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NOW, indeed, a soft, comfortable, smooth, commodious, and warm bed is required; for the nerves become unyielding, hard, and distended by the disease; and also the skin, being dry

and rough, is stretched; and the eye-lids, formerly so mobile, can scarcely wink; the eyes are fixed and turned inwards; and likewise the joints are contracted, not yielding to extension. Let the house also be in a tepid condition; but, if in the summer season, not to the extent of inducing sweats or faintness; for the disease has a tendency to syncope. We must also not hesitate in having recourse to the other great remedies; for it is not a time for procrastination. Whether, then, the tetanus has come on from refrigeration, without any manifest cause, or whether from a wound, or from abortion in a woman, we must open the vein at the elbow, taking especial care with respect to the binding of the arm, that it be rather loose; and as to the incision, that it be performed in a gentle and expeditious manner, as these things provoke spasms; and take away a moderate quantity at first, yet not so as to induce fainting and coldness. And the patient must not be kept in a state of total abstinence from food, for famine is frigid and arid. Wherefore we must administer thick honeyed-water without dilution, and strained ptisan with honey. For these things do not press upon the tonsils, so as to occasion pain; and, moreover, they are soft to the gullet, and are easily swallowed, are laxative of the belly, and very much calculated to support the strength. But the whole body is to be wrapped in wool soaked in oil of must or of saffron, in which either rosemary, fleabane, or wormwood has been boiled. All the articles are to be possessed of heating properties, and hot to the touch. We must rub with a liniment composed of lemnestis, euphorbium, natron, and pellitory, and to these a good deal of castor is to be added. The tendons also are to be well wrapped in wool, and the parts about the ears and chin rubbed with liniments; for these parts, in particular, suffer dreadfully, and are affected with tension. Warm fomentations, also, are to be used for the tendons and bladder, these being applied in bags containing toasted millet, or in the bladders of cattle half

filled with warm oil, so that they may lay broad on the fomented parts. Necessity sometimes compels us to foment the head, a practice not agreeable to the senses, but good for the nerves; for, by raising vapours, it fills the senses with fume, but relaxes the nervous parts. It is proper, then, to use a mode of fomentation the safest possible, and materials not of a very heavy smell; and the materials should consist of oil devoid of smell, boiled in a double vessel,1 and applied in bladders; or of fine salts in a bag: for millet and linseed are pleasant indeed to the touch, but gaseous, and of an offensive smell. The patient having been laid on his back, the fomentations are to be spread below the tendons, as far as the vertex; but we must not advance further to the bregma, for it is the common seat of all sensation, and of all remedial and noxious means it is the starting-point. But if it be necessary to apply cataplasms to the tendons, it must be done below the occiput; for if placed higher, they will fill the head with the steam of the linseed and fenugreek. After the cataplasms, it is a good thing to apply the cupping-instrument to the occiput on both sides of the spine; but one must be sparing in the use of heat, for the pressure of the lips of the instrument is thus painful, and excites contractions. It is better, then, to suck slowly and softly, rather than suddenly in a short time; for thus the part in which you wish to make the incision will be swelled up without pain. Your rule in regard to the proper amount of blood must be the strength. These are the remedies of tetanus without wounds.

But if the spasm be connected with a wound, it is dangerous,

and little is to be hoped. We must try to remedy it, however, for some persons have been saved even in such cases. In addition to the other remedies, we must also treat the wounds with the calefacient things formerly described by me, by fomentations, cataplasms, and such other medicines as excite gentle heat, and will create much pus: for in tetanus the sores are dry. Let the application consist of the manna of frankincense, and of the hair of poley, and of the resins of turpentine and pine-trees, and of the root of marsh-mallow and of rue, and of the herb fleabane. These things are to be mixed up with the cataplasms, melting some of them, sprinkling the others upon them, and levigating others beforehand with oil; but the mallow, having been pounded, is to be boiled beforehand in honeyed-water. We are to sprinkle, also, some castor on the ulcer, for no little warmth is thereby communicated to the whole body, because the rigors proceeding from the sores are of a bad kind. Rub the nostrils with castor along with oil of saffron; but also give it frequently, in the form of a draught, to the amount of three oboli. But if the stomach reject this, give intermediately of the root of silphium an equal dose to the castor, or of myrrh the half of the silphium: all these things are to be drunk with honeyed-water. But if there be a good supply of the juice of the silphium from Cyrene,2 wrap it, to the amount of a tare, in boiled honey, and give to swallow. It is best given in this way, as it slips unperceived through the palate; for it is acrid, and occasions disagreeable eructations, being a substance which has a bad smell. But if it cannot be swallowed thus, it must be given dissolved in honeyed-water; for it is the most powerful of all the medicines given to be swallowed, which are naturally

warming, diluent, and can relax distensions and soothe the nerves. But if they can swallow nothing, we must inject it into the anus with the oil of castor; and thus the anus is to be anointed with oil or honey. With this, also, we must anoint the fundament, along with oil or honey. But if they will drink nothing, we must make an injection of some castor with the oil. With this, also, we are to anoint the fundament, along with fat or honey; and also foment the bladder; and use it as an ointment, having melted it with a sufficiency of wax to bring it to the proper consistence. But if it be the time for evacuating flatulence and fæces, we are to inject two drams of the purgative hiera along with honeyed-water and oil, since, along with the expulsion of these, it warms the lower belly; for hiera is both a compound and heating medicine.

1 A double vessel was a smaller vessel, to which heat was applied by placing it in a larger. It was called balneum mariœ by the alchemists. It is frequently made mention of in the works of the ancient writers on pharmacy. See, in particular, Galen, sec. loc. vii. 2; De Sanit. tuend iv. 8; Meth. Med. viii. 5; Dioscorid. ii. 95; Oribasius Meth. Med. viii. 6, and the learned note of Daremberg.

2 I would remind the professional reader, that the Cyrenaic silphium was a superior kind of assa-fœtida, which at one time grew copiously in the region of Cyrene. See Paulus Ægineta, Syd. Soc. Edit., t. iii. 337.

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