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. . . . . should indeed the apoplexy be severe, for by all means the patients are, as it were, dead men whenever one is old, to whom this affection is congenial, and they cannot survive the greatness of the illness, combined with the misery of advanced life. It has been formerly stated by me, how the magnitude of the disease is to be estimated. If the patient be young, and the attack of apoplexy weak, it is still no easy matter to effect a cure; it must, however, be attempted. The equivalent remedy, then, as being the great assistance in a a great disease, is venesection, provided there be no mistake as to quantity; but the amount is difficult to determine, since if you take a little too much, you despatch the patient at once; for to them a little blood is most potent, as being that which imparts the vital heat to the frame itself, and to the food. But, if the quantity be inferior to the cause, you do little good with this the great remedy, for the cause still remains. But it is better to err on the side of smallness; for, if it should seem to have been deficient, and the appearance of the eyes, as seen from below, be favourable, we can open a vein again. We must open the vein at the hollow of the elbow, for the blood flows readily from it in the left arm. But in smaller attacks of apoplexy, it is necessary to consider whether the paralytic seizure be on the left side or the right. In a word, the abstraction is to be made from the healthy parts, for there the blood flows more freely, and thither the revulsion is made from the parts affected. When, therefore, the patient is seized with apoplexy without any obvious cause, we should decide thus concerning the abstraction of the blood. But if the attack happen from a blow, a fall from a high place,

or compression, there must be no procrastination, for in certain cases this alone is sufficient for the cure and to save life.

But if it is not thought expedient to open a vein, owing to the patient's having been seized with much coldness, torpor, and insensibility, an injection must be given for the evacuation of the engorgement in the bowels (for very generally persons are seized with apoplexy from the immoderate use of food and wine), and for the revulsion of the humours seated in the head. The clyster should be acrid; and an evacuant of phlegm and bile, consisting not only of natron, but also of euphorbium, to the amount of three oboli, added to the usual amount of a clyster, also the medullary part of the wild cucumber, or the decoction of the hair (leaves) of centaury in oil or water. The following is a very excellent clyster: To the usual amount of honey add rue boiled with oil and the resin of the turpentine tree, and some salts, instead of natron, and the decoction of hyssop.

And if by these means the patient be somewhat aroused, either from being moved by the supervention of fevers, or having recovered from his insensibility, or the pulse has become good, or if the general appearance of the face has become favourable, one may entertain good hopes, and apply the remedies more boldly. Wherefore, when the strength is confirmed, the purgative hiera may be given to the patient fasting, and particularly a full dose. But, if the strength be an objection, it is to be given, to the amount of one-half, with honeyed-water. And we are to move him about, after having laid him stretched on a couch; and those who carry him must do so gently, he being allowed to rest frequently, to avoid inducing lassitude. And if there be a copious evacuation from the bowels, we are to permit it; but if not, give water, or honeyed-water, to the amount of two cupfuls, for drink. And if nausea supervene upon the purging, we are not to interfere with it; for the exertions of the body have some tendency to

resuscitate the patient, and the vomiting of the bile carries off the cause of the disease. The medicine hiera is a purger of the senses, of the head, and of the nerves. Enough, indeed, has been said respecting evacuation of every kind at the commencement.

But having wrapped the whole of his person in wool, we are to soak it with some oil -- the Sicyonian, oil of musk (gleucinum), or old oil, either each of these separately, or all mixed together; but it is best to melt into it a little wax, so as to bring it to the thickness of ointments; and it is to be rendered more powerful by adding some natron and pepper: these are to be reduced to a powder, and strained in a sieve. But castor has great efficacy in cases of palsy, both in the form of a liniment with some of the fore-mentioned oils, and it is still more potent when taken in a draught with honeyed-water, the quantity being to the amount we have stated under lethargics; but, at the same time, we must consider the age and disposition of the patient, whether he be ready to take the drink for several days. Inunctions are more powerful than fomentations, as being more easily borne, and also more efficacious; for the ointment does not run down so as to stain the bed-clothes (for this is disagreeable to the patient), and adheres to the body until, being melted by the heat thereof, it is drunk up. Moreover, the persistence of their effects is beneficial, whereas liquid applications run off. The ingredients of the ointments are such as have been stated by me; but along with them castor, the resin of the turpentine-tree, equal parts of euphorbium, of lemnestis, and of pellitory; of pepper, and of galbanum one-half, with triple the amount of Egyptian natron; and of wax, so as to bring it to a liquid consistence. But a much more complex mode of preparing these medicines has been described by me on various occasions, and under a particular head. Cataplasms are to be applied to the hardened and distended parts; their ingredients are linseed, fenugreek, barley-meal, oil

in which rue or dill has been boiled, the root of mallows pounded and boiled in honeyed-water, so as to become of the consistence of wax. They should be of a soft and agreeable consistence. These things are to be done if the patient still remains free of fever, or if the fever be slight, in which case no regard need be had to the heat.

But if the fevers be of an acute nature, and the remaining disease appear to be of minor consequence, and if these induce urgent danger, the diet and the rest of the treatment must be accommodated to them. Wherefore, the patients must use food altogether light and of easy digestion; and now, most especially, attention ought to be paid to the proper season for eating, and, during the paroxysms, the whole of the remedial means must be reduced; and, altogether, we must attend to the fevers.

But if the disease be protracted, and if the head be at fault, we must apply the cupping-instrument to the back of the head, and abstract blood unsparingly; for it is more efficacious than phlebotomy, and does not reduce the strength. But, dry-cupping is to be first applied between the shoulders, in order to produce revulsion of the matters in the occiput.

Sometimes, also, the parts concerned in deglutition are paralysed, which is the sole help and safety of persons in apoplexy, both for the swallowing of food and for the transmission of medicines. For not only is there danger of want of nourishment and hunger, but also of cough, difficulty of breathing, and suffocation; for if one pour any liquid food into the mouth it passes into the trachea, neither the tonsils coming together for the protrusion of the food, nor the epiglottis occupying its proper seat where it is placed by nature, as the cover of the windpipe; we must, therefore, pour honeyed-water or the strained ptisan into a piece of bread resembling a long spoon, and passing it over the trachea, pour its contents into the stomach; for in this way deglutition is

still accomplished. But if the patient be in the extremity of danger, and the neck with the respiration is compressed, we must rub the neck and chin with heating things and foment. They effect nothing, and are unskilful in the art, who apply the cupping-instrument to the throat, in order to dilate the gullet; for distension, in order to procure the admission of food, is not what is wanted, but contraction of the parts for the purposes of deglutition. But the cupping-instrument distends further; and, if the patient wish to swallow, it prevents him by its expansion and revulsion, whereas it is necessary to pass into a state of collapse, in order to accomplish the contraction of deglutition; and in addition to these, it stuffs the trachea so as to endanger suffocation. And neither, if you place it on either side of the windpipe, does it any good; for muscles and nerves, and tendons and veins, are in front of it.

The bladder and the loose portion of the rectum are sometimes paralysed, in regard to their expulsive powers, when the bowels are constantly filled with the excrements, and the bladder is swelled to a great size. But sometimes they are affected as to their retentive powers, for the discharges run away as if from dead parts. In this case one must not boldly use the instrument, the catheter, for there is danger of inducing violent pain of the bladder, and of occasioning a convulsion in the patient. It is better to inject with no great amount of strained ptisan; and if the bowel be evacuated of the fæces, it will be proper to inject castor with oil. But the sole hope, both of general and partial attacks of paralysis, consists in the sitz bath of oil. The manner of it will be described under the chronic diseases.

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