencement of puberty, in girls of menstruation, has removed it. Now sometimes there is a spasm of the sinews when the man falls down, sometimes there is none. Some try to rouse the patients as is done in the case of those affected by lethargy; which is quite useless, both because not even the lethargic patient is cured by this method, and because, though it may be impossible to waken him and he may thus die of starvation, the epileptic, on the other hand, returns to himself. If a man falls in a fit without the addition of spasms, certainly he should not be bled; if there are spasms, at any rate he should not be bled unless there are other indications for the bleeding. But it is necessary to move the bowels by a clyster, or by a purge of black hellebore, or by both if the strength allows of it. Next the head should be shaved and oil and vinegar poured over it, the patient should be given food on the third day, as soon as the hour has passed at which he had a fit. But neither gruels, nor other soft and easily digested food, nor meat, least of all pork, are suitable for such patients, but food materials of the middle class: for there is need to give strength and indigestion is to be avoided; in addition he should avoid sunshine, the bath, a fire, all heating agents; also cold, wine, venery, overlooking a precipice, and everything terrifying, vomiting, fatigue, anxiety, and all business.
3.23.2
When food has been given upon the third day, it should be omitted on the fourth, and then on alternate days, observing the same hour for the meal, until fourteen days have elapsed. When the malady lasts beyond this period, it loses its acute character, and if it persists, it is now to be treated as chronic. But if the practitioner has not been in attendance from the day of the first fit, but a patient who is liable to fits has been handed over to of him, the class of diet given above should straightway be adhered to, and the day awaited upon which the patient may have a fit; than there is to be used either blood-letting, or clystering, or purgation by black hellebore, as prescribed above. Next on the following days the patient is to be supported by those foods I have mentioned, avoiding everything which I have said must be avoided. If the malady has not been brought to an end by these measures recourse should be had to white hellebore, administering it three or four times, without many days between, never, however, repeating it unless he has had a fit. Moreover, on intermediate days his strength must be supported by additions to what has been prescribed above. On awakening in the morning, his body should be lightly rubbed with old oil, including the head, but excluding the stomach; he should then walk as straight and as far as he can; after the walk he should be rubbed vigorously for a long while in a warm place, and with not less than two hundred hand-strokings, unless he is weak (II.14); next plenty of cold water should be poured over his head; he should take a little food; rest; again before night take a walk; and once more be vigorously rubbed, yet without touching either his stomach or his head; after this he may have dinner, and at intervals of three or four days he should eat for a day or two acrid foods. If not freed by these measures, his head should be shaved; anointed with old oil, to which vinegar and nitre have been added; have salt water poured over it; next upon an empty stomach he should take castoreum in water; no water should be used for drinking unless it has been boiled. Some have freed themselves from such a disease by drinking the hot blood from the cut throat of a gladiator: a miserable aid made tolerable by a malady still most miserable. But as to what is really the concern of the practitioner, the last resources are: to let a left blood from both legs near the ankle, to incise the back of the scalp and apply cups, to burn in two places with a cautery, at the back of the scalp and just below where the highest vertebra joins the head, in order that pernicious humour may exude through the burns. If the disease has not been brought to an end by the foregoing measures, it is probable that it will be lifelong. To mitigate it to some extent all you can do is to use exercise, plenty of rubbing, and the food which has been mentioned above, particularly avoiding what we have declared to be harmful.
3.24.1
24 Equally well-known is the disease which they name sometimes the rainbow-hued, sometimes the royal. Of this Hippocrates said that if it comes on after the patient has been suffering from fever for seven days, the patient is safe, provided that the parts under the ribs remain soft. Diocles stated positively that if it arise after a fever, it is even favourable, but deadly if fever follows it. The colour reveals this malady, particularly of the eyes; they become yellow in the parts which should be white. And it is usually accompanied by thirst and headache and frequent hiccough and induration under the ribs on the right side, and when a sharp movement of the body is made there is difficulty in breathing and laxness of the limbs; and when the disease persists for a long while, the whole body whitens with a sort of pallor.
3.24.2
On the first day the patient should fast, on the second day have the bowels moved by a clyster, then if there is fever, it is dispersed by appropriate diet; if not, scammony is given in a draught, or white beet pounded up in water, or bitter almonds, wormwood, and a very little aniseed in hydromel. Asclepiades used also to make the patient drink salted water, even for a couple of days, in order to purge, and rejected diuretics. Some, omitting the remedies given above, say they gain the same end through diuretics and those foods which cause thinness. For myself, if there is sufficient strength, I prefer the stronger remedies, the milder if there is but little. After purgation, for the first three days a moderate amount of food of the middle-class should be taken with salted Greek wine to drink, in order to keep the bowels loose; then on the ensuing three days, food of the stronger class with some meat, keeping to water for drink; next there is a return to the middle class of food, but in such a way that he may be more satisfied therewith, and for drink an undiluted dry wine in place of the Greek; and this diet is varied so that sometimes acrid foods are put in, sometimes the salted wine is again given. But throughout the whole time use is to be made of exercise, of rubbing, in winter of the bath, in summer of swimming in cold water, the patient should enjoy a specially good bed and room, also dicing, jesting, play-acting and jollification, whereby the mind may be exhilarated; on account of this treatment the disease seems to have been termed royal. In addition a dispersive poultice, applied under the ribs, is beneficial, or if the liver or spleen has become affected a dried fig is put on.
3.25.1
25 The disease which the Greeks call elephantiasis, whilst almost unknown in Italy, is of very frequent occurrence in certain regions; it is counted among chronic affections; in this the whole body becomes so affected that even the bones are said to become diseased. The surface of the body presents a multiplicity of spots and of swellings, which, at first red, are gradually changed to be black in colour. The skin is thickened and thinned in an irregular way, hardened and softened, roughened in some places with a kind of scales; the trunk wastes, the face, calves and feet swell. When the disease is of long standing, the fingers and toes are sunk under the swelling: feverishness supervenes, which may easily destroy a patient overwhelmed by such troubles. At once, therefore, at the commencement, he should be bled for two days, or the bowels loosened by black hellebore, then a scanty diet is to be adopted as far as can be borne; after that the strength should be a little reinforced and the bowels clystered; subsequently, when the system has been relieved, exercise and especially running is to be used. Sweating should be induced primarily by the patient's own exertion, afterwards also by dry sweatings, rubbing is to be employed with moderation so that strength is preserved. The bath should be seldom used; neither fatty nor glutinous nor flatulent food; wine is properly given except on the first days. Plantain crushed and smeared on seems to protect the body best.
3.26.1
26 We also see occasionally some who have been stunned, in whom the body and the mind are stupefied. This is produced sometimes by lightning stroke, sometimes by disease; the Greeks call this latter apoplexia. In these cases, blood is to be let, and either white hellebore (II.13.2) or a clyster administered; then rubbings are applied, and food of the middle class given, and that the least fatty; also some which is acrid; there is to be abstinence from wine.
3.27.1
27 Relaxing of the sinews, on the other hand, is a frequent disease everywhere. It attacks at times the whole body, at times part of it. Ancient writers named the former apoplexy, the latter paralysis: I see that now both are called paralysis. Those who are gravely paralyzed in all their limbs are as a rule quickly carried off, but if not so carried off, some may live a long while, yet rarely however regain health. Mostly they drag out a miserable existence, their memory lost also. The disease, when partial only, is never acute, often prolonged, generally remediable. If all the limbs are gravely paralyzed withdrawal of blood either kills or cures. Any other kind of treatment scarcely ever restores health, it often merely postpones death, and meanwhile makes life a burden. If after blood-letting, neither movement nor the mind is recovered, there is no hope left; if they do return, health also is in prospect. But when a particular part is paralyzed, in accordance with the force of the disease, and the strength of the body, either blood is to be let, or the bowel clystered. The rest that has to be done is the same in both conditions: in particular cold should be avoided; and the patient should return to exercise a little at a time, in such a way that he should begin to walk at once, if he can. If the weakness of the legs prevent this, he should be carried about in a litter or rocked in his bed, then, if possible, his defective limb should be moved by himself, failing that by someone else, and by a form of compulsion, it should be restored to is customary state. It is also beneficial to stimulate the skin of the torpid limb, either by whipping with nettles, or by applying mustard plasters, these latter being removed as soon as the skin becomes red. Appropriate applications also are crushed squills, and onions pounded up with frankincense. Nor is it amiss to pluck on the skin for some time by the aid of a pitch plaster every third day (III.22.6) and sometimes to apply dry cups in several places. Again for anointing, old olive oil is most suitable, or soda mixed with oil and vinegar. Further, it is also highly necessary to foment with warm sea water, or failing that with salt and water. And if there are at hand swimming baths, whether natural or artificial, they should be used as much as possible; especially the defective limb should be moved in them; if there are none such the ordinary bath is of service. The food should be of the middle class, particularly game, the drink hot water without wine. If, however, the disease is of long standing, every fourth or fifth day Greek salted wine may be given, in order to purge. An emetic after supper is of use.
3.27.2
At times also there occurs pain in the sinews. In that case it is not expedient to excite vomiting nor urination as some prescribe, nor indeed sweating other than through exercise; water should be drunk; twice a day in bed the body should be rubbed gently and for some time, and then whilst holding the breath, the limbs, preferably the upper, are to be moved in the course of exercise. The bath should be seldom used; from time to time there should be a change of air by travel. If there is pain, the part should be wetted with water containing soda, but not oil, then wrapped up, and under it should be placed a brazier containing some glowing charcoal with sulphur, so that it may be fumigated for a while; this should be repeated from time to time, but only on an empty stomach and after digestion is completed. Cups also may be applied at frequent intervals to the painful part, and this place lightly beaten with inflated ox bladders. It is also of service to mix fat with pounded henbane and nettle seeds, equal parts of each, and put this on, also to foment with a decoction of sulphur. Further, it is a good plan to apply leather bottles filled with hot water, or bitumen mixed with barley meal. And for the actual pain the best remedy is forceful rocking; which in other kinds of pain is the worst.
3.27.3
Tremor of sinews again is like with made worse by an emetic, and by medicaments causing urination. Inimical also are baths and dry sweatings. Water is to be drunk; the patient should there are a smart walk and be anointed and rubbed as well, especially by himself; the upper limbs are to be exercised by ball games and the like; he may think what food he likes provided that he studies his digestion. He should avoid worry after meals; make the rarest use of venery. If at any time he has given way to it, then he ought to be rubbed, with oil, gently and for some time, whilst in bed, by the hands of boys rather than men.
3.27.4
Now suppurations which arise in some interior part, when they become noticeable, first should be acted upon by those poultices which repress, less there is produced a harmful collection of the material of disease; next if these remedies are unsuccessful, the suppurations may be dissipated by dispersive poultices. If we are not successful in that, it follows that the suppuration should be drawn outwards, next that it should mature. The ending of every abscess is to rupture; the indication is pus discharged either from the bowels or mouth. But nothing ought to be done to diminish the discharge of the pus. Broth and hot water are chiefly to be given. When pus ceases to be discharged, then there should be a transition to digestible yet nutritious food consumed cold, also cold water for drink, commencing, however, with lukewarm. To begin with, things such as pine kernels, or almonds, or hazel nuts, may be eaten along with honey; afterwards these make way for whatever can make the scar form earlier. At this stage as a medicament for the ulceration there is to be taken either leek or horehound juice, and whatever the food, leeks should be added. Rubbing is required also for parts unaffected, so also gentle walks; to be avoided are wrestling and running and other things tending to irritate healing ulcerations, for in this malady the vomiting of blood is most pernicious and to be guarded against in every way.
4.1.1
1 Thus far I have dealt with those classes of diseases which so affect bodies as a whole, that fixed situations cannot be assigned to them: I will now speak of diseases in particular parts. Diseases of all the internal parts and their treatment, however, will come under view more readily if I first describe briefly their institutions.
4.1.2
The head, then, and the structures within the mouth are not only bounded by the tongue and palate, but also by whatever is visible to our eyes. On the right and left sides around the throat, great blood-vessels named sphagatides, also arteries called carotids, run upwards in their course beyond the ears. But actually within the neck are placed glands, which at times become painfully swollen.
4.1.3
From that point two passages begin: one named the windpipe, the more superficial, leads to the lung; the deeper, the gullet, to the sm; the former takes in the breath, the latter food. Though their courses diverge, where they are joined, there is a little tongue in the windpipe, just below the fauces, which is raised when we breathe, and, when we swallow food and drink, closes the windpipe. Now the actual windpipe is rigid and gristly; in the throat it is prominent, in the remaining parts it is depressed. It consists of certain little rings, arranged after the likeness of those vertebrae which are in the spine, but in such a way that whilst rough on the outer surface, the inside is smooth like the gullet; descending to the praecordia, it makes a junction with the lung.
4.1.4
The lung is spongy, and so can take in the breath, and at the back it is joined to the spine itself, and it is divided like the hoof of an ox into two lobes. To the lung is attached the heart, which, muscular in nature, is placed under the left breast, and has two small stomach-like pockets. Now, under the heart and lung is a transverse partition of strong membrane, which separates the belly from the praecordia; it is sinewy, and many blood-vessels also take their course through it; it separates from the parts above not only the intestines but also the liver and the spleen. These organs are placed against it but under it, on the right and left sides respectively.
4.1.5
The liver, which starts from the actual partition under the praecordia on the right side, is concave within, convex without; its projecting part rest lightly on the stomach, and it is divided into four lobes. Outside its lower part the gall-bladder adheres to it: but the spleen to the left is not connected to the same partition, but to the intestine; in texture it is soft and loose, moderately long and thick; and it hardly projects at all from beneath the ribs into the belly, but is hidden under them for the most part. Now the foregoing are joined together. The kidneys on the other hand are different; they adhere to the loins above the hips, being concave on one surface, on the other convex; they are both vascular, have ventricles, and are covered by coats.
4.1.6
These then are the situations of the viscera. Now the gullet, which is the commencement of the intestines, is sinewy; beginning at the seventh spinal vertebra, it makes a junction in the region of the praecordia with the stomach. And the stomach, which is the receptacle of the food, consists of two coats; and it is placed between the spleen and the liver, both overlapping it a little. There are also fine membranes by which these three are interconnected, and they are joined to that partition, which I have described above as transverse.
4.1.7
Thence the lowest part of the stomach, after being directed a little to the right, is narrowed into the top of the intestine. This juncture the Greeks call pylorus, because, like a gateway, it lets thru into the parts below whatever we are to excrete.
4.1.8
From this point begins the fasting intestine, not so much infolded; it has this name because it does not hold what it has received, but forthwith passes it on into the parts below.
4.1.9
Beyond is the thinner intestine, infolded into many loops, its several coils being connected with the more internal parts by fine membranes; these coils are directed rather to the right side, to end in the region of the right hip; however, they occupy mostly the upper parts.
4.1.10
After that spot this intestine makes a junction crosswise with another, the thicker intestine; which, beginning on the right side, is long and pervious towards the left, but not towards the right, which is therefore called the blind intestine.
4.1.11
But that one which is pervious being widespread and winding, and less sinewy than the upper intestines, has a flexure on both sides, right and left, especially on the left side and in the lower parts and touches the liver and stomach, next it is joined to some fine membranes coming from the left kidney, and thence bending backwards and to the right, it is directed straight downwards to the place where it excretes; and so it is there named the straight intestine.
4.1.12
The omentum too, which overlies all these, is at its lower part smooth and compact, softer at its upper part; fat also is produced in it, which like the brain and marrow is without feeling.
4.1.13
Again from the kidneys, two veins, white in colour, lead to the bladder; the Greeks call them ureters, because they believe that through them the urine descending drops into the bladder.
4.1.14
Now the bladder, sinewy and in two layers at its bag, is at its neck bulky and fleshy; it is connected by blood-vessels with the intestine, and with that bone which underlies the pubes. The bladder itself is loose and rather free, and situated differently in men and women: for in men it is close to the straight intestine, being inclined rather to the left side; in women it is situated over the genitals, and whilst free above, is supported actually by the womb.
4.1.15
Again, in males, a longer and narrower urinary passage descends from the neck of the bladder into the penis; in women, a shorter and wider one presents itself over the neck of the womb. Now the womb in virgins is indeed quite small; in women, unless they are pregnant, it is not really much larger than a handful. Beginning over against the middle of the rectum by a straight narrow neck, which they call canalis, it is then turned a little towards the right hip joint; next, as it rises above the right intestine, its sides are fastened into the woman's ilia. Again, these ilia are situated between the hip joints and the pubes at the bottom of the abdomen. From them and from the pubes the abdominal wall extends upwards to the praecordia; it is covered visibly upon the outside by skin, inside by a smooth membrane which makes a junction with the omentum; and it is named by the Greeks peritoneal membrane.
4.2.1
2 Having made a sort of survey as it were of these organs, so far as it is necessary for a practitioner to know them, I shall follow out the remedies for the several parts when diseased, starting with the head; under that term I now mean that part which is covered with hair; for pain in the eyes, ears and teeth and the like will be elsewhere explained (VI.6‑9, VII.7‑12).
4.2.2
In the head, then, there is at times an acute and dangerous disease, which the Greeks call cephalaia; the signs of which are hot shivering, paralysis of sinews, blurred vision, alienation of the mind, vomiting, so that the voice is suppressed, or bleeding from the nose, so that the body becomes cold, vitality fails. In addition there is intolerable pain, especially in the region of the temples and back of the head. Again, there is sometimes a chronic weakness in the head, which, although neither severe nor dangerous, lasts through life; sometimes there is more severe pain, but of short duration, and not fatal, which is brought about by wine or indigestion or cold or heat or the sun. And all these pains occur, sometimes with fever, sometimes without fever; sometimes they affect the whole head, sometimes a part only; at times so as to cause excruciating pain also in the adjacent part of the face. Besides the foregoing there is a class which may become chronic, in which a humour inflates the scalp, so that it swells up and yields to the pressure of the fingers. The Greeks call it hydrocephalus. Of these forms, that mentioned second, while it is slight, is to be treated by the regimen I have stated when I was describing what healthy men should do in the case of weakness of any part (I.4). For pain in the head accompanied by fever the remedies have been detailed when describing the treatment of fevers in general (III.3‑17). Now to speak of the rest.
4.2.3
Of these the case that is acute, also that which surpasses ordinary limits, and that which is of sudden causation and although not deadly, is yet violent, has its primary remedy in blood-letting. But this measure is unnecessary, unless the pain is intolerable, and it is better to abstain from food; also from drink, when possible; if not possible, then to drink water. If, on the day following, pain persists, the bowels should be clystered, sneezing provoked, and nothing but water taken. For often, in this way, all the pain is dispersed within one or two days, especially if it has originated from wine of indigestion. But if there is little benefit from the above, the head should be shaved down to the scalp; then it should be considered what cause excited the pain. If the cause was hot weather, it is well to pour cold water freely over the head, to put on the head a concave sponge now and again wrung out of cold water; to anoint the head with rose oil and vinegar, or better to put on unscoured wool saturated with the same, or else other refrigerant plasters. But if cold has done the harm, the head should be bathed with warm sea-water, or at any rate salt and water, or with a laurel-leaf decoction, after which the head should be rubbed smartly, have warm oil poured on it, and then be covered up. Some even bandage up the head, some load it with neck-wraps and mufflers, and so get relief; warm plasters give help in other cases. Hence, even when the cause is unknown, it should be observed whether cooling or heating methods afford the more relief, and to make use of those which experience has approved. But if the cause is not known, the head should be bathed, first in warm water as noted above, or in salt and water, or in the laurel decoction, next in cold vinegar and water. For all long-standing pain in the head, the following are the general measures: to provoke sneezing; to rub the legs smartly; to gargle things which provoke salivation; to apply cups to the temples and occiput; to draw blood from the nostrils; to pluck upon the skin of the temples frequently by the aid of pitch plasters; to apply mustard in order to cause ulcers over the site of the pain, after having put a layer of linen over the skin to prevent violent erosion; to excite ulcerations by cautery, applied over the seat of the pain; to take food in great moderation, with water; after the pain has been relieved, to go to the bath, and there to have much water poured over the head, first hot, then cold; if the pain has been quite dispersed, the patient may even return to wine, but should always before anything else drink some water.
4.2.4
The class in which humour collects upon the head is different. In that case it is necessary to shave the head to the scalp; then to apply mustard until it causes ulcers; if this is of little avail, recourse must be had to the scalpel. The following measures are the same as for dropsical patients: exercise, sweating, smart rubbing, and such food and drink as will specially promote urination.
4.3.1
3 Again, about the face there originates an affection which the Greeks call "dog spasm." And it begins along with acute fever; the mouth is drawn to one side by a peculiar movement, and so it is nothing else than a distortion of the mouth. In addition there is frequent change of colour in the face as well as over all the body, also an inclination to sleep. In this case blood-letting is the best thing; if that does not end the disorder, the bowels are moved with a clyster; when not even thus dispersed, vomiting is provoked by white hellebore. It is necessary besides to avoid the sun, fatigue and wine. If it is not dispersed by these measures, use running, rubbing of the affected part gently and repeatedly, also rub other parts for less time, but smartly. It is also useful to provoke sneezing; to shave the head, to pour over it hot sea water, or at any rate salt and water, provided that sulphur is also added; after this affusion the patient should again be rubbed; should chew mustard, applying at the same time to the parts of the mouth affected a wax salve, likewise to the unaffected parts mustard until it produces erosion. Food of the middle class is most suitable.
4.4.1
4 But if there is paralysis of the tongue, which sometimes occurs of itself, sometimes is produced by some disease, so that the man's speech is not distinct, he should gargle a decoction of thyme, hyssop or mint; drink only water; have the head, face, the parts under the chin and the neck smartly rubbed; the tongue itself smeared with laser; chew very acrid materials, mustard, onion, garlic, and strive with all his force to pronounce words; hold his breath at exercise; frequently pour cold water over his head; on occasion eat a quantity of radish and then vomit.
4.5.1
5 Again there is dripping from the head sometimes into the nose, which is a mild affair; sometimes into the throat, which is worse, sometimes into the lung, which is worst of all. When the drip is into the nostrils, a thin phlegm is discharged from them; there is slight pain, and a feeling of weight in the head, with frequent sneezing; if the drip is into the throat, it irritates and excites a slight cough; if the drip is into the lung, besides the sneezing, cough and even weight in the head, there is lassitude, thirst, a feeling of heat, and bilious urine.
4.5.2
Another although not very different affection is gravedo. This closes up the nostrils, renders the voice hoarse, excites a dry cough; in it the saliva is salt, there is ringing in the ears, the blood-vessels in the head throb, the urine is turbid. Hippocrates named all the above coryza; I note that now the Greeks reserve this term for gravedo, the dripping they call catastagmus. These affections are commonly of short duration, but if neglected may last a long while. None is fatal, except that which causes ulcers in the lung.
4.5.3
Whenever we feel anything of the sort, we should forthwith keep out of the sun, and abstain from the bath, wine and coition; but the use meanwhile of anointing and of customary food is allowable. The patient should walk, but only briskly and under cover; after that the head and face should be rubbed for more than fifty strokes. This complaint is generally relieved, provided that we take care of ourselves for a couple of days, or for three at the most. When the disease has been relieved so that the drip of phlegm becomes thick, or the gravedo so that the nostrils are more open, the bath may be resumed, much water, at first hot, then lukewarm, being used to foment the face and head; next, along with more food, wine may be taken. But if on the fourth day the phlegm is still thin, or the nostrils still stuffed up, the patient should take dry Aminaean wine, then for a couple of days water; after which he can return to the bath and his usual habits. Nevertheless, even during those days, when some things are to be avoided, it is not expedient to treat the patients as sick men, but they are to do everything as in health, unless these symptoms have been liable to cause more prolonged and severe trouble; for then a somewhat more careful attention is needed.
4.5.4
Therefore in such a case if there is a drip into the nose or into the throat, besides the treatment described above, the patient from the start should walk a good deal during the first days: have the lower limbs smartly rubbed, together with more gentle rubbing of the chest, face and head; his accustomed food should be reduced by one-half; he may take eggs, also starchy and such-like foods, which thicken phlegm; thirst should be resisted as far as he can bear it. When by these measures a patient has been prepared for the bath, and has used it, there may be added to the diet small fish or meat, provided that at first he should not take the full quantity of food; undiluted wine should be taken more freely.
4.5.5
But if the drip is into the lung also, there is even more need for walking and rubbing and the same regimen as to diet, and if that diet is not effective, more acrid food is to be employed; he should allow himself more sleep, and abstain from all business; but the bath should be tried at a somewhat later stage.
4.5.6
In the case of gravedo, he should lie in bed on the first day, neither eat nor drink, cover the head, and wrap wool around the throat; on the next day he should get up, and still abstain from drink, or, if he must have some, take not more than one tumbler-full of water; on the third day he may eat the crumb of bread, but not much, with some small fish, or light meat, and water for drink. Should the patient be unable to restrain himself from using a fuller diet, he is to provoke a vomit; when he gets to the bath, he should foment freely his head and face with hot water until he sweats, and then have recourse to wine. After the above measures it is scarcely possible for the same discomfort to persist; but if it does so, use cold, dry, light food with the least possible fluid, whilst continuing the rubbings and the exercises, such as are needed in all such sorts of illness.
4.6.1
6 From the head we pass to the neck, which is liable to harm from diseases of considerable gravity. There is, however, no disease more distressing, and more acute, than that which by a sort of rigor of the sinews, now draws down the head to the shoulder-blades, now the chin to the chest, now stretches out the neck straight and immobile. The Greeks call the first opisthotonus, the next emprosthotonus, and the last tetanus, although some with less exactitude use these terms indiscriminately. These diseases are often often fatal within four days. If the patients survive this period, they are no longer in danger. They are all treated by the same method and this is agreed upon, but Asclepiades in particular believed in blood-letting, which some said should be particularly avoided, because the body was then especially in need of that heat which was in the blood. But this is false; for it is not in the nature of the blood to be especially hot, but of all that composes man, the blood most quickly turns, now hot, now cold. Still, whether or no it ought to be let, can be learnt from the instructions concerning blood-letting (II.10, 11). But anyhow it is right to give castory, and with it pepper or laser; further, a warm and moist fomentation is needed. For this purpose most pour hot water freely at intervals over the neck. This affords temporary relief, but renders the sinews more susceptible to cold, a thing certainly to be avoided. It is, therefore, more beneficial, first to anoint the neck with a liquid wax-salve, then to apply ox-bladders or leathern bottles filled with hot oil, or else a hot meal plaster, or a pod of round pepper crushed up in a fig. The best thing, however, is to foment with moistened salt according to the method already described (II.17.9, 10; 33.1). Whatever meanwhile is being done, the patient should be brought near a fire, or into the sun in hot weather, and old oil in particular should be rubbed into his neck, shoulder-blades and spine; or if that is not at hand, Syriac oil, or if not even that, oldest lard. Rubbing applied to the whole length of the vertebrae is beneficial, but especially so to those of the neck. Therefore, with certain intervals however, this procedure should be carried out both by day and by night. During such intervals some kind of an emollient composed of heating substances should be put on. Cold is especially to be guarded against; and so there ought to be a fire kept burning constantly in the room in which the patient is lying, especially during the hours before dawn, when the cold is particularly intense. It is not unserviceable to keep the head closely clipped, moistened with hot iris or cyprus oil, and covered by putting on a cap; sometimes even to submerge the patient either in hot oil, or in hot water in which fenugreek has been boiled and a third part of oil added. If the bowels also have been moved by a clyster, this often relaxes the upper parts. Should the pain grow even still more severe, cups should be applied to the neck after the skin has been incised; or the same spot is to be burnt either with the cautery, or by mustard. When the pain has been relieved and the neck begins to be moved, it can be recognized that the disease is yielding to treatment. But for a long while food which has to be chewed should be avoided; sops and eggs, raw or soft boiled, are to be used; any kind of soup may be taken. But if the patient has done well, and the neck appears to be all right, then will be the time to begin with pulse porridge, or well-moistened crumbled bread. He is to chew bread, however, earlier than to drink wine, because the use of wine is particularly risky, and so ought to be deferred for a longer time.
4.7.1
7 Whilst this kind of disease involves the region of the neck as a whole, another equally fatal and acute has its seat in the throat. We call it angina; the Greeks have names according to its species. For sometimes no redness or swelling is apparent, but the skin is dry, the breath drawn with difficulty, the limbs relaxed; this they call synanche. Sometimes the tongue and throat are red and swollen, the voice becomes indistinct, the eyes are deviated, the face is pallid, there is hiccough; that they call cynanche: the signs in common are, that the patient cannot swallow food nor drink, and his breathing is obstructed. It is a slighter case when there is merely redness and swelling, not followed by the other symptoms; this they call parasynanche. Whichever form occurs blood must be let if strength permits; if there is no surplus strength, then move the bowels by a clyster. Cups also may be applied with benefit under the chin, also outside the throat, so as to draw out the matter which is suffocating. Next, moist foments are needed, for dry ones hinder the breath. Consequently sponges, dipped into hot oil at intervals, should be put on; that is better than hot water; but most efficacious here too is hot moistened salt. Moreover, it is useful: to make a decoction with hydromel of hyssop, catmint, thyme, wormwood, or even of bran, and dried figs, and to gargle with it; afterwards to smear the palate with ox-gall, or with the medicament made of mulberries. It is also appropriate for a cough to dust the palate with pounded pepper. If there is little effect from these remedies, the last resource is to make sufficiently deep incisions into the upper part of the neck under the lower jaw, or into the palate in front of the uvula, or into the veins under the tongue, in order that the disease may discharge through the incisions. If the patient is not benefited by all this, it must be recognized that he has been overcome by the disease. But if these measures have relieved the disease, and the throat again admits both food and breath, a return to health is easy. And sometimes nature also assists when the disease moves from a more restricted to a more widespread seat; so when redness and swelling have arisen over the praecordia, it may be recognized that the throat is becoming free. But whatever has relieved it, the patient should begin with fluids, especially with the hydromel decoction; next soft and unacrid food should be taken until the throat has returned to its original condition. I hear it commonly said that if a man eat a nestling swallow, for a whole year he is not in danger from angina; and that when the disease attacks anyone it is also beneficial to burn a nestling which has been preserved in salt and to crumble the powdered ash into hydromel which is administered as a draught. Since this remedy has considerable popular authority, and cannot possibly be a danger, although I have not read of it in medical authorities, yet I thought that it should be inserted here in my work.
4.8.1
8 There is also in the region of the throat a malady which amongst the Greeks has different names according to its intensity. It consists altogether in a difficulty of breathing; when moderate and without any choking, it is called dyspnoea; when most severe, so that the patient cannot breathe without making a noise and gasping, asthma; but when in addition the patient can hardly draw in his breath unless with the neck outstretched, orthopnoea. Of these, the first can last a long while, the two following are as a rule acute. The signs common to them are: on account of the narrow passage by which the breath escapes, it comes out with a whistle; there is pain in the chest and praecordia, at times even in the shoulder-blades, sometimes subsiding, then returning; to these there is added a slight cough. Blood-letting is the remedy unless anything prohibits it. Nor is that enough, but also the bowels are to be relaxed by milk, the stool being rendered liquid, at times even a clyster is given; as the body becomes depleted by these measures the patient begins to draw his breath more readily. Moreover, even in bed the head is to be kept raised; the chest movement assisted by hot foments and plasters, dry or even moist, and later either emollients are to be applied or at any rate a wax-salve made with cyprus, or iris ointment. Next, on an empty stomach the patient should take a draught of hydromel, in which either hyssop or crushed caper root has been boiled. It is also of use to suck either soda or white nasturtium seed, parched, crushed and then mixed with honey; and for the same purpose, galbanum and turpentine resin are boiled together to a coherent mass, and a bit of this, the size of a bean, is sucked every day, or unfused sulphur 1 gram and 0·66 gram of southernwood are pounded up in a cupful of wine and sipped lukewarm. It is also not a foolish idea that the liver of a fox should be dried, pounded and the mash sprinkled into the above, or that the lung of that animal, as fresh as possible, roasted without touching iron in the cooking, should be eaten. In addition to the above, gruels and light food are to be used, at intervals also a light dry wine, occasionally an emetic. Some kind of diuretic is also beneficial, but there is nothing better than a walk until almost fatigued, also frequent rubbings, especially of the lower extremities, either in the sun, or before a fire, done by the patient himself or others, until he sweats.
4.9.1
9 But in the interior parts of the throat there is sometimes ulceration. For this most employ plasters and hot foments externally; they also order hot steam to be inhaled by the mouth. Others say that by these measures the parts are rendered more soft and more liable to the complaint already existing there. But these applications are salutary if cold can be completely avoided; if cold is to be apprehended, they are useless. But anyhow to rub the throat is dangerous; for it provokes ulceration. Nor are diuretics useful, because in the course of being swallowed they can also make thin the phlegm there, which is better suppressed. Asclepiades, who wisely advises many things, which we also ourselves practise, said that very sour vinegar should be sipped; for by this the ulcers are constricted without doing harm. But whilst vinegar can suppress bleeding, it cannot heal the actual ulcerations. For that purpose lycium is better, and Asclepiades approved equally of it, or leek or horehound juice, or almonds pounded up with tragacanth and mixed with raisin wine, or linseed pounded and mixed with sweet wine. Exercise also by walking and by running is necessary, and smart rubbing from the chest downwards should be applied to the whole of the lower part of the body. The food too should be neither very acrid nor rough, honey, lentils, wheat porridge, milk, pearl barley gruel, fat meat and especially a leek decoction and anything mixed with it. Of drink the least possible is proper; water can be given either by itself, or when quince or dates have been boiled in it. Bland gargles are of service also, or when ineffectual then repressants. This sort of affection is not acute, and cannot last long; nevertheless, it requires timely treatment, lest it should become a severe and chronic complaint.
4.10.1
10 Cough again is generally owing to ulceration of the throat. This is incurred in many ways: and so when the throat has healed the cough is ended. Nevertheless, at times cough is a trouble by itself, and when it has become chronic, is difficult to get rid of. Sometimes the cough is dry, sometimes it excites phlegm. Hyssop should be taken every other day; the patient should run whilst holding the breath, but not where there is dust; he should practise reading loudly, which may at first be impeded by the cough, but later overcomes it; next walking; then manual exercises also, and the chest should be rubbed for a long while. After such exercises he should eat three ounces of very juicy figs, cooked over charcoal. Besides the above, when the cough is moist, smart rubbings with some kind of heating substance are good, provided that the head too is briskly rubbed when dry; in addition, cups are applied to the chest; mustard put on outside over the throat until there is slight excoriation; and a draught taken, composed of mint, almonds, and starch; first of all dry bread should be eaten, then any kind of bland food. But if the cough is dry and very troublesome, it is relieved by taking a cup of dry wine, provided that this is done only three or four times at rather long intervals; further, there is need to swallow a little of the best laser, to take juice of leeks or horehound; to suck a squill, to sip vinegar of squills, or at any rate sharp vinegar; or two cupfuls of wine with a bruised clove of garlic. In every case of cough it is of use to travel, take a long sea voyage, live at the seaside, swim, sometimes to take bland food, such as mallows, or nettle-tops, sometimes acrid; milk cooked with garlic; gruels to which laser has been added, or in which leeks have been boiled to pieces; a raw egg to which sulphur has been added; at first warm water to drink, than, in turn, one day water, the next day wine.
4.11.1
11 When blood is spat up there is more cause for alarm, although that presents at one time less, at another more of danger. Blood sometimes comes from the gums, sometimes from the mouth, and that at times copiously, yet without cough, without ulceration, without any disease of the gums, so that there is no expectoration. But just as there is on occasion bleeding from the nostrils, so also does it burst out from the mouth. And sometimes it is blood which flows, sometimes something resembling water in which fresh meat has been washed. On the other hand, blood may come from the uppermost part of the throat, at one time when there is ulceration in that part, at another without ulceration, but either the mouth of some blood-vessel has opened, or the blood breaks out of certain tubercles which have originated there. When this happens, neither food nor drink does harm, nor is there any expectoration as from an ulcer. When, however, the throat and air tubes are ulcerated, the frequent cough also forces out blood; at times it is even brought up out of the lung or out of the chest or out of the sides or out of the liver. Often women, in whom the blood is not being given out through the menses, expectorate blood.
4.11.2
According to medical authorities blood gains exit either from some part eroded, or ruptured, or from the opened mouth of some blood-vessel; the first they call diabrosis, the second rhexis, the third anastomosis. The last is the least harmful, the first, the worst. And often indeed it happens that pus follows the blood. Now at times to stop the bleeding suffices to promote recovery; but if there follow ulcerations, or pus, or a cough, according to the situation there arise various and dangerous classes of diseases. But if only blood flows out, both the remedy and the ending are the quicker. Nor ought we to ignore that in those who are in the habit of bleeding or in whom the back or hips ache whether after hard running or walking, a limited flow of blood is not disadvantageous as long as fever is absent, and when blood is passed by the urine it even relieves this very lassitude; nor indeed, in the case of a fall from a height, is there anything alarming if blood comes with the urine, so long as there is nothing else unusual in the urine; nor does vomiting of blood bring about danger, even when repeated, if before it recurs the body is allowed to regain strength and fill up; and it does no harm at all in a robust man, if not excessive, and when it excites neither cough nor fever.
4.11.3
The foregoing are general remarks: now I come to the particular points mentioned above. If blood escapes from the gums, it suffices to chew purslane; if from the mouth, undiluted wine should be held in it; if this does no good, then vinegar. If in spite of these remedies there is a severe outburst, since this may be the death of the patient, its attack is best diverted by applying a cup to the occipital region, after first incising the skin; when this happens in a woman whose menses are not forthcoming, a cup is applied to each groin, likewise after making incisions. But if the bleeding comes from the throat, or from more internal parts, there is more to fear, and a more active treatment is to be adopted. Blood should be let, and if the flow from the mouth is not lessened, the venesection should be repeated a second or a third time, and every day a little. From the first also the patient should sip either vinegar or plantain or leek juice with frankincense, and outside over the seat of pain there is to be applied unscoured wool soaked in vinegar, cooled at intervals by means of a sponge. Erasistratus used also to bind up the legs and thighs and the forearms of such patients in several places. This constricting Asclepiades declared far from being beneficial, to be even harmful. But that it often answers well experience bears witness. Yet there is no necessity to bind the patient in many places; it is enough to do it below the groins and above the ankles and at the upper part of the arms, also the forearms. Further, if fever is troublesome, gruel must be given, and for drink water in which has been boiled any one of the intestinal astringents. But if fever is absent, there may be given: either washed spelt or bread soaked in cold water and also soft eggs, and for drink either that mentioned above, or sweet wine or cold water; but drink must be given with the knowledge that in this disease thirst is an advantage. Besides these, there are needed rest, freedom from care, and silence. The head also of the patient whilst in bed should be kept raised, and well shaved; the face is often to be bathed with cold water. On the other hand, there is danger in wine, the bath, coition, oil in the food, all acrid food; the same applies to hot foments, a hot close room, much bedclothes piled on the patient. Rubbings also are useful after the bleeding has quite stopped. Then indeed a beginning can be made on the arms and legs, avoiding the chest. A patient in this case should live through the winter by the sea, during the summer inland.
4.12.1
12 Below the throat is placed the stomach, in which there tend to occur many chronic complaints. For sometimes great heat affects it, sometimes flatulence, sometimes inflammation, sometimes ulceration; at times phlegm collects, at times bile; but the most frequent malady is that in which it undergoes paralysis, nor does anything else so affect it, or, through it, the whole body. As diverse as are its complaints, so are the remedies.
4.12.2
When heated, it should be bathed externally at intervals with vinegar and rose oil, and road dust applied with oil, and those plasters which simultaneously repress and soothe. For drink, unless there is anything against it, lukewarm water is the best.
4.12.3
If there is flatulence, it is beneficial to apply cups, but there is no need to incise the skin; dry and hot foments do good, but not the strongest kind. At intervals there should be enjoyed abstinence from food; a draught of wormwood or hyssop or of rue on an empty stomach is useful. Exercise at first should be light, then more is to be taken, especially such as moves the upper limbs; the kind most appropriate in all complaints of the stomach. After exercise there is need of anointing, rubbing, occasionally also the bath, yet less often than usual; now and then a clyster; later, food which is hot but not flatulent, and similarly hot drinks, first water and after the flatulence has subsided, dry wine. In all complaints of the stomach this also is to be prescribed, that each should adopt in health that regimen which has cured him; for his weakness will recur unless his health is protected by the same measures as those by which it was restored.
4.12.4
But if there is inflammation of any kind, which is generally followed by swelling and pain, the primary remedies are rest, abstinence, a belt of sulphurated wool, and the wormwood draught upon an empty stomach. If a burning heat troubles the stomach, it should be fomented at intervals with vinegar and rose oil; next food should be given in moderation, external applications are also to be made which simultaneously both repress and soothe; next after that, when these are taken off, hot meal plasters are put on to disperse the remnants of the disease: now and again a clyster must be given, exercise must be taken, and a fuller diet.
4.12.5
But if ulcers attack the stomach, generally the same treatment should be applied as has been prescribed in the case of an ulcerated throat (IV.9). Exercise, also rubbing of the lower extremities, is to be practised; bland and glutinous foods taken short of satiety; and all pungent and sharp food withdrawn. Sweet wine is to be used if there is no fever, or if that causes flatulence at any rate light wine, but neither very cold nor too hot.
4.12.6
If the stomach becomes filled with phlegm an emetic is needed, sometimes on an empty stomach, sometimes after food: there is benefit in exercise, rocking, a sea-voyage, rubbing. Nothing should be eaten or drunk unless hot, whilst such things must be avoided as have tended to collect phlegm.
4.12.7
There is worse trouble when the stomach is vitiated by bile. Patients who are troubled with this, vomit up bile at intervals of some days, and worst of all, vomit black bile. For such a clyster is appropriate, and draughts of wormwood should be given; rocking and a sea-voyage are necessary; vomiting when possible is induced by sea-sickness; indigestion must be avoided, the food should be such as is readily swallowed, and not repugnant to the stomach, the wine must be dry.
4.12.8
But the commonest and worst complaint of the stomach is paralysis, when it does not retain food, and the nutrition of the body is wont to cease, and so it is consumed by wasting. In this sort of disease the bath is most harmful; reading aloud and exercise of the upper limbs are needed, as also anointing and rubbings; it is good for the patient to have cold water poured over him, and to swim in cold water, also to submit his stomach to jets of it, especially at the back of the stomach from the shoulder-blades downwards, to bathe in cold medicinal springs, such as those at Cutilia and Simbruvium. Food should be also taken cold, rather that which is digested with difficulty than that which readily decomposes. Hence many who can digest nothing else, digest beef, and therefore it may be inferred that neither poultry no venison, nor fish except the harder kinds, should be given. The most suitable drink is wine cold, or else undiluted and well heated, particularly Rhaetic or Allobrogic wine, or any other which is both dry and seasoned with resin; if there is none of the above at hand, then the harshest possible, especially Signine wine. If food is not retained, water must be given and a more copious vomit elicited, after which food is to be given again, and then cups are to be applied two fingers' breadth below the stomach, and they are to be kept on two or three hours. If simultaneously there is both vomiting and pain, there should be placed over the stomach unscoured wool or sponge soaked in vinegar, or a refrigerant plaster. The arms and legs too are to be rubbed sharply, but not for long, and to be kept warm. If pain is more severe, a cup is to be put on four fingers' breadth below the praecordia, and following that bread in cold vinegar and water is to be given; should this not be retained, after the vomiting, anything light or not unsuitable for the stomach can be given; if even that is not retained, give a cupful of wine every hour until the stomach settles down. Radish juice also is an active remedy; more active still is a mixture of the juice of sour and sweet pomegranates in equal parts, with the addition of endive and mint juice, the least quantity of the last; the whole of the above may be mixed thoroughly well with an equal quantity of cold water, which is better than wine for tightening up the stomach. Now, vomiting when spontaneous should be arrested; but if there is nausea, or if food turns acid inside, or decomposes, both of which are manifested by eructations, the food should be evacuated, and the stomach forthwith replenished by the taking of food of the kind just noted (§ 9). When immediate apprehension has been removed a return should be made to the prescriptions given above (§ 7).
4.13.1
13 The stomach is girt about by the ribs, and in these also severe pains occur. And the commencement either is from a chill, or from a blow, or from excessive running, or from disease. But at times pain is all there is the matter, and this is recovered from be it slowly or quickly; at times it goes on until it is dangerous, and the acute disease arises which the Greeks call pleurisy. To the aforesaid pain in the side is added fever and cough; and by means of the cough, phlegm is expectorated when the disease is less serious, but blood when it is grave. At times also there is a dry cough without expectoration, which is worse than the former condition, and better than the latter. The aparo remedy for severe and recent pain is blood-letting; but if the case is either of a slighter or of a more chronic kind, then this remedy becomes either unnecessary or belated; and recourse is to be had to cupping after incising the skin. It is also appropriate to apply vinegar and mustard upon the chest until this raises ulcerations and pustulations, and then a medicament to draw out the humour that way. Besides the above the side should be first surrounded with a sheet of sulphurated wool; next, after the inflammation has subsided somewhat, have dry and hot foments applied to it. From these transition is made to emollients. If the pain persists for a longer time, it may finally be dispersed by resin plaster. Food and drink should be taken hot, avoiding cold. Along with the above treatment, however, it is not unfitting to rub the lower limbs with oil and sulphur. If the cough has been relieved, the patient should read a little out loud, and now take both sharp food and undiluted wine. Though such are what medical practitioners prescribe, yet our country people, lacking these remedies, find help enough in a draught of germander. The foregoing are the remedies common to all cases of pain in the side: there is more to do if this affection has also become acute. In such cases, besides what has been described above, attention must be given to the following: that the food be as thin and bland as possible, and gruel is most suitable, especially that made with pearl barley, or soup made by boiling a chicken with leeks, and this may be given, but only every third day, if the patient's strength permits of this; the drink should be hydromel in which hyssop or rue has been boiled. The times at which these should be given will become apparent from the way the fever increases or diminishes, so that it should be given when there is least fever, not forgetting, however, that a dry throat must not be combined with that kind of cough; for often when there is no expectoration, the cough is incessant and chokes the patient. On this account I stated above that a cough which brings up nothing is of a worse kind than that causing phlegm to be expectorated. But here the disease does not allow of wine being sipped as prescribed above (10.3); pearl barley gruel is to be taken instead. As these have to sustain the patient during the hot stage of the disease, as soon as there is a little remission, the diet can be increased and also some wine given, as long as nothing is given that will either chill the body or irritate the throat. If the cough persists in convalescence, it will be well on one day to omit the wine, and on the next to take a little extra wine with the food. And also at the beginning of a cough, as stated above, it is not amiss to sip cupfuls of wine; but sweet or at any rate light wine, is the more suitable in this kind of illness. If the malady has become inveterate the body must be strengthened by food fit for an athlete.
4.14.1
14 Passing from the framework of the body to the viscera, we come first to the lung, where a grave and acute disease arises, which the Greeks name peripleumoniacon. The conditions are these: the lung is attacked as a whole; this is followed by a cough which draws up bile or pus; there is a feeling of weight over the praecordia and all the chest; there is difficult breathing, high fever, persistent insomnia, loss of appetite, wasting. This sort of disease has in it more of danger than of pain. Blood should be let if there is strength enough; if not, dry cups should be applied over the praecordia. Then if the patient is strong enough he should be rocked to disperse the disease; if not, he should yet be moved about in the house: his drink should then be a decoction of hyssop with a dried fig, or hydromel in which hyssop or rue has been boiled; he should be rubbed twice daily, longest between the shoulder-blades, then the arms, feet and legs, but lightly over the lung. As regards food too, in this instance it should be neither salted nor acrid nor bitter nor constipating, but of the rather blander kinds. Therefore on the first days pearl barley or spelt or rice gruel in which fresh lard has been boiled are to be given; with this raw eggs, pine kernels in honey, bread or washed groats of spelt in hydromel; then he may drink not only water by itself but also lukewarm hydromel, or even this cold in summer, unless there is some objection. But whilst the disease is on the increase, it is enough to give these every other day. When the increase has come to a stand, he should abstain, so far as is practicable, from everything except lukewarm water. If the strength begins to fail, hydromel is to be added. For the relief of pain it is helpful to apply foments hot, or those which both repress and soothe. The application to the chest of salt, well rubbed up and mixed with wax-salve, is beneficial because it slightly erodes the skin, and thereby draws out that flood of the matter by which the lung is being oppressed. Useful also is any one of the emollients which draw out the matter. During the pressure of the disease it is not wrong to keep the patient with the windows shut: when he is somewhat better, some windows should be opened three or four times a day to let in a little air. Next during recovery he should for several days abstain from wine, use rocking, rubbing and gruels; to the previous foods add: of vegetables, leeks, of meat, trotters and tit-bits, also small fish, so long as for a while nothing but what is soft and bland is consumed.
4.15.1
15 Further a disease of another of the viscera, the liver, is also sometimes chronic, sometimes acute: the Greeks call it hepaticon. There is severe pain in the right part under the praecordia, which spreads to the right side, to the clavicle and arm of that side; at times there is also pain in the right hand, there is hot shivering. In a grave case there is vomiting of bile; sometimes the patient is nearly choked by hiccough. Such are the signs when acute; but in a more chronic case, where there is suppuration within the liver, the praecordia on the right side become hard and swollen; after a meal there is greater difficulty in breathing; then supervenes a sort of paralysis of the lower jaws. When the disease has become inveterate, the abdomen and legs and feet swell; there is wasting of the chest and arms and about the clavicle on both sides. It is best to begin by letting blood; then the bowel is to be moved, if nothing else takes effect, by black hellebore. Externally plasters are to be applied, first repressants, then hot ones to disperse; appropriate additions are iris or wormwood unguents; after these emollients. Gruels, moreover are to be given, all food hot and not too nourishing, generally that kind which is also suitable to pleurisy (IV.13, 4), and in addition such food and drink as promote urination. Beneficial in this disease are: thyme, savory, hyssop, catmint, starch, sesamum seeds, laurel berries, young pine-cone tips, knotgrass, mint, quince pulp, the fresh raw liver of a pigeon. Some of the above may be eaten alone, some can be added to the gruel or draughts, so long as they are taken sparingly. There is no objection to wormwood rubbed up in honey and pepper, of which a dose is taken daily. All cold things must be especially avoided; for nothing is more harmful to the liver. Rubbings of the extremities should be employed; all manual work should be avoided, and all more active movement; the patient should never even hold his breath for long together. Anger, hurry, weight-lifting, boxing, running are harmful. A copious affusion of the body with water, hot in winter, tepid in summer, is beneficial, also free anointing and sweating at the bath. But if the liver suffers from an abscess, the same is to be done as in other internal suppurations. Some even with a scalpel make an incision over the liver, and burn through into the actual abscess with the cautery.
4.16.1
16 Now the spleen when affected swells, and with it simultaneously the left side; and this becomes hard and resists pressure. The abdomen is tense: there is even some swelling of the legs. Ulcerations either do not heal at all, or at any rate form a scar with difficulty: there is also pain and some difficulty in walking fast or running. Rest increases this complaint, and so there is need for exercise and work; nevertheless, care must be taken lest if carried too far fever be excited. Anointings and rubbings and sweatings are necessary. All sweet things are hurtful, also milk and cheese; but sour things are the most suitable. Therefore sharp vinegar may be sipped by itself, vinegar of squills is even better. Such patients should eat salt fish or olives preserved in strong brine, lettuce dipped in vinegar, also endive in the same, beet with mustard, asparagus, horse-radish, parsnip, trotters, chaps, poultry not fatted, and similar game. The drink too, when taken on an empty stomach, should be wormwood decoction; after food, water in which a blacksmith has from time to time dipped his red-hot irons; since this water especially reduces the spleen. For it has been observed that animals reared by our blacksmiths, have small spleens. Dry thin wine can also be given: and everything, whether food or drink, which causes urination. Of particular value in this respect are: trefoil seeds or cummin or celery or creeping thyme or broom tops or purslane or catmint or thyme or hyssop or savory: for these seem best adapted to draw out humour from the spleen. Ox-spleen may be usefully given to eat; rocket and nasturtium in particular render the spleen smaller. Palliatives must also be applied externally: there is one made of ointment and dates which the Greeks call myrobalanon, or that made of linseed and nasturtium seeds, to which wine and oil have been added; or that made of green cypress and a dried fig; or that made with mustard to which is added a fourth part by weight of he-goat's kidney fat, and which is rubbed up in the sun and applied forthwith. Moreover, capers may be employed in several ways; for they may be both taken with the food, and the brine and vinegar in which they have been soaked may be sipped. They may be even applied externally, the root or bark having been rubbed up with bran or the capers themselves with honey. There are also emollients suitable for this affection.
4.17.1
17 As regards the kidneys, these when they have become affected, continue diseased for a long while. It is worse if bilious vomiting is added. The patient should rest, sleep on a soft bed, keep the bowels loose even using a clyster when they do not act otherwise; he should sit frequently in a hot bath; take neither food nor drink cold, abstain from everything salted, acid, acrid, and from orchard fruit; drink freely; add whether to the food or to the drink pepper, leeks, fennel, white poppy; which are the most active in causing a discharge of urine. As an additional remedy when there is ulceration of the kidneys, if the ulcerations are still in need of being cleaned, sixty cucumber seeds stript of the husk, twelve pine kernels, of aniseed as much as can be taken up by three fingers, and a little crocus, are rubbed up together, and divided between two draughts of honey wine: but if it is merely pain was has to be relieved, thirty of the cucumber seeds, twenty pine kernels, five almonds, and a little crocus are rubbed up together and given in milk. And besides it is right to apply certain emollients, and especially such as extract humour.
4.18.1
18 From the viscera we proceed to the intestines, which are subject to diseases, both acute and chronic. And in the first place mention is to be made of cholera, because it appears to be a complaint common to the stomach and intestines: for there occur simultaneously diarrhoea and vomiting, and in addition flatulence. The intestines are griped, bile bursts upwards and downwards; first it is watery, then like water in which fresh meat has been washed; at times it is white in colour, at other times black or variously coloured. Hence the Greeks term this affection by the name of cholera. Besides those symptoms which are mentioned above, often the legs and arms are also contracted, there is urgent thirst, and fainting; when such things occur together, it is not to be wondered at if the patient dies suddenly, and yet in no other disease is there less time for affording relief. Therefore immediately upon the commencement of the above signs, the patient should drink as much as he can of tepid water, and vomit. Vomiting hardly ever fails to follow; but even if it does not occur, nevertheless it is advantageous to have mixed fresh material with that which is decomposed; the cessation of vomiting is a step towards recovery. If this happens, the patient should abstain forthwith from all drink; if there are still gripings, the stomach should be treated with cold and moist foments, or if there is pain in the belly, these should be lukewarm, so that the belly itself is relieved by moderately warm applications. But if vomiting, diarrhoea and thirst give rise to severe distress, and the vomit still contains undigested food, it is not yet a fitting time for wine: water should be given, not cold but rather lukewarm: pennyroyal in vinegar should be applied to the nostrils, or wine sprinkled with polenta, or mint in its natural state. But when the indigestion has been relieved, there is then greater apprehension of fainting. Recourse therefore should then be had to wine. The wine taken should be thin, aromatic, mixed with cold water, adding either polenta or crumbled bread, and bread by itself ought also to be taken, and as often as either the stomach or intestines discharge their contents, so often should the patient recruit his strength by these means. Erasistratus said that a draught should have mixed with it at first three or five drops of wine, subsequently gradual additions of undiluted wine. If Erasistratus both gave wine at the beginning and was influenced by fear of causing indigestion, he acted not without reason; if he thought that severe weakness could be relieved by three drops of wine, he erred. But if the patient is empty and his legs are contracted, a draught of wormwood should be given at intervals. If the extremities become cold, they should be anointed with hot oil to which a little wax has been added, and stimulated by hot foments. If there is no relief even from the above remedies, outside over the actual stomach cups should be applied, or mustard laid upon it. When he has settled down, he should go to sleep. On the next day he should be sure to abstain from drinking, on the third day he should go to the bath, gradually recruit himself with food. Whoever easily gets to sleep is quickly restored; the trouble is brought back by indigestion and also by fatigue and cold. If, after the suppression of the cholera, slight fever persists, there is need for a clyster, and then to take food and wine.
4.19.1
19 Now the disorder just described is both acute and has its seat between the intestines and stomach, so that it is not easy to say to which part it most belongs. That which the Greeks term coeliacus has its seat at the gateway of the stomach and is usually both acute and chronic. Under this affection the belly becomes hard and painful; the bowels void nothing, not even wind; the extremities become cold; the breath is passed with difficulty. To begin with it is best to apply hot foments and plasters all over the belly to relieve pain, after food to induce a vomit and thus to empty the belly; next on the following days to apply dry cups to the abdomen and hips; to loosen the bowels, by giving milk and cold salted wine; also if in season green figs, provided that neither drink nor food is given all at once but a little at a time. It is enough, therefore, to take two or three cupfuls at intervals, and food in the same proportion; a cup of milk, mixed with one of water, and so administered, is suitable; flatulent and pungent foods are more useful, hence it is well to add pounded garlic to the milk. And as time goes on there is need for: rocking, especially a sea-voyage; rubbing three or four times a day, soda being added to the oil; hot-water affusions after food; then mustard should be put upon all the extremities, omitting the head, until there is irritation and redness, especially if the body is robust and virile. Gradual transition should next be made to remedies which confine the bowels. Roast meat, such as is nutritious and does not readily decompose, is to be given; and for drink, boiled rainwater, of which two or three cupfuls should be drunk at a time. If the disorder is of longer standing the proper thing is to swallow a bit of the best laser the size of a peppercorn, to drink wine and water on alternate days, between meals at times to sip a cupful of wine; to administer a clyster of tepid rain-water, especially if pain persists in the lower bowel.
4.20.1
20 In the intestines proper two diseases have their seat, one in the small, the other in the large. The mr is acute, the latter may become chronic. Diocles of Carystus named the disease of the small intestines chordapsos, of the large eileos. I note that by many the former is now termed eileos, the latter colicos. The former excites pain, at times above, at times below the navel. At one or the other of these places there is inflammation; neither motion nor wind is passed downwards. If the upper part is affected, food, if the lower, faeces is returned by the mouth; if either happens the disease is chronic. Additional signs of danger are if the vomit is bilious, malodorous, either varying in colour of black. The remedy is blood-letting or cupping in several places, the skin not being incised at all; for it is sufficient to do so in two or three places; in the others it is quite enough to extract wind. Next attention should be turned to the seat of disease: for there is commonly a swelling over it. And if this is situated above the navel, there is no use in the clyster; if below, to clyster the bowels as Erasistratus advised is the best remedy and often that is all the treatment required. Now the clyster should consist of strained pearl barley gruel, together with oil and honey, nothing else being added. If there is no swelling, the two hands should be placed upon the upper part of the belly, and little by little drawn downwards; for the seat of the trouble may be thus discovered, owing to its being necessarily resistent; and from this one can form an opinion whether the bowels should be clystered or not. The treatments common to both forms are: the application of hot plasters, put on from the breasts to the groins, and back to the spine, and often changed; rubbing of the arms and legs; immersing the patient all over in hot oil. If the pain is not relieved, there is injected into the bowels from below three or four cupfuls of hot oil. When we have brought it about by these measures that wind is now passed down and out, tepid honeyed wine, not much, is given to drink; for before that every care should be taken that nothing at all is drunk. If the honeyed wine is kept down, then give gruel. When pain and feverishness have subsided, then at length a fuller diet is adopted, but nothing flatulent nor solid nor rich, lest the intestines, whilst still weak, take harm; but for drink nothing is better than plain water, for in this disease vinous and acid drinks are objectionable. Subsequently the patient should avoid the bath, walking, rocking and other bodily movements; for this disorder is very liable to recur, and, unless the intestines have already returned to a sound state, either cold or shaking of any kind may cause a return of the trouble.
4.21.1
21 The disease which is in the larger intestine is situated chiefly in that part which I have described as a blind alley (IV.1, 8). There is extreme flatulence, violent pains especially on the right side; the intestine which appears to undergo torsion, . . . almost forces out wind. In most cases it comes on after chills and fits of indigestion, then subsides, and in course of time often recurs so as to be a cause of suffering but without shortening the length of life. At the commencement of the pain, dry, hot foments should be applied, at first mild, then stronger ones, at the same time rubbing is used to draw off the matter to the extremities, into the legs and arms; if the pain be not so dispersed, dry cups should be applied. There is even a medicament compounded for this very purpose called colicos: Cassius used to boast that he had invented it. It is of more benefit when given as a draught, but when applied externally too it relieves pain by dispersing the wind. Until griping has quite ceased it is not right to take properly either food or drink. I have already stated what kind of food should be used in this kind of disorder (1, 7). The composition of the medicament termed colicos is as follows: costmary, anise, castor, of each 12 grams, of parsley 12 grams, of long and round peppers, a.a. 8 grams, of poppy tears, round rush, myrrh, nard, a.a. 24 grams, all mixed together with honey. This may be either swallowed by itself of the taken in hot water.
4.22.1
22 The most akin to the above among intestinal maladies are gripings, called by the Greeks dysenteria. The insides of the intestines ulcerate; from these blood trickles and at times is excreted with some faeces which are always liquid, at times with a sort of mucus, sometimes at the same time something fleshlike comes down; there is frequent desire to stool and pain in the anus. Along with this pain a scanty motion is discharged, and by this too the griping pain is intensified: and after a while there is some relief and a short interval of ease; sleep is broken, feverishness comes; when the disorder has continued for a long while, it either carries off the patient, or even, although it come to an end, puts him to torture. Rest must be adopted from the first, since any shaking sets up ulceration; next on an empty stomach he is to sip a cupful of wine to which has been added powdered cinquefoil root; then repressant plasters are put upon the abdomen, which in the case of disorders of the upper abdomen is not expedient; whenever the patient goes to stool, he should bathe the anus with hot water in which vervains have been boiled; purslane should be eaten, whether cooked or pickled in strong brine; also such foods and drink as are astringent to the bowel. If the distemper is of longer standing, there should be injected into the rectum either a tepid cream of pearl barley, or milk, or melted fat, or deer marrow, or olive oil, or rose oil with butter or with raw white of egg, or a decoction of linseed, or if sleep does not occur, yolk of eggs in a decoction no rose-leaves: for such remedies relieve pain and mitigate ulceration, and are of special utility if loss of appetite has ensued. Themison has stated in writing that the strongest brine should be used in these cases. Food too should be of the kind which will act as mild astringents. But diuretics if they take effect are beneficial by directing humour to another part: if they do not take effect, they increase the trouble; so unless for those on whom they act promptly, they should not be used. If there is feverishness, the drink should be hot water, either plain or with some astringent in it; if none, then light dry wine. If for several days other remedies have done no good, and the disease is now of long standing, drinking of very cold water acts as an astringent upon the ulcerations and starts recovery. But as soon as the movement of the bowels is under control, there should forthwith be a return to warm drinks. Sometimes also there is discharged a putrid sanies having a foul odour, sometimes unmixed blood escapes. If the former occurs, a hydromel clyster should be given, and then the other things mentioned above injected. An effective remedy even for intestinal canker is a lump of minium rubbed up with 250 grams of salt, dissolved in water, and administered as a clyster. But if there is a flux of blood, food and drink should be astringent.
4.23.1
23 From dysentery there proceeds sometimes leienteria, when the intestines cannot retain anything, and whatever is swallowed is straightway excreted imperfectly digested. Sometimes in the patients this drags on, sometimes it hurries them off. In this affection especially astringents should be put on the chest, and when the skin becomes ulcerated, then an emollient to draw out humour; and the patient should sit in a decoction of vervains; take both food and drink which control the bowel: and have cold water poured over him. Nevertheless, care should be taken lest with all these remedies there be an opposite trouble set up by excessive flatulence. Consequently, little by little, the intestines should be strengthened by some additions daily. As in the case of any abdominal flux, so in this, it is particularly necessary that the patient should go to stool, not as often as inclined, but as often as compelled, so that by such delay the intestines may be got into the habit of holding up their contents. There is another thing which, whilst applicable equally to all similar affections, is to be specially observed in this, that as many beneficial medicaments are disagreeable to the taste, such as the mixture containing plantain and blackberries and any mixture containing pomegranate rind, that shall be chosen which the patient likes most. Moreover, if he loathes all of them, something to excite his appetite should be interposed, less useful, perhaps, but most pleasant. Exercise and rubbing are needed in this disease also, as well as heat, whether of the sun, or a fire, and baths; and according to Hippocrates, a vomit even by white hellebore, when other measures prove of little avail.
4.24.1
24 Again, worms also occasionally take possession of the bowel, and these are discharged at one time from the lower bowel, at another more nastily from the mouth: and we observe them sometimes to be flattened, which are the worse, at times to be rounded. For the flat worms there should be given as draughts, a decoction of lupins, of or of mulberry bark, to which may be added, after pounding, either hyssop or a vinegar cupful of pepper, or a little scammony. Alternatively on one day let him eat a quantity of garlic and vomit, then on the next day take a handful of fine pomegranate roots, crush them and boil them in a litre and a half of water down to one-third, to this add a little soda, and drink it on an empty stomach. At three hours' interval, let him take two further draughts; but with the addition of half a pint of sea water or strong brine; then on going to stool, sit over a basin of hot water. Again, for the round worms which especially trouble children, both the same remedies may be given and some milder ones, such as pounded-up seeds of nettles or of cabbage or of cummin in water, or mint in the same or a decoction of wormwood or hyssop in hydromel or cress seeds pounded up in vinegar. It is also of service either to eat lupin or garlic, or administer into the lower bowel a clyster of olive oil.
4.25.1
25 There is, again, another affection which the Greeks call tenesmos, slighter than all those last spoken of. It should be counted neither with acute nor with chronic diseases, since it is readily relieved, and never by itself fatal. As in the case of dysentery, there is equally the frequent desire for stool, and equally the pain when anything is passed. There is a discharge resembling phlegm and mucus; sometimes it is even slightly bloodstained; but mingled with properly formed faeces derived from food. The patient should sit in hot water, and make application frequently to his anus. For this there are several suitable medicaments; butter in rose oil, gum acacia dissolved in vinegar; that wax-salve which the Greeks call tetrapharmacon, made liquid with rose oil; alum wrapped up in wool and so applied; the same clysters as are beneficial in dysentery; the same decoction of vervains to foment the lower parts. He should drink on alternate days water and a thin dry wine lukewarm or better cold. The diet should be the same as prescribed above 922) for dysentery.
4.26.1
26 Even slighter, while recent, is diarrhoea, in which the stool is liquid and more frequent than ordinary; and sometimes the pain is bearable, at times very severe, when it is a worse affair. But a flux from the bowel for one day is often salutary, and even for several days, provided that fever is absent and it subsides within seven days. For the body is purged, and whatever is about to cause a complaint inside is evacuated with advantage. But persistence is the danger; for it excites at times dysentery and feverishness and exhausts strength. It is sufficient on the first day to rest, and not to check the movement of the bowels. If it stops of itself, the patient should make use of the bath, and take a little food; if it persists, he should abstain, not only from for, but even from drink. If on the day following, in spite of all, the stool is still liquid, he should rest as before and take a little astringent food. On the third day he should go to the bath; be rubbed all over vigorously except the abdomen, sit with his loins and shoulder-blades before a fire; take food of an astringent kind, and a little undiluted wine. If on the fourth day the flux persists, he should eat more but provoke a vomit afterwards, and counter in a general way the diarrhoea by thirst, hunger and vomiting, until it subsides for it is scarcely possible that after so attending to it, the bowel will not be controlled. Another method to suppress the diarrhoea is to dine and then vomit; the next day to rest in bed, in the evening to be anointed, but lightly, then to eat about half a pound of bread soaked in undiluted Aminaean wine; after that something roasted, poultry in par=ticular, and lastly to drink the same wine mixed with rain-water; and to do so until the fifth day, then vomit again. Now Asclepiades, against the opinion of previous writers, affirmed that the drink should be kept constantly cold, indeed as cold as possible. I myself hold that each should trust in his own experiences, whether hot than cold drink should be made us of. It sometimes happens also that this disorder, having been neglected for several days, is more difficult to relieve. Such a patient should commence with an emetic; then the following day at evening be anointed in a warm room; take food in moderation, and the sourest wine undiluted; a wax-salve with rue should be applied to the abdomen. In this affection neither walking nor rubbing is of benefit; sitting in a carriage and even more riding on horseback is advantageous; for nothing strengthens the intestines more. But if use is to be made of medicaments as well, the most suitable is that made from orchard fruit. At the time of the vintage, pears and crab apples are thrown into a large vessel; and if the latter are not to be had, green Tarentine or Signine pears, Scaudian, or Amerian apples, sweet-scented. To these are added quinces and pomegranates with their rind, service fruit, and those that are called torminalia, which we use by preference, so that these occupy one-third of the jar; then this is next to be fille up with must, and boiled until all the ingredients have become resolved into a uniform mass. It is not unpleasant to the taste, and taken as needed, it controls the bowel gently, without any harm to the stomach. It is enough to take in one day two or three spoonfuls. Another composition is stronger: myrtle berries are gathered, and wine expressed from them is boiled down to one-tenth, of which a cup is sipped. A third can be prepared at any time by scooping out the inside of a pomegranate, removing all the seeds, and returning the pulp into the cavity, than raw eggs are pounded in, and stirred round with a small rod; next the fruit itself is heated over charcoal, for it does not burn so long as the inside is liquid; when the inside begins to dry the pomegranate is taken off the brazier and with a spoon the inside is scooped out and eaten. By certain acrid additions this remedy can be made more active; thus also it may be stirred up in peppered wine and mixed with salt and pepper, and so eaten. Pease porridge, with which a little of an old honeycomb has been boiled, also lentil porridge boiled with pomegranate rind, also a decoction of bramble tops eaten with oil and vinegar, are efficacious, as also draughts of a decoction of dates or quinces or dried service fruits or brambles. Such are the kind I refer to whenever I say an astringent draught should be administered. Also a half-pint of wheat is boiled in dry Aminaean wine, and first the wheat is eaten on a stomach empty both of food and drink, afterwards the wine itself is drunk and can be justly counted amongst the most active remedies. Also there can be given to drink Signian wine, or dry and resinated wine, or any other dry wine. And a pomegranate may be pounded up along with its rind and seeds, and mixed with wine of the above sort; the patient either sips it undiluted, or drinks it mixed with water. But it is superfluous except in bad cases to make use of medicaments.
4.27.1
27 From the womb of a woman, also, there arises a violent malady; and next to the stomach this organ is affected the most by the body, and has the most influence upon it. At times it makes the woman so insensible that it prostrates her as if by epilepsy. The case, however, differs from epilepsy, in that the eyes are not turned nor is there foaming at the mouth nor spasm of sinews; there is merely stupor. In some women this attack recurs at frequent intervals and lasts throughout life. When this happens, if there is sufficient strength, blood-letting is beneficial; if too little, yet cups should be applied to the groins. If she lies prostrate for a long while, or if she has done so at other times, hold to her nostrils an extinguished lamp wick, or some other of these materials which I have referred to as having a specially foetid odour (III.20, 1), to arouse the woman. For the same end, affusion with cold water is also effectual. And there is benefit from rue pounded up with honey, or from a wax-salve made up with cyprus oil or from hot moist plasters of some sort applied to the external genitals as far as the pubes. At the same time also the hips and the backs of the knees should be rubbed. Then when she has come to herself, she should be cut off from wine for a whole year, even if a similar attack does not recur. Friction should be applied daily to the whole body, but particularly to the abdomen and behind the knees. Food of the middle class should be given: every third or fourth day mustard is to be applied over the hypogastrium until the skin is reddened. If induration persists, a convenient emollient appears to be bitter sweet steeped in milk, then pounded and mixed with white wax and deer marrow in iris oil, or suet of beef or goat mixed with rose oil. Also there should be given in draught either castory, or git, or dill. If the womb is not healthy, it is cleaned with square rushes; but if it is actually ulcerated a wax-salve is made with rose oil, with pounded rose-leaves added to give it consistence. When painful the womb should be fumigated from below with sulphur. But if excessive menstruation is doing harm to the woman, the remedy is to scarify and cup the groins, or even to apply cups under the breasts. If the menstrual discharge is bad, the following medicaments are to be applied to evoke blood: costmary, pennyroyal, white violet, parsley, catmint and savory and hyssop. Let her include what is suitable in her diet: leeks, rue, cummin, onion, mustard, or any other acrid vegetable. If blood bursts out from the nose at a time when it should do so from the genitals, the groins are to be scarified and cupped, repeating this every thirtieth day for three or four months, then you may be sure that this affection has been cured. But if there is no show of blood, you may be sure that there are pains coming in the head. Then blood is to be let from the arms, and you have given relief at once.
4.27.2
. . . constricting remedies. White olives also produce the same effect, also black poppy seeds, taken with honey, and liquid gum, mixed with pounded celery seeds, and given in a cupful of raisin wine. Besides the above, draughts suited for all bladder pains are made from aromatics, such as spikenard, saffron, cinnamon, cassia, and such like, also decoction of mastic does good. If in spite of these pain becomes intolerable and there is blood in the urine, venesection is proper, or at any rate wet cupping over the hips.
4.27.3
But when the urine exceeds in quantity the fluid taken, even if it is passed without pain, it gives rise to wasting and danger of consumption; if it is thin, there is need for exercise and rubbing, particularly in the sun and before a fire. The baths should be taken but seldom, and the patient should not stay in it for long; the food should be astringent, the wine dry and undiluted, cold in summer, lukewarm in winter, and in quantity the monument required to allay thirst. The bowels also are to be moved by a clyster or by taking milk. If the urine is thick, exercise and rubbing should be more though, and the patient should stay longer in the bath; food and wine should be of the lighter kind. In both affections, everything that promotes urine should be avoided.
4.28.1
28 There is also a complaint about the genitals, an excessive outflow of semen; which is produced without coition, without nocturnal apparitions, so that in course of time the man is consumed by wasting. Salutary remedies in this affection are: vigorous rubbings, affusions, swimming in quite cold water; no food and drink taken unless cold. He should, moreover, avoid everything indigestible, everything flatulent; nothing should be taken of those things which appear to collect the semen, such things are siligo, simila, eggs, spelt, starch, all glutinous flesh, pepper, colewort, bulbs, pine kernels. It is not inexpedient to bathe the lower extremities in a decoction of astringent vervains, to cover the hypogastrium and groins with plasters prepared from the same decoction, and in particular from rue preserved in vinegar: also the patient should avoid sleeping on his back.
4.29.1
29 It remains for me to come to the extremities of the body which are interconnected by joints. I begin with the hips. In these severe pain is wont to occur, and this often weakens the patient, and some it never leaves: and on this account it is a difficult class to treat, for it is generally after chronic diseases that a pestiferous force directs itself to the hip; which, as it releases other parts, seizes upon this, which now becomes the seat of the disease. The hip is to be first fomented with hot water, after which hot plasters are applied. Those which appear to be especially beneficial are these: caper bark chopped up and mixed either with barley meal or with fig decoction, or darnel meal boiled in diluted wine and mixed with sour wine lees: since these are apt to grow cold, by night it is better to put on emollients. Inula root also pounded and afterwards boiled in dry wine and applied widely of the hip is among the most efficacious of remedies. If these do not resolve the trouble, then hot moist salt is to be employed. If even these measures do not end the pain, and a swelling supervenes, the skin is incised and cups are to be applied; diuretics are given; and the bowels if costive are to be clystered. The ultimate measure and the most efficacious in cases of old standing, is to set up issues in three or four places over the hip by burning the skin with cauteries. But rubbing is also to be employed, particularly in the sun and often each day, in order that the materials of the disease, which have been doing harm by collecting, may be the more readily dispersed; and the rubbing is applied actually over the hips in the absence of ulceration; if there is any, then to other parts. Since now some issue often has to be set up by the hot cautery, in order that matter may be extracted, it is the general rule not to let ulcerations of this kind heal offhand, but to let them drag on until the complaint which we aim to relieve has quieted down.
4.30.1
30 Next to the hips come the knees, in which pain now and again occurs, and these same plasters and cuppings are a safeguard, as also when any pain arises in the shoulder or other joints. Riding on horseback is of all things the most injurious to anyone with painful knees. All such pains, when of long standing, are hardly ever ended except by cauterization.
4.31.1
31 Joint troubles in the hands and feet are very frequent and persistent, such as occur in cases of podagra and cheiragra. these seldom attack eunuchs or boys before coition with a woman, or women except those in whom the menses have become suppressed. Upon the commencement of pain blood should be let; for when this is carried out at once in the first stages it ensures health, often for a year, sometimes for always. Some also, when they have washed themselves out by drinking asses' milk, evade this disease in perpetuity; some have obtained lifelong security by refraining from wine, mead and venery for a whole year; indeed this course should be adopted especially after the primary attack, even although it has subsided. But if the malady has already become established, it may be possible to act with more freedom in those seasons in which the pain tends to remit; but he should adopt more careful treatment at those times in which it recurs, which is generally in spring or autumn. Now when the pain requires it, in the morning the patient should be rocked; then carried to a promenade; there he should move about, and in the case of podagra he should take short turns at sitting down and walking about: next before taking food and without entering the bath itself, but in a hot room, he should be gently rubbed, sweated, and then douched with lukewarm water: the food following should be of the middle class; diuretics are given with it, and an emetic whenever he is of a fuller habit. When the pain is very severe, it makes a difference whether there is an absence of swelling, or a swelling with heat, or swellings which already hardened. For if there is no swelling, hot foments are needed. Either sea-water, or strong brine should be heated, then poured into a vessel; and as soon as he can bear it, the man puts his feet in, over the vessel is spread a cloak, and over him a blanket; after that hot water is poured over the lip of the vessel, a little at a time, to prevent the contents from losing heat: and then at night heating plasters are applied, especially mallow root boiled in wine. But if there is swelling and heat, refrigerants are more useful, and the joints may be rightly held in very cold water, but not every day, nor for long, lest the sinews become hardened. There is to be applied also a cooling plaster; this, however, is not to be kept on for long, but a change made to those which soothe as well as repress. If pain is greater, rind of poppy-heads is to be boiled in wine, and mixed with wax-salve made up with rose oil; or wax and lard, equal parts, are melted together, and then the wine mixed with these; and as soon as this application becomes hot, it is to be removed and another immediately put on. But if the swellings have grown hard and are painful, the application of a sponge frequently squeezed out of oil and vinegar, or out of cold water, or the application of pitch, wax and alum, equal parts mixed, gives relief. There are also several emollients suitable alike for the hands and feet. But if the pain does not allow of anything being put on, when there is no swelling, the joint should be fomented with a sponge which has been dipped in a warm decoction of poppy-head rind, or of wild cucumber root, next the joints are smeared with saffron, poppy-juice and ewe's milk. But if there is a swelling, this ought to be bathed with a tepid decoction of mastic or some other repressant vervain, and then covered with a medicament composed of bitter almonds pounded up in vinegar, or of white lead, to which has been added the juice of pounded pellitory. The stone, too, which corrodes flesh, which the Greeks call sarcophagos, is carved out so as to admit the feet; when these are painful, they are inserted and held there, and are usually relieved. In Asia Minor Assian limestone is held in esteem for this purpose. When pain and inflammation have subsided, which should happen within forty days, unless the patient is in fault, gentle exercise, spare diet, soothing anoint-ings, are to be employed, provided that also then the joints may be rubbed with an anodyne salve or with a liquid wax-salve of cyprus oil. But riding on horseback is harmful for those with podagra. Those, too, in whom joint-pains tend to recur at certain seasons ought both to take precautions beforehand as to their diet, lest there should be a surfeit of harmful material in the body, and to use an emetic the most frequently; and those in any anxiety as to their body should make use of clystering, or of purgation by milk. This treatment for those with podagra was rejected by Erasistratus, lest a flux directed downwards might fill up the feet, though it is evident that any purgation extracts, not only from the upper parts, but also from the lower as well.
4.32.1
32 Now from whatever disease he is recovering, if his convalescence is slow, the patient ought to keep awake from dawn, but nevertheless stay at rest in bed: about nine o'clock he should be gently stroked over with anointed hands, after that by way of amusement, and as long as he pleases, walk, all business being omitted: then he should use conveyances for a good while, be rubbed much, often change his residence, climate and diet. Having taken wine for three or four days, he should for one or two days drink water only. For thus he will ensure that he does not lapse into a complaint which causes wasting, but soon gets back his full strength. When he has, in fact, completely recovered, it will be dangerous for him suddenly to change his way of life and to act without restraint. Therefore he should only little by little leave off what has been prescribed, and pass to a way of life of his own choosing.
5.0.1
I have spoken of those maladies of the body in which the regulation of the diet is most helpful: now I pass on to that part of medicine which combats rather by medicaments. These were held of high value by ancient writers, both by Erasistratus and those who styled themselves Empirics, especially how by Herophilus and his school, insomuch that they treated no kind of disease without them. A great deal has also been recorded concerning the powers of medicaments, as in the works of Zeno or of Andreas or of Apollonius, surnamed Mys. On the other hand, Asclepiades dispense with the use of these for the most part, not without reason; and since nearly all medicaments harm the stomach and content bad juices, he transferred all his treatment rather to the management of the actual diet. But while in most diseases that is the more useful method, yet very many illnesses attack our bodies which cannot be cured without medicaments. This before all things it is well to recognize, together, that it is impossible to separate off any one part completely, but each gets its name from the treatment which it uses most. Therefore, both that which treats by dieting has recourse at times to medicaments, and that which combats disease mainly by medicaments ought also to regulate diet, which produces a good deal of effect in all maladies of the body.
5.0.2
But since all medicaments have special powers, and afford relief, often when simple, often when mixed, it does not seem amiss beforehand to state both their names and their virtues and how to compound them, that there may be less delay when we are describing the treatment itself.
5.1.1
1 The following suppress bleeding: Blacking with the Greeks call chalcanthon, copper ore, acacia, and lycium with water, frankincense, lign-aloe, gums, lead sulphide, leek, polygonum; Cimolian chalk or potter's clay, antimony sulphide; cold water, wine, vinegar; alum from Melos, iron and copper scales and of this last there are two kinds, one from ordinary copper, the other from red copper.
5.2.1
2 The following agglutinate a wound: myrrh, frankincense, gums, especially gum arabic; fleawort, tragacanth, cardamon, bulbs, linseed, nasturtium; white of egg, glue, isinglass; white vine, snails pounded with their shells, cooked honey, a sponge squeezed out of cold water or out of wine or out of vinegar; unscoured wool squeezed out of the same; if the wound is slight, even cobwebs.
5.2.2
The following subdue inflammation: alum, both split alum called schiston, and alum brine; quince oil, orpiment, verdigris, copper ore, blacking.
5.3.1
3 The following mature abscessions and promote suppuration: nard, myrrh, costmary, balsam, galbanum, propolis, storax, frankincense, both the soot and the bark, bitumen, pitch, sulphur, resin, suet, fat, oil.
5.4.1
4 The following open, as it were, mouths in our bodies, called in Greek stomou=n: cinnamon, balsam, all-heal; rush-root, pennyroyal, white violet flowers, bdellium, galbanum, turpentine and pine-resin, propolis, old olive-oil; pepper, pyrethrum, ground pine thistle, black bryony berries, sulphur, alum, rue seed.
5.5.1
5 The following have a cleaning effect: verdigris, orpiment, called by the Greeks arsenicon now this has the same property as sandarach, but copper scales are stronger, pumice; orris root, balsam, storax, frankincense, frankincense bark, pine-resin and liquid turpentine, vine-flowers; lizard dung, blood of pigeon and wood pigeon and swallow; ammoniacum, bdellium which has the same virtue as ammoniacum, but southernwood is more powerful, dry fig, Cnidian berry, powdered ivory, omphacium, radish; rennet, especially of the hare which has the same faculty as other rennet but is far more active, ox-bile, uncooked yolk of e.g., burnt stagshorn, ox-glue, raw honey, antimony sulphide, copper ore; saffron, black bryony berries, southernwood, litharge, oak-gall, haematite, minium, costmary, sulphur, crude pitch, suet, fat, oil, rue, leek, lentil, bitter vetch.
5.6.1
6 The following are erodents: alum brine, especially when made from round alum, verdigris, copper ore, antimony sulphide, copper scales, especially from red copper, calcined copper, sandarach, minium from Sinope; oak-galls, balsam, myrrh, frankincense, frankincense bark, galbanum, liquid turpentine, pepper of both kinds but especially the round, cardamon; orpiment, lime, soda and its scum; parsley seed, narcissus root, omphacium, coral, oil of bitter almonds, garlic, uncooked honey, wine, mastich, iron scales, ox-bile, scammony, black bryony berries, cinnamon, storax, hemlock seed, omphacium, parsley seed, resin, narcissus seed, bitter almonds and their oil, blacking, chrysocolla, hellebore, ash.
5.7.1
7 The following are exedents: acacia juice, ebony, verdigris, copper scales, chrysocolla, ash, cyprus ash, soda, cadmia, litharge, hypocistis, slag, salt, orpiment, sulphur, hemlock, sandarach, salamander-ash, coral, flowers of copper, copper ore, blacking, ochre, lime, vinegar, oak-gall, alum, milk of the wild fig, or of sea spurge which the Greeks call tithymallos, coral, bile, frankincense, spode, lentil, honey, olive leaves, horehound, haematite stone, Phrygian, Assian and ironschist, antimony sulphide, wine, vinegar.
5.8.1
8 The following are caustics: orpiment, blacking, copper ore, antimony sulphide, verdigris, lime, burnt papyrus-ash, salt, copper scales, burnt wine-lees, myrrh, dung of lizard and pigeon and wood pigeon and swallow, pepper, Cnidian berry, garlic, slag, both the milks mentioned in the previous chapter, hellebore both white and black, cantharides, coral, pyrethrum, frankincense, salamander-ash, rocket, sandarach, black bryony berries, chrysocolla, ochre, split alum, sheep's dung, vine-flower buds.

Perseus Latin. CTS URN phi0836.phi002.perseus-eng2. Via the Perseus Digital Library / Open Greek and Latin TEI corpora. Licence: CC BY-SA 4.0. Source.