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CHAPTER VI. CURE OF THE ACUTE AFFECTIONS ABOUT THE LIVER.

THE formation of the blood is in the liver, and hence the distribution of it over the whole system. And the entire liver is, as it were, a concretion of blood. Wherefore the inflammations there are most acute; for nutrition is seated in this

place. If, therefore, inflammation form anywhere else, it is not remarkably acute; for it is an influx of blood that is inflamed; but in the liver there is no necessity for its coming from another quarter. For if any obstruction shut the outlets, the liver becomes inflamed by being deprived of its efflux, since the entrance of the food to the liver still continues patent; for there is no other passage of the food but this from the stomach and intestines to the whole body.

It is necessary, therefore, to make a copious evacuation, by opening the veins at the elbow, and taking away blood frequently, but not in large quantity at a time. Total abstinence from food at first, but restricted diet afterwards, so that the liver may be devoid of its customary ingesta. It is necessary, also, by external applications to dispel the matters impacted in the liver. Lotions, therefore, with aloe or natron are proper, and unwashed wool is to be applied. There is need, then, of cooling means, because the liver is inflamed by the blood; for the blood is hot. The cataplasms, also, should be of such a nature, consisting of the meal of darnel, or of hedge-mustard, or of barley, or of linseed; and of liquid substances, such as acid wine, the juice of apples, of the tendrils of the vine, or of the leaves of the vine in season, or of the oil prepared with it. Fomentations are to be applied on sponges, of the decoction of the fruit of bays, of the lentisk, of penny-royal, and of iris.

When you have soothed by these means, you must apply a cupping-instrument, unusually large, so as to comprehend the whole hypochondriac region, and make deeper incisions than usual, that you may attract much blood. And, in certain cases, leeches are better than scarifications; for the bite of the animal sinks deeper, and it makes larger holes, and hence the flow of blood from these animals is difficult to stop. And when the animals fall off quite full, we may apply the cupping-instrument, which then attracts the matters within. And

if there be sufficient evacuation, we are to apply styptics to the wounds; but these not of a stimulant nature, such as spiders' webs, the manna of frankincense, and aloe, which are to be sprinkled in powder on the part; or bread boiled with rue or melilot, and the roots of marsh-mallow; but on the third day a cerate, made with nut-ben, or the hairy leaves of wormwood and iris. The malagmata should be such as are calculated to attenuate, rarify, or prove diuretic. Of these the best is that "from seeds" (diaspermatôn) well known to all physicians from experience. That also is a good one of which marjoram and melilot are ingredients.

The food should be light, digestible, possessed of diuretic qualities, and which will quickly pass through the bowels; such as granulated seeds of spelt (alica1) with honeyed-water, and a draught of these articles with salts and dill. The juice of ptisan, also, is detergent; and if you will add some of the seeds of carrot, you will make it more diuretic: for it evacuates by the passages which lead from the liver to the kidneys; and this is the most suitable outlet for matters passing out from the liver, owing to the wideness of the vessels and the straightness of the passage. We must also attract thither by cupping, applying the instrument to the region of the kidneys in the loins. To these parts, lotions are also to be applied, prepared with rue, the juncus, or calamus aromaticus. By these means, it is to be hoped that the patient may escape death.

But when it is turning to a suppuration, we must use the suppurative medicines which will be described by me under the head of colics. But if pus is formed, how the collection is to be opened, and how treated, will be explained by me in another place. The same observations apply to the spleen, in the event of an inflammation seizing this part also.

1 See, in particular, Dr. Daremberg's elaborate dissertation on the χόνδρος, ap. Oribasium, t.i. p. 559.

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