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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,1 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.2 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.3 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;4

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.

1 Spelt, Triticum spelta, deprived of its husks and broken down into granules. See Paul. Ægin. t. i. p.123, Syd. Soc. Edit.

2 The tragus (called tragum by Pliny, H. N. xviii. 10) was a culinary preparation frym Spelt, and would seem to have been much the same as the chondrus. See Galen, Comment. in lib. de ratione victus in morb. acut.

3 See Paul. Ægin. t. iii. p. 241.

4 Probably the Cachrys libanotis. See Dioscorides, M. M. iii. 78; and appendix to Dunbar's Greek Lexicon under λιβανωτίς.

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