BOOK I.
CHAPTER I. THE PROŒMIUM.
IN chronic diseases, the postponement of medical treatment is a
bad thing; for, by procrastination, they pass into incurable affections,
being of such a nature that they do not readily go off if
they once attack; and if protracted by time, they will become
strong, and end only in death. Small diseases also are succeeded
by greater, so that although devoid of danger at first, their
progeny proves deadly. Wherefore neither should the patient
conceal his complaint, from the shame of exposure, nor shrink
from fear of the treatment; nor should the physician be inactive,
for thus both would conspire to render the disease incurable.
Some patients, from ignorance of the present and
what will come at last, are content to live on with the disease.
For since in most cases they do not die, so neither do they
fear death, nor, for this reason, do they entrust themselves to
the physician. Cephalæa, of which I am about to treat in the
first place, is a proof of these statements.
CHAPTER II. CURE OF CEPHALÆA.
THE head, inasmuch as it is necessary towards life, so is it
also very dangerous in disease. And the onset of diseases
about it is quite tolerable, being attended with slight pain,
noises in the ears, and heaviness; but if they acquire increase,
they become fatal at last. Wherefore even slight pains should
not be overlooked, and, in certain cases, they have been cured
by slight remedies. But if prolonged for a longer space, as
greater sufferings supervene, we must open the vein at the
elbow. But, for two days previous, the patient must get wine
to drink, and the quantity of blood abstracted must be regulated
by the strength; and it is best not to make the whole
evacuation at once, so that the strength may bear the amount
thereof; and the disease is rather removed by the repetition of
the means. The same rule applies to all chronic diseases.
During an interval of three or four days, a fuller diet is to be
given, and then the purgative hiera is to be taken in a
draught; for it, in an especial manner, draws the pabulum of
the disease from the head. The quantity of the medicine
given is to be to the amount of four or five drams. And if
well purged, we are to administer the bath, give wine, and
improve the strength. Then again we are to open the straight
vein (
temporal?) on the forehead, for abstraction by it is most
efficacious; the amount, about a hemina (
half-pint?) or a little
more. But we must not evacuate further, for we must avoid
emptying the vessels. Then, having removed the hair with a
razor, we are first to apply one cupping-instrument to the
vertex, and another between the scapulæ, without drawing
blood; but along with the instrument applied to the vertex,
we are to scarify unsparingly, for the purpose of attracting the
redundant fluid and of making an incision in the deep-seated
parts. For remedial means applied even to the bones are beneficial
in cephalæa. When the wounds are cicatrised, we are to
excise a portion of the arteries;
1 (of these there are two, one
behind the ears, at a little distance from them, being obvious
from their pulsations; the others in front of the ear, and close
to it, for they lie close to the antitragus; and these also are
discovered by their pulsations); we are to incise the larger
ones at the bones, for they afford relief. Adjacent to them are
others, very slender, which there is no benefit from excising.
The mode of operating has been described under operative
surgery. This is the great remedy in cephalæa, epilepsy,
vertigo, and, in fine, in all the diseases of the head.
In all cases we are to bring off phlegm, first evacuating the
bowels, either by a purgative draught, or by a clyster; and
sometimes from the nostrils by sternutatories; and sometimes
from the mouth by sialogogues. Among the kinds of sternutatories
are pepper, the root of soapwort, and the testicle of
the beaver; these may all be used together; having levigated
and sifted them, we are to blow the powder in, either with a
reed or the thick stalk of a goose quill. Euphorbium is more
active and stronger than these when mixed with any of them.
It is also mixed up with the oils, such as
gleucinum, the
Sicyonian, or the ointment from storax. It is made into a
liquid form as an injection, and it is injected by means of a
nasal pipe; the instrument consists of two pipes united
together by one outlet, so that we can inject by both at the
same time. For to dilate each nostril separately is a thing
which could not be borne, as the head gets quickly filled, and
thus contracts a sharp pain. The medicines which evacuate
phlegm from the mouth are, mustard, the
granum cnidium,
pepper, stavesacre, these either together or separately; and
one may masticate these substances and spit out constantly;
and give them mixed up with water or honeyed-water, rinse
the mouth, and press them back to the tonsils with stretching
of the neck, thus wash out along with the breath in expiration;
2
and when you have evacuated phlegm as much as you
think proper, you must bathe and foment the head with a
very large quantity of hot water to promote perspiration, for
the obstructions become strong.
Supper should be spare; but wine also is to be given, to
restore the tone of the stomach, for it also suffers in this
complaint. When, in the meantime, you have re-established
the strength, you will require to give a common clyster having
sprinkled upon it much natron, or dissolving it in two drams
of the resin of the turpentine tree. On the next day we are
to abstract blood from the inside of the nostrils, and for this
purpose push into them the long instrument named
Katidion,
or the one named
Toryne, or, in want of these, we must take
the thick quill of a goose, and having scooped the nervous
part of it into teeth like a saw, we are to push it down the
nostrils as far as the ethmoid cells, then shake it with both
hands so that the part may be scarified by its teeth. Thus we
shall have a ready and copious flow of blood; for slender
veins terminate there, and the parts are soft and easily cut.
The common people have many modes of scarification, by
rough herbs, and the dried leaves of the bay, which they
introduce with the fingers and move strongly.
3 Having
evacuated to a sufficient amount--say to the amount of half a
hemina--we are to wipe the parts with sponges and oxycrate,
or blow in some styptic powder, gall, fissil alum, or the
flower of the wild pomegranate.
Whether the pain remain, or cease after these things, we
must go on to the conclusion of the system of treatment;
for the mischief is apt to return, and frequently lurks in the
seat of the disease. Wherefore, having removed the hair
with a razor (and this also is beneficial to the head), we are to
burn with heated cauteries, superficially, down to the muscles;
or if you wish to carry the burning to the bone, you must
avoid the muscles, for the muscles when burnt occasion convulsions.
And if you burn superficially you must foment the
part with plenty of fragrant sweet wine, along with rose-oil;
a linen cloth wetted with this is to be spread over the eschars
until the third day. But, if the eschars be deep, having
pounded the hairy leaves of leeks with salt, and spread upon
a linen rag, we are to apply it. On the third day, we are to
put the cerate from rose-oil upon the superficial eschars, and
lentil with honey upon the deeper. The medicinal applications
to be made to the wound will be described in another place.
Some have made an incision in the skin above the forehead,
at the coronal suture, down to the bone, and having scraped it,
or cut out a portion down to the diploe, have afterwards
brought the part to incarnation. Some have perforated
the bone, even to the meningx. These are bold remedies,
but are to be used, if, after all, the cephalæa continue,
and the patient be courageous, and the tone of the body
good.
4
But, if they progress gradually, they are to take exercises
in the erect state of the body for the benefit of the chest and
shoulders; the
chironomy,
5 the throwing of the
halteres;
leaping,
and the well-regulated contortions of the body accompanying
it; friction, first and last of the limbs, of the head
in the middle of the process.
The process of pitching
6 is to be frequently applied to the
head; and also rubefacients, sometimes rubbing in mustard
with double quantity of bread, so that the heat may not be
intolerable; and sometimes other medicines are to be so used,
like the compound from lemnestis, euphorbium, and pellitory.
The juice of thapsia, and the medicines made with it which
produce swelling of the skin, and an eruption resembling vari,
are beneficial both for allaying present pain and contributing
to eradicate the evil.
The diet in both kinds of the complaint should be light;
little drink, water for drink, especially before giving any
medicine; complete abstinence from acrid things, such as
onions, garlic, the juice of silphium, but not altogether from
mustard, for its acrimony, in addition to its being stomachic,
is not unpleasant to the head, dissolving phlegm, and exhaling
or discharging downwards. Of pulse, the worst is the common
bean and its species, the common peas, and the species
called
ochrys,
7 and the common
kidney-beans; next to them
are the lentils, which have indeed certain good properties for
promoting digestion and secretion, but induce fulness of the
head and occasion pain; only when boiled with pepper they
are not to be rejected. Granulated spelt (
alica) when washed,
is pleasant along with wine and honey, so as to sweeten, and,
in like manner, their soups, and with plain broths. The seeds
of carui, coriander, anise, and parsley, in the Lydian sauce
8
are excellent. But, of these articles, the best are the herbs
mint and penny-royal, with the fragrant things which have
some diuretic and carminative properties. Of fleshes, all such
as are old are bad; of the recently killed, that of the hen is
good; of birds, the wood pigeon, the common pigeon, and
such others as are not very fat; the extremities of the swine;
the roasted hare; that of the ox and of the sheep is incrassant
and fills the head; the kid is not altogether bad. Milk and
cheese occasion headache. Of fishes, those found among
rocks, and those things that are best in each particular
country. Of potherbs, such as promote the urinary and alvine
discharges, the mallow, the blite, the beet, and asparagus; but
the kale is also acrid. Among raw articles, the lettuce is the
best of all. Roots are bad, even when boiled, such as radishes,
navews, and parsnips, which are diuretic, but occasion repletion;
the garden parsnip indeed is flatulent and swells up
the stomach. Wine which is white, thin, and sweet, is to be
admitted, if it have some astringency, so as not to bind the
bowels. All articles of the dessert occasion headache, except
dates of every species. In autumn the fig and grape are
wholesome, and whatever other fruit is very good at any
particular season. Repletion of all things, even of such as are
proper, is bad; and so, also, indigestion is bad. Lassitude is
less injurious than indigestion, but still it is hurtful. The
morning walk after evacuation of the bowels, but so as not to
affect the breathing nor induce weariness; and it is also very
good after supper. Prolonged gestation, not exposed to wind
or sun, is good for the head; but the dog-star is bad for it.
Sexual intercourse is a self-inflicted evil to the head and
nerves. A journey from a cold to a warmer climate, or from
a humid to a drier, is proper; also a sea-voyage, and passing
one's life at sea; and if one lives by the sea-side it is a good
thing to bathe in the sea-water, to tumble on the sands, and to
reside close by the sea.
The remedies for
heterocrania are the same; for it is well to
apply to a portion of the head the same remedies as are proper
for the whole of it. In all cases in which the disease is not
removed by these means, we are to use hellebore, as being the last and most potent of all methods of treatment.
CHAPTER III. CURE OF VERTIGO.
VERTIGO arises as the successor of cephalæa; but also
springs
up as a primary affection from certain causes, as the suppression
of the hemorrhoidal flux; and if blood which used to flow
from the nose has ceased to flow; or if the body has not
perspired properly, either by sweating, or labour, when it had
been used to labour. If then it arise as the consequence of
cephalæa, we must do for its cure those things which have been
described under cephalæa; and I will afterwards state certain
other more powerful means which must be tried ultimately.
But if the disease happen from the suppression of any of the
humours, we must excite the customary secretion; for the
recurrence of nature promotes recovery. If it be delayed, and
the disease increases, in the other suppressions, those by the
nose or sweats, we are to open the vein at the elbow; but in
plethora of the liver, spleen, or any of the viscera in the
middle of the body, cupping affords relief, but as much blood
as is taken from a vein, so much is to be thus abstracted from
them; for it is the nutriment of the exciting cause, in like
manner as the belly. After this the remedies of the head are
to be applied, opening the straight vein on the forehead, or
those at the canthi on either side of the nose; a cupping-instrument
is to be fastened to the vertex, the (
temporal?）
arteries are to be excised, the head shaven, rubefacients applied
to it, phlegm evacuated from the nostrils by sternutatories, or
from the mouth as I have stated--all these things are to be
done in the order described under cephalæa, except that the
juice of sow-bread or of pimpernel is to be used as an injection
into the nose.
But when you have exhausted all the remedies for cephalæa,
the more violent means which are applicable for vertigo are
to be used; we must use the emetics after supper, and those
from radishes, which is also required as a preparation for the
hellebore; for the stomach is to be trained beforehand to the
more violent emetics. But the phlegm now becomes thinner,
and fit for solution in the hellebore. There are several modes
of giving the hellebore; to the stronger sort of patients it is to
be given to the size of a
sesame,
9 or a little larger; or, in slices,
with washed chondrus or lentil, the dose, about two drams.
In the case of feebler and more slender persons, the decoction
with honey, to the amount of two or three spoonfuls, is to be
given. The manner of preparing it will be described else-where.
In the interval between each remedy, the patient is to
be supported, in order that he may be able to endure what is
to be given in the intermediate periods.
The patient is to be assisted during the paroxysms thus:--The
legs are to be bound above the ankles and knees; and the
wrists, and the arms below the shoulders at the elbows. The
head is to be bathed with rose-oil and vinegar; but in the oil
we must boil wild-thyme, cow-parsnip, ivy, or something such.
Friction of the extremities and face. Smelling to vinegar,
penny-royal, and mint, and these things with vinegar. Separation
of the jaws, for sometimes the jaws are locked together;
the tonsils to be tickled to provoke vomiting; for by the discharge
of phlegm they are sometimes roused from their gloom.
These things, then, are to be done, in order to alleviate the
paroxysm and dispel the gloomy condition.
With regard to the regimen during the whole period of the
treatment and afterwards, I hold as follows:--Much sleep is
bad, and likewise insomnolency; for truly much sleep stupefies
the senses of the head. From a redundance of vapours
there is disinclination to every exertion; and these are also
the cause of the weight in the head, the noises, and the
flashes of light, which are the marks of the disease. Insomnolency
induces dyspepsia, atrophy, and wearies out the body;
the spirits flag, and the understanding is unsettled; and for
these reasons such patients readily pass into mania and melancholy.
Moderate sleep is suitable for the proper digestion of
the food and refreshment from the labours of the day; care
and perseverance in these respects; and particular attention is
to be paid to the evacuation of the bowels, for the belly is the
greater source of the bodily perspiration. Next, friction of
the limbs, by means of rough towels, so as to produce rubefaction;
then, of the back and sides; last, of the head. Afterwards,
exercise in walking, gentle at first and in the end;
carried to running in the middle; rest and tranquillity of the
breathing (
pneuma) after the walking. They are to practise
vociferation, using grave tones, for sharp occasion distension
of the head, palpitation of the temples, pulsatory movements
of the brain, fulness of the eyes, and noises in the ears. Sounds
of medium intensity are beneficial to the head. Then the season
of gestation should be regulated so as to promote the expulsion
of the weight in the head; it should be prolonged, yet not so
as to induce fatigue; neither should gestation be made in
tortuous places, nor where there are frequent bendings of the
road, for these are provocative of vertigo. But let the walks
be straight, long, and smooth. If then the patients have been
in the habit of taking lunch, we must only allow of a little
bread, so as to be no impediment to the exercises; for digestion
should take place previously. The head and the hands,
and the frictions thereof, are to be attended to; in the latter it
is to be gently performed for the restoration of the heat, for
plumpness, and strength. Then the head is to be rubbed while
the patient stands erect below a person of higher stature than
himself. Gymnastics skilfully performed which tend to distension
of the neck, and strong exercise of the hands. It is proper,
also, by raising the head, to exercise the eyes at
chironomy, or
at throwing the quoit, or contending at boxing. The exercise
both with the large and the small ball is bad, for the rolling of
the head and eyes, and the intense fixing of them, occasion
vertigo. Leaping and running are very excellent; for everything
that is keen is beneficial to the limbs, and gives tone to
the general system.
10 The cold bath is better than no bath at
all; no bath at all is better than the hot bath: the cold bath is
very powerful as an astringent, incrassant, and desiccant of the
head, which is the condition of health; while the warm bath
is most powerful to humectate, relax, and create mistiness; for
these are the causes of disease of the head, and such also are
south winds, which occasion dulness of hearing. There should
be rest after exercises, to allay the perturbation. Pinching of
the head, even to the extent of producing excoriation of the
skin.
Whetters made of water, or of wine diluted with water,
should be given before a meal. Lunch should be slight: laxatives
from the capillary leaves of pot-herbs,--of mallow, of beet,
and of blite. A condiment of a stomachic nature, which is pleasant
to the mouth, laxative of the bowels, and not calculated to
induce heaviness of the head, is made of thyme, or of savory,
or of mustard. Eggs, hot in winter, and cold in summer,
stripped of their shell, not roasted; olives, dates, pickled meat
in season. Granulated spelt washed, with some of the sweet
things, so as to give it a relish, is to be chosen; and, with
these, salts. Solitude, rest as regards hearing and speaking.
Promenades in a well-ventilated place, rendered agreeable by
trees or herbs. But if it be come to supper-time, they are
again especially to take the cold bath, having been slightly
anointed with oil; or, otherwise, the limbs only. The supper
should be of frumentaceous articles, such as pastry, or a soup
from chondrus (granulated spelt), or a carminative ptisan,
rendered easy of digestion by boiling. The medicines used
for seasoning of the ptisan, pepper, penny-royal, mint, a small
proportion of onions or of leeks, not so much as to float on
the stomach; the acrid part of vinegar is suitable; of fleshes,
the parts of fat animals which are not fat; of swine, the feet
and head; all winged animals--you must select from the great
variety of them what is suitable; the hare and the other kinds
of venison are proper; the hen is easily procured, and suitable.
All articles of the dessert create headaches, except the date, or
figs in the summer season, or the grape if the patient be free
from flatulence; and of sweetmeats, such as are well seasoned,
without fat, and light. Walking, exhilaration; in solitude,
resignation to sleep.
CHAPTER IV. CURE OF EPILEPSY.
OF remedies, whatever is great and most powerful is needed
for epilepsy, so as to find an escape not only from a painful
affection, and one dangerous at each attack, but from the disgust
and opprobrium of this calamity. For it appears to me,
that if the patients who endure such sufferings were to look at
one another in the paroxysms, they would no longer submit to
live. But the want of sensibility and of seeing conceals from
every one what is dreadful and disgusting in his own case. It
is best that the method of cure should follow the alleviation of
nature, when, with the changes of age, she changes greatly
the man. For if the diet akin to the ailment, and on which
the disease subsisted, be changed, the disease no longer seizes
the man, but takes its departure along with that in which it
delighted.
11
If, then, it seize on the head, it settles there; to it, therefore,
we are to do those things which have been described by
me under cephalæa, regarding the abstraction of blood (and
also the purgings) from the veins at the elbow, the straight
vein at the forehead, and by cupping; but the abstraction is
not to be carried the length of deliquium animi; for deliquium
has a tendency to induce the disease; we are to open
all the ordinary arteries before and behind the ears, and we are
also to practise purgings, which are more potent than all these
things, by the purgative
hiera and those medicines which
draw off phlegm from the head; but the medicines should be
particularly powerful, for the habit of such persons renders
them tolerant of pains, and their goodness of spirits and good
hopes render them strong in endurance. It is necessary, also,
to apply heat to the head, for it is effectual. In the first
place, we must perforate the bone as far as the diploe, and
then use cerates and cataplasms until the meninx separate
from the bone. The exposed bones are to be perforated with
the trepan if still any small portion prevent its spontaneous
removal, when the meninx there is found black and thickened;
and when, having gone through the process of putrefaction
and cleansing under the bold treatment of the physician,
the wound comes to complete cicatrization, the patients escape
from the disease. In all cases we are to use rubefacient applications
to the head; namely, the common ones, as described by
me formerly; and a still more powerful one is that from cantharides,
but for three days before using it the patient must
drink milk as a protection of the bladder, for cantharides are
very injurious to the bladder. These are the remedies when
the head is the part affected.
But if the cause be seated in the middle parts, and if these
induce the disease (this, however, very rarely happens, for, as
in a mighty ailment, the middle parts of the body rather sympathise
with the head, which is the origin of the disease), but
however it may be, we must open the vein at the elbow in
these cases also; for the flow by it is from the viscera. But
such patients, more than the others, are to be purged with the
hiera, cneoron,
12 and the
granum cnidium,
13 for these are phlegmagogues.
But the most suitable remedy in these cases is
cupping. Of epithemes and cataplasms the components are
well known, and it would be superfluous to describe them on
all occasions, except in so far as to know the powers of them;
namely, that by such means we must attenuate, promote exhalation,
and render the secretions and perspirations healthy.
We are also to use digestive, heating, desiccant, and diuretic
articles, both in food and in medicine. But the best of all
things is castor, taken frequently during the month in honeyed-water,
and the compound medicines which possess the same
powers, as the compound medicine from vipers, and the still
more complex one of Mithridates, and also that of Vestinus;
for these things promote digestion, form healthy juices, and
are diuretic; for whatever simple medicines you could describe
are contained in these powerful compositions -- cinnamon.
cassia, the leaves of melabathrum, pepper, and all the varieties
of seseli; and which of the most potent medicines will you not
find in them? It is told, that the brain of a vulture, and the
heart of a raw cormorant, and the domestic weasel, when
eaten, remove the disease; but I have never tried these things.
However, I have seen persons holding a cup below the wound
of a man recently slaughtered, and drinking a draught of the
blood! O the present, the mighty necessity, which compels
one to remedy the evil by such a wicked abomination! And
whether even they recovered by this means no one could tell
me for certain. There is another story of the liver of a man
having been eaten. However, I leave these things to be
described by those who would bear to try such means.
It is necessary to regulate the diet, in respect to everything
that is to be done either by others or by the patient himself.
Now nothing must be omitted, nor anything unnecessarily
done; and more especially we must administer everything
which will do the slightest good, or even that will do no
harm; for many unseemly sights, sounds, and tastes, and multitudes
of smells, are tests of the disease. Everything, therefore,
is to be particularly attended to. Much sleep induces
fatness, torpor, and mistiness of the senses, but moderate sleep
is good. An evacuation of the bowels, especially of flatulence
and phlegm, is very good after sleep. Promenades long, straight,
without tortuosities, in a well ventilated place, under trees of
myrtle and laurel, or among acrid and fragrant herbs, such as
calamint, penny-royal, thyme, and mint; so much the better
if wild and indigenous, but if not, among cultivated; in
these places, prolonged gestation, which also should be
straight. It is a good thing to take journeys, but not by a
river side, so that he may not gaze upon the stream (for the
current of a river occasions vertigo), nor where he may see
anything turned round, such as a rolling-top, for he is too weak
to preserve the animal spirits (
pneuma) steady, which are,
therefore, whirled about in a circle, and this circular motion is
provocative of vertigo and of epilepsy. After the gestation,
a gentle walk, then rest so as to induce tranquillity of the
agitation created by the gestation. After these, the exercises
of the arms, their extremities being rubbed with a towel
made of raw flax. Not much oil to be used in the inunction.
The friction to be protracted, and harder than usual for condensation,
since most of them are bloated and fat: the head
to be rubbed in the middle of the process, while the patient
stands erect. The exercises of the neck and shoulders,
chironomy, and the others mentioned by me under the
treatment of Vertigo, with sufficient fulness of detail; only
the exercises should be sharper, so as to induce sweat and
heat, for all these attenuate. During the whole of his life he
should cultivate a keen temper without irascibility.
All kinds of food derived from gross pulse are bad; but we
are to give frumentaceous things, the drier sorts of bread,
washed alica, and the drinks prepared from them. The
medicines added for relish the same as before; but there
should be more of acrid things, such as pepper, ginger, and
lovage. Sauces of vinegar and cumin are both pleasant and useful.
From fleshes in particular the patient is to be entirely restricted,
or at least during the cure; for the restoration, those things
are to be allowed which are naturally light, such as all sorts of
winged animals, with the exception of the duck, and such as
are light in digestion, such as hares, swines' feet, and pickled
fish, after which thirst is good. A white, thin, fragrant, and
diuretic wine is to be drunk in small quantity. Of boiled
pot-herbs, such as are possessed of acrid powers, attenuate and
prove diuretic, as the cabbage, asparagus, and nettle; of raw,
the lettuce in the season of summer. The cucumber and ripe
melon are unsuitable to a strong man; but certain persons may
have just a tasting of them. But being of a cold and humid
nature, much of them is bad. The seasonable use may be
granted of the green fig and the grape. Promenades; after
these, recreation to dispel grief.
Passion is bad, as also sexual enjoyment; for the act itself
bears the symptoms of the disease. Certain physicians have
fallen into a mistake respecting coition; for seeing that the
physical change to manhood produces a beneficial effect, they
have done violence to the nature of children by unseasonable
coition, as if thus to bring them sooner to manhood. Such
persons are ignorant of the spontaneous law of nature by
which all cures are accomplished; for along with every age
she produces that which is proper for it in due seasons. At a
given time there is the maturity of semen, of the beard, of
hoary hairs; for on the one hand what physician could alter
Nature's original change in regard to the semen, and, on the
other, the appointed time for each? But they also offend
against the nature of the disease; for being previously injured
by the unseasonableness of the act, they are not possessed of
seasonable powers at the proper commencement of the age
for coition.
The patients ought to reside in hot and dry places, for the
disease is of a cold and humid nature.
CHAPTER V. CURE OF MELANCHOLY.
IN cases of melancholy, there is need of consideration in
regard to the abstraction of blood, from which the disease
arises, but it also springs from cacochymy in no small amount
thereof. When, therefore, the disease seizes a person in early
life, and during the season of spring we are to open the
median vein at the right elbow, so that there may be a
seasonable flow from the liver; for this viscus is the fountain
of the blood, and the source of the formation of the bile,
both which are the pabulum of melancholy. We must open
a vein even if the patients be spare and have deficient blood,
but abstract little, so that the strength may feel the evacuation
but may not be shaken thereby; for even though the blood
be thick, bilious, coagulated, and black as the lees of oil,
yet still it is the seat and the pabulum of Nature. If, then,
you abstract more than enough, Nature, by the loss of nourishment,
is ejected from her seat. But if the patient has much
blood, for the most part in such cases it is not much vitiated,
but still we must open a vein, and not abstract all the blood
required the same day, but after an interval, or, if the whole
is taken the same day, the strength will indicate the amount.
During the interval, the patient is to be allowed a fuller diet
than usual, in order to prepare him for enduring the evacuation;
for we must assist the stomach, it being in a state of
disease, and distress from the black bile lodging there. Wherefore,
having kept the patient on a restricted diet for one day
previously, we must give black hellebore to the amount of
two drams with honeyed-water, for it evacuates black bile.
And likewise the capillary leaves of Attic thyme, for it also
evacuates black bile. But it is best to mix them together, and
give a part of each, to the amount of two drams altogether.
After the purging we are to administer the bath, and give a little
wine and any other seasoner in the food; for purging fatigues
the powers of the stomach. We are, then, to come down to
the middle parts, and having first relaxed by cataplasms and
bathing, we are to apply a cupping-instrument over the liver
and stomach, or the mouth of it; for this evacuation is
much more seasonable than venesection. We are also to apply
it to the back between the scapulæ, for to this place the
stomach is adjacent. Then again we are to recruit; and if
the strength be restored by the regimen, we are to shave the
head, and afterwards apply the cupping-instrument to it, for
the primary and greatest cause of the disease is in the nerves.
But neither are the senses free from injury, for hence are
their departure and commencement. Wherefore these also
are changed, by participating in the affection. Some, likewise,
from alienation of the senses have perverted feelings. It
is necessary, then, especially to cure the stomach as being
disordered of itself, and from black bile being lodged in it.
Wherefore we must give to drink continuously of the juice of
wormwood from a small amount to a cupful (
cyathus), for it
prevents the formation of bile. Aloe also is a good thing, for
it brings down the bile into the lower gut. If, then, the
disease be of recent origin, and the patient be not much
changed, he will require no other treatment in these circumstances.
There is a necessity, however, for the remaining
part of the regimen to the restoration of the habits, and the
complete purification of the affection, and the strengthening of
the powers, so that the diseases may not relapse. I will explain
afterwards the course of life during convalescence.
But if the disease, having yielded a little to these means,
should be seen relapsing, there will be need of greater
remedies. Let there, then, be no procrastination of time, but
if the disease appear after suppression of the catamenial discharge
in women, or the hemorrhoidal flux in men, we must
stimulate the parts to throw off their accustomed evacuation.
But if it is delayed and does not come, the blood having
taken another direction, and if the disease progress rapidly,
we must make evacuations, beginning from the ankles. And
if you cannot get away from this place so much blood as you
require, you must also open the vein at the elbow. And
after pursuing the restorative process for three or four days,
we are to give the purgative medicine, the hiera. Then we
are to apply the cupping-instrument to the middle parts of
the body, bringing it near to the liver, and do those things
which speedily prove effectual; for melancholy does not yield
to small remedies, and, if long continued, it remains fixed in
a spot. And if the disease lodge in all parts of the
body,--in the senses, the understanding, the blood, and the
bile,--and if it seize on the nerves, and turn to an incurable
condition, it engenders in the system a progeny of other
diseases,--spasms, mania, paralysis. And if they arise from
melancholy, the newly-formed diseases are incurable. Wherefore
we are to use hellebore for the cure of the ailment.
But before the administration of the hellebore, we must train
the stomach to vomiting, attenuate the humours, and render
the whole system freely perspirable; emetics will accomplish
these things sometimes those which are given with an
empty stomach, and sometimes those which consist of radishes.
I will describe the mode and materials of it; and I will also
describe the species of hellebore and the modes of using it;
and how we ought to judge of everything beforehand, and
how to render assistance during the operation of the emetics.
It cannot be doubted that by these means the disease has
either been entirely removed or had intervals of several years.
For generally melancholy is again engendered. But if it be
firmly established, we are no longer to hesitate, but must
have recourse to everything relating to the hellebore. It is
impossible, indeed, to make all the sick well, for a physician
would thus be superior to a god; but the physician can produce
respite from pain, intervals in diseases, and render them
latent. In such cases, the physician can either decline and
deny his assistance, alleging as an excuse the incurable nature
of the disease, or continue to the last to render his services.
The hiera from aloe is to be given again and again; for this
is the important medicine in melancholy, being the remedy
for the stomach, the liver, and the purging of bile. But experience
has proved, that the seed of mallow, to the amount of
a dram, when taken in a drink with water answers excellently.
But there are many other simple medicines which are useful,
some in one case, and some in another.
After these sufferings, the patient is to be recruited. For,
in certain cases, during the time of this treatment, the disease
has been removed; but if the patient come to a renewal of his
flesh and of his strength, all traces of the disease become eradicated.
For the strength of nature produces health, but her
weakness, disease. Let the patient, then, proceed to the process
of restoration by frequenting the natural hot baths; for the
medicinal substances in them are beneficial, such as bitumen,
or sulphur, or alum, and many others besides these which are
possessed of remedial powers. For, after the parching heat of
the disease, and the annoyance of the treatment, dilution is a
good thing. Moreover, rare and soft flesh most readily throws
off the disease; but in melancholy the flesh is dry and dense.
An oily liniment, by gentle friction, with much oil containing
. . . . . . . . . . . . washed bread, with something sweet, as
the Cretan must, and the Scybelitic from Pamphylia, or wine
and honey which have been mixed up together for some time.
Eggs, both cold and hot, which have been stripped of their
shells. Of fleshes, such as are not fatty, and are detergent. Of
swine, the feet and the parts about the head. Of fowls, the
wings, which are not fatty. Of wild animals, hares, goats, and
deer. Of autumnal fruits, whatever is excellent in its kind.
When the stomach rejects the food, we must consider beforehand
that what is taken be not vomited up. Wherefore,
before giving food, we are to administer honeyed-water to the
amount of half a cyathus, which, being drunk, is vomited up
again for cleansing the stomach. For, in this way, the
food remains in the stomach. Medicines which are purgative
of the necessary discharges are--the fruit of the pine, of
the nettle, and seeds of the
coccalus,14 and pepper; bitter
almonds; and let honey give it consistence. But if you wish
to dry, the best thing is myrrh, or the root of iris, the medicine
from vipers, and that of Vestinus, of Mithridates, and
many others. For the epithemes, the
materiel of cataplasms,
melilot and poppies, and the tear (gum?) of turpentine,
and hyssop, and the oil of roses, or of vine-flowers;
wax should give consistence to all these. Liniments of
oil; gestation, promenades, and whatever promotes the reproduction
of flesh, and the strength of the powers, and the restoration
of nature to its pristine state of * * *
* * * * * * * *
* * * * * * * *
* * * * * * * *
CHAPTER VIII. CURE OF PHTHISIS.
. . . . . as in a ship and in a calm. And if the patient have
it fortunately at his command, gestation and living on the sea
will be beneficial. For the sea-water contributes something
desiccant to the ulcers. After the gestation, having rested,
the patient is now to be anointed with fat oil. After the
frictions . . . . . . . . . . . from a small dose gradually up
to five or six heminæ, or even much more; or if not, as much
as one can, for often this alone sufficeth in place of all food.
For milk is pleasant to take, is easy to drink, gives solid
nourishment, and is more familiar than any other food to
one from a child. In colour it is pleasant to see: as a
medicine it seems to lubricate the windpipe, to clean, as if
with a feather, the bronchi, and to bring off phlegm, improve
the breathing, and facilitate the discharges downwards. To
ulcers it is a sweet medicine, and milder than anything
else. If one, then, will only drink plenty of this, he will
not stand in need of anything else. For it is a good
thing that, in a disease, milk should prove both food and
medicine. And, indeed, the races of men called
Galactophagi
use no food from grain. But yet it is a very good thing
to use porridge, pastry, washed groats of spelt (
alica), and the
other edibles prepared with milk. And if other food is
required, let it be of the same nature, as the juice of ptisan,
well-concocted and plain; but it is to be so seasoned as that it
may become easy to swallow; or if anything be added as a
seasoner, let it be something medicinal, as the hair (
capillary
leaves?) of lovage, penny-royal, mint, and a little of salts,
vinegar, or honey. If the stomach suffer from dyspepsia, this
is to be given; but if there be no such necessity, ptisan is of
all things the best. One may also change the ptisan for alica,
for this is less flatulent, and of easier digestion, and becomes
detergent if, when used in the ptisan, the grain be bruised.
When the sputa are unusually fluid, the bean cleanses the
ulcers, but is flatulent. The pea and the
pisum ochrys, in so
far as they are less flatulent, are in the same degree inferior as
cleansers of the ulcers. Forming a judgment, then, from present
symptoms, select accordingly. Their condiments are to
be such as described respecting the ptisan. Eggs from the
fire, in a liquid state, but hot; they are best when newly laid,
before the * * * * * *
* * * * * * * *
* * * * * * * *
CHAPTER XIII. CURE OF THE LIVER.
. . . in the liver the ulcer may be dangerous. But the most
troublesome is a defluxion of pus on the stomach, when it
makes the stomach its route in the course of being distributed
upwards. For the food is the cause of life, but the stomach is
the leader in the process of nutrition, and it also sometimes
conveys medicines to the internal parts. If, then, in addition
to all the other evils, a difficulty of deglutition come on, the
patient must speedily die of disease and famine. But the indications
by which it is discovered in what direction the pus
will be diverted are diversified. If it pass by the intestines,
there are tormina, watery discharges from the bowels, phlegm,
and bile; then clots of blood floating in a fluid, or a thin
discharge like the washings of raw flesh. But, if it pass
by the bladder, there is a weight in the kidneys and loins;
at first, therefore, the evacuations are copious, and tinged with
bile; then turbid, which do not deposit their sediment, nor
get settled. In all cases the sediment should become white.
But if it be determined upwards to the stomach, nausea, loss
of appetite, vomitings of phlegm or of bile, deliquium, and
vertigo supervene, until it burst.
This, then, is to be especially avoided, as being a bad
course. But if the defluxion of pus be more violent, we
must take every means, assisting the stomach by food, and
medicines, and regimen, all in a mild way. We must administer
the medicines for bursting the abscess; give to
drink of the herb hyssop with honeyed-water, and the juice
of the hair of horehound, and this with honeyed-water and
the juice of the wormwood. These things must be given
before food to dilute the fluids, to lubricate the parts, and
facilitate the rupture of the abscesses. We are also to give
the milk of an ass, which is soft, not bilious, nutritious, does
not admit of being made into cheese, which is the perfection of
milk. We should gratify the patient in regard to food and
drink. And we are even to give things inferior to other more
beneficial articles (for we thereby afford a passage to the fluid
which occasions nausea and loathing of food, and many are
hurt by the transit of the pus), lest they should come to loathe
their food. And if they should take anything, they readily
vomit. It is necessary, also, in the other defluxions, to have
especial care of the stomach, for it is the passage to all sorts of
medicine. It is necessary to keep in mind the liver, which is
the root of the ulcerations.
15 But if the defluxion be to the
bladder, we are to promote it by diuretics, as the root of
asarabacca, valerian, maiden-hair, spignel, in drinks; for these
things are to be given to drink in honeyed-water. The compound
medicine of Vestinus is also very good, and that from
alkekengi, and such others as from trial have acquired reputation.
But if you determine to draw off the discharge by the
bowels, you can do this with milk, especially that of the ass, or
otherwise of the goat or sheep. Give, also, juices of a lubricating
nature and detergent, as the juice of ptisan; condiments,
as pepper, ginger, and lovage. In a word, with regard to
every method of diet in any case of abscess tending to rupture,
the food should consist of things having wholesome juices, of
savoury things, things of easy digestion, either juices, or the
gruels with milk, starch, pastry with milk * * *
* * * * * * * *
CHAPTER XIV. CURE OF THE SPLEEN.
RESOLUTION of scirrhus of the spleen is not easy to accomplish.
But if the diseases engendered by it come on, as dropsy
and cachexia, the ailment tends to an incurable condition
. . . . . . . the physician to cure the scirrhus; we must try
then to avert it when it is coming on, and to remove it when
just commencing; and attend to the inflammations, and if the
scirrhus be the substitute . . . . . . . . are brought by suppuration
. . . . . the abscess. For these, if the inflammation
. . . . . we are to use the remedies described by me among
the acute diseases. But if, while you are doing everything,
the scirrhus remain in an inflammatory state, you must use
also the means resembling fire to soften the hardness; lotions
of vinegar, oil, and honey; but, instead of wool, use compresses
of linen; add to them, in powder, nut-ben sifted; and
to the most emollient cataplasms * * * *
* * * * * * * *
