OF ARETÆUS, THE CAPPADOCIAN, ON THE THERAPEUTICS OF ACUTE DISEASE
BOOK I.
PREFACE.
THE remedies of acute diseases are connected with the form
of the symptoms, certain of which have been described by me
in the preceding works. Whatever, therefore, relates to the
cure of fevers, according to their differences, the form of the
diseases, and the varieties in them, the greater part of these will
be treated of in my discourses on fevers. But acute affections
which are accompanied with fevers, such as Phrenitis, or those
without fevers, as Apoplexy, of these alone will I now write;
and that I may not commit blunders, or become diffuse by
treating of the same matters in different places, the beginning and end correspond to the same in the work on the affections.
CHAPTER I. THE CURE OF PHRENITICS.
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 frieze
1 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. Alica
2 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.
CHAPTER II. THE CURE OF LETHARGICS.
LETHARGICS are to be laid in the light, and exposed to the
rays of the sun (for the disease is gloom); and in a rather
warm place, for the cause is a congelation of the innate heat.
A soft couch, paintings on the wall, bed-clothes of various
colours, and all things which will provoke the sense of sight;
conversation, friction along with squeezing of the feet, pulling,
tickling. If deep sleep prevail, shouting aloud, angry reproach,
threats regarding those matters which he is accustomed
to dread, announcement of those things which he
desires and expects. Everything to prevent sleep--the reverse
of that which is proper for phrenitics.
With regard to the depletion of lethargics this should be
known:--If the obliviousness be the sequela of another disease,
such as phrenitis, we must not open a vein, nor make a great
evacuation of blood in any way, but inject the belly, not
solely for the evacuation of its contents, but in order to produce
revulsion from above, and to determine from the head:
there should be a good deal of salts and natron in it, and it
answers very well if you add a sprinkling of castor to the
clyster; for in lethargics the lower intestine is cold, and dead,
as it were, to evacuation. But, if the lethargy is not the consequence
of another disease, but is the original affection, and
if the patient appear to be plethoric, provided it be with blood,
we must open a vein at the elbow; but, if with a watery
phlegm, or other humours, we must purge by means of cneoros
5
with the ptisan, or by black hellebore with honeyed-water, in
the beginning, if you wish to do so moderately; but if to a
greater extent, you must give to the patient when fasting of the
medicine called Hiera, to the extent of two drams with three
cupfuls of honeyed-water; and, having waited until it purges,
then give food, if it be the proper season; but otherwise
nourishment is to be given the next day. It will be seasonable
then to give in the evening a dram of the hiera, dissolved
either in two cupfuls of water or of honeyed-water.
Total abstinence from food is bad, as is also much food. It
is proper, then, to administer a little food every day, but not
to withdraw food altogether; for the stomach to be reminded
of its duties and fomented, as it were, during the whole day.
Also the food must be attenuant and laxative, rather in the
form of soups than roasted, such as hens or shell-fish; and the
herb mercury is to be boiled with it, and some vinegar added.
And we may add to the juices, if it be proper to use the juice
of ptisan, something to promote exhalation and the discharge
of urine, such as fennel, parsley--the pot-herbs themselves, or
their fruits. Horehound, also, by its acrid qualities, does good;
and likewise colewort with oil, and the brine of fish (
garum).
The sweet cumin is a most excellent medicine for the flatulence
and urine; for the stomach and bladder are to be stimulated
during the whole time of the disease.
The moist applications to the head the same as in the case
of phrenitics; for in both the senses are filled with vapours,
which must either be expelled by refrigerants and astringents,
such as the oil of roses or the juice of ivy, or dissipated into
exhalation by attenuants, such as wild thyme in vinegar, with
the rose-oil. But if there be pain of the nerves, and coldness of
the whole body, but more especially of the extremities, we
must besmear and bathe the head and neck with castor and
oil of dill, and anoint the spine with the same along with
Sicyonian oil, the oil of must, or old oil; at the same time, we
must rub both the arms from the shoulders and both the legs
from the groins. With these, moreover, the bladder is to be
soothed, which suffers, as being of a nervous nature, and is
stressed as being the passage for the urine; and also is irritated
by the acrimony of the humours, for the urine is bilious. But
if the trembling increase, and there be danger of a convulsion,
we must necessarily use Sicyonian oil to the head, but use it
in small quantity. But if there be inflammation of the hypochondria,
and fulness thereof, flatulence, and tension of the
skin, or if there be a hollow there from retraction inwards of
the hypochondria, we must apply the embrocations and cataplasms,
described by us under Phrenitics.
The cupping-instrument is by no means to be used if the
disease be the consequence of phrenitis, but this may be done
more boldly if it be the original disease. If the tongue be
black, and a swelling point in the hypochondria, the cupping-instrument
must necessarily be used. When in the course of
time the senses have been evacuated, and the patient is otherwise
more tolerant of the disease, we may apply the cupping-instrument
to the top of the head, since we can evacuate from
it without injury to the strength.
Flatulence is to be expelled both upwards and downwards;
for lethargy produces collections of flatus both in the cavities
and in the whole frame, from inactivity, torpor, and want of
spirit, which motion and watchfulness dissipate; wherefore,
having rubbed up green rue with honey and natron, we anoint
therewith; it will expel the wind more effectually if one part
of the resin of turpentine be added to these things. A fomentation
also will expel flatus, either with hot unwashed wool,
or with rough old rags, or a sponge with water in which hyssop,
marjoram, penny-royal, or rue, have been boiled. The
potions
6
also which are taken before food expel flatus, and these also
bring away phlegm and bile in the stomach and bowels; such
are hyssop, boiled mulse, Cretan dictamny, or marjoram:
maiden-hair and agrostis
7
are
acrid, but possessed of expulsive
qualities, for indeed they evacuate flatus and urine.
If there be trembling of the hands and head, he may take
a draught, consisting of castor with three cupfuls of honeyed-water,
for some days; or if he will not drink this, we may
melt down the castor in a sufficient quantity of oil, wherein
rue has been boiled, to the amount of three cupfuls; and a
double amount of this is to be injected into the lower bowel,
and is to be repeated for several days; and after the benefit
derived from it (for it brings off flatus upwards and downwards,
and, in certain cases, urine and fæces), if it should
be diffused over the whole system in any way, the nerves
recover from their tremblings and become strong, and it
changes the habit of body to the hot and dry, and alters the
constitutions of diseases. It is also a very excellent thing to
blow it into the nostrils, for in this way it expels flatulence by
sneezing; for as the bladder secretes urine, so does the nose
mucus. It effects these things by its gentle heat, in which respect
it is superior to the other sternutatories, pepper, hellebore,
soap-wort, and euphorbium; for these things, both at their first
and last impression are harsh, and disorder the head and the sense,
whereas castor gradually creates a gentle heat. To the head
it is also otherwise suitable, because the nerves everywhere
derive their origin from it; and castor is a remedy for the
diseases of the nerves; but to mix it with some one or more
of the medicines described will not be disagreeable, for if it
be mixed, it will not immediately disorder the head, even in
a moderate degree, but after a time it will stir up the heat.
The nose is to be moistened by tickling; by odours acrid
indeed to the sense, but possessed of heating powers, such as
the castor itself, or savory, or penny-royal, or thyme, either
in a green state, or in a dried, moistened well with vinegar.
Anointing with acrid medicines is proper to the feet and
knees. The
materiel thereof should be heating and pungent
by degrees; for there is need of both in cases of lethargy to
induce warmth and watchfulness. In the first place, it is
proper to whip the limbs with the nettles, for the down
thereof sticking to the skin does not endure long, but imparts
no disagreeable tingling and pain; it also moderately stimulates,
induces swelling, and provokes heat. But if you desire
to have these effects produced more powerfully, rub in equal
parts of lemnestis
8 and euphorbium, with oil of must. It is
also a very good thing to rub with raw squill pulverised; but
it is necessary to rub off the oily matter of the limb (for
everything acrid loses its stimulant properties with oil) --
unless it be medicinal -- either the oil of privet, or that
of must, or the Sicyonian. But if after these things a deep
coma prevail, it will be proper, having pounded the wild
cucumber with vinegar, and mixed it with an equal quantity
of a cake of mustard, to apply this as an acrid cataplasm,
and one which will speedily occasion redness, and will also
quickly produce swelling. But if there be danger of blistering
and of wounds, it will be proper to raise the cataplasm
frequently, and see that none of these effects be produced.
These things, therefore, are to be done to relieve the torpor
and insensibility of the parts at all seasons, except at the
commencement of the paroxysms.
But if the patient have already recovered his sensibility,
but there is still some heaviness of the head, noise, or ringing
thereof, it will be proper to evacuate phlegm by the mouth,
first by giving mastich to chew, so that he may constantly
spit, then again stavesacre, the granum cnidium,
9 but more
especially mustard, because it is a common article, and also
because it is more of a phlegmagogue than the others. And
if the patient drink it willingly, it will be sufficient to dissolve
the matters in the stomach, it will also be able to moisten the
stomach and expel flatulence; for this once fortunately happened
to myself in the case of a man who drank it by my
directions; for experience is a good teacher, one ought, then,
to try experiments, for too much caution is ignorance.
The head, then, after the hair has been clipped to the skin,
if much good is not thereby accomplished, is to be shaven to
procure insensible perspiration, and also to allow the anointing
with acrid medicines, such as that from lemnestis (or
adarce),
or thapsia,
10 or mustard moistened with water; these things,
with double the quantity of bread, are to be rubbed on an old
piece of skin, and applied to the head, taking good care at the
expiry of an hour to foment the parts with hot sponges.
It will also not be devoid of utility, when all, or most at
least, of the fatal symptoms of the disease are gone, but the
languor remains, to bathe; and then also gestation, friction,
and all gentle motion will be beneficial.
CHAPTER III. THE CURE OF MARASMUS. 11
IN these cases, indeed, if Marasmus prevail, we must remedy
it by quickly having recourse to the bath and to exercises.
And truly milk is a remedy of marasmus by nourishing,
warming, moistening the stomach, and soothing the bladder.
Moreover, the same means are beneficial in cases of
catochus,
for the form of these diseases is alike and the same. Castor,
then, is more particularly proper in these cases, and most
particularly soothing, whether to drink, to anoint with, or to
inject into the bowel. The affections similar to these which
happen to women from the uterus, will be treated of among
female diseases.
CHAPTER IV. THE CURE OF APOPLEXY.
. . . . . 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.
CHAPTER V. CURE OF THE PAROXYSM OF EPILEPTICS.
EVEN the first fall in epilepsy is dangerous, if the disease
attack in an acute form; for it has sometimes proved fatal in
one day. The periodical paroxysms are also dangerous; and,
therefore, on these accounts, epilepsy has been described among
the acute diseases. But if the patient has become habituated
to the illness, and the disease has taken a firm hold of him, it
has become not only chronic, but, in certain cases, perpetual;
for if it pass the prime of life, it clings to him in old age and
in death.
Such remedies, then, as are applicable in the chronic state
will be described among the chronic diseases; but such things
as must be done for a sudden attack of the disease, of these
the greater number have been described under apoplectics,
namely, venesection, clysters, anointings, the cupping instrument;
these means being the most powerful for the purpose of
arousing. But I will now describe the peculiar remedies for
an attack of the falling sickness. In children, then, to whom,
owing to dyspepsia, or from excessive cold, the disease is
familiar, vomiting, either of food, or of phlegm, or of any
other humour, is beneficial. Feathers, then, dipped in the
ointment of iris, excite vomiting; and the unguentum irinum
is not inapplicable for smearing the tonsils with. But having
first laid the child on his belly (this is the easiest position for
vomiting), we must press gently on his lower belly. But if
the lower jaw be convulsed or distorted, or if the hands and
legs be tossed about, and if the whole face be fixed, the limbs
are to be soothed by gentle rubbing with oil, and the distortions
of the countenance rectified; the straight parts are to
be gently bound, so that they may not become distorted. The
cold parts are to be fomented with unscoured wool, or with
old rags. The anus is to be rubbed with honey along with
the oil of rue, or with natron and liquid resin along with these
things; and they are to be gently pushed within the anus, for
they expel flatus, and children pass flatus in this disease. But
if they can swallow, we may give them of this medicine: Of
cardamom, one part; of copper, one siliqua. These things
are to be drunk with honeyed-water; for either it is vomited
up along with the matter annoying the stomach, or the bowels
are opened. This is a very excellent linctus: Of cardamom, of
mustard, and of the hair of hyssop equal parts; of the root of
iris, one part, with a double quantity of natron; of pepper, to
the amount of one-third. Having mixed up all these things
together, and having separated the jaw, pour into the mouth,
and even beyond the tonsils, so that the things may be swallowed.
These things are proper for infants, and for young
persons the same are applicable. But the more powerful
emetics are to be taken: the bulbous root of narcissus; of
mustard and of hyssop, equal parts; of copper and pepper,
one-half the proportion of the former things. They are to be
mixed with honey and given. These things are proper, in
order to rouse from the paroxysm; but those calculated to
produce the resolution of the disease will be described under
the chronic diseases.
CHAPTER VI. THE CURE OF TETANUS.
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,
12 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,
13 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.
CHAPTER VII. THE CURE OF QUINSEY.
THERE are two forms of quinsey. The one is attended with
heat, and great inflammation of the tonsils, and swelling outwardly;
moreover, the tongue, uvula, and all the parts there,
are raised up into a swelling. The other is a collapse of these
parts, and compression inwardly, with greater sense of suffocation,
so that the inflammation appears to be determined to the
heart. In it, then, particularly, we must make haste to apply
our remedies, for it quickly proves fatal.
If, then, it proceed from taking too much food and wine,
we must inject the bowels on the day of the attack, and that
with two clysters: the one a common clyster, so as to bring off
the feculent matters; and the other for the purpose of producing
revulsion of the humours from the tonsils and chest.
It will therefore be, but not undiluted . . . . . . . and the
decoctions of centaury and hyssop; for these medicines also
bring off phlegm. And if the patient has been on a restricted
diet, we open the vein at the elbow, and make a larger incision
than usual, that the blood may flow with impetuosity and in
large quantity; for such a flow is sufficient to mitigate the
heat most speedily, is able to relieve the strangulation, and
reduce all the bad symptoms. It is no bad practice, likewise,
to bring the patient almost to fainting, and yet not so as that
he should faint altogether, for some from the shock have died
of the fainting . . . . . . . . or binding them with ligatures
above the ankles and knees. It is a very good thing, likewise,
to apply ligatures to the forearms above the wrists, and
above the forearms to the arms. And if deglutition be easy, we
are to give elaterium with honeyed-water, and the whey of
milk, as much as will be sufficient to purge the patient. In
these cases, elaterium is preferable to all other cathartics; but
cneoros and mustard are also suitable, for both these purge the
bowels. If the inflammations do not yield to these means,
having bent the tongue back to the roof of the mouth, we
open the veins in it; and if the blood flow freely and copiously,
it proves more effectual than all other means. Liquid
applications to the inflamed parts, at first of an astringent
nature, so as to dispel the morbid matters: unwashed wool,
then, with hyssop, moistened in wine, and the ointment from
the unripe olive. But the cataplasms are similar to the liquid
applications,--dates
soaked in wine, and levigated with rose-leaves.
But in order that the cataplasm may be rendered glutinous
and soft, let flour or linseed, and honey and oil be added, to
produce the admixture of all the ingredients. But if it turn
to a suppuration, we are to use hot things, such as those used
in the other form of synanche. Let fenugreek be the powder,
and manna and resin the substances which are melted; and let
the hair of poley be sprinkled on it, and a hot fomentation
be made with sponges of the decoction of the fruit of the bay
and of hyssop. And the powdered dung of pigeons or of dogs,
sifted in a sieve, is most efficacious in producing suppuration,
when sprinkled on the cataplasm. As gargles, honeyed-water,
with the decoction of dried lentil, or of hyssop, or of
roses, or of dates, or of all together. We are also to smear the
whole mouth, as far as the internal fauces, either with Simples,
such as the juice of mulberries, or the water of pounded pomegranates,
or the decoction of dates; or with Compound preparations,
such as that from mulberries, or that from
besasa,
14 or
that from the juice of pomegranates, and that from swallows.
But if the ulcers proceed from eschars, these gargles, and
washes for the mouth, the decoction of hyssop in honeyed-water,
or of fat figs in water, and along with them starch dissolved
in honeyed-water, or the juice of ptisan, or of tragus
(
spelt?).
But in the species of synanche attended with collapse, we are
to make a general determination from within outwardly, of the
fluids, of the warmth, and of all the flesh, so that the whole may
swell out. Let the liquid applications then be of a hot nature,
with rue and dill, natron being sprinkled upon them; and along
with them the cataplasms formerly mentioned. It is a good thing
also to apply a cerate with natron and mustard for inducing heat;
for heat determined outwardly is the cure of such complaints; and
thus swelling takes place in the neck, and an external swelling
rescues from peripneumonia; but in cases of synanche, the evil
when inwardly is of a fatal nature. But those who, in order to
guard against suffocation in quinsey, make an incision in the
trachea for the breathing, do not appear to me to have proved
the practicability of the thing by actual experiment; for the
heat of the inflammation is increased by the wound, and thus
contributes to the suffocation and cough. And, moreover, if
by any means they should escape the danger, the lips of the
wound do not coalesce; for they are both cartilaginous, and
not of a nature to unite.
15 * * * * *
* * * * * * * *
* * * * * * * *
* * * * *
CHAPTER VIII. CURE OF THE AFFECTIONS ABOUT THE COLUMELLA (OR
UVULA).
OF the affections which form about the
columella, some
require
to be treated by excision; but the surgical treatment of such
cases does not come within the design of this work. Some
are to be treated as acute affections; for some of them readily
prove fatal by suffocation and dyspnœa. These are the diseases
which we call
uva and
columella; for both are attended
with inflammation and increase in thickness and length, so
that the parts hang down, and come into the
arteria aspera.
The
columna is of equal thickness from the base to the extremity
in the palate: the
uva is of unequal thickness; for its base
at the palate is slender, whereas at its extremity it is rounded
and thick, with redness and lividity, whence it gets the appellation
of
uva. These, then, must be speedily relieved; for the
death from suffocation is very speedy.
If, then, the patients be young, we must open the vein at the
elbow, and evacuate copiously by a larger incision than usual;
for such an abstraction frees one from suffocation, as it were,
from strangulation. It is necessary, also, to inject with a mild
clyster, but afterwards with an acrid one, again and again,
until one has drawn from the parts above by revulsion; and
let ligatures be applied to the extremities above the ankles
and knees, and above the wrists and forearms to the arms.
But if the suffocation be urgent, we must apply a cupping-instrument
to the occiput and to the thorax, with some scarifications,
and also do everything described by me under
synanche; for the mode of death is the same in both. We
must also use the same medicines to the mouth, both astringents
and emollients, with fomentation of the external parts,
cataplasms, and liniments to the mouth. For the forms named
columella and
uva, as an astringent medicine take the juice of
pomegranate, acacia dissolved in honey or water, hypocistis,
Samian, Lemnian, or Sinopic earth, and the inspissated juice
of sour grapes. But if the diseased part be ulcerated, gum
and starch moistened in the decoction of roses or of dates, and
the juice of ptisan or of spelt (
tragus). But in
columella let
there be more of the stronger medicines, from myrrh,
costus,
16
and cyperus;
17 for the
columella endures
these acrid substances.
But should the part suppurate, in certain cases even the bones
of the palate have become diseased, and the patients have
died, wasted by a protracted consumption. The remedies of
these will be described elsewhere.
CHAPTER IX. CURE OF THE PESTILENTIAL AFFECTIONS ABOUT THE
PHARYNX.
IN some respects, the treatment of these is the same as that of
the
other affections in the tonsils, and in some peculiar. In inflammation
and suffocation, the remedies are clysters, venesection,
liquid applications, cataplasms, fomentation, ligatures, cupping;
and all these are applicable here. But anointing with more potent
medicines is proper; for the ulcers do not stop, nor do eschars
form on the surface. But if a sanies from them run inwardly,
the parts, even if before in a healthy state, very soon become
ulcerated, and very soon the ulcers spread inwardly, and prove
fatal. It might be beneficial to burn the affection with fire,
but it is unsuitable owing to the isthmus. But we must use
medicines resembling fire to stop the spreading and also for
the falling off of the eschars: these are alum, gall, the flowers
of the wild pomegranate, either in a dried state or with
honeyed-water. And the same medicines may be blown in
by means of a reed, or quill, or a thick and long tube, so that
the medicines may touch the sores. The best of these medicines
is calcined chalcitis,
18 with cadmia
19 triturated in vinegar.
Let there be a double proportion of the cadmia, and of the
root of rhubarb, with some fluid. It is necessary, however, to
guard against their pressure, for the ulcers thus get moist and
spread farther. We must, therefore, sprinkle them in a dry
state with a quill. But the liquid medicines, having been
much diluted, are to be injected upon the columella. But if
the eschars be already loosened, and the ulcers become red,
there is then most danger of convulsion; for generally the
ulcers are dried up, and thereby tonic contractions of the
nerves are induced. It is necessary then to soften and moisten
by means of milk, with starch, and the juice of ptisan, or of
tragus, or linseed, or the seed of fenugreek. In certain cases
also the uvula has been eaten down to the bone of the
palate and the tonsils to their base and epiglottis; and in
consequence of the sore, the patient could neither swallow
anything solid nor liquid; but the drink regurgitating has cut him off by starvation.
CHAPTER X. CURE OF PLEURISY.
IN cases of Pleurisy there is no time for procrastination, nor
for putting off the great remedy. For the fever, being very
acute, hastens to a fatal termination; the pain also of the
succingens hurries on to the worse; and moreover coughs which
agitate the chest and head exhaust the powers. Wherefore
then, on the selfsame day we must by all means open a vein.
But if it be in connection with repletion of food and drink,
having kept the patient fasting for one day, we are to abstract
blood from the vein in the hollow of the elbow, in a line
with the opposite side, (for it is better to take it from a very
great distance); but not to the extent of deliquium animi,
for there is danger of Peripneumonia supervening if the body,
being congealed, should leave the soul; for the fluids rush inward
when deprived of their external heat and tension. For the
Lungs are of loose texture, hot, and possessed of strong powers
of attraction; the lungs also are the neighbours of the ribs,
and their associates in suffering; and this succession of disease
is not readily recovered from; whereas in Pleuritis from
Peripneumonia, recovery readily takes place, this combination
being milder. It is necessary, therefore, after a moderate
flow of blood, to recruit the patient for a time, and afterwards
abstract again; if matters go on well, the same day, provided
the remission be long; but if not, on the day following. But if
there is no remission of the fever (for generally the fever
prevails and increases for one day), we are to abstract blood
the third day during the second remission, when also food is
to be given--after having anointed the patient freely, having
also applied to the side soft oil with the heating ointment of
rue, or the decoction of dill. A very soothing fomentation
is also to be applied to the side. In certain cases, the pain
and inflammation are determined outwardly, so as to make it
appear an affection of the parts there; but it is merely an exacerbation
of the internal symptoms.
Let us now treat of regimen, in order that, respecting all
the system of treatment, there may be no mistake. "For in
food will consist the medicines, but also the medicines in
food." In kind, then, it is to be hot and humid, smooth and
consistent, detergent, solvent, having the power of dissolving
and attenuating phlegm. Of all kinds of food, therefore,
ptisan is to be preferred; at the commencement, then, strained
to its juice, so that the solid part of it may be separated; and
made with honey only; and let the usual articles added to it
for seasoning and variety be absent (for now the juice alone
is sufficient). It will be calculated to moisten and warm, and
able to dissolve and clear away phlegm, to evacuate upwards
without pain such matters as should be brought up, and also
readily evacuate the bowels downwards. For its lubricity
is agreeable and adapted to deglutition. Moreover, its glutinous
quality soothes heat, purges the membranes, concocts
coughs, and softens all the parts. These are the virtues of
barley. The next place to it is held by chondrus,
20 being
possessed of some of the good qualities of ptisan. For in
regard to its glutinous quality, its lubricity, and its appropriateness
for deglutition, it is equal to the other, but in other
respects inferior. They are to be made plain, with honey
alone. The tragus also is excellent.
21 But rice is worse than
these, inasmuch as it has the property of drying, roughening,
and of stopping the purgation of the sides, rather than of
making it more fluid. A very excellent thing is dry bread,
broken into pieces, passed through a sieve, gently warmed,
well concocted, which with honeyed-water is sufficient nourishment.
But if the disease have already progressed, and the
patient have given up his food, the ptisan of barley is to be
administered in a soft state, and well boiled. Dill and salts
are to be the condiments of the ptisan, and oil which is thin,
without quality, without viscidity, without asperity; it is
better, however, not to boil much of the oil with the ptisan;
for thus the draught becomes fatty, and the oil loses its
badness, and with much boiling is no longer perceptible, being
drunk up by the juice. And let leek with its capillary leaves,
and bitter almonds, be boiled with the juice of ptisan; for the
draught thus promotes perspiration, and becomes medicinal,
and the leeks eaten out of the juice are beneficial and very
delicious. Now also is the season for using wholesome eggs;
but if the expectoration be fluid and copious, sprinkle on them
some native sulphur and natron. But the best thing of all
is to give new-laid eggs which have never been subjected to
the fire; for the heat of the hen is more humid than fire, and
more congenial to the patient, as proceeding from one animal
to another. But if the phlegm be glutinous and viscid,
pour oil into the eggs, and sprinkle some of the dried resin
of pine--so that the sulphur may be more powerful; melting
also with them some of the resin of turpentine; pepper also
and all cognate substances are beneficial in eggs, and in all
kinds of food; the extremities of animals melted down in
soups, pigeons, boiled hens; the brains of swine roasted with
the cawl, but without it they are not savoury. If the patient
has no
râle, we must give him fish from the depth of the sea,
or rock fish, the best which the country produces. And that
the patient may not transgress in regimen, owing to his
appetite, nor become wasted by a spare diet, he is to be gratified
with some fruit; such as apples boiled in water, or
honeyed-water, or stewed in suet (but we must take off the
skin and rough parts within along with the seeds,); and in
season we may give some figs. We must give likewise of any
other kind of autumn fruit which is not only not hurtful but
also beneficial. So much with regard to diet.
Wool fumigated with sulphur and moistened with oil
in which dill and rue have been boiled, is to be laid on the
side. Foment the side constantly with these, and, before the
administration of food, apply cataplasms, in addition to the
usual ingredients containing melilot boiled with honeyed-water,
and mixing therewith some of the fleshy part of the
poppy in a boiled state, and sprinkling on it the meal of the
manna thuris.
22 But if the expectoration be more fluid and
copious, we are to mix the flour of darnel, or of hedge
mustard, and sprinkle natron on it. But if the disease be
prolonged, the pain having become fixed, and the purging
liquid, it is to be apprehended that pus is about to form;
wherefore mix with the cataplasms mustard and
cachrys;23
and if the patients have a feeling as if the internal parts were
cold, some vinegar may be poured into it. The heat of the
cataplasms should be of a strong kind, that it may last the
longer; for this is better than having the heat kept up by
renewal of the cataplasms. Let the fomentations consist of
salts and millet in bags, or of warm oil in bladders. Every
apparatus used for fomentation should be light, so that the
weight may not add to the pain. These things moreover are
to be used also after the food, if the pain be urgent.
And, in addition to these means, now also should be the
time of cupping; but it is best after the seventh day: before
this you should not be urgent with it, for the diseases are not
of a favourable character which require cupping before the
seventh day. Let the instrument be large, broad every way,
and sufficient to comprehend the place which is pained; for
the pain does not penetrate inwardly, but spreads in width.
There should be plenty of heat below the cupping-instrument,
so as not only to attract, but also to warm before the extinction
of the fire. And after the extinction, having scarified, we are
to abstract as much blood as the strength will permit; much
more than if you had to take away blood from the hypochondria
for any other cause. For the benefit from cupping is
most marked in cases of Pleurisy. But salts or natron are to
be sprinkled on the scarifications, a pungent and painful practice
indeed, but yet a healthful one. But we must estimate the
powers and habits of the patient. For if strong in mind and
robust in body, we must sprinkle some of the salts, not indeed so
as to come into immediate contact with the wounds themselves,
but they are to be sprinkled on a piece of linen-cloth damped
with oil, and it is to be spread over the place; for the brine
which runs from the melting of the salts is less stimulant than
the salts themselves. We must also pour in much of the oil, that
by its soothing properties it may obtund the pain occasioned by
the acrimony of the other. On the second day it will be a very
good rule to apply the cupping-instrument again, so as that a
thin sanies may be abstracted from the wounds. This, indeed,
is much more effectual than the previous cupping, and much
less calculated to impair the strength; for it is not blood, the
nutriment of the body, but sanies that runs off. This then
you are to do after having made a previous estimate of the
strength. On the third day we are to apply cerate with the
ointments of privet and of rue. But if the sputa still require
purging, we are to melt into the cerates some resin, or mix
some native sulphur therewith, and again the part is to have
a fomentation. With regard to the form of the cupping-instrument,
it should either be an earthen vessel, light, and adapted
to the side, and capacious; or, of bronze, flat at the lips, so as
to comprehend the parts affected with pain; and we are to
place below it much fire along with oil, so that it may keep
alive for a considerable time. But we must not apply the lips
close to the skin, but allow access to the air, so that the heat
may not be extinguished. And we must allow it to burn a
long while, for the heat within it, indeed, is a very good fomentation,
and a good provocative of perspirations.
And we must not overlook purging downwards, in men
injecting oil of rue into the gut, and, in women, also into the
womb. And let something be constantly drunk and swallowed;
for this purpose, honeyed-water, with rue and juice of ptisan,
if there is a constant cough, as being a medicine in the food.
But if it is not the season of administering food, let it be one
of the compound preparations, such as butter boiled with
honey to a proper consistence. Of this, round balls the size
of a bean are to be given to hold under the tongue, moving
them about hither and thither, so that they may not be
swallowed entire, but melted there. The medicine also from
poppies with honey and melilot is agreeable, being possessed
of soothing and hypnotic properties. This is to be given
before the administration of food, after it, and after sleep. To
the patient when fasting, the following medicinal substances are
to be given: of nettle, of linseed, of starch, and of pine fruit in
powder, of each, a cupful (
cyathus), and of bitter almonds twenty-five
in number, and as many seeds of pepper. These things
being toasted and triturated with honey, are to be mixed up
into a linctus; of these the dose is one spoonful (
cochleare).
But if he expectorate thin and unconcocted matters, two
drams of myrrh, one of saffron, and fifteen grains of pepper to
be mixed with one pound of honey. This medicine should be
given also before the administration of food to the amount of
half a spoonful. It is good also in chronic cases, when
oxymel likewise is to be given if the dyspnœa be urgent.
Such physicians as have given cold water to pleuritics, I
cannot comprehend upon what principle they did so, nor can
I approve the practice from experience; for if certain patients
have escaped the danger from having taken cold water, these
would appear to me not to have been pleuritic cases at all.
But by the older physicians, a sort of congestion was called
pleuritis, being a secretion of bile with pain of the side,
attended with either slight fever or no fever at all. This
affection, indeed, got the name of pleurisy, but it is not so in
reality. But sometimes a spirit (or
wind, pneuma) collecting
in the side, creates thirst and a bad sort of pain, and gentle
heat; and this ignorant persons have called pleurisy. In
them, then, cold water might prove a remedy through the
good luck of the person using it; for the thirst may have
been extinguished, and the bile and wind expelled downwards,
while the pain and heat have been dissipated. But in inflammation
of the side and swelling of the
succingeus, not only
cold water but also cold respiration is bad.
If, then, owing to the treatment formerly described persons
affected with pleurisy survive the attack, but have still a
short cough, and now and then are seized with heat, we must
hasten to dissipate these symptoms; for the residue of the
disease either produces a relapse, or it is converted into a suppuration.
BOOK II.
CHAPTER I. THE CURE OF PERIPNEUMONIA.
INFLAMMATION and swelling of the lungs, and along with them
a sense of suffocation, which does not long endure, constitute a
very acute and fatal ailment. The remedies opposed to it, therefore,
ought to be of equal power and speedily applied. We are
to open instantly the veins at the elbow, and both together,
on the right and on the left side, rather than abstract blood
from one larger orifice, so that revulsion of the humours may
take place from either side of the lungs: but we must not
carry it to the extent of
deliquium animi for the
deliquium cooperates
with the suffocation. But when even a small respite
has been obtained, we must suppress the flow and abstraet
more afterwards; for, if the exciting causes be from blood,
the venesection carries them away; and if phlegm, or froth,
or any other of the humours be the agent, the evacuations of the
veins widen the compass of the lungs for the passage of the
breath.
We must expel the fluids and flatus downwards, by anointing
the anus after the venesection with natron, honey, rue,
and the liquid resin from turpentine. Instead of the venesection,--provided
there be a greater impediment,--we must
give a clyster of acrid juice, namely, of salts, in addition to
the natron, and turpentine resin with the honey; and rue
boiled in the oil, and hyssop boiled in the water; and the
fleshy parts of the wild cucumber, boiled with water, are
very excellent.
Dry-cupping applied to the back, the shoulder, and the
hypochondria, is altogether beneficial. And if the chest be
fleshy, so that the cupping-instrument may not by its pressure
bruise the skin about the bones, it is to be also applied there;
for if the humours be attracted from all parts of the body, and
the spirit (
pneuma) be determined outwardly, in those cases
in which the lungs are, as it were, choked, there will be respite
from the mischief; for peripneumonia is to be attacked in
every possible way.
But, likewise, neither are we to neglect any of the medicines
which prove useful when swallowed by the mouth, for
the lungs attract fluids whether they be in health or diseased.
We must, therefore, give such medicines as attenuate the
fluids so as to promote their perspiration, and such as will
lubricate and render them adapted for expectoration. For
speedy relief, then, natron is to be drunk with the decoction
of hyssop, or brine with vinegar and honey; or mustard
moistened with honeyed-water; and we may confidently
sprinkle on each some of the root of iris and pepper. But
also these things, having been sifted, are to be given in a
powder along with honey. But if the patients get no sleep
during the day, and remain sleepless also during all the night,
it is to be feared lest they become delirious, and there will be
need of various soporific medicines unless the disease give
way, so that the seasonable administration of these medicines
may lull the suffering, for these things are usually
soporific. But if you give a medicine at the acme of the
suffocation, or when death is at hand, you may be blamed for
the patient's death by the vulgar.
The food also must be suitable, acrid, light, solvent of thick
matters, detergent: of pot-herbs, the leek, or the cress, or the
nettle, or the cabbage boiled in vinegar; of austere things
(
frumentacea?) the juice of ptisan, taking also of marjoram,
or of hyssop, and of pepper, and more natron instead of the
salts. Also spelt in grains well boiled with honeyed-water: in
the course of the boiling, they should all be deprived of their
flatulence, for flatulent things are hurtful to persons in peripneumonia.
If they are free from fever, wine is to be given
for drink, but not such as is possessed of much astringency,
for astringency condenses bodies; but in these the parts are
rather to be relaxed. We must also promote the expulsion of
the sputa. On the whole the drink should be scanty, for
drenching is prejudicial to the lungs, because the lungs attract
from the stomach and belly.
Let the chest be covered up in wool, with oil, natron, and
salts. The best ointment is that prepared of the lemnestis,
and dried mustard with liquid cerate; and, on the whole, we
are to determine outwardly the fluids, the heat, and the spirit
(
pneuma). And smelling to acrid things is beneficial, also
anointings, and ligatures of the extremities. When these
things are done, if the disease do not yield, the patient is in a hopeless condition.
CHAPTER II. CURE OF THE BRINGING UP OF BLOOD.
ALL the forms of the bringing up of blood are of an unmild
character, not only as to mode, whether the flow proceed from
rupture, erosion, or even rarefaction; and whether it come
from the chest, the lungs, the stomach, or the liver, which are
the most dangerous cases; but also from the head, although it
occasions less mischief. For the flow is of blood; and blood
is the food of all parts, the heat of all parts, and the colour of
all parts. It is dreadful to see it flowing from the mouth in
any way; but bad indeed if it proceed from an important
viscus, and still worse if it proceed from rupture and erosion.
It is necessary, therefore, that the physician should make
the more haste in bringing assistance to this affection; and, in
the first place, the patient must get coldish air to breathe, a
chamber on the ground, and a couch firmly fixed, so that he
may not be shaken (for all shaking is stimulant); the bed
should be solid, not very yielding, nor deep, nor heated; his
position erect; rest from speaking and hearing; tranquillity of
mind, cheerfulness, since depression of spirits especially accompanies
these cases; for who is there that does not dread death
when vomiting blood?
If, therefore, the patient be full of blood, and have large
veins, in every form of rejection we must open a vein; whether
it proceed from rupture, or erosion, venesection is very
suitable; and even, if from rarefaction, there is danger, lest
the fulness of blood burst forth.
24 And we are to open the
hollow vein at the elbow (for the blood flows readily from it,
and it is easily opened, and the orifice can be safely kept open
for several days). In a word, then, in all the diseases of all
the vital organs, this is the outlet of the blood. For the one
higher up and this are both branches of the humeral, so that
the one above can have no more remedial power than the
mesal. They are ignorant of these divisions who have connected
the upper vein with the stomach and liver. But if the
flow proceed from the spleen, they direct us to open the vein
of the left hand, which runs between the little finger and the
one next the middle; for certain physicians held it to terminate
in the spleen; but it is a branch of the vein below those at
the elbow. Why, then, should we rather open the vein at the
fingers than the one at the elbow? for there it is larger, and
the blood flows readily from it. Altogether, then, we are to
stop before coming to
deliquium animi. Yet neither, also, is
much blood to be abstracted; for the hemorrhage itself is calculated
to enfeeble the patient; but, after abstracting a small
quantity, repeat the bleeding the same day, the next, and the
day following. But if the patient be thin, and scantily supplied
with blood, we must not open a vein. So much respecting
the abstraction of blood.
We are also to assist by means of ligatures to the extremities.
Above the feet to the ankles and knees, and above the hands
to the wrists and arms, a broad band is to be used, so that the
constriction may be strong, and yet not produce pain. To the
regions, also, from which the blood flows, we are to apply unwashed
wool from the sheep; but moisten it with a liquid,
such as austere wine, and the oils of roses and of myrtles.
But if the hemorrhage be of an urgent nature, instead of the
wool we are to use sponges, and vinegar instead of the wine,
and let the part be anointed with myrtle oil; and we are to
dust upon the sponges some of the dry inspissated juices, such
as that of acacia, or of hypocistis, or else of aloes. The juice
of the unripe grape, dissolved in vinegar, is also a very excellent
thing. But if the liquid application be troublesome or
disagreeable, we are to use plasters; for these stretch the skin
around, and press it, as it were, with the hand, and they are
possessed of very strong powers as astringents and desiccants.
In addition to these, there are very many others of tried
efficacy; but the best are those which contain vinegar, and the
expressed juice of ivy leaves, and asphaltos, and verdigris,
alum, frankincense, myrrh, calcined copper, the squama æris,
and such of the plasters as resemble these; or unscoured wool,
or sponges damped in a small quantity of vinegar. But if the
patients cannot bear the distension of the plasters, we are to
make these things into an epitheme: fat dates, damped in dark
austere wine, are pounded into a cake; then we are to sprinkle
on it acacia in a soft state, and the rinds of pomegranate;
these things having been all rubbed upon a rag, are applied to
the chest. Barley-meal, moistened in wine or vinegar, or the
fine flour of the dried lentil, sifted in a sieve, and made up
with cerate or rose ointment, is to be applied; we are also to
mix some of the root of the comfrey sifted. Another: Boil
the roots of the wild prunes in vinegar, and having pounded
into a cake, mix a little of sumach, and of gum, and of myrtle.
These are to be mixed with one another differently, according
as the strength of the medicines, mildness, or smell thereof is
wanted. For we must also gratify the sick. These are the
external remedies.
But a more important part of the treatment lies in things
drunk and swallowed, since these remedies come nearest the
injured parts. Of these there are three distinct kinds: either
they are calculated by the contraction or compression of the
vessels to bind the passages of the flux; or to incrassate and
coagulate the fluid, so that it may not flow, even if the passages
were in a state to convey it; or to dry up the outlets, by
retaining the blood in its pristine state, so that the parts may
not thus remain emptied by the flux, but may regurgitate
where the effusion is. For rarefaction of the veins, astringency
is sufficient, for it runs through the pores like a fluid when
poured into a water-cask newly wetted. And also in the
division of vessels stypticity is the remedy, by producing contraction
of the lips; but for this purpose we must use the
greater and more powerful medicines. But if the form of
hemorrhage be that from erosion, and if the lips of the ulcer
do not coalesce by the action of the astringents, but the wound
gapes, and cannot be brought together by compression, we must
produce congelation of the blood, and also of the heat; for the
flow is stopped by the immobility and coagulation of these.
To the rare parts, then, oxycrate is sufficient for producing
astriction; for the fluid is not pure blood, but the sanies thereof
from small orifices; and even of this medicine, there is no
necessity of much being given, or frequently; and in certain
cases, the external treatment is sufficient. So, likewise, the
decoction of dates and of edible carobs, when drunk, has by
itself proved sufficient. Let the vinegar be from wines of an
astringent nature, and if not by pharmaceutical preparation,
at all events let it be such as by time has become acrid and
astringent. But in dilatations of the wounds, in addition to
the oxycrate, let there be given the simple medicines at first,
such as the juice of plantain, of knot-grass, or of endive; of
each an equal part with the oxycrate. But if the flow increase,
sprinkle on it one dram of the dried hypocistis, or of acacia,
on three cupfuls of the oxycrate. The juice, also, of the wild
grape is very excellent. But if the ailment prevail over this,
sprinkle on it triturated gall, and the dried root of the bramble,
and the sea stone, the coral, triturated and dried. But the
root of rhubarb is more powerful than these to cool, to dry,
to astringe; in short, for every purpose. But it is used with
the oxycrate alone; or, if more powerful things are required,
as a remedy. To the juices of endive with plantain we add
some of the root, namely, three oboli of it to three or four
cyathi of the fluid. But in crosions, we must produce astringency
even in it, so as to induce coagulation of the blood that
flows, and also for the sake of the containing vessels, so that
the veins which have sustained a large wound may shut their
mouths. But the medicines which are drunk should be strong,
and capable of inducing coagulation. Wherefore, give the
juice of coriander with vinegar, and the rennet of a hare, or
of a hind, or of a kid, but not in great quantity (for certain of
these have proved fatal in a large dose); but of the juice of
the coriander give not less than half a cyathus to three of the
oxycrate, and of the rennet three oboli, or at most four. For
such modes of the flow, the Samian earth is very excellent, and
the very white Aster, and the Eretrian, and the Sinopic, and the
Lemnian seal: of these, at least, one dram weight, and at most
three, with some of the decoctions, as of dates, or of edible
carobs, or of the roots of brambles. But if there be roughness
of the windpipe, and cough along with it, we must sprinkle
these things on Cretic rob. Starch, dissolved in these, is a
most excellent thing for lubricating the windpipe; for along
with its power of lubricating, it also possesses that of agglutinating.
If, therefore, the flow of blood be not urgent, it must
be given once a day, before the administration of food; but if
it be urgent, also a second and third time in the evening. And
from the medicines are to be made draughts of the dried substances
with honey, boiled to the proper consistence; galls pulverised:
and a very good thing is sumach for the condiments,
also grape-stones, and the fruit of the sharp dock, either each
by itself, or all together. These things, moreover, are good
to be kept below the tongue during the whole time of melting;
but likewise common gum with the plant, (?) and the gum
tragacanth. The compound medicines of tried efficacy are
infinite; and various are the usages of trochisks--of that from
Egyptian thorn, of another from amber, and another named
from saffron, of which the composition has been described
separately.
In the absence of fevers, everything is to be attempted in
regard to medicines, giving them copiously and frequently.
But if fever come on--and most frequently fever takes place,
along with inflammations of the wounds--we must not stop
the flow suddenly, nor give medicines during the paroxysms,
for many die sooner of the fevers than of the flow of blood.
The articles of food are various in kind like the medicines,
but also "the medicines are in the food;" for neither would it be
easy to find all the good properties of food in any one article,
nor even if a solitary thing were sufficient for the cure, should
one only be used, as one would thus readily produce satiety;
but we must grant variety if the disease should prove prolonged.
Let the food, then, be astringent and refrigerant in
properties, as also to the touch, for heat encourages bleeding.
Washed alica; rice added to oxycrate; but if the vinegar
excite coughing, the decoction of dates; baked bread which
has been dried and pounded down to meal, and sifted. Of
all these things a draught is to be made with oil; savory
seasoned with salts, and sumach to be sprinkled upon it. And
if you wish to gratify the patient's palate, let coriander be
added, for this purpose, whenever it is agreeable, or any of the
diuretic and diffusible seeds. Lentil, then, with the juice of
plantain, if the hemorrhage be urgent, but if not, we should
spare the juice, for neither is it of easy digestion, nor pleasant
to the taste; for in these cases we must not give indigestible
things. But if you apprehend death from the hemorrhage,
you must also give what is unpalatable and indigestible; nay,
let even harsh things be given if they will preserve life;
wherefore, let galls, dried and pulverised, be sprinkled when
dry, and cold lentil: eggs thick from boiling, with the seeds
of pomegranate or galls, for the food necessarily consists in
the medicines. The drink altogether should be scanty, since
liquids are incompatible with a dry diet. These are the proper
things, provided you wish to astringe and cool. But if
you wish also to thicken the blood and spirit (
pneuma), milk
along with starch and granulated spelt (
chondrus), the milk
being sometimes given with the starch, and sometimes with
the
chondrus; they should be boiled to such a consistence as
that the draught may not be liquid. But if you wish to
incrassate and astringe still more, let the
chondrus be boiled
with dates, and for the sake of giving consistence, let there be
starch and milk; and the Tuscan
far is a very excellent thing,
being thick, viscid, and glutinous when given along with the
milk; the rennet of the kid is to be added to the liquid
decoctions for the sake of coagulation, so that with the milk,
it attains the consistency of new cheese: still thicker than these
is millet boiled with milk like the
far, having gall and pomegranate
rind sprinkled on it as a powder. But we must look to
the proportions of the desiccants and incrassants, for all these
things provoke coughing, and in certain cases, from excess of
desiccant powers, they have burst the veins. But if things
turn out well, and the blood is stopped, we must gradually
change to the opposite plan of treatment, "and nothing in
excess," for these cases are apt to relapse, and are of a bad
character. We must also strive to put flesh and fat on the
patient by means of gestation, gentle frictions, exercise on
foot, recreation, varied and suitable food.
These are the means to be used if, after the flow of blood,
the wound adhere and the part heal properly. But if the
ulcer remain and become purulent, another plan of treatment
is needed, for a discharge of different matters succeeds. This, however, will be treated of among the chronic diseases.
CHAPTER III. THE CURE OF CARDIAC AFFECTIONS.
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,
25 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.
26 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,
27 or Sicyonian
oil, along with pepper, castor, natron, and cachry,
28
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;
29 and by these means the patient is to
be brought back to convalescence and his accustomed habits.
CHAPTER IV. CURE OF CHOLERA.
IN Cholera, the suppression of the discharges is a bad thing, for
they are undigested matters. We must, therefore, readily permit
them to go on, if spontaneous, or if not, promote them by
giving some tepid water to swallow, frequently indeed, but in
small quantity, so that there may be no spasmodic retchings
excited in the stomach. But if there also be tormina and
coldness of the feet, we are to rub the abdomen with hot oil,
boiled with rue and cumin, to dispel the flatulence; and we
are to apply wool. And, having anointed the feet, they are to
be gently rubbed, stroking them rather than pinching them.
And these things are to be done up to the knees for the
restoration of the heat; and the same is to be practised until
the fæces pass downwards, and the bilious matters ascend
upwards.
But if all the remains of the food have been discharged
downwards, and if bile be evacuated, and if there still be
bilious vomiting, retchings, and nausea, uneasiness and loss of
strength, we must give two or three cupfuls (
cyathi) of cold
water, as an astringent of the belly, to stop the reflux, and in
order to cool the burning stomach; and this is to be repeatedly
done when what even has been drunk is vomited. The cold
water, indeed, readily gets warm in the stomach, and then
the stomach rejects it, annoyed as it is both by hot and cold:
but it constantly desiderates cold drink.
But, if the pulse also fall to a low state, and become exceedingly
rapid and hurried, if there be sweat about the forehead
and region of the clavicles, if it run in large drops from all
parts of the body, and the discharge from the bowels is not
restrained, and the stomach still vomits, with retchings and
deliquium animi, we must add to the cold water a small
quantity of wine, which is fragrant and astringent, that it
may refresh the senses by its
bouquet, contribute to the
strength of the stomach by its spirit, and to the restoration
of the body by its nutritious powers. For wine is swiftly distributed
upwards over the system, so as to restrain the reflux;
and is subtil, so that when poured into the frame it strengthens
the habit, and it is strong so as to restrain the dissolving
powers. We are also to sprinkle on the body some fresh
and fragrant meal. But if the bad symptoms become urgent,
with sweating, and strainings, not only of the stomach, but
also of the nerves, and if there be hiccups; and if the feet are
contracted, if there be copious discharges from the bowels,
and if the patient become dark-eoloured, and the pulse is
coming to a stop, we must try to anticipate this condition beforehand;
but if it be come on, we must give much cold water
and wine, not indeed wine slightly diluted, for fear of intoxication,
and of hurting the nerves, and along with food, namely,
pieces of bread soaked in it. We are likewise to give of other
kinds of food, such as have been described by me under syncope,
autumnal fruit of an astringent nature, services, medlars,
quinces, or the grape.
But if everything be vomited, and the stomach can contain
nothing, we must return again to hot drink and food, for in
certain cases the change stops the complaint; the hot things,
moreover, must be intensely so. But if none of these things
avail, we are to apply the cupping-instrument between the
shoulder-blades, and turn it below the umbilicus; but we are
to shift the cupping-instrument constantly, for it is painful
when it remains on a place, and exposes to the risk of blistering.
The motion of gestation is beneficial by its ventilation,
so as to recreate the spirit (
pneuma), stay the food in the
bowels, and make the patient's respiration and pulse natural.
But if these symptoms increase, we must apply epithemes
over the stomach and chest; and these are to be similar to
those for syncope--dates soaked in wine, acacia, hypocistis,
mixed up with rose cerate, and spread upon a linen cloth, are
to be applied over the stomach; and to the chest we are
to apply mastich, aloe, the pulverised hair of wormwood,
with the cerate of nard, or of wild vine, as a cataplasm to the
whole chest; but if the feet and muscles be spasmodically distended,
rub into them Sicyonian oil, that of must, or old oil with
a little wax; and also add in powder some castor. And if the
feet also be cold, we are to rub them with the ointment containing
lemnestis and euphorbium, wrap them in wool, and
rectify by rubbing with the hands. The spine also, the
tendons, and muscles of the jaws are to be anointed with the
same.
If, therefore, by these means the sweat and discharges from
the bowels are stopped, and the stomach receives the food
without vomiting it again, the pulse becomes large and strong,
and the straining ceases; if the heat prevails everywhere, and
reaches the extremities, and sleep concocts all matters, on the
second or third day the patient is to be bathed, and remitted
to his usual course of living. But if he vomit up everything,
if the sweat flow incessant, if the patient become cold and
livid, if his pulse be almost stopped and his strength exhausted,
it will be well in these circumstances to try to make one's
escape with credit.
CHAPTER V. CURE OF ILEUS.
IN Ileus it is pain that kills, along with inflammation of the
bowels, or straining and swelling. A most acute and most disgusting
form of death! For others, when in a hopeless state of
illness, fear nothing except their impending death; but those
in ileus, from excess of pain earnestly desire death. The
physician, therefore, must neither be inferior to the affection,
nor more dilatory; but, if he find inflammation to be the cause,
open a vein at the elbow by a large orifice, so that blood,
which is the pabulum of the inflammation, may flow copiously;
and it may be carried the length of deliquium animi, for this
is either the commencement of an escape from pain, or of a
torpor ending in insensibility. For in ileus a breathing-time
for a short space, even from loss of sensibility, will prove an
interval from pain; since, also, to persons enduring these
pains, to die is happiness, but to impart it is not permitted to
the respectable physician; but at times it is permitted, when
he foresees that present symptoms cannot be escaped from, to
lull the patient asleep with narcotics and anæsthetics.
But if the ileus arise without inflammation, from corruption
of the food or intense cold, we are to abstain from bleeding,
but at the same time to do all the other things, and procure
vomiting frequently by water, and drinking plenty of oil;
then, again, we are to procure vomiting, and produce the expulsion
of the flatus downwards, by stimulant medicines.
Such a stimulant is the juice of sow-bread, and natron, or
salts. Cumin and rue are carminatives. Wherefore we must
rub in together all these things with turpentine resin, and
foment with sponges; or we must inject with these things and
oil, honey, hyssop, and the decoction of the fleshy parts of the
wild cucumber. And if feculent matter be evacuated, we
are again to inject hot oil with rue; for, if this remain inwardly,
it proves a grateful fomentation to the bowels: and
apply to the suffering parts lotions composed of oil which has
been strongly boiled with rue and dill. And the fomentation
is also to be applied, either by means of earthen or brazen
vessels, or with millet and roasted salts. In addition to the
ordinary cataplasms, one may be made of the flour of darnel
and cumin, and the hair of hyssop and of marjoram. Cupping,
without the abstraction of blood, indeed, but frequently
applied, sometimes to one place, and sometimes to another--to
the epigastric region, and to the loins as far as the groins,
and behind to the ischiatic region as far as the kidneys and
spine; for it is expedient to produce revulsion of the pain by
all means. They should also get whetters (
propomata30) of the
decoction of cumin, or of rue, and of sison;
31 or along with
these some of the anodyne medicines. Of these there are very
many of tried efficacy. The medicine from vipers is also a
good one, when drunk to a larger amount than usual. But if
neither the pain remit, nor the flatulence nor fæces pass, we
must necessarily give of the purgative hiera; for either the
medicine is rejected with phlegm and bile, or it passes downwards,
bringing off flatus, scybala, phlegm, and bile, which
occasion the intensity of the evil. Laxative food: soups of
hens, of shell-fish; the juice of ptisan boiled with much oil
poured in at first before the boiling; boil along with it cumin,
natron, leek with its hair. Or the cure is to be made with
some laxative soup: snails much boiled, and their gravy, or
that of limpet. Water is to be taken for drink, if there be
fever, boiled with asarabacca, or nard, or cachry. For these
things dispel flatus, are diuretic, and promote free breathing.
But if he be free from pain, wine also is beneficial for the
heat of the intestines, and for the restoration of the strength;
and likewise the decoction of fennel-root, in a draught, and
maiden-hair and cinnamon.
But if the inflammation turn to an abscess, it is better to
contribute thereto by using the medicine for abscesses. These
have been described under chronic diseases, where the treatment of cholics is described.
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 (
alica32) 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.
CHAPTER VII. CURE OF THE ACUTE DISEASE OF THE DORSAL VEIN
AND ARTERY.
THE inflammation of the
vena cava and large artery, which
extend along the spine, was called a species of Causus by
those of former times. For in these cases the affections are
similar: febrile heat acute and acrid, loathing of food, thirst,
restlessness; a palpitating pulsation in the hypochondriac
region and in the back, and the other symptoms described by
me under this head. Moreover, the febrile heat tends to syncope,
as in cases of causus. For, indeed, the liver is formed
by the roots of the veins, and the heart is the original of the
artery. You may suppose, then, that the upper portions of
these viscera are subject to fatal ailments; for it is the heart
which imparts heat to the artery, and the liver which conveys
blood to the vein; and being both mighty parts, the inflammations,
likewise, which spring from them are great.
Wherefore we are to open the veins at the elbow, and
abstract a considerable amount of blood; not all at once, however,
but at two or three times, and on a different day, so that
the strength may recruit during the interval. Then we are to
apply a cupping-instrument and cataplasms to the hypochondrium,
where is the pulsation of the artery; and also between
the scapulæ, for there, too, there are pulsations. We are to
scarify unsparingly, and abstract much blood; for from this
sort of evacuation the patients are not much prone to deliquium.
The bowels, also, are apt to be unusually confined, and emollient
clysters are to be used to lubricate them, but not on any
account acrid ones; for they suffer an increase of fever from
brine and the melting of the natron. The juice, therefore, of
linseed and of fenugreek, and the decoction of the roots of
mallows, are sufficient to rouse and stimulate the bowels. The
extremities, namely, the feet and hands, are to be warmed
with gleucinum,
33 or Sicyonian oil, or with the liniment from
lemnestis; for these parts of them become very cold. And
before the administration of food, we must give draughts to
promote the urinary discharge, containing spignel, asarabacca,
and wormwood, to which some natron in powder is to be
added. But of all such medicines the strongest are cassia and
cinnamon, provided one has plenty of it. In such cases, milk
is both food and medicine; for they stand in need of refrigeration,
a sort of fire being wrapped up within; and also of sweet
food, and of that a copious supply in small bulk. Such virtues
milk possesses as an article of food. Plenty of the milk of an
ass which has just had a foal is to be given, and to two cupfuls
of the milk one of water is to be added. That of the cow is
also very good; and, thirdly, that of a goat. The articles of
food should be of easy digestion; for the most part juices,
such as that from the juice of the fennel; and let parsley seed
be added to it, and honey. And the water which is drunk
should contain these things.
But we must also promote sweats, and in every way make
the perspiration moist and free. Lotions to the head, as in
cases of causus. An epitheme to the chest and left mamma,
such as in syncope. To lie in bed with the head elevated, so
that everything may be alike as in causus. Gestation to a
small extent, so as to provoke sweats; a bath, also, if he be
burned up within. For these affections do not pass off by
crises, even though they be forms of causus.
CHAPTER VIII. CURE OF THE ACUTE DISEASE IN THE KIDNEYS.
INFLAMMATION in the kidneys is of an acute nature; for the
veins passing from the liver to the kidneys are inflamed at the
same time, and with these the liver; for these veins are not
very long, but are very broad, so as to give the kidneys the
appearance of being suspended near the liver. But suppression
of urine takes place along with the inflammation, thereby
contributing to the intensity of the inflammation; for the
cavity of the kidneys is filled by the overflow of the urine
which fails to escape. The same happens also with stones,
provided one larger than the breadth of the ureters be formed
in the kidneys: it then becomes seated there, and, not passing
through, it occasions a stoppage of the urine. But we will
treat of the formation of calculi among the chronic diseases;
how they may either be prevented from forming, or how they
may be broken when formed. With regard to heat and obstruction,
such of these affections as prove quickly fatal will be
described by me in this place.
Whether it be impaction of stones, or whether it be inflammation,
we must open the vein at the elbow, unless a particular
period of life prove an obstacle, and blood must be taken in a
full stream and in large quantity. For not only are inflammations
alleviated by evacuation, but also impacted stones are
slackened by the evacuation of the vessels, and thus the stones
escape during the passing of the urine. Then the parts are
to be relaxed by bathing them with oil of must or of privet,
and by fomentations and cataplasms. The herb southernwood,
the schœnus, and calamus aromaticus, should form the
ingredients of the cataplasms. Then we are to apply
the cupping-instrument over the kidneys, in the loins, more
especially if the evacuation from this place has been of service.
The bowels are to be softened by lubricating clysters, rather of
a viscid than of an acrid nature, such as the juiees either of
mallows or of fenugreek. Sometimes, also, diuretic medicines
are to be given before food, such as are described respecting
the liver, and also similar food of easy digestion: for in such
cases indigestion is bad. Milk is a most excellent article, especially
that of an ass; next, of a mare; even that of an ewe or a
goat is useful, as being a kind of milk. If, then, they be free
of fever, it is better also to prescribe the bath; but if not, they
are to be placed in a sitz-bath formed of the decoction of herbs,
filling the vessel up to their navel. But if it be turned to
suppuration, what cataplasms and other medicines we are to
use have formerly been laid down by us on many occasions.
But, if the stone stick, we are to use the same fomentations
and cataplasms, and try to break the stones with medicines
taken in the form of drink. The simples are the herbs waterparsnip
and
prionitis,
34 boiled with oil or edible vinegar, and
the juice of it taken for drink: the compound ones are, that
named from Vestinus, that from vipers and the reptile the
skink, and such as from experience appear to be best. Gestation
and succussion are calculated to promote the movement
and protrusion of the calculi; for the passage of calculi into
the bladder is very painful. But if the stones drop out, the
patients become free from pain, which they have not been
accustomed to be, not even in their dreams; and, as if escaped
from inevitable evils, they feel relieved both in mind and in
body.
CHAPTER IX. CURE OF THE ACUTE AFFECTIONS ABOUT THE BLADDER.
ACUTE affections, resembling those of the kidneys, form also
in the bladder; namely, inflammations, ulcerations, calculi,
and the obstructions from clots, and, along with these, suppression
of urine and strangury. But in this part the pain is
more acute, and death most speedy; for the bladder is a broad
nerve, whereas the kidneys are like a concretion of blood, of
the same species as the liver. But, moreover, the sufferings
are most dreadful and most lamentable:
for there, by far,
On wretched men most cruel pains inflicts the god of war.
We must, therefore, straightway make an incision in the
flanks, and soothe the bladder by means of a fomentation of
much oil, with rue and dill. But if grumous blood be the
cause of the pains and stoppage of the urine, we are to give
oxymel to drink, or a little quantity of lime with honeyedwater
for the solution of the clots, and also such other things,
both herbs and seeds, as promote the secretion of urine. But
if there be danger from hemorrhage, it is to be stopped without
delay, more than in the other cases; for the danger from
it is not small. We must remedy it by the medicines which
stop bleeding. In this case refrigeration of the bladder is
beneficial; bathing with rose-oil and wine, and wrapping the
parts in cloths made of unwashed wool.
35 An epitheme may
be formed with dates soaked in wine, with pomegranate or the
juice of sumach. But if the patient is averse to the weight of
the epithemes and the great cooling, they must both be given
up; for we must not cool greatly a part naturally thin and
cold like the bladder. But we are to anoint the parts with
oil of must, or acacia, or hypocistis with wine. But we must
not use sponges, unless the hemorrhage be very urgent. The
food should be farinaceous, of easy digestion, wholesome,
diuretic, such as have been described by me under the head of
the kidneys; milk, sweet wine, the Theræan and Scybelitic.
Medicines should be drunk which are diuretic, fragrant, and
diffusible, and other such things. A very excellent thing for
the bladder is
cicadœ; roasted, in season, as an article of
food;
and out of season, when dried and triturated with water. Let
also a little of the root of nard be boiled up with the
cicadœ.
The same things may be used for preparing a bath to sit in for
relaxation of the bladder.
But, if it be the impaction of calculi which stops the urine,
we must push away the calculus and draw off the urine, with
the instrument, the catheter, unless there be inflammations;
for, in inflammations, neither do the passages well admit the
instrument, and in addition they are hurt by the catheter.
But if this treatment be inadmissible, and the patient is nearly
killed with the sufferings, we must make an incision in the
part under the
glans penis, and the neck of the bladder, in
order to procure an outlet for the stone and the expulsion of
the urine. And we must particularly endeavour to cure the
part by bringing the wound to cicatrization. But if not, it is
better that the patient should have a flux of urine for the
remainder of his life, than that he should die most miserably
of the pain.
CHAPTER X. CURE OF THE HYSTERICAL CONVULSION.
THE uterus in women has membranes extended on both sides
at the flanks, and also is subject to the affections of an animal
in smelling; for it follows after fragrant things as if for pleasure,
and flees from fetid and disagreeable things as if for dislike.
If, therefore, anything annoy it from above, it protrudes even
beyond the genital organs. But if any of these things be
applied to the os, it retreats backwards and upwards. Sometimes
it will go to this side or to that,--to the spleen and
liver, while the membranes yield to the distension and contraction
like the sails of a ship.
It suffers in this way also from inflammation; and it protrudes
more than usual in this affection and in the swelling of
its neck; for inflammation of the fundus inclines upwards; but
if downwards to the feet, it protrudes externally, a troublesome,
painful and unseemly complaint, rendering it difficult
to walk, to lie on the side or on the back, unless the woman
suffer from inflammation of the feet. But if it mount upwards,
it very speedily suffocates the woman, and stops the
respiration as if with a cord, before she feels pain, or can
scream aloud, or can call upon the spectators, for in many
cases the respiration is first stopped, and in others the
speech. It is proper, then, in these cases, to call the physician
quickly before the patient die. Should you fortunately
arrive in time and ascertain that it is inflammation, you must
open a vein, especially the one at the ankle, and pursue the
other means which prove remedial in suffocation without inflammation:
ligatures of the hands and feet so tight as to
induce torpor; smelling to fetid substances--liquid pitch, hairs
and wool burnt, the extinguished flame of a lamp, and castor,
since, in addition to its bad smell, it warms the congealed
nerves. Old urine greatly rouses the sense of one in a death-like
state, and drives the uterus downwards. Wherefore we
must apply fragrant things on pessaries to the region of the
uterus--any ointment of a mild nature, and not pungent to
the touch, nard, or Ægyptian bacchar, or the medicine from
the leaves of the malabathrum, the Indian tree,
36 or cinnamon
pounded with any of the fragrant oils. These articles are to
be rubbed into the female parts. And also an injection of
these things is to be thrown into the uterus. The anus is to
be rubbed with applications which dispel flatus; and injections
of things not acrid, but softening, viscid, and lubricant, are
to be given for the expulsion of the fæces solely, so that the
region of the uterus may be emptied,--with the juice of
marsh-mallow, or of fenugreek, but let melilot or marjoram
be boiled along with the oil. But, if the uterus stands in
need of support rather than evacuation, the abdomen is to be
compressed by the hands of a strong woman, or of an expert
man, binding it round also with a roller, when you have
replaced the part, so that it may not ascend upwards again.
Having produced sneezing, you must compress the nostrils;
for by the sneezing and straining, in certain cases, the uterus
has returned to its place. We are to blow into the nostrils
also some of the root of soapwort,
37 or of pepper, or of castor.
We are also to apply the instrument for dry-cupping to the
thighs, loins, the ischiatic regions, and groins, in order to
attract the uterus. And, moreover, we are to apply it to the
spine, and between the scapulæ, in order to relieve the sense
of suffocation. But if the feeling of suffocation be connected
with inflammation, we may also scarify the vein leading along
the pubes, and abstract plenty of blood. Friction of the
countenance, plucking of the hair, with bawling aloud, in
order to arouse. Should the patient partially recover, she is
to be seated in a decoction of aromatics, and fumigated from
below with fragrant perfumes. Also before a meal, she is to
drink of castor, and a little quantity of the hiera with the
castor. And if relieved, she is to bathe, and at the proper
season is to return to her accustomed habits; and we must look
to the woman that her menstrual discharges flow freely.
CHAPTER XI. CURE OF SATYRIASIS.
INFLAMMATION of the nerves in the genital organs occasions
erection of the member with desire and pain
in re venerea:
there arise spasmodic strainings which at no time abate, since
the calamity is not soothed by the coition. They also become
maddened in understanding, at first as regards shamelessness
in the open performance of the act; for the inability to refrain
renders them impudent; but afterwards . . . . . . . . when they
have recovered, their understanding becomes quite settled.
For all these causes, we must open the vein at the elbow,
and also the one at the ankle, and abstract blood in large
quantity and frequently, for now it is not unseasonable to
induce deliquium animi, so as to bring on torpor of the
understanding and remission of the inflammation, and also
mitigation of the heat about the member; for it is much blood
which strongly enkindles the heat and audacity; it is the
pabulum of the inflammation, and the fuel of the disorder of
the understanding, and of the confusion. The whole body is
to be purged with the medicine, the hiera; for the patients
not only require purging, but also a gentle medication, both
which objects are accomplished by the hiera. The genital
organs, the loins, the perineum and the testicles, are to be
wrapped in unwashed wool; but the wool must be moistened
with rose-oil and wine, and the parts bathed, so much the
more that no heating may be produced by the wool, but that
the innate heat may be mitigated by the cooling powers of the
fluids. Cataplasms of a like kind are to be applied; bread with
the juice of plantain, strychnos,
38 endive, the leaves of the poppy,
and the other narcotics and refrigerants. Also the genital
organs, perineum, and ischiatic region, are to be rubbed with
similar things, such as cicuta with water, or wine, or vinegar;
mandragora, and acacia; and sponges are to be used instead of
wool. In the interval we are to open the bowels with a
decoction of mallows, oil, and honey. But everything acrid
. . . . . . Cupping-instruments are to be fixed to the ischiatic
region, or the abdomen; leeches also are very good for attracting
blood from the inner parts, and to their bites a
a cataplasm made of crumbs of bread with marsh-mallows.
Then the patient is to have a sitz bath medicated with worm-wood,
and the decoction of sage, and of flea-bane. But when
the affection is protracted for a considerable time without
any corresponding intermission, there is danger of a convulsion
(for in this affection the patients are liable to convulsions),
we must change the system of treatment to calefacients, there
is need of oil of must or of Sicyonian oil instead of oil of roses,
along with clean wool and warming cataplasms, for such
treatment then soothes the inflammations of the nerves,--and
we must also give castor with honeyed-water in a draught.
Food containing little nourishment, in a cold state, in small
quantity, and such as is farinaceous; mostly pot-herbs, the
mallow, the blite, the lettuce, boiled gourd, boiled cucumber,
ripe pompion. Wine and fleshes to be used sparingly until
convalescence have made considerable progress; for wine imparts
warmth to the nerves, soothes the soul, recalls pleasure,
engenders semen, and provokes to venery.
Thus far have I written respecting the cures of acute diseases.
One must also be fertile in expedients, and not require
to apply his mind entirely to the writings of others. Acute
diseases are thus treated of, so that you may avail yourself of
what has been written of them, in their order, either singly
or all together.
