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THE patient ought to be laid in a house of moderate size, and mild temperature--in a warm situation, if winter, and in one that is cool and humid, if summer; in spring and autumn, to be regulated according to the season. Then the patient himself, and all those in the house, are to be ordered to preserve quiet; for persons in phrensy are sharp of hearing, are sensitive to noise, and easily become delirious. The walls should be smooth, level, without projections, not adorned with frieze1 or paintings; for painting on a wall is an excitant. And, moreover, they catch at certain false appearances before their eyes, and grope about things which are not projecting, as if they were so; and any unreal occasion may be a cause sufficient to make them raise their hands. Length and breadth of the couch moderate, so that the patient may neither toss about in a broad one, nor fall out of a narrow bed. In plain bed clothes, so that there may be no inducement to pick at their nap. But on a soft bed, for a hard one is offensive to the nerves; as in phrenitics, above all others, the nerves especially suffer, for they are subject to convulsions. Access of their dearest friends is to be permitted; stories and conversation not of an exciting character; for they ought to be gratified in everything, especially in cases where the delirium tends to anger. Whether they are to be laid in darkness or in light must be determined by the nature of the attack; for if they are exasperated by the light, and

see things which exist not, and represent to themselves things not present, or confound one thing with another, or if strange images obtrude themselves upon them; and, in a word, if they are frightened at the light, and the things in the light, darkness must be chosen; but if not, the opposite state. It is a good symptom, too, when they become of a sound mind, and their delirium abates, on exposure to the light. Abstinence from food should not be prolonged; food should be rather liquid, scanty, and frequently administered, for food soothes the soul: the proper time for giving it is during the remissions, both of the fever and of the delirium. But if they have become delirious from want of food, and if the fever do not remit, we are to give food that does not do much harm in fever. It is a favourable circumstance, when the fever and the delirium agree both as to the paroxysms and intermissions.

If, therefore, the time for the administering of food be come, in the first place, it must be enquired whether it be necessary to abstract blood. If, then, the delirium have come on with fever at the commencement, in the first or second day, it will be proper to open a vein at the elbow, especially the middle. But if the delirium supervene on the third or fourth day, we are to open a vein up to the first period of critical days. But if it was past the proper time for bleeding, on the sixth or seventh day, it will be proper to evacuate considerably before the crises in acute diseases, either by giving purgative medicines, or by using other stimulants. But when opening a vein you must not abstract much, even if you open the vein at the commencement; for phrenitis is an ailment easily convertible into syncope. But if the patient be plethoric and youthful, and if the ailment be connected with fulness in eating and drinking, those indications have nothing to do with the phrenitis; for even without the delirium, it would be proper to abstract much blood in such circumstances; but much less is to be abstracted, if such persons labour under phrenitis.

But we may open a vein the more boldly in these cases, if the disease proceed from the præcordia, and not from the head; for there (in the præcordia) is the origin of life. But the head is the seat of sensation, and of the origin of the nerves; and it attracts more blood from the heart than it imparts to the others. If it therefore suffer, it is not proper to open the vein at the elbow; for these affections are such that it is no small injury to evacuate in them. And if the strength be sufficient to withstand the evacuation, we must abstract only once, lest during the interval between the acts of evacuation, the proper season for food be lost. The fevers, in cases of phrenitis, are of a continual type, neither have they long intermissions, but experience short and ill-marked remissions. But if the patient give way before a sufficient quantity has been abstracted, it must be put off until another remission, unless it occur at a distant period; but, if not, having resuscitated the patient by odours, stroking the face, and pricking the feet, we are immediately to abstract blood. The measure of sufficiency is the strength.

Liquid food is proper in all febrile diseases, but especially in phrenitic cases, for these are more arid than mere fevers. The mulse is to be given, unless they are bilious, for it is indigestible in patients who are subject to bitter bile. Alica2 washed with water, or mulse, is a good thing; also it is good to give pottages of a plain kind, such as decoctions of savory, of parsley, or of dill, for these are beneficial to the respiration, and are diuretic, and a free discharge of urine is beneficial in phrenetics. All kinds of pot-herbs, especially melons, for their gluten is good for lubricating the tongue, the trachea, and for

the alvine evacuations; but the best of all are beet, blite, cress, gourd in season, and whatever else is best in its own season. The juice of ptisan in a very liquid state, and containing little nourishment, is most proper at first, being made always thicker as the disease progresses. But the quantity of nourishment is to be diminished at the crises, and a little before them. And, if the disease be protracted, the customary food must not be abstracted, but we must give nourishing articles from the cereals, in order to support the patient; and when there is need, of the flesh of the extremities of beasts and fowls, mostly dissolved in the soups: these ought to be completely dissolved during the process of boiling. The rock fishes are preferable to all others;3 but on the whole we must choose the best in the country, for countries are believed to differ as to the kinds of fish which are best in them. Fruit containing wine must be given restrictedly, for it is apt to affect the head and præcordia; but if required by the state of the strength and of the stomach, we must give such articles as apples boiled in mulse or roasted in suet. Of other things, each is to be diluted with hot water, if you give it solely for the refreshment of the stomach; but if it is wanted also for strength, you must not dilute the vinous part much. In a word, the food must be such as I have described.

For the sake of refrigeration, the head is to be damped with the oil of the unripe olive pounded; for in phrenitics the head is not fond of being kept warm. But if restlessness and false visions be present, we must mix equal parts of rose-oil at first; and the rose-oil is to be increased for the astringing and cooling of the head. But if they become disordered in understanding, and their voice change, the hair (capillary leaves?) of the wild thyme must be boiled in oils, or the juice of ivy or

of knot-grass is also to be infused. But if the delirium get more violent, hog's-fennel and cow-parsnip are to be boiled in the oils, and some vinegar poured in; for these things dissipate the vapours and heat, and are solvents of the thick humours which contribute to the delirium. But care must be taken that the moist application do not extend to the neck and the tendons, for it is prejudicial to tendons and nerves. Every season is suitable for the damp application, except the commencement of a paroxysm; it should be used more rarely during the increase, but most frequently at the acme; and whenever they are delirious, then, in particular, it will be proper to use a cold application, made still more cold in the season of summer, but in winter tepid. To soothe the delirium it is well to foment the forehead with oxycrate, or the decoction of fleabane, by means of a sponge, and then to anoint with the oil of wild vine or of saffron, and also to anoint the nose and ears with them.

These things, moreover, also induce sleep. For if they lay awake all night, nor sleep during the day, and the eyes stand quite fixed like horns, and the patients toss about and start up, we must contrive to procure sleep and rest for them; first, by fomentations to the head, with unmixed rose-oil, or oil of marjoram with the juice of ivy, or the decoction of wild thyme or of melilot. But poppy boiled in oil is particularly soporific when applied to the fontenelle of the head, or with a sponge to the forehead. But the poppies, if recently plucked and green, may be applied whole under the pillows; for they thicken and humectate the spirit (pneuma), which is dry and attenuated, and diffuse over the senses fumes which prove the commencement of sleep. But if greater applications are needed, we may rub in the meconium (expressed juice of poppy) itself on the forehead with water, and also anoint the nostrils with the same, and pour it into the ears. Gentle rubbing of the feet with oil, patting of the head, and particularly stroking of

the temples and ears is an effectual means; for by the stroking of their ears and temples wild beasts are overcome, so as to cease from their anger and fury.4 But whatever is familiar to any one is to him a provocative of sleep. Thus, to the sailor, repose in a boat, and being carried about on the sea, the sound of the beach, the murmur of the waves, the boom of the winds, and the scent of the sea and of the ship. But to the musician the accustomed notes of his flute in stillness; or playing on the harp or lyre, or the exercise of musical children with song. To a teacher, intercourse with the tattle of children. Different persons are soothed to sleep by different means.

To the hypochondria and region of the stomach, if distended by inflammation, hardness, and flatulence, embrocations and cataplasms are to be applied, with the addition of the oil of the over-ripe olive, for it is thick, viscid, and calefacient; it therefore is required in inflammation: let dill or flea-bane be boiled in it, and it is a good thing to mix all together; but if flatulence be present also, the fruits of cumin and parsley, and whatever other things are diuretic and carminative, along with sifted natron, are to be sprinkled on the application. But if the liver experience suffering and pain, apply unwashed wool just taken from the ewe, oil from the unripe olive, or rose-oil; but we must mix also Hellenic or Cretan rob, and boil in it melilot, and mixing all these things into one juice, foment the liver therewith. To the spleen the oil must be

mixed with vinegar; or if it should appear to be enlarged in bulk, oxycrate, and instead of the wool a soft sponge; for the spleen delights in and is relieved by such things. But if the hypochondria be collapsed and retracted upwards, and the skin be stretched, it will be best instead of the oil, or along with it, to use thick butter in equal quantity, and let fleabane and rosemary be boiled in the decoction, and dill is not unsuitable.

But if it be the proper time for cataplasms, we may use the same oils to the same places, the ingredients of the cataplasms being linseed, fenugreek, or fine barley-meal; beans and vetches, also, are proper if the abdomen be swelled. Roasted millet, also, in bags, makes a light and soft fomentation; when ground it makes, along with honey, oil, and linseed, an excellent cataplasm for the hypochondria. Also let the same flowers, herbs, and seeds which I have described among the embrocations be used for the cataplasms. Honey, also, is useful along with these things, to give consistency to the dry things, and for the mixing of the toasted things, and for the preservation of the heat; it is a good thing, likewise, by itself; also a cataplasm half-boiled, and an embrocation dissolved in some of the liquids, is effectual as an emollient, calefacient, carminative, and diuretic, and to moderate the inflammations. These effects are produced also by mulse when drunk, and even more and greater effects when conveyed internally to the trachea, the lungs, the thorax, and the stomach.

The bowels, also, are to be frequently stimulated by suppositories or liniments (for they are generally constipated), in order to act as derivatives from the head, and also for the evaporation of the vapours in the chest, and for the evacuation of the matters in the belly; but, if the belly be confined for several days, it must be opened by a clyster of mulse, oil, and natron.

But if the distension of the inflammation do not properly

subside, we must apply a cupping-instrument with scarificators where the inflammation points and is greatest, on the first or second day, according as the inflamed parts may indicate, and the strength direct; and from those the amount of the evacuation of the blood must be determined, for excess occasions syncope. During the first and second day the fomentation should be the same; but, on the third, cerate with some of the oils used in the embrocations is to be applied: then, if they be still in a state of inflammation, epithemes, consisting of hyssop, fenugreek boiled in mulse, the resin of the turpentine plant, and wax; the oils the same for these places. If by these means the delirium do not at all abate, it will be necessary to have recourse to cropping of the head, provided the hairs be very long, to the extent of one half; but, if shorter, down to the skin: then, in the meantime having recruited the strength, to apply a cupping-instrument to the vertex, and abstract blood. But dry-cupping is first to be applied to the back.

But since in all the acute diseases the chest must be remedied, this part generally suffering with the heart and lungs, more especially from the difficulty of the respiration, which is sometimes hot, at other times cold; and, moreover, from ardent fever, cough, badness of the humours, and sympathy of the nerves, and complaint of the stomach, and illness of the pleura and of the diaphragm (for the heart, if it suffer from any dreadful illness, never recovers),--in cases of phrenitis these parts in particular must be soothed. For, indeed, the delirium in certain cases arises from some of the parts in the chest; respiration hot and dry; thirst acrid; febrile heat not easily endured, as being determined from all parts to the chest; and illness from the perversion of its native heat, but greater and more intolerable the communication of the same from the other parts to the chest: for the extremities are cold--the head, the feet, and the hands; but, above these last, the chest. It is to be remedied,

then, by humectation and refrigeration. For bathing, oil boiled with camomile or nard; in summer, also, Hellenic rob. But if it be necessary also to apply epithemes, dates moistened with austere wine, then levigated and pounded into a mass with nard, barley meal, and flower of the wild vine, form a soothing cataplasm for the chest: a cooling one is formed of apples bruised with mastich and melilot; all these things, however, are to be mixed up with wax and nard. But if the stomach be affected with torpor and loathing of food, the juice or hair of worm-wood are mixed up with them; and the hypochondriac region is to be fomented with this boiled up in oil. The infusion or the juice of it may be drunk before food to the amount of two cupfuls of the infusion, or one cupful of the bitter juice with two cupfuls of water. But if the stomach be affected with heartburn, not from the constitution of the disease, but of itself from acrid and saltish humours, or from being pinched with bile, or from being parched with thirst, we must give in the food milk mixed with water to the amount of half a hemina of milk in one cupful of water; the patient should swallow the most of it, but he may take a small portion of it with bread.

But if the patient be also affected with Causus, and there be thirst, restlessness, mania, and a desire of cold water, we must give less of it than in a case of Causus without phrenitis, for we must take care lest we injure the nerves; we are to give them as much as will prove a remedy for the stomach, and a little is sufficient, for phrenitics are spare drinkers.

But if converted into syncope, and this also happens (the powers of life being loosened, the patient being melted in sweat, and all the humours being determined outwardly, the strength and spirit (pneuma) being also dissolved), we must disregard the delirium, and be upon our guard lest the patient be resolved into vapours and humidity. Then the only support is wine, to nourish quickly by its substance, and to penetrate

everywhere, even to the extremities; to add tone to tone, to rouse the torpid spirit (pneuma), warm that which is cold, brace what is relaxed, restrain those portions which are flowing and running outwards, wine being sweet to the senses of smell so as to impart pleasure; powerful to confirm the strength for life; and most excellent to soothe the mind in delirium. Wine, when drunk, accomplishes all these good purposes; for they become composed by the soothing of their minds, are spontaneously nourished to strength, and are inspired with pleasure.

But when the fever has become protracted and feeble, and the delirium is converted into fatuity, but the hypochondrium is not much injured by swelling, flatulence, or hardness, and the head is the part principally affected, we must boldly wash the head, and practise copious affusions on it; for thus will the habit of body be moistened, the respiration of the head and exhalation over the whole body will be restored; and thus will that which is dry become diluted, and the sense purified of its mist, while the understanding remains sound and firm. These, indeed, are the indications of the removal of the disease.

1 The Greek word ἄχναι would appear to have been applied like frieze in English, both to the nap on woollen cloth, and in architecture, to ornaments of sculpture on a flat face. Our author evidently uses it in the latter sense; but I suspect the translators fail to recognise it. For the former meaning, see Erotian, and Föes Œc. Hippocr. Modern lexicographers do not seem acquainted with this use of the term. See Liddel and Scott's; and Dunbar's Lexicons.

2 As this term is of frequent occurrence in the works of our author, as in those of Hippocrates, it may be proper to mention, once for all, that the χόνδρος of the Greeks and the alica of the Romans was the species of grain called Spelt (Triticum Spelta) broken down into rough granules; that is to say, it was coarsely ground Spelt.

3 All the Greek and Arabian authorities on dietetics hold, that fishes caught among rocks are particularly excellent. See Paulus Ægineta, t. i. p. 159.

4 This passage savours much of magnetical manipulation. The following verses of Solon have been quoted as referring to the same subject :--


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