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IN Syncope, it is necessary that the physician should exercise fore-knowledge; for, if you foresee its approach, and if things present co-operate strongly with you,1 you may avert it before its arrival. When it is come on, patients do not readily escape from it, for I have said that syncope is the dissolution of nature; and nature when dissolved cannot be restored. We must try to prevent it then, when still impending, or if not, at the commencement. We must form our prognosis from the circumstances stated by us among the acute diseases, where we have described the cause and also the symptoms. The fever Causus, then, is the commencement of the attack, and with Causus the worst of symptoms, dryness, insomnolency, heat of the viscera, as if from fire, but the external parts cold; the extremities, that is to say, the hands and feet, very cold; breathing slowly drawn; for the patients desiderate cold air, because they expire fire: pulse small, very dense, and trembling. Judging from these and the other things stated by me among the symptoms, you will immediately give assistance at the commencement.

Unless, then, when everything is against it, the habit, the age, the season, the timidity of the patient, we must open a vein, and even if many symptoms contra-indicate it, but an especial one require it, such as the tongue rough, dry, and black (for it is indicative of all the internal parts). And in

all cases we must form an estimate of the strength, whether or not it has failed owing to the pains of the disease and the regimen; for the loss of strength takes place, not only from deficiency, but also from smothering; and if the syncope arise from redundancy, and if inflammation of the hypochondria, or of the liver strongly indicate, there is no necessity for deferring the bleeding. We are to open the hollow vein at the elbow, and abstract the blood by a small orifice, that it may not have a marked effect on the strength; for sudden depletion tries the natural strength: and we must take away much less than if from any other cause; for in syncope, even a slight mistake readily sends a man to the regions below. We must, therefore, immediately give food for the restoration of the strength; for Nature delights in the removal of the old, and in the supply of new things.

But if the strength reject venesection, and inflammations be present, we must apply the cupping-instrument to the seat thereof a considerable time previous to the crisis of the disease; for the crisis takes place at the critical periods; since at the same periods Nature brings on a favourable crisis, and diseases prove fatal. And if the patient should come to such a state as to require wine, it is not very safe to take wine in inflammations; for, wine to persons labouring under inflammation is an increase of the pains, but to those free from inflammation it is an increase of the natural strength. A day or two before the cupping there is need of cataplasms, both in order to produce relaxation of the parts and to procure a flow of blood; and in certain cases, after the cupping, we are to apply a cataplasm on the next day. In this, too, let there be moderation; for there is the same danger from the abstraction of too much blood by cupping. Use clysters only for removing scybala which have long lodged in the bowels; but spare the strength.

Cold lotions to the head, such as have been directed by me

under Phrenitis, but somewhat more liberally. Pure air, rather cooler than otherwise, for respiration. The delight of the sight is to be studied as to plants, painting, waters, so that everything may be regarded with pleasure. The conversation of attendants cheerful; silence and cheerfulness on the part of the patient. Smells fragrant, not calculated to prove heavy to the senses in the head. And let the articles of food also possess a fragrant smell, such as flour moistened with water or vinegar; bread hot, and newly baked. The mouth not to be very often rinsed with wine, nor is it to be altogether rejected.

Drink to be given more frequently and more copiously than in other complaints. Food every day, light, digestible, mostly from grain, and that which is pleasant, even if somewhat less suitable. For, in these cases, rather than in any other, the palate is to be gratified, since not unusually the disease is generated in the stomach, so as to occasion resolution thereof. Abstinence or famine by no means; for the disease is sufficient to devour up all. But if the period be already come to a crisis, if there be a dew on the clavicle and forehead, the extremities cold; the pulse very small and very frequent, as if creeping, and feeble in tone, the patient must take a little food, and partake of wine effectually. The head, too, is to be strengthened by lotions, as also the bladder. These remedies have been described by me under Phrenitis. We are to give wine, not copiously nor to satiety, for certain patients by unseasonable repletion have died of anorexia, and inability to eat and drink; and to many patients having a good appetite, when the natural powers were dissolved, the abundant supply of food was of no avail; the food descending, indeed, into the stomach, but not ascending from the belly to recruit the strength. Let the food, therefore, be diversified, for the most part from grain, so as that it may be supped rather than masticated; or if solid, let it be made easy to

swallow. Eggs, not quite consistent nor roasted whole, but deprived of their solid portion; two or three pieces of bread soaked in wine, at first hot; but, after these, everything cold, unless there be latent inflammations. The wine is to be fragrant, and not very astringent; but by no means thick. Of the Greek wines, the Chian or Lesbian, and such other of the insular wines as are thin; of the Italian, the Surrentine, or Fundan, or Falernian, or Signine, unless it be very astringent; but of these we must reject such as are very old or very young. It is to be given at first hot, to the amount of not less than four cyathi, before the crisis, nor more than a hemina even if the patient be accustomed to drink. But after these things, having given food, if the symptoms of inflammation be past, we are again to give it cold as if for a remedy of the thirst; but this from necessity, and not by itself, but along with the food. We must also take care that the wine do not affect the brain; and after this, abstain. And if after an interval, he wish to sleep, quiet is to be enforced. But if much sweat flow, the pulse come to a stop, the voice become sharp, and the breast lose its heat, we are to give as much wine as the patient can drink. For those who are cold, wine is the only hope of life. Wine, therefore, if the patient be accustomed to it, is sometimes to be taken in drink, and sometimes food is to be eaten with the wine, after an interval, as a respite from the fatigue induced by the disease and the food, for when the strength is small, they are much fatigued, even by the act of taking food. Wherefore the patient must be stout-hearted and courageous, and the physician must encourage him with words to be of good cheer, and assist with diversified food and drink.

The other treatment is also to be applied energetically for restraining the sweats, and for resuscitating the spark of life. Let, therefore, an epitheme be applied to the chest on the left mamma,--dates triturated in wine along with aloes and

mastich,--and let these things be mixed up with a cerate composed of nard.2 And if this become disagreeable, we may apply another epitheme, made by taking the seed, and whatever is hard out of the apples, and having bruised them down, mix up with some fragrant meal; then we are to mix together some of the hair of wormwood, and of myrtle, and of acacia, and of the manna of frankincense, all sifted; which being all rubbed up together, are to be added to the cerate of wild vine. But if the sweat be not thereby restrained, the juice of the wild grape is to be added to the mixture, and acacia, and gum, and the edible part of sumach, and alum, and dates, and the scented juice of roses. All these things along with nard and oil of wild vine are to be applied to the chest; for this at the same time cools and is astringent. Let him lie in cool air, and in a house having a northern exposure; and if the cool breeze of Boreas breathe upon him, "it will refresh his soul sadly gasping for breath." The prospect should be to-wards meadows, fountains, and babbling streams, for the sweet exhalations from them, and the delightful view, warm the soul and refresh nature. And, moreover, it is also an incentive to eat and to drink. But if from want one is not fortunate enough to possess these things, we must make an imitation of the cool breeze, by fanning with the branches of fragrant boughs, and, if the season of spring, by strewing the ground with such leaves and flowers as are at hand. The coverlet should be light and old, so as to admit the air, and permit the exhalation of the heat of the chest; the best kind is an old linen sheet. We are to sprinkle the neck, the region of the clavicle and chest with flour, so that it may nourish by its fragrance, and restrain by its dryness; and the spongy parts of the body are to be dusted with meal, but the face with the Samian earth, which is to be passed through a sieve; and

having been bound into a spongy cloth, it is to be dusted on the part, so that the finer particles may pass through the pores to the forehead and cheeks. And slaked lime and roasted gypsum, sifted in a small sieve, are to be applied to the moist parts. A sponge out of cold water applied to the face has sometimes stopped the sweats, by occasioning congelation of the running fluids, and by condensation of the pores. The anus is to be anointed, so that the flatus arising from the cold and food may be discharged. And we are to recall the heat of the extremities by gleucinum,3 or Sicyonian oil, along with pepper, castor, natron, and cachry,4 melting into them a little wax, so that the liniment may stick. And we are to resuscitate the heat by means of the ointment of lemnestis, and of euphorbium, and of the fruit of the bay. The small red onions raw, along with pepper, and the powdered lees of vinegar, make an excellent cataplasm to the feet; but it is to be constantly raised from the place every hour, for there is danger of ulceration and blisters. From these things there is hope that the patient may thus escape.

And if the physician should do everything properly, and if everything turn out well, along with the syncope the inflammations that supervene are resolved; and sweat, indeed, is nowhere, but a restoration of the heat everywhere, even at the extremities of the feet and the nose; but the face is of a good colour; pulse enlarged in magnitude, not tremulous, strong; voice the same as customary, loud, and in every respect lively. Lassitude not out of place, but the patient is also seen sleeping: and, if sleep seize him, he digests his food, recovers his senses, and sprouts out into a new nature; and if roused from sleep, the breathing is free, he is light

and vigorous; and here calls to his memory the circumstances of the disease like a dream.

But in other cases obscure fevers are left behind, and sometimes slight inflammations, and a dry tongue: they are parched, have rigors, are enfeebled, and relaxed, in which cases there is a conversion to marasmus; when we must not waste time with rest and a slender diet, but have recourse to motions, by gestation, and to friction and baths, so that the embers of life may be roused and mended. We are to give milk, especially that of a woman who has just borne a child, and that a male child; for such persons require nursing like new-born children. Or if it cannot be obtained, we must give the milk of an ass which has had a foal not long before, for such milk is particularly thin;5 and by these means the patient is to be brought back to convalescence and his accustomed habits.

1 Allusion is here made to Hippocrates Aph. i. In the Aphorism it is "the attendants and externals" (τοὺς παρέοντας καὶ τὰ ἔχωθεν), which our author condenses into "things present" (τὰ παρέοντα); and this is no doubt the reason why in this instance the neuter plural is construed with a verb plural. See the text.

2 No doubt the Indian nard, namely, Patrinia Jatamansi, Don.

3 A fragrant oil prepared from must. See Paulus Ægineta, t.iii. p. 596.

4 The fruit of the Cachrys libanotis, L. See Dioscorides, iii. 79.

5 The author appears to refer to the common way of trying the specific gravity of milk, by pouring a small quantity on the nail. See Paulus Ægineta, i. 3, Syd. Soc. Ed.

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