diff --git a/data/tlg0638/tlg007/tlg0638.tlg007.perseus-grc2.xml b/data/tlg0638/tlg007/tlg0638.tlg007.perseus-grc2.xml index 6b78c8f58..b6254be4e 100644 --- a/data/tlg0638/tlg007/tlg0638.tlg007.perseus-grc2.xml +++ b/data/tlg0638/tlg007/tlg0638.tlg007.perseus-grc2.xml @@ -1,5 +1,5 @@ - + @@ -15,6 +15,7 @@ Bridget Almas Lisa Cerrato Rashmi Singhal + JuliaDeen Center for Hellenic Studies diff --git a/data/tlg0719/tlg001/__cts__.xml b/data/tlg0719/tlg001/__cts__.xml index 2c8f2774d..5ec680c8c 100644 --- a/data/tlg0719/tlg001/__cts__.xml +++ b/data/tlg0719/tlg001/__cts__.xml @@ -4,6 +4,11 @@ Περὶ αἰτίων καὶ σημείων ὀξέων παθών - Aretaeus. The Extant Works of Aretaeus, The Cappadocian. Adams, Francis, editor. Boston, MA: Milford House, Inc., 1972 (reprint); London: Sydenham Society, 1856. + Aretaeus. The Extant Works of Aretaeus, The Cappadocian. Adams, Francis, editor. Boston, MA: Milford House, Inc., 1972 (reprint); London: Sydenham Society, 1856. + + + On the Causes and Symptoms of Acute Diseases + Aretaeus. The Extant Works of Aretaeus, The Cappadocian. Adams, Francis, translator. Boston, MA: Milford House, Inc., 1972 (reprint); London: Sydenham Society, 1856. + \ No newline at end of file diff --git a/data/tlg0719/tlg001/tlg0719.tlg001.perseus-eng1.xml b/data/tlg0719/tlg001/tlg0719.tlg001.perseus-eng1.xml index 269314c98..407fa4cb2 100644 --- a/data/tlg0719/tlg001/tlg0719.tlg001.perseus-eng1.xml +++ b/data/tlg0719/tlg001/tlg0719.tlg001.perseus-eng1.xml @@ -1,33 +1,59 @@ + - + - De causis et signis acutorum morborum - Aretaeus - Francis Adams LL.D. + On the Causes and Symptoms of Acute Diseases + Aretaeus of Cappadocia + Francis Adams + + Gregory Crane + + Prepared under the supervision of + Bridget Almas + Lisa Cerrato + Rashmi Singhal + National Library of Medicine History of Medicine Division - Cultural Heritage Langauge Technologies + Cultural Heritage Language Technologies Kansas City Missouri - February 1, 2005 + February 1, 2005 + + Trustees of Tufts University + Medford, MA + Perseus Digital Library Project + Perseus 4.0 + tlg0719.tlg001.perseus-eng2.xml + + Available under a Creative Commons Attribution-ShareAlike 4.0 International License + + - The Extant Works of Aretaeus, The Cappadocian. - Aretaeus - Francis Adams LL.D. + The Extant Works of Aretaeus, The Cappadocian + Aretaeus of Cappadocia + Francis Adams + + London + Syndenham Society + 1856 + Boston Milford House Inc. - 1972 (Republication of the 1856 edition). + 1972 - + + Internet Archive + @@ -35,1291 +61,149 @@ - - - - - - - - - + + +

This pointer pattern extracts book and chapter.

+ + +

This pointer pattern extracts book.

+ - English - Greek + English + Greek + Latin + + EpiDoc and CTS conversion, file/encoding cleanup, and general header review. + + - - -
- - BOOK I. -
- CHAPTER V. ON THE PAROXYSM OF EPILEPTICS -

* * * * sluggishness, vertigo, heaviness of the tendons, plethora and - distension of the veins in the neck; and much nausea indeed after food, but - also, not unfrequently, with abstinence, there is a faint nausea; and phlegm - is often vomited; want of appetite and indigestion after little food: they - have flatulence and meteorism in the hypochondria. These symptoms, indeed, - are constant.

-

But, if it be near the accession of the paroxysm, there are before the sight - circular flashes of purple or black colours, or of all mixed together, so as - to exhibit the appearance of the rainbow expanded in the heavens; noises in - the ears; a heavy smell; they are passionate, and unreasonably peevish. They - fall down then, some from any such cause as lowness of spirits, but others - from gazing intently on a running stream, a rolling

- -

wheel, or a turning top. But sometimes the smell of heavy odours, such as of - the gagate stone (jet), makes them fall down. In these - cases, the ailment is fixed in the head, and from it the disorder springs; - but, in others, it arises also from the nerves remote from the head, which - sympathise with the primary organ. Wherefore the great fingers of the hands, - and the great toes of the feet are contracted; pain, torpor, and trembling - succeed, and a rush of them to the head takes place. If the mischief spread - until it reach the head, a crash takes place, in these cases, as if from the - stroke of a piece of wood, or of stone; and, when they rise up, they tell - how they have been maliciously struck by some person. This deception occurs - to those who are attacked with the ailment for the first time. But those to - whom the affection has become habitual, whenever the disease recurs, and has - already seized the finger, or is commencing in any part, having from - experience a foreknowledge of what is about to happen, call, from among - those who are present, upon their customary assistants, and entreat them to - bind, pull aside, and stretch the affected members; and they themselves tear - at their own members, as if pulling out the disease; and such assistance has - sometimes put off the attack for a day. But, in many cases, there is the - dread as of a wild beast rushing upon them, or the phantasy of a shadow; and - thus they have fallen down.

-

In the attack, the person lies insensible; the hands are clasped together by - the spasm; the legs not only plaited together, but also dashed about hither - and thither by the tendons. The calamity bears a resemblance to slaughtered - bulls; the neck bent, the head variously distorted, for sometimes it is - arched, as it were, forwards, so that the chin rests upon the breast; and - sometimes it is retracted to the back, as if forcibly drawn thither by the - hair, when it rests on this shoulder or on that. They gape wide, the mouth - is dry; the tongue protrudes, so as to incur the risk of a great wound, - or

- -

of a piece of it being cut off, should the teeth come forcibly together with - the spasm; the eyes rolled inwards, the eyelids for the most part are - separated, and affected with palpitation; but should they wish to shut the - lids they cannot bring them together, insomuch that the white of the eyes - can be seen from below. The eyebrows sometimes relaxed towards the mesal - space, as in those who are frowning, and sometimes retracted to the temples - abnormally, so that the skin about the forehead is greatly stretched, and - the wrinkles in the intersuperciliary space disappear: the cheeks are ruddy - and quivering; the lips sometimes compressed together to a sharp point, and - sometimes separated towards the sides, when they are stretched over the - teeth, like as in persons smiling.

-

As the illness increases lividity of countenance also supervenes, distension - of the vessels in the neck, inability of speech as in suffocation; - insensibility even if you call loudly. The utterance a moaning and - lamentation; and the respiration a sense of suffocation, as in a person who - is throttled; the pulse strong, and quick, and small in the - beginning,--great, slow, and feeble in the end, and irregular throughout; - tentigo of the genital organs. Such sufferings do they endure towards the - end of the attack.

-

But when they come to the termination of the illness, there are unconscious - discharges of the urine, and watery discharges from the bowels, and in some - cases an evacuation also of the semen, from the constriction and compression - of the vessels, or from the pruriency of the pain, and titillation of the - humours; for in these cases the pains are seated in the nerves. The mouth - watery; phlegm copious, thick, cold, and, if you should draw it forth, you - might drag out a quantity of it in the form of a thread. But, if with length - of time and much pain, the matters within the chest ferment, but the - restrained spirit (pneuma) agitates all things, and - there is a convulsion and disorder of the same, a flood, as it were, of - humours swells up to

- -

the organs of respiration, the mouth, and the nose; and if along with the - humours the spirit be mixed, it appears like the relief of all the former - feelings of suffocation. They accordingly spit out foam, as the sea ejects - froth in mighty tempests; and then at length they rise up, the ailment now - being at an end. At the termination, they are torpid in their members at - first, experience heaviness of the head, and loss of strength, and are - languid, pale, spiritless, and dejected, from the suffering and shame of the - dreadful malady.

-
-
- CHAPTER VI. ON TETANUS -

TETANUS, in all its varieties, is a spasm of an - exceedingly painful nature, very swift to prove fatal, but neither easy to - be removed. They are affections of the muscles and tendons about the jaws; - but the illness is communicated to the whole frame, for all parts are - affected sympathetically with the primary organs. There are three forms of - the convulsion, namely, in a straight line, backwards, and forwards. Tetanus - is in a direct line, when the person labouring under the distention is - stretched out straight and inflexible. The contractions forwards and - backwards have their appellation from the tension and the place; for that - backwards we call Opisthotonos; and that variety we call Emprosthotonos in - which the patient is bent forwards by the anterior nerves. For the Greek - word TO/NOS is applied both to a nerve, - and to signify tension.

-

The causes of these complaints are many; for some are apt to supervene on - the wound of a membrane, or of muscles, or of punctured nerves, when, for - the most part, the patients die; for, "spasm from a wound is fatal." And - women also suffer from

- -

this spasm after abortion; and, in this case, they seldom recover. Others - are attacked with the spasm owing to a severe blow in the neck. Severe cold - also sometimes proves a cause; for this reason, winter of all the seasons - most especially engenders these affections; next to it, spring and autumn, - but least of all summer, unless when preceded by a wound, or when any - strange diseases prevail epidemically. Women are more disposed to tetanus - than men, because they are of a cold temperament; but they more readily - recover, because they are of a humid. With respect to the different ages, - children are frequently affected, but do not often die, because the - affection is familiar and akin to them; striplings are less liable to - suffer, but more readily die; adults least of all, whereas old men are most - subject to the disease, and most apt to die; the cause of this is the - frigidity and dryness of old age, and the nature of the death. But if the - cold be along with humidity, these spasmodic diseases are more innocent, and - attended with less danger.

-

In all these varieties, then, to speak generally, there is a pain and - tension of the tendons and spine, and of the muscles connected with the jaws - and cheek; for they fasten the lower jaw to the upper, so that it could not - easily be separated even with levers or a wedge. But if one, by forcibly - separating the teeth, pour in some liquid, the patients do not drink it but - squirt it out, or retain it in the mouth, or it regurgitates by the - nostrils; for the isthmus faucium is strongly compressed, and the tonsils - being hard and tense, do not coalesce so as to propel that which is - swallowed. The face is ruddy, and of mixed colours, the eyes almost - immoveable, or are rolled about with difficulty; strong feeling of - suffocation; respiration bad, distension of the arms and legs; subsultus of - the muscles; the countenance variously distorted; the cheeks and lips - tremulous; the jaw quivering, and the teeth rattling, and in certain rare - cases even the ears are thus affected. I myself have beheld

- -

this and wondered! The urine is retained, so as to induce strong dysuria, or - passes spontaneously from contraction of the bladder. These symptoms occur - in each variety of the spasms.

-

But there are peculiarities in each; in Tetanus there is tension in a - straight line of the whole body, which is unbent and inflexible; the legs - and arms are straight.

-

Opisthotonos bends the patient backward, like a bow, so that the reflected - head is lodged between the shoulder-blades; the throat protrudes; the jaw - sometimes gapes, but in some rare cases it is fixed in the upper one; - respiration stertorous; the belly and chest prominent, and in these there is - usually incontinence of urine; the abdomen stretched, and resonant if - tapped; the arms strongly bent back in a state of extension; the legs and - thighs are bent together, for the legs are bent in the opposite direction to - the hams.

-

But if they are bent forwards, they are protuberant at the back, the loins - being extruded in a line with the back, the whole of the spine being - straight; the vertex prone, the head inclining towards the chest; the lower - jaw fixed upon the breast bone; the hands clasped together, the lower - extremities extended; pains intense; the voice altogether dolorous; they - groan, making deep moaning. Should the mischief then seize the chest and the - respiratory organs, it readily frees the patient from life; a blessing this, - to himself, as being a deliverance from pains, distortion, and deformity; - and a contingency less than usual to be lamented by the spectators, were he - a son or a father. But should the powers of life still stand out, the - respiration, although bad, being still prolonged, the patient is not only - bent up into an arch but rolled together like a ball, so that the head rests - upon the knees, while the legs and back are bent forwards, so as to convey - the impression of the articulation of the knee being dislocated - backwards.

- -

An inhuman calamity! an unseemly sight! a spectacle painful even to the - beholder! an incurable malady! owing to the distortion, not to be recognised - by the dearest friends; and hence the prayer of the spectators, which - formerly would have been reckoned not pious, now becomes good, that the - patient may depart from life, as being a deliverance from the pains and - unseemly evils attendant on it. But neither can the physician, though - present and looking on, furnish any assistance, as regards life, relief from - pain or from deformity. For if he should wish to straighten the limbs, he - can only do so by cutting and breaking those of a living man. With them, - then, who are overpowered by the disease, he can merely sympathise. This is - the great misfortune of the physician.

-
-
- CHAPTER VII. ON ANGINA, OR QUINSEY -

ANGINA is indeed a very acute affection, for it is - a compression of the respiration. But there are two species of it; for it is - either an inflammation of the organs of respiration, or an affection of the - spirit (pneuma) alone, which contains the cause of the - disease in itself.

-

The organs affected are, the tonsils, epiglottis, pharynx, uvula, top of the - trachea; and, if the inflammation spread, the tongue also, and internal part - of the fauces, when they protrude the tongue outside the teeth, owing to its - abnormal size; for it fills the whole of the mouth, and the protuberance - thereof extends beyond the teeth. This species is called Cynanche, either - from its being a common affection of those animals, or from its being a - customary practice for dogs to protrude the tongue even in health.

- -

The opposite symptoms attend the other species; namely, collapse of the - organs, and diminution of the natural size, with intense feeling of - suffocation, insomuch that it appears to themselves as if the inflammation - had disappeared to the internal parts of the thorax, and had seized upon the - heart and lungs. This we call Synanche, as if from the disease inclining - inwardly and producing suffocation. It appears to me that this is an illness - of the spirit (pneuma) itself, which has under-gone a - morbid conversion to a hotter and drier state, without any inflammation of - the organ itself. Nor is this any great wonder. For in the Charonæan caves - the most sudden suffocations occur from no affection of any organ,The Charonæan ditches or pits here mentioned, were in Phrygia. See - Strabo, xii. 8. They are mentioned by Galen, de usu partium, vii.; - Epid.i.t.xvii. p. 10, ed. K”n; and Pliny, H.N. vii. 93. Their - pestilential exhalations are often noticed by ancient authors. - but the persons die from one inspiration, before the body can sustain any - injury. But likewise a man will be seized with rabies, - from respiring the effluvia of the tongue of a dog, without having been - bitten. It is not impossible then, that such a change of the respiration - should occur within, since many other phenomena which occur in a man bear a - resemblance to external causes, such as juices which become spoiled both - within and without. And diseases resemble deleterious substances, and men - have similar vomitings from medicines and from fevers. Hence, also, it was - not a wonderful thing, that in the plague of Athens, certain persons fancied - that poisonous substances had been thrown into the wells in the Piræus by - the Peloponnesians; for these persons did not perceive the affinity between - a pestilential disease and deleterious substances.

-

Cases of Cynanche are attended with inflammation of the tonsils, of the - fauces, and of the whole mouth; the tongue protrudes beyond the teeth and - lips; they have salivation, the

- -

phlegm running out very thick and cold; they have their faces ruddy and - swollen; their eyes protuberant, wide open, and red; the drink regurgitates - by the nostrils. The pains violent, but obscured by the urgency of the - suffocation; the chest and heart are in a state of inflammation; there is a - longing for cold air, yet they inspire but little, until they are suffocated - from the obstruction of the passage to the chest. In certain cases, there is - a ready transference of the disease to the chest, and these die from the - metastasis; the fevers feeble, slight, bringing no relief. But if, in any - case, there is a turn to the better, abscesses form on either side, near the - ears externally, or internally about the tonsils; and if these occur with - torpor, and are not very protracted, the patients recover, indeed, but with - pain and danger. But, if a particularly large swelling should occur, in such - cases as are converted to an abscess, and the abscess is raised to a point, - they are quickly suffocated. Such are the peculiar symptoms of cynanche.

-

Those of Synanche are, collapse, tenuity, and paleness; the eyes hollow, - sunk inwardly; the fauces and uvula retracted upwards, the tonsils - approaching one another still more; loss of speech: the feeling of - suffocation is much stronger in this species than in the former, the - mischief being seated in the chest whence the source of respiration. In the - most acute cases, the patients die the same day, in some instances, even - before calling in the physician; and in others, although called in, he could - afford them no relief, for they died before the physician could apply the - resources of his art. In those in which the disease takes a favourable turn, - all the parts become inflamed, the inflammation being determined outwardly, - so that the disease becomes cynanche in place of synanche. It is also a good - thing when a strong swelling, or erysipelas, appears externally on the - chest. And the skilful physician diverts the mischief to the chest by means - of the cupping-instrument, or

- -

by applying mustard to the breast and the parts near the jaws he determines - outwardly and discusses the disease. In certain cases, indeed, the evil by - these means has been for a time driven outwards, but when so driven out it - speedily reverts, and produces suffocation.

-

The causes are infinite, more especially exposure to cold, and, less - frequently, to heat; blows; fish-bones fixed in the tonsils, cold draughts, - intoxication, repletion, and the ills from respiration.

-
-
- CHAPTER VIII. ON THE AFFECTIONS ABOUT THE UVULA -

THE solid body suspended from the roof of the - mouth between the two tonsils is called columella and gurgulio. Uva is the - name of the affection. The columella (uvula) is of a - nervous nature, but humid, for it is situated in a humid region. Wherefore - this body, the columella, suffers from various affections, for it becomes - thickened from inflammation, being elongated and of equal thickness from the - base to the extremity, and is attended with redness. Columna is the - appellation of this affection. If it be rounded towards the extremity alone, - and with its enlargement become livid and darkish, the name of the affection - is Uva; for it altogether resembles a grape in figure, colour, and size. A - third affection is that of the membranes when they have the appearance of - broad sails, or the wings of bats, on this side and on that. This is called - Lorum, for the lengthened folds of the membranes resemble thongs. But if the - columella terminates in a slender and elongated membrane, having at its - extremity a resemblance to the butt-end of a spear, it gets the name of

- -

Fimbria. This affection arises spontaneously from a defluxion, like the - others, but also from an oblique incision when the surgeon leaves the - membrane at one side.Our author alludes here to the surgical - operation, excision of the tonsils, described by Paulus Ægineta, vi. - 30. But if the organ (uvula) become bifid with two membranes - hanging on this side and on that, it has no distinct appellation, but it is - an easy matter for any one who sees it to recognise the nature of the - disease.

-

A sense of suffocation accompanies all these affections, and they can by no - means swallow with freedom. There is cough in all the varieties, but - especially in those named lorum and fimbria. For a titillation of the - trachea is produced by the membrane, and in some cases it secretly instils - some liquid into the windpipe, whence they cough. But in uva and columella - there is still more dyspnœa and very difficult deglutition; for, in these - cases, the fluid is squeezed up to the nostrils, from sympathy of the - tonsils. The columella is common in old persons, the uva in the young and in - adults; for they abound in blood, and are of a more inflammatory nature. The - affections of the membranes are common in puberty and infancy. It is safe to - apply the knife in all these varieties; but in the uva, while still red, - hemorrhage, pains, and increase of inflammation supervene.

-
-
- CHAPTER IX. ON ULCERATIONS ABOUT THE TONSILS -

ULCERS occur on the tonsils; some, indeed, of an - ordinary nature, mild and innocuous; but others of an unusual kind, - pestilential, and fatal. Such as are clean, small, superficial, without - inflammation and without pain, are mild; but such as

- -

are broad, hollow, foul, and covered with a white, livid, or black - concretion, are pestilential. Aphtha is the name given to these ulcers. But - if the concretion has depth, it is an Eschar and is so called: but around - the eschar there is formed a great redness, inflammation, and pain of the - veins, as in carbuncle; and small pustules form, at first few in number, but - others coming out, they coalesce, and a broad ulcer is produced. And if the - disease spread outwardly to the mouth, and reach the columella (uvula) and divide it asunder, and if it extend to the - tongue, the gums, and the alveoli, the teeth also become loosened and black; - and the inflammation seizes the neck; and these die within a few days from - the inflammation, fever, fœtid smell, and want of food. But, if it spread to - the thorax by the windpipe, it occasions death by suffocation within the - space of a day. For the lungs and heart can neither endure such smells, nor - ulcerations, nor ichorous discharges, but coughs and dyspnœa supervene.

-

The cause of the mischief in the tonsils is the swallowing of cold, rough, - hot, acid, and astringent substances; for these parts minister to the chest - as to the purposes of voice and respiration; and to the belly for the - conveyance of food; and to the stomach for deglutition. But if any affection - occur in the internal parts, namely, the belly, the stomach, or the chest, - an ascent of the mischief by the eructations takes place to the isthmus - faucium, the tonsils, and the parts there; wherefore children, until - puberty, especially suffer, for children in particular have large and cold - respiration; for there is most heat in them; moreover, they are intemperate - in regard to food, have a longing for varied food and cold drink; and they - bawl loud both in anger and in sport; and these diseases are familiar to - girls until they have their menstrual purgation. The land of Egypt - especially engenders it, the air thereof being dry for respiration, and the - food diversified, consisting of roots, herbs of many kinds, acrid seeds, and - thick drink;

- -

namely, the water of the Nile, and the sort of ale prepared from barley. - Syria also, and more especially Cœlosyria, engenders these diseases, and - hence they have been named Egyptian and Syrian ulcers.

-

The manner of death is most piteous; pain sharp and hot as from - carbuncle;The term in the original, A)/NQRAC, may either signify "a live coal," or the - disease "Carbuncle." See Paulus Ægineta, iv. 25. It is somewhat doubtful - to which of these significations our author applies it here; indeed, the - former would be the more emphatic. respiration bad, for their - breath smells strongly of putrefaction, as they constantly inhale the same - again into their chest; they are in so loathsome a state that they cannot - endure the smell of themselves; countenance pale or livid; fever acute, - thirst is if from fire, and yet they do not desire drink for fear of the - pains it would occasion; for they become sick if it compress the tonsils, or - if it return by the nostrils; and if they lie down they rise up again as not - being able to endure the recumbent position, and, if they rise up, they are - forced in their distress to lie down again; they mostly walk about erect, - for in their inability to obtain relief they flee from rest, as if wishing - to dispel one pain by another. Inspiration large, as desiring cold air for - the purpose of refrigeration, but expiration small, for the ulceration, as - if produced by burning, is inflamed by the heat of the respiration. - Hoarseness, loss of speech supervene; and these symptoms hurry on from bad - to worse, until suddenly falling to the ground they expire.

-
-
- CHAPTER X. ON PLEURISY -

UNDER the ribs, the spine, and the internal part - of the thorax as far as the clavicles, there is stretched a thin strong - membrane,

- -

adhering to the bones, which is named succingens. When - inflammation occurs in it, and there is heat with cough and parti-coloured - sputa, the affection is named Pleurisy. But all these symptoms must - harmonise and conspire together as all springing from one cause; for such of - them as occur separately from different causes, even if they all occur - together, are not called pleurisy. It is accompanied by acute pain of the - clavicles; heat acrid; decubitus on the inflamed side - easy, for thus the membrane (pleura) remains in its - proper seat, but on the opposite side painful; for by its weight, the - inflammation and suspension of the membrane, the pain stretches to all its - adhesions at the shoulders and clavicles; and in certain cases even to the - back and shoulder blade; the ancients called this affection Dorsal pleurisy. - It is attended with dyspnœa, insomnolency, anorexia, florid redness of the - cheeks, dry cough, difficult expectoration of phlegm, or bilious, or deeply - tinged with blood, or yellowish; and these symptoms observe no order, but - come and go irregularly; but, worst of all, if the bloody sputa cease, and - the patients become delirious; and sometimes they become comatose, and in - their somnolency the mind wavers.

-

But if the disease take a bad turn, all the symptoms getting worse, they die - within the seventh day by falling into syncope; or, if the commencement of - the expectoration, and the more intense symptoms occurred with the second - hebdomad, they die on the fourteenth day. It sometimes happens that in the - intermediate period there is a transference of all the symptoms to the - lungs; for the lung attracts to itself, being both porous and hot, and being - moved for the attraction of the substances around, when the patient is - suddenly suffocated by metastasis of the affection. But if the patient pass - this period, and do not die within the twentieth day, he becomes affected - with empyema. These, then, are the symptoms if the disease get into a bad - state.

- -

But if it take a favourable turn, there is a profuse hemorrhage by the - nostrils, when the disease is suddenly resolved; then follow sleep and - expectoration of phlegm, and afterwards of thin, bilious matters; then of - still thinner, and again of bloody, thick, and flesh-like; and if, with the - bloody, the bile return, and with it the phlegm, the patient's convalescence - is secure; and these symptoms, if they should commence on the third day, - with an easy expectoration of smooth, consistent, liquid, and (not) rounded - sputa, the resolution takes place on the seventh day, when, after bilious - discharges from the bowels, there is freedom of respiration, the mind - settled, fever diminishing, and return of appetite. But if these symptoms - commence with the second week, the resolution occurs on the fourteenth - day.

-

But if not so, it is converted into Empyema, as indicated by rigors, pungent - pains, the desire of sitting erect, and the respiration becoming worse. It - is then to be dreaded, lest, the lungs suddenly attracting the pus, the - patient should be thereby suffocated, after having escaped the first and - greater evils. But if the abscess creep in between the ribs and separate - them, and point outwardly; or, if it burst into an intestine, for the most - part the patient recovers.

-

Among the seasons of the year winter most especially engenders the disease; - next, autumn; spring, less frequently; but summer most rarely. With regard - to age, old men are most apt to suffer, and most readily escape from an - attack; for neither is there apt to be a great inflammation in an arid - frame; nor is there a metastasis to the lungs, for old age is more frigid - than any other age, and the respiration small, and the attraction of all - things deficient. Young men and adults are not, indeed, very apt to suffer - attacks; but neither, also, do they readily recover, for from a slight cause - they would not experience even a slight attack of inflammation, and from - great attacks there is greater danger. Children are least of all

- -

liable to pleurisy, and in their case it is less frequently fatal; for their - bodies are rare, secretions copious, perspiration and exhalation abundant; - hence neither is a great inflammation formed. This is the felicity of their - period of life in the present affection.

-
-
-
- - BOOK II. -
- CHAPTER I. ON PNEUMONIA -

ANIMALS live by two principal things, food and - breath (spirit, pneuma); of these by far the most - important is the respiration, for if it be stopped, the man will not endure - long, but immediately dies. The organs of it are many, the commencement - being the nostrils; the passage, the trachea; the containing vessel, the - lungs; the protection and receptacle of the lungs, the thorax. But the other - parts, indeed, minister only as instruments to the animal; but the lungs - also contain the cause of attraction, for in the midst of them is seated a - hot organ, the heart, which is the origin of life and respiration. It - imparts to the lungs the desire of drawing in cold air, for it raises a heat - in them; but it is the heart which attracts. If, therefore, the heart suffer - primarily, death is not far off.

-

But if the lungs be affected, from a slight cause there is difficulty of - breathing; the patient lives miserably, and death is the issue, unless some - one effects a cure. But in a great affection, such as inflammation, there is - a sense of suffocation,

- -

loss of speech and of breathing, and a speedy death. This is what we call - Peripneumonia, being an inflammation of the lungs, with acute fever, when - they are attended with heaviness of the chest, freedom from pain, provided - the lungs alone are inflamed; for they are naturally insensible, being of - loose texture, like wool. But branches of the aspera arteria are spread - through them, of a cartilaginous nature, and these, also, are insensible; - muscles there are nowhere, and the nerves are small, slender, and minister - to motion. This is the cause of the insensibility to pain. But if any of the - membranes, by which it is connected with the chest, be inflamed, pain also - is present; respiration bad, and hot; they wish to get up into an erect - posture, as being the easiest of all postures for the respiration. Ruddy in - countenance, but especially the cheeks; the white of the eyes very bright - and fatty; the point of the nose flat; the veins in the temples and neck - distended; loss of appetite; pulse, at first, large, empty, very frequent, - as if forcibly accelerated; heat indeed, externally, feeble, and more humid - than natural, but, internally, dry, and very hot, by means of which the - breath is hot; there is thirst, dryness of the tongue, desire of cold air, - aberration of mind; cough mostly dry, but if anything be brought up it is a - frothy phlegm, or slightly tinged with bile, or with a very florid tinge of - blood. The blood-stained is of all others the worst.

-

But if the disease tend to a fatal termination, there is insomnolency; sleep - brief, heavy, of a comatose nature; vain fancies; they are in a doting state - of mind, but not violently delirious; they have no knowledge of their - present sufferings. If you interrogate them respecting the disease, they - will not acknowledge any formidable symptom; the extremities cold; the nails - livid, and curved; the pulse small, very frequent, and failing, in which - case death is near at hand, for they die mostly on the seventh day.

-

But if the disease abate and take a favourable turn, there is

- -

a copious hemorrhage from the nose, a discharge from the bowels of much - bilious and frothy matters, such as might seem to be expelled from the lungs - to the lower belly, provided it readily brings off much in a liquid state. - Sometimes there is a determination to the urine. But they recover the most - speedily in whose cases all these occur together.

-

In certain cases much pus is formed in the lungs, or there is a metastasis - from the side, if a greater symptom of convalescence be at hand. But if, - indeed, the matter be translated from the side to the intestine or bladder, - the patients immediately recover from the peripneumony; but they have a - chronic abscess in the side, which, however, gets better. But if the matter - burst upon the lungs, some have thereby been suffocated, from the copious - effusion and inability to bring it up. But such as escape suffocation from - the bursting of the abscess, have a large ulceration in the lungs, and pass - into phthisis; and from the abscess and phthisis old persons do not readily - recover; but from the peripneumony, youths and adults.

-
-
- CHAPTER II. ON THE BRINGING UP OF BLOOD -

THERE are two species of the discharge of blood by - the mouth. The one that by the mouth from the head and the vessels there; - the passage is by the palate and fauces, where are situated the commencement - of the œsophagus and trachea; and with hawking, and small and more urgent - cough, they eructate the blood into the mouth; whereas, in that from the - mouth, neither does hawking accompany, and it is called Emptysis [or spitting of blood]. But when the - discharge is more scanty, and by drops, or when it comes more copiously from - the head,

- -

or from the mouth, it is no longer called a bringing up, but either the - same, or a spitting, or a hemorrhage. But if it ascend from the chest, and - the viscera there, the lungs, aspera arteria, the parts about the spine, the - discharge from these is not called a spitting, but a bringing up (in Greek, - A)NAGWGH/, the name being expressive - of its coming upwards).Cælius Aurelianus, under the head of - "Sanguinis fluor," thus explains the term:--"Improprium est enim fluorem - vocare id quod ascensu quodam non lapsu fertur. Sed hæc Græci versa vice - posuerunt, derivationem nominis intuentes. Hi enim anagogen vocant quod - magis ex inferioribus ad superiora fluorem significat.'--Tard. pass. iii. 9. We are at a loss for a proper vocable in - English to express this term. It is usually translated rejectio in Latin, which, however, is not sufficiently - expressive. The most suitable in English, which I can think of, is "a - bringing up."

-

The symptoms of both are partly common, small and few in number, such as the - seat of them, in which there is a coincidence between the bringing up and - the spitting. But the peculiarities of each are great, many, and of vital - importance, by which it is easy to distinguish either of them from the - other. If, therefore, it came from the head, with a large discharge of - blood, greater and more numerous symptoms will arise, but scanty from a - slight and small spitting; in these cases, there is heaviness of the head, - pain, noises of the ears, redness of countenance, distension of the veins, - vertigo; and these are preceded by some obvious cause, such as a blow, - exposure to cold, or heat, or intoxication; for drinking of wine speedily - fills the head, and speedily empties it, by the bursting of a vessel; but - from a slight intoxication there may be spitting, proceeding from - rarefaction. Occasionally an habitual hemorrhage from the nostrils is - stopped, and being diverted to the palate, produces the semblance of a - bringing up of blood. If, therefore, it be from the head, there is - titillation of the palate, frequent hawking, and with it a copious spitting - takes place; a desire supervenes, and they readily cough. But if it flow - into the aspera

- -

arteria from the palate, they then bring it up by coughing, and this it is - which deceives them into the supposition that it comes from the viscera - below. It runs, also, from the head into the stomach, when it is vomited up - with nausea, and thus proves a source of deception, as appearing to come - from the stomach. The blood brought up by spitting is not very thick, but - dark in colour, smooth, consistent, unmixed with other substances; for, - being hawked up, it comes immediately upon the tongue in a round shape, - being readily separated; and if you examine the roof of the palate, you will - find it thickened and ulcerated, and, for the most part, bloody; and a - slight and simple plan of treatment will suffice, namely, astringents - applied to the palate in a cold state; for by hot, relaxing, and dilating - applications the flow is increased, and this is an indication that the - spitting is from the head, in which case evacuations are to be made from the - head by the veins, the nostrils, or by any other channel of discharge. And - these things must be done speedily; for if the blood is discharged a - considerable time, the flow will become permanent, and the parts there will - contract the habit of receiving the blood. The trachea, also, becomes - ulcerated, and the patients cough instead of hawking; and this proves the - commencement of a consumption.

-

The flow of blood from the chest and viscera below is called a bringing up - (in Greek, A)NAGWGH/). It is truly of a - fatal nature, if it proceed from any of the vital parts which are - ruptured--either the vena cava in the heart, which - conveys the blood from the liver, or from the large vein which lies along - the spine. For from hemorrhage, as from slaughtering or impeded respiration, - death is very speedy. But in those cases in which the blood comes from the - lungs, the side, or the trachea, they do not die so speedily; but, - nevertheless, they become affected with Empyema and Phthisis. Of these the - least formidable is that from the trachea. But if the vomiting come from the - stomach or bowels, the cases are not of a very

- -

fatal nature, even though the hemorrhage be large; neither is the recovery - slow and changeable. But if it proceed from the liver and spleen, it is - neither readily nor constantly discharged upwards, but the defluxion is more - easy into the stomach and intestines. Yet neither is the discharge upwards - by the lungs impossible or incredible, for in fevers there occur hemorrhages - of blood from the liver and spleen by the nostrils, the blood flowing from - the nostril on the same side as the viscus from which it comes. These, then, - are the places from which the blood comes in the bringing up, and such the - differences as to danger or mortality.

-

But the modes are three; for it is brought up either from rupture of a - vessel, or from erosion, or from rarefaction. Rupture, then, takes place - suddenly, either from a blow, straining at a load, or lifting a weight - upward, or a leap from a height, or from bawling aloud, from violent - passion, or some other similar cause, when blood is instantly poured forth - from the vessel in great quantity.

-

But if it proceed from erosion, the patient is to be interrogated if he ever - had a cough before, or was affected with dyspnœa, and whether nausea or - vomiting ever afflicted him previously. For from such chronic affections the - vessels are corroded by a continued, copious, and acrid defluxion. When, - therefore, the containing vessels, having been long wasted and attenuated, - at length give way, they pour forth blood.

-

But the mode by rarefaction is, indeed, unattended by rupture, and on that - account the discharge is neither copious nor sudden, nor does it consist of - thick blood; for by the rarefaction of the vessels, the thin portion is - excreted. But if much collect in a cavity, and be again brought up, it - becomes thicker than natural, but yet not very thick, neither black, like a - clot; but it is quickly brought up in greater quantity, as being from a - collection. This mode of bringing up blood is common with women who have not - their monthly purgation,

- -

and appears at the periods of the purgation, and stops during the intervals - between them; and if the woman is not cured, the discharge upwards of blood - will revert for many periods, and also, in certain cases, the vessels burst - from fulness.

-

And there is a difference of the discharge, whether it be brought up from an - artery or a vein. For it is black, thick, and readily coagulates, if from a - vein; it is less dangerous, and is more speedily stopped; but if from an - artery, it is of a bright yellow colour and thin, does not readily - coagulate, the danger is more imminent, and to stop it is not so easy; for - the pulsations of the artery provoke the hemorrhage, and the lips of the - wound do not coalesce from the frequent movements of the vessel.

-

Recovery, if from erosion, is protracted, difficult, and doubtful; for, - owing to loss of substance, the parts of the ulcer do not come together, for - it is an ulcer, and not a wound; and adhesion takes place more readily in - ruptures, for the lips of the wound touch one another. This, then, is - another difference as to danger. The mode attended with least danger is that - from rarefaction; and in it the styptic and refrigerant method of treatment - is sufficient.

-

The places are to be indicated from which the blood is brought up; for many - of the symptoms are common, deception is easy, and the cure different. - Blood, then, from erosion is not readily brought up from the stomach, for - the coldness and stypticity of the articles of food and drink bring the - parts to a state of condensation. Neither, also, are cases from erosion - common, although more so than the former; for acrid defluxions do not adhere - for any length of time, but are either brought up or are passed downwards. - Rupture is more common in the stomach. If, then, any rupture take place, the - hemorrhage is not very great, such as that from the thorax; for the veins - there are slender, and the arteries also are small.

- -

But in appearance the blood is not very black, not intensely yellowish, - smooth, or mixed with saliva, being brought up with nausea and vomiting, - slight cough, sometimes with some discharge, and sometimes alone, without - any expectoration; for the trachea sympathises with the gullet, being - extended along and connected with it. There is pinching or constriction of - the ulcer from the things swallowed, more especially if they are very cold, - hot, or austere; and in certain cases pain is produced in the stomach, - extending as far as the back; vomitings of phlegm, and sometimes, when the - disease is long protracted, and there has been long abstinence from food, - they bring up a great quantity of them; fevers, not of a continual type, but - of an irregular kind.

-

But, from the stomach, what is brought up may be black and coagulated, even - if it proceed from an artery; but if it proceed from a vein, it is much - blacker and much more compact; much nausea and vomiting of pituitous and - bilious matter; blood mixed up with the food, provided the man had eaten - previously, for both the food and the blood are collected together in the - same place; eructations frequent and fœtid, and, if much collect together, - there is anxiety of mind and vertigo; but if these be vomited they are - relieved. They are prostrate in strength, generally affected with a burning - heat, and constant pain of the stomach.

-

But from the aspera arteria they bring up scanty and very fluid blood, with - a cough; or, if they do not bring it up, they cough incessantly. There is a - painful feeling in the throat, either a little below or above; voice hoarse - and indistinct.

-

But if it be from the lungs, the discharge is copious, especially if from - erosion, with much cough, of an intense yellow colour, frothy, rounded; so - that what is brought up from one part may be distinguished from what is - brought up from another. But the defluxion, though contained in a common - vessel, from the chest, is diversified after mixture, and you

- -

may distinguish parts of them as being portions of the thorax, and parts - which have a fleshy appearance as being portions of the lungs. There is - heaviness of the chest, freedom from pain, and much redness of the face, - particularly in these cases.

-

But if brought up from the thorax, pain stretching to the anterior part of - the breast is indicative of the ruptured part; cough intense, expectoration - difficult, the blood not very fluid, moderately thick, without froth. But - if, in passing, the lung be affected by consent, a certain amount of froth - is imparted to it, for the passage from the chest to the trachea is by the - lungs.

-

But if, indeed, from the side there be discharged with cough blood which is - black, smooth, fœtid, stinking, as from putrefaction, with acute pain of the - side, many die after the manner of pleuritics with fever.

-

A season that is humid and hot engenders these affections. Spring is thus - humid and hot. Next the summer; autumn less, but winter least of all. They - die in summer mostly from hemorrhage, for great inflammations do not readily - occur then; secondly, in spring, from inflammation and ardent fevers; but in - autumn, attacks of phthisis readily occur.

-

In a word, every discharge of blood upwards, even if small, and although the - ruptured vessels may have already united, is attended with lowness of - spirits, dejection, and despair of life. For who is so firm in mind as to - see himself enduring a state resembling that of a slaughtered animal, and - yet have no fear of death? For the largest and most powerful animals, such - as bulls, die very quickly from loss of blood. That, however, is no great - wonder. But this is a mighty wonder: in the discharge from the lungs alone, - which is particularly dangerous, the patients do not despair of themselves, - even although near the last. The insensibility of the lungs to pain appears - to me to be the cause of this; for pain, even although slight, makes one to - fear death, and yet, in most cases, it is more dreadful than pernicious;

- -

whereas the absence of pain, even in the great illnesses, is attended with - absence of the fear of death, and is more dangerous than dreadful.

-
-
- CHAPTER III. ON SYNCOPE -

WELL by all means has the physician, and well have - the common people succeeded in the appellation of this affection! It is, - indeed, the name of a very acute malady; for what is there greater or more - acute than the power of Syncope ? and what other name - more appropriate for the designation of this matter? what other organ more - important than the heart for life or for death? Neither is it to be doubted - that syncope is a disease of the heart, or that it is an injury of the vital - powers thereof--such is the rapidity and such the mode of the destruction. - For the affection is the solution of the bonds of the vital power, being - antagonistic to the constitution of the man; for having seized fast thereon, - it does not let go its hold, but brings him to dissolution. Nor is it any - great wonder; for other diseases are peculiar to, and prove fatal to, - certain organs, in which they are engendered, and to which they attach - themselves. Thus pestilential and very malignant buboes derive their origin - from the liver, but from no other part; tetanus, in like manner, from the - nerves, and epilepsy from the head. Thus, therefore, syncope is a disease of - the heart and of life. But such persons as regard it to be an affection of - the stomach, because by means of food and wine, and in certain cases by cold - substances, the powers have been restored and the mischief expelled--these, - it would seem to me, ought to hold phrenitis to be a disease of the hair and - skin of the

- -

head, since the phrenitics are relieved by the shaving and wetting thereof. - But to the heart the vicinity of the stomach is most important, for from it - the heart draws both what is suitable and what is unsuitable to itself. And - by the lungs the heart draws spirit (pneuma) for - respiration, but yet the lungs do not hold a primary place in respiration; - for the powers are not in the organs, but there where is the original of - life and strength: But the stomach is neither the original nor seat of life; - and yet one would be injured by atony thereof: for food which proves - injurious to the heart does not hurt the stomach itself, but by it the - heart; since those dying in such cases have symptoms of heart-affections, - namely, pulse small and feeble, bruit of the heart, - with violent palpitation, vertigo, fainting, torpor, loss of tone in their - limbs, sweating copious and unrestrainable, coldness of the whole body, - insensibility, loss of utterance. How should the stomach endure such - symptoms? For those peculiar to it are nausea, vomiting, loss of appetite, - hiccup, eructation, acidity; whereas in cardiac affections the patients are - more acute in their senses, so that they see and hear better than formerly; - they are also in understanding more sound, and in mind more pure, not only - regarding present things, but also with regard to futurity they are true - prophets. These, then, are the powers, not of the stomach, but of the heart, - where is the soul and the nature thereof, and to it is to be referred this - affection of its powers.

-

But this form of disease is a solution of the natural tone from a cold cause - and humidity, and therefore they are not affected with heat, either - internally or externally, neither do they suffer from thirst, and their - breath is cold even when the disease proceeds from strong and ardent fevers, - by which syncope is usually kindled up. For when nature is strong, and of - the proper temperament, it rules all and commands all, whether humour, - spirit (pneuma), or solid, and, by their good order and - symmetry, regulates the man in life; but if the bond

- -

of nature--that is to say, its tone--be dissolved, then this affection is - produced. The original of it is causus, which is in - this form.

-
-
- CHAPTER IV. ON CAUSUS, OR ARDENT FEVER -

HEAT, indeed, everywhere, both acrid and subtil, - but especially in the internal parts; respiration hot, as if from fire; - inhalation of air large; desire of cold; dryness of tongue; parchedness of - lips and skin; extremities cold; urine intensely tinged with bile; - insomnolency; pulse frequent, small, and feeble; eyes clear, glancing, - reddish; healthy colour of the countenance.

-

But if the affection increase, all appearances become greater and worse; the - pulse very small and very frequent; heat very dry and very acrid; intellect - wavering; ignorance of all things; they are thirsty; a desire to touch - anything cold, whether a wall, a garment, the floor, or a fluid; hands cold, - palms thereof very hot, nails livid; breathing thick; perspiration like dew - about the forehead and clavicles.

-

But if nature attain the extremity of dryness and of heat, the hot is - converted into cold, and the parched into humidity; for extreme intensities - of things change to the opposite state. When, therefore, the bonds of life - are dissolved, this is syncope. Then is there an irrestrainable sweat over - all the body; respiration cold, much vapour about the nostrils; they have no - thirst, and yet the other parts are parched except the organs of thirst, - namely, the mouth and stomach; the urine thin and watery; belly for the most - part dry, yet in certain cases the discharges are scanty and bilious; a - redundancy of

- -

humours; even the bones, being dissolved, run off; and from all parts, as in - a river, there is a current outwards.

-

As to the state of the soul, every sense is pure, the intellect acute, the - gnostic powers prophetic; for they prognosticate to themselves, in the first - place, their own departure from life; then they foretell what will - afterwards take place to those present, who fancy sometimes that they are - delirious; but these persons wonder at the result of what has been said. - Others, also, talk to certain of the dead, perchance they alone perceiving - them to be present, in virtue of their acute and pure sense, or perchance - from their soul seeing beforehand, and announcing the men with whom they are - about to associate. For formerly they were immersed in humours, as if in mud - and darkness; but when the disease has drained these off, and taken away the - mist from their eyes, they perceive those things which are in the air, and - with the naked soul become true prophets. But those who have attained such a - degree of refinement in their humours and understanding will scarcely - recover, the vital power having been already evaporated into air.

-
-
- CHAPTER V. ON CHOLERA -

CHOLERA is a retrograde movement of the materiel in the whole body on the stomach, the belly, - and the intestines; a most acute illness. Those matters, then, which collect - in the stomach, rush upwards by vomiting; but those humours in the belly, - and intestines, by the passages downwards. With regard to appearance, then, - those things which are first discharged by vomiting, are watery; but those - by the anus, liquid and

- -

fetid excrement, (for continued indigestion is the cause of this disease); - but if these are washed out, the discharges are pituitous, and then bilious. - At first, indeed, they are borne easily, and without pain; but afterwards - the stomach is affected with retchings, and the belly with tormina.

-

But, if the disease become worse, the tormina get greater; there is - fainting, prostration of strength in the limbs, anxiety, loss of appetite; - or, if they take anything, with much rumbling and nausea, there is - discharged by vomiting bile intensely yellow, and the downward discharges - are of like kind; spasm, contractions of the muscles in the legs and arms; - the fingers are bent; vertigo, hiccup, livid nails, frigidity, extremities - cold, and altogether they are affected with rigors.

-

But if the disease tend to death, the patient falls into a sweat; black - bile, upwards and downwards; urine retained in the bladder by the spasm; - but, in fact, sometimes neither is there any urine collected in the bladder, - owing to the metastasis of the fluids to the intestine; loss of utterance; - pulse very small, and very frequent in the cases affected with syncope; - continual and unavailing strainings to vomit; the bowels troubled with - tenesmus, dry, and without juices; a painful and most piteous death from - spasm, suffocation, and empty vomiting.

-

The season of summer, then, engenders this affection; next autumn; spring, - less frequently; winter, least of all. With regard to the ages, then, those - of young persons and adults; old age least of all; children more frequently - than these, but their complaints are not of a deadly nature.

- -
-
- CHAPTER VI. ON ILEUS -

AN inflammation takes place in the intestines, - creating a deadly pain, for many die of intense tormina; but there is also - formed a cold dull flatus (pneuma), which cannot - readily pass either upwards or downwards, but remains, for the most part - rolled up in the small convolutions of the upper intestines, and hence the - disease has got the appellation of Ileus (or Volvulus). But if in addition to the tormina, there - be compression and softening of the intestines, and the abdomen protrude - greatly, it is called Chordapsus, from the Greek word - E(/YHSIS, which signifies softening, - and XORDH\, which is a name for the - intestines; and hence the Mesentery, which contains all the nerves, vessels, - and membranes that support the intestines, was called E)PIXORDI\S by the ancients.Both - Petit and Ermerins have animadverted on this singular derivation of the - term XORDAYO/S. As Petit remarks, the - true derivation is no doubt from A(/PTESQAI, and XORDH/. - The Greeks, it is well known, were very fanciful etymologists, of which - we have striking proofs in the Cratylus of Plato.

-

The cause of Ileus is a continued corruption of much multifarious and - unaccustomed food, and repeated acts of indigestion, especially of articles - which are apt to excite Ileus, as the ink of the cuttle-fish. And the same - effects may be expected from a blow, or cold, or the drinking of cold water - largely and greedily in a state of sweating; and in those cases, in which - the gut has descended into the scrotum with fæces, and has not been replaced - into the belly, or has been restored to its place with violence, in such - cases it is customary for the

- -

lower intestines to get inflamed.The substance of all the - information to be found in the works of the ancient authorities on the - subject of Hernia, may be seen in Paulus Ægineta, b.vi., 65, p. 66, Syd. - Soc. Edit. I may mention, however, that although there be nothing in the - works of the medical authorities which would lead us to suppose that the - ancient surgeons were in the practice of operating to relieve - incarcerated Hernia, the following passage in one of Martial's Epigrams - would almost lead us to suppose the contrary, "Mitius implicitas Alcon - secat enterocelas," Epigr. xi. 84; which might be - thus translated, "The surgeon Alcon inflicts less pain in cutting for - incarcerated intestinal hernia.' This affection is customary with - children, who are subject to indigestion, and they more readily escape from - the mischief, owing to their habits and the humidity of their intestines, - for they are loose. Old persons do not readily suffer from the complaint, - but rarely recover. The season of summer engenders the disease rather than - that of spring; autumn, than winter; but the summer more than both.

-

Many therefore die speedily of these tormina. But in other cases pus is - formed; and then again, the intestine having become black and putrified, has - separated, and thus the patients have died. In these cases, provided the - Ileus is mild, there is a twisting pain, copious humours in the stomach, - loss of tone, languor, vacant eructations bringing no relief, borborygmi in - the bowels, the flatus passing down to the anus, but not making its - escape.

-

But if the attack of Ileus acquire intensity, there is a determination - upwards of everything, flatus, phlegm, and bile; for they vomit all these; - they are pale, cold over the whole body; much pain; respiration bad, they - are affected with thirst.

-

If they are about to die, there is cold sweat, dysuria, anus constricted, so - that you could not pass a slender metal plate by it;Perhaps he - means "a needle." See Testa, Mal. del Cuore, t. - iii. vomiting of fæces; the patients are speechless; pulse, at - last

- -

rare and small, but before death very small, very dense, and failing. These - symptoms attend the disease in the small intestines.

-

But the same affections occur also in the colon, and the symptoms are - similar, as also the issue; some of these escape if pus form in the colon, - the reason of which is the fleshy thickness of this intestine. The pain is - slender and sharp in the small intestines, but broad and heavy in the colon; - the pain also sometimes darts up to the ribs, when the disease puts on the - appearance of pleurisy; and these, moreover, are affected with fever; but - sometimes it extends to the false ribs, on this side or on that, so that the - pain appears to be seated in the liver and spleen; again it affects the - loins, for the colon has many convolutions in all directions; but in other - cases it fixes on the sacrum, the thighs, and the cremasters of the - testicles. But in colic affections, they have rather retchings; and what is - vomited is then bilious and oily. And the danger therefrom is so much the - less, as the colon is more fleshy, and thicker than the small intestines, - and consequently more tolerant of injury.

-
-
- CHAPTER VII. ON THE ACUTE AFFECTIONS ABOUT THE LIVER -

IN the affections of the liver, the patients do - not die, indeed, more quickly than in those of the heart; but yet they - suffer more pain; for the liver is, in a great measure, a concretion of - blood. But if the cause of death happen to be situated in its Portæ, they die no less speedily than from the heart; - for these parts are tissues formed of membranes, of important and slender - nerves, and of large veins. Hence certain of the philosophers

- -

have held that the desires of the soul are seated there. In hemorrhage it - greatly surpasses all the others; "for the liver is made up from the roots - of veins." Wherefore a great inflammation does form in it, but not very - frequently, nor in its vital parts, for the patient would die previously. - But a smaller inflammation often takes place, whence it happens that they - escape death, indeed, but experience a more protracted state of disease. For - of its office, as regards sanguification, there is no stop nor - procrastination, as from it a supply of blood is sent to the heart, and to - the parts below the diaphragm.

-

If from a greater cause--a stroke, or continued indigestion of much and bad - food, and intoxication, or great cold--an inflammation forms in the portal - system, a very speedy death is the result. For there is a latent, smothered, - and acrid heat; pulse languid; the kind of pain varied, and every way - diversified, sometimes darting to the right side, so as to resemble a sharp - weapon fixed in the place, and sometimes resembling tormina; again, at other - times the pain is deep--nay, very deep; and, intermediate between the pain, - atony and loss of utterance. The diaphragm and succingens (pleura) are dragged downwards; for from them the liver is - suspended as a weight. For this reason, a strong pain extends to the - clavicle on the same side; an ineffectual cough, or only a desire thereof, - and when it comes to a conclusion, dry; respiration bad, for the diaphragm - does not co-operate with the lungs, by assisting them in contraction and - dilatation. They draw in a small breath, but expire a larger; colour, a - dark-green, leaden; they loathe food, or if they force themselves to take - any, they become flatulent in the epigastrium; eructations bilious, acid, - fetid; nausea, retchings, belly mostly loose, discharges bilious, viscid, - small in quantity. The affections always go on increasing; mind not very - much deranged, but torpid, unsettled, stupid; much timidity; coldness of the - extremities, tremblings, rigors,

- -

hiccup of a spasmodic nature, jaundice, bile intense, the whole body tinged - with bile. But if it appear before the seventh day, it proves fatal in many - cases.

-

But those who have escaped a fatal termination, either by a hemorrhage, or a - rapid discharge from the bowels of bilious matters, or from frequent - discharges of intense urine, in these cases, after three weeks, the liver is - converted into a purulent abscess. But if it pass considerably this period - without an abscess, it ends inevitably in dropsy; the patients are thirsty, - drink little, are dried in body, lose fat; there is a desire for acids, and - an insensibility to taste.

-

Autumn engenders this affection, along with the indigestion produced by much - summer-fruit and multifarious food. Of all ages, the adult is most subject - to it.

-
-
- CHAPTER VIII. ON THE ACUTE DISEASE OF THE VENA CAVA -

FROM the portæ of the liver, there passes a wide - vein through the space intermediate between its extremities, which, being - always divided into slender and more numerous branches, is distributed at - last all over the liver in vessels imperceptible to the sight; and with - their extremities anastomose the extremities of other veins, which, at - first, are slender and numerous, grow larger and fewer in number, and, at - last, they are collected into one large vein; hence, having become two by - division, these pass through the liver. The upper one, then, having passed - through the first lobe, appears on its convex side; then, having passed the - diaphragm, it is inserted into the heart: this is called the vena cava. The other, having passed through the lower lobe, the - fifth, to its concave side, makes its

- -

exit near the spine, and is extended along it as far as the ischiatic - region; and it, also, is called vena cava. It obtains - the same name, as being one and the same vein, which derives its origin from - the liver. For if one choose, one may pass a plate of metal from the vena - cava connected with the heart to that by the spine, and from the spine - through the liver to the heart; for it is the same passage leading - upwards.

-

This vein, then, as I think, is all diseased in acute and strong affections; - for it is altogether one vein. But other physicians fancy that only the part - along the spine is affected, because there are no manifest symptoms in - regard to the portion about the heart; for it is extended through the chest, - having no adhesions, but floating in the chest, until, from the diaphragm, - it adheres to the heart. If, then, any of the great ailments seize this - vein, they are concealed by the thorax surrounding it.

-

Wherefore kedmataSee the note on the - English translation of Hippocrates, Syd. Soc. Edit., vol. i. p. 216, and - the authorities there referred to. The aneurismal varix would apply best - to it in this place. It is not unlikely that aortal aneurisms were - sometimes confounded with it. On this subject, see further Testa, Malattie del Cuore, t. iii. also form about - this vein when a hemorrhage, bursting forth quickly proves fatal, the blood - being discharged by the lungs and the arteria aspera, if it burst in the - chest; but if, at its origin, the blood is poured into the lower belly, so - that the bowels float in it, when the patients die before the blood makes - its appearance, the belly being filled with blood.

-

Inflammation likewise forms about the vein, and it, also, proves fatal, if - it be great; for there is an acrid and pungent heat enclosed in the cavities - of both, but little surpassing what is natural, so that to the touch the - heat appears to be slight; but the patient fancies himself burning hot; - pulse small, very frequent, so as to appear compressed and forcibly - accelerated;

- -

coldness of the extremities; intense thirst; dryness of the mouth; redness - of countenance, along with paleness; he is reddish over the whole body; - hypochondriac region hard, and retracted upwards; pain principally on the - right side, and palpitation therein, extending to the flanks; and in certain - cases, also, of the artery along the spine, provided the pulsation displays - itself in the other hypochondriac region; for lying, as it does, on the left - side, it sympathises with the other; the exhalation in the general system - affording no relief, and not even making the skin soft, for it is dry, - shrivelled, and rough; and more especially in the regions of the body where - the bones are prominent, such as the back part of the elbow, the knees, or - the knuckles. Sleep disturbed; the bowels, in certain cases, discharging - nothing, and in others, the discharges small, acrid, bilious; urine, a - bright yellow and pungent; not disordered, indeed, in mind, but they are - torpid and wasted. Hence, those who have seen this constitution of disease - have called it Causus, for the present symptoms are those of a species of - Causus; and in autumn there is a tendency to malignity, both in adults and - the young, in whom the habit of body is slender, from bad diet and hard - labour. These, for the most part, die on the fourteenth day; but when the - disease is protracted, they die in double that period. But those who either - originally have a slight inflammation, or when a great inflammation is - gradually resolved, escape the disease indeed, but never get rid of the - mischief; for they labour under causus a long time. But the dangerous - symptoms cease, namely, the pains, distension of the hypochondria, the bad - pulse, and torpor of the intellect; but still they have nausea, are ill at - ease, with distress of mind; and, moreover, these are attended with an - accession of causus and thirst, dryness of the tongue and mouth; they - inspire largely, drawing in a long and copious breath, as if wishing to draw - in the whole atmosphere, for the purpose of refrigeration. And if they drink - a large draught of cold water, they are

- -

relieved, indeed, for a short time; but then again the thirst is kindled up, - and again they drink copiously. And this is the successive course of the - malady. And a good physician would give with impunity a copious cold - draught, as in other species of causus, and even with less risk, in the case - of those labouring under causus from disease of the vena - cava. And if either the bowels or the bladder carry off the drink, - there is no necessity for inducing vomiting; but if not, after much cold - drink much vomiting must be induced. For the patient would burst, if, after - drinking so much, he should have no discharges by sweating, by urine, or by - the bowels.

-
-
- CHAPTER IX. ON ACUTE AFFECTIONS OF THE KIDNEYS -

THE kidneys, as far as regards the peculiar - structure of the organ, are not productive of any great danger, even if they - should suffer acutely; for, being of a glandular nature, they are mild and - do not experience deadly diseases. But their office is important, namely, - the secretion of the urine from the blood, and its expulsion.

-

It is stopped either by a stone, or an inflammation arising there, or a clot - of blood, or something such; when no mischief arises from sympathy, owing to - the peculiar nature of the organ affected, but the retention of the urine - produces all sorts of dreadful symptoms. Heat, which is acrid, and induces - nausea; a heavy pain along the spine at the loins; distention of the parts, - especially of those about the hypochondrium; suppression of urine, not - entirely, but they pass urine in drops, and have a desire to pass more, for - there is the sensation of an overflow. But if the urine become acrid and - pungent, coldness, tremblings, spasms, distention and fulness of the - hypochondria

- -

supervene. This miserable state and the conjoined feeling become similar to - that of tympanites produced by indigestion, from the taking of too much - food. Pulse, at first, indeed, slow and languid; but, if the evil press - harder, small, frequent, tumultuous, and irregular: sleep slight, painful, - not continued; and suddenly starting up as if from the stroke of a sharp - instrument, they fall over again into a deep sleep as if from fatigue: they - are not much deranged in intellect, but talk incoherently; the countenance - livid. But if the desire of making water return again, the patients pass a - small quantity in drops, along with spasms and great pains, when, for a - short time, they are relieved from their sufferings, and again they - experience a relapse. Of those that die, they sink most quickly who pass no - urine; but the greater part recover, either from the stone dropping down - into the bladder along with the urine, or from the inflammation being - converted into pus, or from being gradually dispelled. For, if the urine - pass easily even in small quantity, they escape death; but for a length of - time they waste in constitution; the patients undergo these sufferings while - still able to keep up, but gradually fall into a state of consumption. The - same seasons, places, and ages induce these affections as induce those in - connection with the venæ cavæ.

-

Sometimes blood bursts from the kidneys suddenly in large quantity, and - flows continuously for many days. None, however, die from the hemorrhage - itself, but from the inflammation accompanying the hemorrhage, if the - bleeding is stopped; but most frequently they die of strong inflammation - induced by the stoppage.

-
- -
- CHAPTER X. ON THE ACUTE AFFECTIONS ABOUT THE BLADDER -

THE bladder is a dangerous part to suffer in acute - diseases, even when it merely sympathizes with other parts; but more - dangerous and fatal if the affection begin with itself; for it is very - potent to make the other parts sympathise with it, as the nerves and the - understanding: for the bladder is a cold and white nerve, at a very great - distance from the innate heat, but very near the external cold: for it is - situated in the lowest part of the belly, at the greatest distance from the - chest. But, also, its office is of vital importance, namely, the passage of - the urine.

-

Even, then, when the passage is only stopped by stones, or clots, or from - any native or foreign mischief, it is of a deadly nature. In women, the - phlegmonous tumour of the uterus may compress it; and in men, the straight - intestine at the end bowels, called the Rectum. In many cases, too, owing to - involuntary restraint from modesty in assemblies and at banquets, being - filled it becomes distended; and, from the loss of its contractile power, it - no longer evacuates the urine. When, then, the urine is stopped, there is - fulness of the parts above, namely, the kidneys; distension of the ureters, - grievous pain of the loins, spasms, tremblings, rigors, alienation of mind. - But if it suffer from an ulcer or inflammation, there are, indeed, many bad - symptoms; but death from the ulcers is by far the most speedy. With regard, - however, to the ulceration and purulent abscess, and those other affections - which are not very acute, they will be treated of among the chronic - diseases; but such as are acute, and prove fatal in fourteen days, or a - little earlier or later, such as inflammation, thrombus, or a stone falling - down to the neck of the bladder, of these I will now treat. If, therefore, - any of these occur, there is retention

- -

of urine; swelling in the hypogastric region; acute pain all over the - abdomen; distension of the bladder; a sallow sweat on the tenth day; - vomitings of phlegm, then of bile; coldness of the whole body, but - especially of the feet: but, if the mischief spread farther, there come on - fevers attended with hiccup, pulse irregularly frequent and small, redness - of the countenance, thirst, distress of mind, delirium, spasms. From - deleterious substances, such as cantharides and buprestis, both the bladder - is distended with flatus, and the whole belly suffers violence; and all - things get worse, and death cannot be long delayed.

-

The bladder also sometimes suffers from hemorrhage; the blood there is - bright and thin, but the patients never die from it, although it may not be - easy to stop. But from the clots and the inflammation there is danger; for - the coldness, mortification, gangrene, and the other evils consequent upon - it readily prove fatal.

-

Winter and autumn bring on these diseases. As to age, manhood, but still - more old age. The other seasons and periods of life do not generally produce - the diseases, and they very rarely prove fatal. Of all others, infants are - most free from danger.

-
-
- CHAPTER XI. ON HYSTERICAL SUFFOCATION -

IN the middle of the flanks of women lies the - womb, a female viscus, closely resembling an animal; for it is moved of - itself hither and thither in the flanks, also upwards in a direct line to - below the cartilage of the thorax, and also obliquely to the right or to the - left, either to the liver or spleen; and it likewise is subject to prolapsus - downwards, and, in a word, it is

- -

altogether erratic. It delights, also, in fragrant smells, and advances - towards them; and it has an aversion to fetid smells, and flees from them; - and, on the whole, the womb is like an animal within an animal.

-

When, therefore, it is suddenly carried upwards, and remains above for a - considerable time, and violently compresses the intestines, the woman - experiences a choking, after the form of epilepsy, but without convulsions. - For the liver, diaphragm, lungs and heart, are quickly squeezed within a - narrow space; and therefore loss of breathing and of speech seems to be - present. And, moreover, the carotids are compressed from sympathy with the - heart, and hence there is heaviness of head, loss of sensibility, and deep - sleep.

-

And in women there also arises another affection resembling this form, with - sense of choking and loss of speech, but not proceeding from the womb; for - it also happens to men, in the manner of catochus. But - those from the uterus are remedied by fetid smells, and the application of - fragrant things to the female parts; but in the others these things do no - good; and the limbs are moved about in the affection from the womb, but in - the other affection not at all. Moreover, voluntary and involuntary - tremblings . . . . . . . . . . . but from the application of a pessary to - induce abortion, powerful congelation of the womb, the stoppage of a copious - hemorrhage, and such like.

-

If, therefore, upon the womb's being moved upwards, she begin to suffer, - there is sluggishness in the performance of her offices, prostration of - strength, atony, loss of the faculties of her knees, vertigo, and the limbs - sink under her; headache, heaviness of the head, and the woman is pained in - the veins on each side of the nose.

-

But if they fall down they have heartburn . . . . . in the hypochondriac - regions; flanks empty, where is the seat of the womb; pulse intermittent, - irregular, and failing; strong sense

- -

of choking; loss of speech and of sensibility; respiration imperceptible and - indistinct; a very sudden and incredible death, for they have nothing deadly - in their appearance; in colour like that of life, and for a considerable - time after death they are more ruddy than usual; eyes somewhat prominent, - bright, not entirely fixed, but yet not very much turned aside.

-

But if the uterus be removed back to its seat before the affection come to a - conclusion, they escape the suffocation. When the belly rumbles there is - moisture about the female parts, respiration thicker and more distinct, a - very speedy rousing up from the affection, in like manner as death is very - sudden; for as it readily ascends to the higher regions, so it readily - recedes. For the uterus is buoyant, but the membranes, its supporters, are - humid, and the place is humid in which the uterus lies; and, moreover, it - flees from fetid things, and seeks after sweet: wherefore it readily - inclines to this side and to that, like a log of wood, and floats upwards - and downwards. For this reason the affection occurs in young women, but not - in old. For in those in whom the age, mode of life, and understanding is - more mobile, the uterus also is of a wandering nature; but in those more - advanced in life, the age, mode of living, understanding, and the uterus are - of a steady character. Wherefore this suffocation from the womb accompanies - females alone.

-

But the affections common to men happen also to the uterus, such as - inflammation and hemorrhage, and they have the common symptoms; namely, - fever, asphexy, coldness, loss of speech. But in hemorrhage the death is - even more sudden, being like that of a slaughtered animal.

-
- -
- CHAPTER XII. ON SATYRIASIS -

THE Satyrs, sacred to Bacchus, in the paintings - and statues, have the member erect, as the symbol of the divine performance. - It is also a form of disease, in which the patient has erection of the - genital organ, the appellation of Satyriasis being derived from its - resemblance to the figure of the god.

-

It is an unrestrainable impulse to connection; but neither are they at all - relieved by these embraces, nor is the tentigo soothed by many and repeated - acts of sexual intercourse. Spasms of all the nerves, and tension of all the - tendons, groins, and perineum, inflammation and pain of the genital parts, - redness of countenance, and a dewy moisture. Wrapped up in silent sorrow, - they are stupid, as if grievously afflicted with their calamity. But if the - affection overcome the patient's sense of shame, he will lose all restraint - of tongue as regards obscenity, and likewise all restraint in regard to the - open performance of the act, being deranged in understanding as to - indecency; for they cannot restrain themselves, are thirsty, and vomit much - phlegm. Afterwards, froth settles on their lips, as is the case with goats - in the season of rutting, and the smell likewise is similar. The urine, - after long retention, is white, thick, and like semen; bowels constipated; - spontaneous titillations of the sides and arm-pits; they have convulsions, - loathe food, or, if presented to them, they snatch it confusedly.

-

But if the illness tend to death, they become flatulent, belly protuberant, - tension of the tendons and of all the muscles, difficulty of movement, - contraction of the limbs, pulse small, weak, and irregular.

-

All these symptoms have been sometimes removed by copious discharges from - the bowels of phlegm and bile, and by

- -

vomiting in like manner, not without danger. The proper cure is deep and - very protracted sleep; for much sleep induces coldness, paralysis, and - torpor of the nerves; and torpidity and refrigeration cure Satyriasis.

-

The affection, for the most part, is formed in spring and summer. Of the - periods of life, it occurs principally in boys and striplings, more - especially in such as are naturally prone to sexual intercourse. It is a - most acute, disgusting, and unseemly ailment. For the most part, the - patients die on the seventh day. It is said, that women also suffer from - this affection; that they have the same impulse to venery, and the other - symptoms the same. I believe, indeed, that lust is engendered in women of a - humid temperament, so as to induce a copious discharge of the superfluous - humours; but I do not at all believe that they are affected with Satyriasis, - for their nature, being cold, is not adapted to it. But neither, also, has - woman the parts necessary for erection, like those of a Satyr, whence the - affection derives its name; and neither also are men subject to suffocation - from the womb, because men have not an uterus.

- -
-
+ + + +
+
BOOK I. +
CHAPTER V. ON THE PAROXYSM OF EPILEPTICS +

* * * * sluggishness, vertigo, heaviness of the tendons, plethora and distension of the veins in the neck; and much nausea indeed after food, but also, not unfrequently, with abstinence, there is a faint nausea; and phlegm is often vomited; want of appetite and indigestion after little food: they have flatulence and meteorism in the hypochondria. These symptoms, indeed, are constant.

+

But, if it be near the accession of the paroxysm, there are before the sight circular flashes of purple or black colours, or of all mixed together, so as to exhibit the appearance of the rainbow expanded in the heavens; noises in the ears; a heavy smell; they are passionate, and unreasonably peevish. They fall down then, some from any such cause as lowness of spirits, but others from gazing intently on a running stream, a rolling wheel, or a turning top. But sometimes the smell of heavy odours, such as of the gagate stone (jet), makes them fall down. In these cases, the ailment is fixed in the head, and from it the disorder springs; but, in others, it arises also from the nerves remote from the head, which sympathise with the primary organ. Wherefore the great fingers of the hands, and the great toes of the feet are contracted; pain, torpor, and trembling succeed, and a rush of them to the head takes place. If the mischief spread until it reach the head, a crash takes place, in these cases, as if from the stroke of a piece of wood, or of stone; and, when they rise up, they tell how they have been maliciously struck by some person. This deception occurs to those who are attacked with the ailment for the first time. But those to whom the affection has become habitual, whenever the disease recurs, and has already seized the finger, or is commencing in any part, having from experience a foreknowledge of what is about to happen, call, from among those who are present, upon their customary assistants, and entreat them to bind, pull aside, and stretch the affected members; and they themselves tear at their own members, as if pulling out the disease; and such assistance has sometimes put off the attack for a day. But, in many cases, there is the dread as of a wild beast rushing upon them, or the phantasy of a shadow; and thus they have fallen down.

+

In the attack, the person lies insensible; the hands are clasped together by the spasm; the legs not only plaited together, but also dashed about hither and thither by the tendons. The calamity bears a resemblance to slaughtered bulls; the neck bent, the head variously distorted, for sometimes it is arched, as it were, forwards, so that the chin rests upon the breast; and sometimes it is retracted to the back, as if forcibly drawn thither by the hair, when it rests on this shoulder or on that. They gape wide, the mouth is dry; the tongue protrudes, so as to incur the risk of a great wound, or of a piece of it being cut off, should the teeth come forcibly together with the spasm; the eyes rolled inwards, the eyelids for the most part are separated, and affected with palpitation; but should they wish to shut the lids they cannot bring them together, insomuch that the white of the eyes can be seen from below. The eyebrows sometimes relaxed towards the mesal space, as in those who are frowning, and sometimes retracted to the temples abnormally, so that the skin about the forehead is greatly stretched, and the wrinkles in the intersuperciliary space disappear: the cheeks are ruddy and quivering; the lips sometimes compressed together to a sharp point, and sometimes separated towards the sides, when they are stretched over the teeth, like as in persons smiling.

+

As the illness increases lividity of countenance also supervenes, distension of the vessels in the neck, inability of speech as in suffocation; insensibility even if you call loudly. The utterance a moaning and lamentation; and the respiration a sense of suffocation, as in a person who is throttled; the pulse strong, and quick, and small in the beginning,—great, slow, and feeble in the end, and irregular throughout; tentigo of the genital organs. Such sufferings do they endure towards the end of the attack.

+

But when they come to the termination of the illness, there are unconscious discharges of the urine, and watery discharges from the bowels, and in some cases an evacuation also of the semen, from the constriction and compression of the vessels, or from the pruriency of the pain, and titillation of the humours; for in these cases the pains are seated in the nerves. The mouth watery; phlegm copious, thick, cold, and, if you should draw it forth, you might drag out a quantity of it in the form of a thread. But, if with length of time and much pain, the matters within the chest ferment, but the restrained spirit (pneuma) agitates all things, and there is a convulsion and disorder of the same, a flood, as it were, of humours swells up to the organs of respiration, the mouth, and the nose; and if along with the humours the spirit be mixed, it appears like the relief of all the former feelings of suffocation. They accordingly spit out foam, as the sea ejects froth in mighty tempests; and then at length they rise up, the ailment now being at an end. At the termination, they are torpid in their members at first, experience heaviness of the head, and loss of strength, and are languid, pale, spiritless, and dejected, from the suffering and shame of the dreadful malady.

+
CHAPTER VI. ON TETANUS +

TETANUS, in all its varieties, is a spasm of an exceedingly painful nature, very swift to prove fatal, but neither easy to be removed. They are affections of the muscles and tendons about the jaws; but the illness is communicated to the whole frame, for all parts are affected sympathetically with the primary organs. There are three forms of the convulsion, namely, in a straight line, backwards, and forwards. Tetanus is in a direct line, when the person labouring under the distention is stretched out straight and inflexible. The contractions forwards and backwards have their appellation from the tension and the place; for that backwards we call Opisthotonos; and that variety we call Emprosthotonos in which the patient is bent forwards by the anterior nerves. For the Greek word τόνος is applied both to a nerve, and to signify tension.

+

The causes of these complaints are many; for some are apt to supervene on the wound of a membrane, or of muscles, or of punctured nerves, when, for the most part, the patients die; for, spasm from a wound is fatal. And women also suffer from this spasm after abortion; and, in this case, they seldom recover. Others are attacked with the spasm owing to a severe blow in the neck. Severe cold also sometimes proves a cause; for this reason, winter of all the seasons most especially engenders these affections; next to it, spring and autumn, but least of all summer, unless when preceded by a wound, or when any strange diseases prevail epidemically. Women are more disposed to tetanus than men, because they are of a cold temperament; but they more readily recover, because they are of a humid. With respect to the different ages, children are frequently affected, but do not often die, because the affection is familiar and akin to them; striplings are less liable to suffer, but more readily die; adults least of all, whereas old men are most subject to the disease, and most apt to die; the cause of this is the frigidity and dryness of old age, and the nature of the death. But if the cold be along with humidity, these spasmodic diseases are more innocent, and attended with less danger.

+

In all these varieties, then, to speak generally, there is a pain and tension of the tendons and spine, and of the muscles connected with the jaws and cheek; for they fasten the lower jaw to the upper, so that it could not easily be separated even with levers or a wedge. But if one, by forcibly separating the teeth, pour in some liquid, the patients do not drink it but squirt it out, or retain it in the mouth, or it regurgitates by the nostrils; for the isthmus faucium is strongly compressed, and the tonsils being hard and tense, do not coalesce so as to propel that which is swallowed. The face is ruddy, and of mixed colours, the eyes almost immoveable, or are rolled about with difficulty; strong feeling of suffocation; respiration bad, distension of the arms and legs; subsultus of the muscles; the countenance variously distorted; the cheeks and lips tremulous; the jaw quivering, and the teeth rattling, and in certain rare cases even the ears are thus affected. I myself have beheld this and wondered! The urine is retained, so as to induce strong dysuria, or passes spontaneously from contraction of the bladder. These symptoms occur in each variety of the spasms.

+

But there are peculiarities in each; in Tetanus there is tension in a straight line of the whole body, which is unbent and inflexible; the legs and arms are straight.

+

Opisthotonos bends the patient backward, like a bow, so that the reflected head is lodged between the shoulder-blades; the throat protrudes; the jaw sometimes gapes, but in some rare cases it is fixed in the upper one; respiration stertorous; the belly and chest prominent, and in these there is usually incontinence of urine; the abdomen stretched, and resonant if tapped; the arms strongly bent back in a state of extension; the legs and thighs are bent together, for the legs are bent in the opposite direction to the hams.

+

But if they are bent forwards, they are protuberant at the back, the loins being extruded in a line with the back, the whole of the spine being straight; the vertex prone, the head inclining towards the chest; the lower jaw fixed upon the breast bone; the hands clasped together, the lower extremities extended; pains intense; the voice altogether dolorous; they groan, making deep moaning. Should the mischief then seize the chest and the respiratory organs, it readily frees the patient from life; a blessing this, to himself, as being a deliverance from pains, distortion, and deformity; and a contingency less than usual to be lamented by the spectators, were he a son or a father. But should the powers of life still stand out, the respiration, although bad, being still prolonged, the patient is not only bent up into an arch but rolled together like a ball, so that the head rests upon the knees, while the legs and back are bent forwards, so as to convey the impression of the articulation of the knee being dislocated backwards.

+ + +

An inhuman calamity! an unseemly sight! a spectacle painful even to the beholder! an incurable malady! owing to the distortion, not to be recognised by the dearest friends; and hence the prayer of the spectators, which formerly would have been reckoned not pious, now becomes good, that the patient may depart from life, as being a deliverance from the pains and unseemly evils attendant on it. But neither can the physician, though present and looking on, furnish any assistance, as regards life, relief from pain or from deformity. For if he should wish to straighten the limbs, he can only do so by cutting and breaking those of a living man. With them, then, who are overpowered by the disease, he can merely sympathise. This is the great misfortune of the physician.

+
CHAPTER VII. ON ANGINA, OR QUINSEY +

ANGINA is indeed a very acute affection, for it is a compression of the respiration. But there are two species of it; for it is either an inflammation of the organs of respiration, or an affection of the spirit (pneuma) alone, which contains the cause of the disease in itself.

+

The organs affected are, the tonsils, epiglottis, pharynx, uvula, top of the trachea; and, if the inflammation spread, the tongue also, and internal part of the fauces, when they protrude the tongue outside the teeth, owing to its abnormal size; for it fills the whole of the mouth, and the protuberance thereof extends beyond the teeth. This species is called Cynanche, either from its being a common affection of those animals, or from its being a customary practice for dogs to protrude the tongue even in health.

+ +

The opposite symptoms attend the other species; namely, collapse of the organs, and diminution of the natural size, with intense feeling of suffocation, insomuch that it appears to themselves as if the inflammation had disappeared to the internal parts of the thorax, and had seized upon the heart and lungs. This we call Synanche, as if from the disease inclining inwardly and producing suffocation. It appears to me that this is an illness of the spirit (pneuma) itself, which has under-gone a morbid conversion to a hotter and drier state, without any inflammation of the organ itself. Nor is this any great wonder. For in the Charonæan caves the most sudden suffocations occur from no affection of any organ,The Charonæan ditches or pits here mentioned, were in Phrygia. See Strabo, xii. 8. They are mentioned by Galen, de usu partium, vii.; Epid. i.t. xvii. p. 10, ed. Kühn; and Pliny, H.N. vii. 93. Their pestilential exhalations are often noticed by ancient authors. but the persons die from one inspiration, before the body can sustain any injury. But likewise a man will be seized with rabies, from respiring the effluvia of the tongue of a dog, without having been bitten. It is not impossible then, that such a change of the respiration should occur within, since many other phenomena which occur in a man bear a resemblance to external causes, such as juices which become spoiled both within and without. And diseases resemble deleterious substances, and men have similar vomitings from medicines and from fevers. Hence, also, it was not a wonderful thing, that in the plague of Athens, certain persons fancied that poisonous substances had been thrown into the wells in the Piræus by the Peloponnesians; for these persons did not perceive the affinity between a pestilential disease and deleterious substances.

+

Cases of Cynanche are attended with inflammation of the tonsils, of the fauces, and of the whole mouth; the tongue protrudes beyond the teeth and lips; they have salivation, the phlegm running out very thick and cold; they have their faces ruddy and swollen; their eyes protuberant, wide open, and red; the drink regurgitates by the nostrils. The pains violent, but obscured by the urgency of the suffocation; the chest and heart are in a state of inflammation; there is a longing for cold air, yet they inspire but little, until they are suffocated from the obstruction of the passage to the chest. In certain cases, there is a ready transference of the disease to the chest, and these die from the metastasis; the fevers feeble, slight, bringing no relief. But if, in any case, there is a turn to the better, abscesses form on either side, near the ears externally, or internally about the tonsils; and if these occur with torpor, and are not very protracted, the patients recover, indeed, but with pain and danger. But, if a particularly large swelling should occur, in such cases as are converted to an abscess, and the abscess is raised to a point, they are quickly suffocated. Such are the peculiar symptoms of cynanche.

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Those of Synanche are, collapse, tenuity, and paleness; the eyes hollow, sunk inwardly; the fauces and uvula retracted upwards, the tonsils approaching one another still more; loss of speech: the feeling of suffocation is much stronger in this species than in the former, the mischief being seated in the chest whence the source of respiration. In the most acute cases, the patients die the same day, in some instances, even before calling in the physician; and in others, although called in, he could afford them no relief, for they died before the physician could apply the resources of his art. In those in which the disease takes a favourable turn, all the parts become inflamed, the inflammation being determined outwardly, so that the disease becomes cynanche in place of synanche. It is also a good thing when a strong swelling, or erysipelas, appears externally on the chest. And the skilful physician diverts the mischief to the chest by means of the cupping-instrument, or by applying mustard to the breast and the parts near the jaws he determines outwardly and discusses the disease. In certain cases, indeed, the evil by these means has been for a time driven outwards, but when so driven out it speedily reverts, and produces suffocation.

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The causes are infinite, more especially exposure to cold, and, less frequently, to heat; blows; fish-bones fixed in the tonsils, cold draughts, intoxication, repletion, and the ills from respiration.

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CHAPTER VIII. ON THE AFFECTIONS ABOUT THE UVULA +

THE solid body suspended from the roof of the mouth between the two tonsils is called columella and gurgulio. Uva is the name of the affection. The columella (uvula) is of a nervous nature, but humid, for it is situated in a humid region. Wherefore this body, the columella, suffers from various affections, for it becomes thickened from inflammation, being elongated and of equal thickness from the base to the extremity, and is attended with redness. Columna is the appellation of this affection. If it be rounded towards the extremity alone, and with its enlargement become livid and darkish, the name of the affection is Uva; for it altogether resembles a grape in figure, colour, and size. A third affection is that of the membranes when they have the appearance of broad sails, or the wings of bats, on this side and on that. This is called Lorum, for the lengthened folds of the membranes resemble thongs. But if the columella terminates in a slender and elongated membrane, having at its extremity a resemblance to the butt-end of a spear, it gets the name of Fimbria. This affection arises spontaneously from a defluxion, like the others, but also from an oblique incision when the surgeon leaves the membrane at one side.Our author alludes here to the surgical operation, excision of the tonsils, described by Paulus Ægineta, vi. 30. But if the organ (uvula) become bifid with two membranes hanging on this side and on that, it has no distinct appellation, but it is an easy matter for any one who sees it to recognise the nature of the disease.

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A sense of suffocation accompanies all these affections, and they can by no means swallow with freedom. There is cough in all the varieties, but especially in those named lorum and fimbria. For a titillation of the trachea is produced by the membrane, and in some cases it secretly instils some liquid into the windpipe, whence they cough. But in uva and columella there is still more dyspnœa and very difficult deglutition; for, in these cases, the fluid is squeezed up to the nostrils, from sympathy of the tonsils. The columella is common in old persons, the uva in the young and in adults; for they abound in blood, and are of a more inflammatory nature. The affections of the membranes are common in puberty and infancy. It is safe to apply the knife in all these varieties; but in the uva, while still red, hemorrhage, pains, and increase of inflammation supervene.

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CHAPTER IX. ON ULCERATIONS ABOUT THE TONSILS +

ULCERS occur on the tonsils; some, indeed, of an ordinary nature, mild and innocuous; but others of an unusual kind, pestilential, and fatal. Such as are clean, small, superficial, without inflammation and without pain, are mild; but such as are broad, hollow, foul, and covered with a white, livid, or black concretion, are pestilential. Aphtha is the name given to these ulcers. But if the concretion has depth, it is an Eschar and is so called: but around the eschar there is formed a great redness, inflammation, and pain of the veins, as in carbuncle; and small pustules form, at first few in number, but others coming out, they coalesce, and a broad ulcer is produced. And if the disease spread outwardly to the mouth, and reach the columella (uvula) and divide it asunder, and if it extend to the tongue, the gums, and the alveoli, the teeth also become loosened and black; and the inflammation seizes the neck; and these die within a few days from the inflammation, fever, fœtid smell, and want of food. But, if it spread to the thorax by the windpipe, it occasions death by suffocation within the space of a day. For the lungs and heart can neither endure such smells, nor ulcerations, nor ichorous discharges, but coughs and dyspnœa supervene.

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The cause of the mischief in the tonsils is the swallowing of cold, rough, hot, acid, and astringent substances; for these parts minister to the chest as to the purposes of voice and respiration; and to the belly for the conveyance of food; and to the stomach for deglutition. But if any affection occur in the internal parts, namely, the belly, the stomach, or the chest, an ascent of the mischief by the eructations takes place to the isthmus faucium, the tonsils, and the parts there; wherefore children, until puberty, especially suffer, for children in particular have large and cold respiration; for there is most heat in them; moreover, they are intemperate in regard to food, have a longing for varied food and cold drink; and they bawl loud both in anger and in sport; and these diseases are familiar to girls until they have their menstrual purgation. The land of Egypt especially engenders it, the air thereof being dry for respiration, and the food diversified, consisting of roots, herbs of many kinds, acrid seeds, and thick drink; namely, the water of the Nile, and the sort of ale prepared from barley. Syria also, and more especially Cœlosyria, engenders these diseases, and hence they have been named Egyptian and Syrian ulcers.

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The manner of death is most piteous; pain sharp and hot as from carbuncle;The term in the original, ἄνθραξ, may either signify a live coal, or the disease Carbuncle. See Paulus Ægineta, iv. 25. It is somewhat doubtful to which of these significations our author applies it here; indeed, the former would be the more emphatic. respiration bad, for their breath smells strongly of putrefaction, as they constantly inhale the same again into their chest; they are in so loathsome a state that they cannot endure the smell of themselves; countenance pale or livid; fever acute, thirst is if from fire, and yet they do not desire drink for fear of the pains it would occasion; for they become sick if it compress the tonsils, or if it return by the nostrils; and if they lie down they rise up again as not being able to endure the recumbent position, and, if they rise up, they are forced in their distress to lie down again; they mostly walk about erect, for in their inability to obtain relief they flee from rest, as if wishing to dispel one pain by another. Inspiration large, as desiring cold air for the purpose of refrigeration, but expiration small, for the ulceration, as if produced by burning, is inflamed by the heat of the respiration. Hoarseness, loss of speech supervene; and these symptoms hurry on from bad to worse, until suddenly falling to the ground they expire.

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CHAPTER X. ON PLEURISY +

UNDER the ribs, the spine, and the internal part of the thorax as far as the clavicles, there is stretched a thin strong membrane, adhering to the bones, which is named succingens. When inflammation occurs in it, and there is heat with cough and parti-coloured sputa, the affection is named Pleurisy. But all these symptoms must harmonise and conspire together as all springing from one cause; for such of them as occur separately from different causes, even if they all occur together, are not called pleurisy. It is accompanied by acute pain of the clavicles; heat acrid; decubitus on the inflamed side easy, for thus the membrane (pleura) remains in its proper seat, but on the opposite side painful; for by its weight, the inflammation and suspension of the membrane, the pain stretches to all its adhesions at the shoulders and clavicles; and in certain cases even to the back and shoulder blade; the ancients called this affection Dorsal pleurisy. It is attended with dyspnœa, insomnolency, anorexia, florid redness of the cheeks, dry cough, difficult expectoration of phlegm, or bilious, or deeply tinged with blood, or yellowish; and these symptoms observe no order, but come and go irregularly; but, worst of all, if the bloody sputa cease, and the patients become delirious; and sometimes they become comatose, and in their somnolency the mind wavers.

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But if the disease take a bad turn, all the symptoms getting worse, they die within the seventh day by falling into syncope; or, if the commencement of the expectoration, and the more intense symptoms occurred with the second hebdomad, they die on the fourteenth day. It sometimes happens that in the intermediate period there is a transference of all the symptoms to the lungs; for the lung attracts to itself, being both porous and hot, and being moved for the attraction of the substances around, when the patient is suddenly suffocated by metastasis of the affection. But if the patient pass this period, and do not die within the twentieth day, he becomes affected with empyema. These, then, are the symptoms if the disease get into a bad state.

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But if it take a favourable turn, there is a profuse hemorrhage by the nostrils, when the disease is suddenly resolved; then follow sleep and expectoration of phlegm, and afterwards of thin, bilious matters; then of still thinner, and again of bloody, thick, and flesh-like; and if, with the bloody, the bile return, and with it the phlegm, the patient’s convalescence is secure; and these symptoms, if they should commence on the third day, with an easy expectoration of smooth, consistent, liquid, and (not) rounded sputa, the resolution takes place on the seventh day, when, after bilious discharges from the bowels, there is freedom of respiration, the mind settled, fever diminishing, and return of appetite. But if these symptoms commence with the second week, the resolution occurs on the fourteenth day.

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But if not so, it is converted into Empyema, as indicated by rigors, pungent pains, the desire of sitting erect, and the respiration becoming worse. It is then to be dreaded, lest, the lungs suddenly attracting the pus, the patient should be thereby suffocated, after having escaped the first and greater evils. But if the abscess creep in between the ribs and separate them, and point outwardly; or, if it burst into an intestine, for the most part the patient recovers.

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Among the seasons of the year winter most especially engenders the disease; next, autumn; spring, less frequently; but summer most rarely. With regard to age, old men are most apt to suffer, and most readily escape from an attack; for neither is there apt to be a great inflammation in an arid frame; nor is there a metastasis to the lungs, for old age is more frigid than any other age, and the respiration small, and the attraction of all things deficient. Young men and adults are not, indeed, very apt to suffer attacks; but neither, also, do they readily recover, for from a slight cause they would not experience even a slight attack of inflammation, and from great attacks there is greater danger. Children are least of all liable to pleurisy, and in their case it is less frequently fatal; for their bodies are rare, secretions copious, perspiration and exhalation abundant; hence neither is a great inflammation formed. This is the felicity of their period of life in the present affection.

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BOOK II. +
CHAPTER I. ON PNEUMONIA +

ANIMALS live by two principal things, food and breath (spirit, pneuma); of these by far the most important is the respiration, for if it be stopped, the man will not endure long, but immediately dies. The organs of it are many, the commencement being the nostrils; the passage, the trachea; the containing vessel, the lungs; the protection and receptacle of the lungs, the thorax. But the other parts, indeed, minister only as instruments to the animal; but the lungs also contain the cause of attraction, for in the midst of them is seated a hot organ, the heart, which is the origin of life and respiration. It imparts to the lungs the desire of drawing in cold air, for it raises a heat in them; but it is the heart which attracts. If, therefore, the heart suffer primarily, death is not far off.

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But if the lungs be affected, from a slight cause there is difficulty of breathing; the patient lives miserably, and death is the issue, unless some one effects a cure. But in a great affection, such as inflammation, there is a sense of suffocation, loss of speech and of breathing, and a speedy death. This is what we call Peripneumonia, being an inflammation of the lungs, with acute fever, when they are attended with heaviness of the chest, freedom from pain, provided the lungs alone are inflamed; for they are naturally insensible, being of loose texture, like wool. But branches of the aspera arteria are spread through them, of a cartilaginous nature, and these, also, are insensible; muscles there are nowhere, and the nerves are small, slender, and minister to motion. This is the cause of the insensibility to pain. But if any of the membranes, by which it is connected with the chest, be inflamed, pain also is present; respiration bad, and hot; they wish to get up into an erect posture, as being the easiest of all postures for the respiration. Ruddy in countenance, but especially the cheeks; the white of the eyes very bright and fatty; the point of the nose flat; the veins in the temples and neck distended; loss of appetite; pulse, at first, large, empty, very frequent, as if forcibly accelerated; heat indeed, externally, feeble, and more humid than natural, but, internally, dry, and very hot, by means of which the breath is hot; there is thirst, dryness of the tongue, desire of cold air, aberration of mind; cough mostly dry, but if anything be brought up it is a frothy phlegm, or slightly tinged with bile, or with a very florid tinge of blood. The blood-stained is of all others the worst.

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But if the disease tend to a fatal termination, there is insomnolency; sleep brief, heavy, of a comatose nature; vain fancies; they are in a doting state of mind, but not violently delirious; they have no knowledge of their present sufferings. If you interrogate them respecting the disease, they will not acknowledge any formidable symptom; the extremities cold; the nails livid, and curved; the pulse small, very frequent, and failing, in which case death is near at hand, for they die mostly on the seventh day.

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But if the disease abate and take a favourable turn, there is a copious hemorrhage from the nose, a discharge from the bowels of much bilious and frothy matters, such as might seem to be expelled from the lungs to the lower belly, provided it readily brings off much in a liquid state. Sometimes there is a determination to the urine. But they recover the most speedily in whose cases all these occur together.

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In certain cases much pus is formed in the lungs, or there is a metastasis from the side, if a greater symptom of convalescence be at hand. But if, indeed, the matter be translated from the side to the intestine or bladder, the patients immediately recover from the peripneumony; but they have a chronic abscess in the side, which, however, gets better. But if the matter burst upon the lungs, some have thereby been suffocated, from the copious effusion and inability to bring it up. But such as escape suffocation from the bursting of the abscess, have a large ulceration in the lungs, and pass into phthisis; and from the abscess and phthisis old persons do not readily recover; but from the peripneumony, youths and adults.

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CHAPTER II. ON THE BRINGING UP OF BLOOD +

THERE are two species of the discharge of blood by the mouth. The one that by the mouth from the head and the vessels there; the passage is by the palate and fauces, where are situated the commencement of the œsophagus and trachea; and with hawking, and small and more urgent cough, they eructate the blood into the mouth; whereas, in that from the mouth, neither does hawking accompany, and it is called Emptysis [or spitting of blood]. But when the discharge is more scanty, and by drops, or when it comes more copiously from the head, or from the mouth, it is no longer called a bringing up, but either the same, or a spitting, or a hemorrhage. But if it ascend from the chest, and the viscera there, the lungs, aspera arteria, the parts about the spine, the discharge from these is not called a spitting, but a bringing up (in Greek, ἀναγωγή, the name being expressive of its coming upwards).Cælius Aurelianus, under the head of Sanguinis fluor, thus explains the term:—Improprium est enim fluorem vocare id quod ascensu quodam non lapsu fertur. Sed hæc Græci versa vice posuerunt, derivationem nominis intuentes. Hi enim anagogen vocant quod magis ex inferioribus ad superiora fluorem significat.—Tard. pass. iii. 9. We are at a loss for a proper vocable in English to express this term. It is usually translated rejectio in Latin, which, however, is not sufficiently expressive. The most suitable in English, which I can think of, is a bringing up.

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The symptoms of both are partly common, small and few in number, such as the seat of them, in which there is a coincidence between the bringing up and the spitting. But the peculiarities of each are great, many, and of vital importance, by which it is easy to distinguish either of them from the other. If, therefore, it came from the head, with a large discharge of blood, greater and more numerous symptoms will arise, but scanty from a slight and small spitting; in these cases, there is heaviness of the head, pain, noises of the ears, redness of countenance, distension of the veins, vertigo; and these are preceded by some obvious cause, such as a blow, exposure to cold, or heat, or intoxication; for drinking of wine speedily fills the head, and speedily empties it, by the bursting of a vessel; but from a slight intoxication there may be spitting, proceeding from rarefaction. Occasionally an habitual hemorrhage from the nostrils is stopped, and being diverted to the palate, produces the semblance of a bringing up of blood. If, therefore, it be from the head, there is titillation of the palate, frequent hawking, and with it a copious spitting takes place; a desire supervenes, and they readily cough. But if it flow into the aspera arteria from the palate, they then bring it up by coughing, and this it is which deceives them into the supposition that it comes from the viscera below. It runs, also, from the head into the stomach, when it is vomited up with nausea, and thus proves a source of deception, as appearing to come from the stomach. The blood brought up by spitting is not very thick, but dark in colour, smooth, consistent, unmixed with other substances; for, being hawked up, it comes immediately upon the tongue in a round shape, being readily separated; and if you examine the roof of the palate, you will find it thickened and ulcerated, and, for the most part, bloody; and a slight and simple plan of treatment will suffice, namely, astringents applied to the palate in a cold state; for by hot, relaxing, and dilating applications the flow is increased, and this is an indication that the spitting is from the head, in which case evacuations are to be made from the head by the veins, the nostrils, or by any other channel of discharge. And these things must be done speedily; for if the blood is discharged a considerable time, the flow will become permanent, and the parts there will contract the habit of receiving the blood. The trachea, also, becomes ulcerated, and the patients cough instead of hawking; and this proves the commencement of a consumption.

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The flow of blood from the chest and viscera below is called a bringing up (in Greek, ἀναγωγή). It is truly of a fatal nature, if it proceed from any of the vital parts which are ruptured—either the vena cava in the heart, which conveys the blood from the liver, or from the large vein which lies along the spine. For from hemorrhage, as from slaughtering or impeded respiration, death is very speedy. But in those cases in which the blood comes from the lungs, the side, or the trachea, they do not die so speedily; but, nevertheless, they become affected with Empyema and Phthisis. Of these the least formidable is that from the trachea. But if the vomiting come from the stomach or bowels, the cases are not of a very fatal nature, even though the hemorrhage be large; neither is the recovery slow and changeable. But if it proceed from the liver and spleen, it is neither readily nor constantly discharged upwards, but the defluxion is more easy into the stomach and intestines. Yet neither is the discharge upwards by the lungs impossible or incredible, for in fevers there occur hemorrhages of blood from the liver and spleen by the nostrils, the blood flowing from the nostril on the same side as the viscus from which it comes. These, then, are the places from which the blood comes in the bringing up, and such the differences as to danger or mortality.

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But the modes are three; for it is brought up either from rupture of a vessel, or from erosion, or from rarefaction. Rupture, then, takes place suddenly, either from a blow, straining at a load, or lifting a weight upward, or a leap from a height, or from bawling aloud, from violent passion, or some other similar cause, when blood is instantly poured forth from the vessel in great quantity.

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But if it proceed from erosion, the patient is to be interrogated if he ever had a cough before, or was affected with dyspnœa, and whether nausea or vomiting ever afflicted him previously. For from such chronic affections the vessels are corroded by a continued, copious, and acrid defluxion. When, therefore, the containing vessels, having been long wasted and attenuated, at length give way, they pour forth blood.

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But the mode by rarefaction is, indeed, unattended by rupture, and on that account the discharge is neither copious nor sudden, nor does it consist of thick blood; for by the rarefaction of the vessels, the thin portion is excreted. But if much collect in a cavity, and be again brought up, it becomes thicker than natural, but yet not very thick, neither black, like a clot; but it is quickly brought up in greater quantity, as being from a collection. This mode of bringing up blood is common with women who have not their monthly purgation, and appears at the periods of the purgation, and stops during the intervals between them; and if the woman is not cured, the discharge upwards of blood will revert for many periods, and also, in certain cases, the vessels burst from fulness.

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And there is a difference of the discharge, whether it be brought up from an artery or a vein. For it is black, thick, and readily coagulates, if from a vein; it is less dangerous, and is more speedily stopped; but if from an artery, it is of a bright yellow colour and thin, does not readily coagulate, the danger is more imminent, and to stop it is not so easy; for the pulsations of the artery provoke the hemorrhage, and the lips of the wound do not coalesce from the frequent movements of the vessel.

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Recovery, if from erosion, is protracted, difficult, and doubtful; for, owing to loss of substance, the parts of the ulcer do not come together, for it is an ulcer, and not a wound; and adhesion takes place more readily in ruptures, for the lips of the wound touch one another. This, then, is another difference as to danger. The mode attended with least danger is that from rarefaction; and in it the styptic and refrigerant method of treatment is sufficient.

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The places are to be indicated from which the blood is brought up; for many of the symptoms are common, deception is easy, and the cure different. Blood, then, from erosion is not readily brought up from the stomach, for the coldness and stypticity of the articles of food and drink bring the parts to a state of condensation. Neither, also, are cases from erosion common, although more so than the former; for acrid defluxions do not adhere for any length of time, but are either brought up or are passed downwards. Rupture is more common in the stomach. If, then, any rupture take place, the hemorrhage is not very great, such as that from the thorax; for the veins there are slender, and the arteries also are small. But in appearance the blood is not very black, not intensely yellowish, smooth, or mixed with saliva, being brought up with nausea and vomiting, slight cough, sometimes with some discharge, and sometimes alone, without any expectoration; for the trachea sympathises with the gullet, being extended along and connected with it. There is pinching or constriction of the ulcer from the things swallowed, more especially if they are very cold, hot, or austere; and in certain cases pain is produced in the stomach, extending as far as the back; vomitings of phlegm, and sometimes, when the disease is long protracted, and there has been long abstinence from food, they bring up a great quantity of them; fevers, not of a continual type, but of an irregular kind.

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But, from the stomach, what is brought up may be black and coagulated, even if it proceed from an artery; but if it proceed from a vein, it is much blacker and much more compact; much nausea and vomiting of pituitous and bilious matter; blood mixed up with the food, provided the man had eaten previously, for both the food and the blood are collected together in the same place; eructations frequent and fœtid, and, if much collect together, there is anxiety of mind and vertigo; but if these be vomited they are relieved. They are prostrate in strength, generally affected with a burning heat, and constant pain of the stomach.

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But from the aspera arteria they bring up scanty and very fluid blood, with a cough; or, if they do not bring it up, they cough incessantly. There is a painful feeling in the throat, either a little below or above; voice hoarse and indistinct.

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But if it be from the lungs, the discharge is copious, especially if from erosion, with much cough, of an intense yellow colour, frothy, rounded; so that what is brought up from one part may be distinguished from what is brought up from another. But the defluxion, though contained in a common vessel, from the chest, is diversified after mixture, and you may distinguish parts of them as being portions of the thorax, and parts which have a fleshy appearance as being portions of the lungs. There is heaviness of the chest, freedom from pain, and much redness of the face, particularly in these cases.

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But if brought up from the thorax, pain stretching to the anterior part of the breast is indicative of the ruptured part; cough intense, expectoration difficult, the blood not very fluid, moderately thick, without froth. But if, in passing, the lung be affected by consent, a certain amount of froth is imparted to it, for the passage from the chest to the trachea is by the lungs.

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But if, indeed, from the side there be discharged with cough blood which is black, smooth, fœtid, stinking, as from putrefaction, with acute pain of the side, many die after the manner of pleuritics with fever.

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A season that is humid and hot engenders these affections. Spring is thus humid and hot. Next the summer; autumn less, but winter least of all. They die in summer mostly from hemorrhage, for great inflammations do not readily occur then; secondly, in spring, from inflammation and ardent fevers; but in autumn, attacks of phthisis readily occur.

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In a word, every discharge of blood upwards, even if small, and although the ruptured vessels may have already united, is attended with lowness of spirits, dejection, and despair of life. For who is so firm in mind as to see himself enduring a state resembling that of a slaughtered animal, and yet have no fear of death? For the largest and most powerful animals, such as bulls, die very quickly from loss of blood. That, however, is no great wonder. But this is a mighty wonder: in the discharge from the lungs alone, which is particularly dangerous, the patients do not despair of themselves, even although near the last. The insensibility of the lungs to pain appears to me to be the cause of this; for pain, even although slight, makes one to fear death, and yet, in most cases, it is more dreadful than pernicious; whereas the absence of pain, even in the great illnesses, is attended with absence of the fear of death, and is more dangerous than dreadful.

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CHAPTER III. ON SYNCOPE +

WELL by all means has the physician, and well have the common people succeeded in the appellation of this affection! It is, indeed, the name of a very acute malady; for what is there greater or more acute than the power of Syncope ? and what other name more appropriate for the designation of this matter? what other organ more important than the heart for life or for death? Neither is it to be doubted that syncope is a disease of the heart, or that it is an injury of the vital powers thereof—such is the rapidity and such the mode of the destruction. For the affection is the solution of the bonds of the vital power, being antagonistic to the constitution of the man; for having seized fast thereon, it does not let go its hold, but brings him to dissolution. Nor is it any great wonder; for other diseases are peculiar to, and prove fatal to, certain organs, in which they are engendered, and to which they attach themselves. Thus pestilential and very malignant buboes derive their origin from the liver, but from no other part; tetanus, in like manner, from the nerves, and epilepsy from the head. Thus, therefore, syncope is a disease of the heart and of life. But such persons as regard it to be an affection of the stomach, because by means of food and wine, and in certain cases by cold substances, the powers have been restored and the mischief expelled—these, it would seem to me, ought to hold phrenitis to be a disease of the hair and skin of the head, since the phrenitics are relieved by the shaving and wetting thereof. But to the heart the vicinity of the stomach is most important, for from it the heart draws both what is suitable and what is unsuitable to itself. And by the lungs the heart draws spirit (pneuma) for respiration, but yet the lungs do not hold a primary place in respiration; for the powers are not in the organs, but there where is the original of life and strength: But the stomach is neither the original nor seat of life; and yet one would be injured by atony thereof: for food which proves injurious to the heart does not hurt the stomach itself, but by it the heart; since those dying in such cases have symptoms of heart-affections, namely, pulse small and feeble, bruit of the heart, with violent palpitation, vertigo, fainting, torpor, loss of tone in their limbs, sweating copious and unrestrainable, coldness of the whole body, insensibility, loss of utterance. How should the stomach endure such symptoms? For those peculiar to it are nausea, vomiting, loss of appetite, hiccup, eructation, acidity; whereas in cardiac affections the patients are more acute in their senses, so that they see and hear better than formerly; they are also in understanding more sound, and in mind more pure, not only regarding present things, but also with regard to futurity they are true prophets. These, then, are the powers, not of the stomach, but of the heart, where is the soul and the nature thereof, and to it is to be referred this affection of its powers.

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But this form of disease is a solution of the natural tone from a cold cause and humidity, and therefore they are not affected with heat, either internally or externally, neither do they suffer from thirst, and their breath is cold even when the disease proceeds from strong and ardent fevers, by which syncope is usually kindled up. For when nature is strong, and of the proper temperament, it rules all and commands all, whether humour, spirit (pneuma), or solid, and, by their good order and symmetry, regulates the man in life; but if the bond of nature—that is to say, its tone—be dissolved, then this affection is produced. The original of it is causus, which is in this form.

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CHAPTER IV. ON CAUSUS, OR ARDENT FEVER +

HEAT, indeed, everywhere, both acrid and subtil, but especially in the internal parts; respiration hot, as if from fire; inhalation of air large; desire of cold; dryness of tongue; parchedness of lips and skin; extremities cold; urine intensely tinged with bile; insomnolency; pulse frequent, small, and feeble; eyes clear, glancing, reddish; healthy colour of the countenance.

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But if the affection increase, all appearances become greater and worse; the pulse very small and very frequent; heat very dry and very acrid; intellect wavering; ignorance of all things; they are thirsty; a desire to touch anything cold, whether a wall, a garment, the floor, or a fluid; hands cold, palms thereof very hot, nails livid; breathing thick; perspiration like dew about the forehead and clavicles.

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But if nature attain the extremity of dryness and of heat, the hot is converted into cold, and the parched into humidity; for extreme intensities of things change to the opposite state. When, therefore, the bonds of life are dissolved, this is syncope. Then is there an irrestrainable sweat over all the body; respiration cold, much vapour about the nostrils; they have no thirst, and yet the other parts are parched except the organs of thirst, namely, the mouth and stomach; the urine thin and watery; belly for the most part dry, yet in certain cases the discharges are scanty and bilious; a redundancy of humours; even the bones, being dissolved, run off; and from all parts, as in a river, there is a current outwards.

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As to the state of the soul, every sense is pure, the intellect acute, the gnostic powers prophetic; for they prognosticate to themselves, in the first place, their own departure from life; then they foretell what will afterwards take place to those present, who fancy sometimes that they are delirious; but these persons wonder at the result of what has been said. Others, also, talk to certain of the dead, perchance they alone perceiving them to be present, in virtue of their acute and pure sense, or perchance from their soul seeing beforehand, and announcing the men with whom they are about to associate. For formerly they were immersed in humours, as if in mud and darkness; but when the disease has drained these off, and taken away the mist from their eyes, they perceive those things which are in the air, and with the naked soul become true prophets. But those who have attained such a degree of refinement in their humours and understanding will scarcely recover, the vital power having been already evaporated into air.

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CHAPTER V. ON CHOLERA +

CHOLERA is a retrograde movement of the materiel in the whole body on the stomach, the belly, and the intestines; a most acute illness. Those matters, then, which collect in the stomach, rush upwards by vomiting; but those humours in the belly, and intestines, by the passages downwards. With regard to appearance, then, those things which are first discharged by vomiting, are watery; but those by the anus, liquid and fetid excrement, (for continued indigestion is the cause of this disease); but if these are washed out, the discharges are pituitous, and then bilious. At first, indeed, they are borne easily, and without pain; but afterwards the stomach is affected with retchings, and the belly with tormina.

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But, if the disease become worse, the tormina get greater; there is fainting, prostration of strength in the limbs, anxiety, loss of appetite; or, if they take anything, with much rumbling and nausea, there is discharged by vomiting bile intensely yellow, and the downward discharges are of like kind; spasm, contractions of the muscles in the legs and arms; the fingers are bent; vertigo, hiccup, livid nails, frigidity, extremities cold, and altogether they are affected with rigors.

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But if the disease tend to death, the patient falls into a sweat; black bile, upwards and downwards; urine retained in the bladder by the spasm; but, in fact, sometimes neither is there any urine collected in the bladder, owing to the metastasis of the fluids to the intestine; loss of utterance; pulse very small, and very frequent in the cases affected with syncope; continual and unavailing strainings to vomit; the bowels troubled with tenesmus, dry, and without juices; a painful and most piteous death from spasm, suffocation, and empty vomiting.

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The season of summer, then, engenders this affection; next autumn; spring, less frequently; winter, least of all. With regard to the ages, then, those of young persons and adults; old age least of all; children more frequently than these, but their complaints are not of a deadly nature.

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CHAPTER VI. ON ILEUS +

AN inflammation takes place in the intestines, creating a deadly pain, for many die of intense tormina; but there is also formed a cold dull flatus (pneuma), which cannot readily pass either upwards or downwards, but remains, for the most part rolled up in the small convolutions of the upper intestines, and hence the disease has got the appellation of Ileus (or Volvulus). But if in addition to the tormina, there be compression and softening of the intestines, and the abdomen protrude greatly, it is called Chordapsus, from the Greek word ἕψησις, which signifies softening, and χορδὴ, which is a name for the intestines; and hence the Mesentery, which contains all the nerves, vessels, and membranes that support the intestines, was called ἐπιχορδὶς by the ancients.Both Petit and Ermerins have animadverted on this singular derivation of the term χορδαψός. As Petit remarks, the true derivation is no doubt from ἅπτεσθαι, and χορδή. The Greeks, it is well known, were very fanciful etymologists, of which we have striking proofs in the Cratylus of Plato.

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The cause of Ileus is a continued corruption of much multifarious and unaccustomed food, and repeated acts of indigestion, especially of articles which are apt to excite Ileus, as the ink of the cuttle-fish. And the same effects may be expected from a blow, or cold, or the drinking of cold water largely and greedily in a state of sweating; and in those cases, in which the gut has descended into the scrotum with fæces, and has not been replaced into the belly, or has been restored to its place with violence, in such cases it is customary for the lower intestines to get inflamed.The substance of all the information to be found in the works of the ancient authorities on the subject of Hernia, may be seen in Paulus Ægineta, b.vi., 65, p. 66, Syd. Soc. Edit. I may mention, however, that although there be nothing in the works of the medical authorities which would lead us to suppose that the ancient surgeons were in the practice of operating to relieve incarcerated Hernia, the following passage in one of Martial’s Epigrams would almost lead us to suppose the contrary, Mitius implicitas Alcon secat enterocelas, Epigr. xi. 84; which might be thus translated, The surgeon Alcon inflicts less pain in cutting for incarcerated intestinal hernia. This affection is customary with children, who are subject to indigestion, and they more readily escape from the mischief, owing to their habits and the humidity of their intestines, for they are loose. Old persons do not readily suffer from the complaint, but rarely recover. The season of summer engenders the disease rather than that of spring; autumn, than winter; but the summer more than both.

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Many therefore die speedily of these tormina. But in other cases pus is formed; and then again, the intestine having become black and putrified, has separated, and thus the patients have died. In these cases, provided the Ileus is mild, there is a twisting pain, copious humours in the stomach, loss of tone, languor, vacant eructations bringing no relief, borborygmi in the bowels, the flatus passing down to the anus, but not making its escape.

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But if the attack of Ileus acquire intensity, there is a determination upwards of everything, flatus, phlegm, and bile; for they vomit all these; they are pale, cold over the whole body; much pain; respiration bad, they are affected with thirst.

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If they are about to die, there is cold sweat, dysuria, anus constricted, so that you could not pass a slender metal plate by it;Perhaps he means a needle. See Testa, Mal. del Cuore, t. iii. vomiting of fæces; the patients are speechless; pulse, at last rare and small, but before death very small, very dense, and failing. These symptoms attend the disease in the small intestines.

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But the same affections occur also in the colon, and the symptoms are similar, as also the issue; some of these escape if pus form in the colon, the reason of which is the fleshy thickness of this intestine. The pain is slender and sharp in the small intestines, but broad and heavy in the colon; the pain also sometimes darts up to the ribs, when the disease puts on the appearance of pleurisy; and these, moreover, are affected with fever; but sometimes it extends to the false ribs, on this side or on that, so that the pain appears to be seated in the liver and spleen; again it affects the loins, for the colon has many convolutions in all directions; but in other cases it fixes on the sacrum, the thighs, and the cremasters of the testicles. But in colic affections, they have rather retchings; and what is vomited is then bilious and oily. And the danger therefrom is so much the less, as the colon is more fleshy, and thicker than the small intestines, and consequently more tolerant of injury.

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CHAPTER VII. ON THE ACUTE AFFECTIONS ABOUT THE LIVER +

IN the affections of the liver, the patients do not die, indeed, more quickly than in those of the heart; but yet they suffer more pain; for the liver is, in a great measure, a concretion of blood. But if the cause of death happen to be situated in its Portæ, they die no less speedily than from the heart; for these parts are tissues formed of membranes, of important and slender nerves, and of large veins. Hence certain of the philosophers have held that the desires of the soul are seated there. In hemorrhage it greatly surpasses all the others; for the liver is made up from the roots of veins. Wherefore a great inflammation does form in it, but not very frequently, nor in its vital parts, for the patient would die previously. But a smaller inflammation often takes place, whence it happens that they escape death, indeed, but experience a more protracted state of disease. For of its office, as regards sanguification, there is no stop nor procrastination, as from it a supply of blood is sent to the heart, and to the parts below the diaphragm.

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If from a greater cause—a stroke, or continued indigestion of much and bad food, and intoxication, or great cold—an inflammation forms in the portal system, a very speedy death is the result. For there is a latent, smothered, and acrid heat; pulse languid; the kind of pain varied, and every way diversified, sometimes darting to the right side, so as to resemble a sharp weapon fixed in the place, and sometimes resembling tormina; again, at other times the pain is deep—nay, very deep; and, intermediate between the pain, atony and loss of utterance. The diaphragm and succingens (pleura) are dragged downwards; for from them the liver is suspended as a weight. For this reason, a strong pain extends to the clavicle on the same side; an ineffectual cough, or only a desire thereof, and when it comes to a conclusion, dry; respiration bad, for the diaphragm does not co-operate with the lungs, by assisting them in contraction and dilatation. They draw in a small breath, but expire a larger; colour, a dark-green, leaden; they loathe food, or if they force themselves to take any, they become flatulent in the epigastrium; eructations bilious, acid, fetid; nausea, retchings, belly mostly loose, discharges bilious, viscid, small in quantity. The affections always go on increasing; mind not very much deranged, but torpid, unsettled, stupid; much timidity; coldness of the extremities, tremblings, rigors, hiccup of a spasmodic nature, jaundice, bile intense, the whole body tinged with bile. But if it appear before the seventh day, it proves fatal in many cases.

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But those who have escaped a fatal termination, either by a hemorrhage, or a rapid discharge from the bowels of bilious matters, or from frequent discharges of intense urine, in these cases, after three weeks, the liver is converted into a purulent abscess. But if it pass considerably this period without an abscess, it ends inevitably in dropsy; the patients are thirsty, drink little, are dried in body, lose fat; there is a desire for acids, and an insensibility to taste.

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Autumn engenders this affection, along with the indigestion produced by much summer-fruit and multifarious food. Of all ages, the adult is most subject to it.

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CHAPTER VIII. ON THE ACUTE DISEASE OF THE VENA CAVA +

FROM the portæ of the liver, there passes a wide vein through the space intermediate between its extremities, which, being always divided into slender and more numerous branches, is distributed at last all over the liver in vessels imperceptible to the sight; and with their extremities anastomose the extremities of other veins, which, at first, are slender and numerous, grow larger and fewer in number, and, at last, they are collected into one large vein; hence, having become two by division, these pass through the liver. The upper one, then, having passed through the first lobe, appears on its convex side; then, having passed the diaphragm, it is inserted into the heart: this is called the vena cava. The other, having passed through the lower lobe, the fifth, to its concave side, makes its exit near the spine, and is extended along it as far as the ischiatic region; and it, also, is called vena cava. It obtains the same name, as being one and the same vein, which derives its origin from the liver. For if one choose, one may pass a plate of metal from the vena cava connected with the heart to that by the spine, and from the spine through the liver to the heart; for it is the same passage leading upwards.

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This vein, then, as I think, is all diseased in acute and strong affections; for it is altogether one vein. But other physicians fancy that only the part along the spine is affected, because there are no manifest symptoms in regard to the portion about the heart; for it is extended through the chest, having no adhesions, but floating in the chest, until, from the diaphragm, it adheres to the heart. If, then, any of the great ailments seize this vein, they are concealed by the thorax surrounding it.

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Wherefore kedmataSee the note on the English translation of Hippocrates, Syd. Soc. Edit., vol. i. p. 216, and the authorities there referred to. The aneurismal varix would apply best to it in this place. It is not unlikely that aortal aneurisms were sometimes confounded with it. On this subject, see further Testa, Malattie del Cuore, t. iii. also form about this vein when a hemorrhage, bursting forth quickly proves fatal, the blood being discharged by the lungs and the arteria aspera, if it burst in the chest; but if, at its origin, the blood is poured into the lower belly, so that the bowels float in it, when the patients die before the blood makes its appearance, the belly being filled with blood.

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Inflammation likewise forms about the vein, and it, also, proves fatal, if it be great; for there is an acrid and pungent heat enclosed in the cavities of both, but little surpassing what is natural, so that to the touch the heat appears to be slight; but the patient fancies himself burning hot; pulse small, very frequent, so as to appear compressed and forcibly accelerated; coldness of the extremities; intense thirst; dryness of the mouth; redness of countenance, along with paleness; he is reddish over the whole body; hypochondriac region hard, and retracted upwards; pain principally on the right side, and palpitation therein, extending to the flanks; and in certain cases, also, of the artery along the spine, provided the pulsation displays itself in the other hypochondriac region; for lying, as it does, on the left side, it sympathises with the other; the exhalation in the general system affording no relief, and not even making the skin soft, for it is dry, shrivelled, and rough; and more especially in the regions of the body where the bones are prominent, such as the back part of the elbow, the knees, or the knuckles. Sleep disturbed; the bowels, in certain cases, discharging nothing, and in others, the discharges small, acrid, bilious; urine, a bright yellow and pungent; not disordered, indeed, in mind, but they are torpid and wasted. Hence, those who have seen this constitution of disease have called it Causus, for the present symptoms are those of a species of Causus; and in autumn there is a tendency to malignity, both in adults and the young, in whom the habit of body is slender, from bad diet and hard labour. These, for the most part, die on the fourteenth day; but when the disease is protracted, they die in double that period. But those who either originally have a slight inflammation, or when a great inflammation is gradually resolved, escape the disease indeed, but never get rid of the mischief; for they labour under causus a long time. But the dangerous symptoms cease, namely, the pains, distension of the hypochondria, the bad pulse, and torpor of the intellect; but still they have nausea, are ill at ease, with distress of mind; and, moreover, these are attended with an accession of causus and thirst, dryness of the tongue and mouth; they inspire largely, drawing in a long and copious breath, as if wishing to draw in the whole atmosphere, for the purpose of refrigeration. And if they drink a large draught of cold water, they are relieved, indeed, for a short time; but then again the thirst is kindled up, and again they drink copiously. And this is the successive course of the malady. And a good physician would give with impunity a copious cold draught, as in other species of causus, and even with less risk, in the case of those labouring under causus from disease of the vena cava. And if either the bowels or the bladder carry off the drink, there is no necessity for inducing vomiting; but if not, after much cold drink much vomiting must be induced. For the patient would burst, if, after drinking so much, he should have no discharges by sweating, by urine, or by the bowels.

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CHAPTER IX. ON ACUTE AFFECTIONS OF THE KIDNEYS +

THE kidneys, as far as regards the peculiar structure of the organ, are not productive of any great danger, even if they should suffer acutely; for, being of a glandular nature, they are mild and do not experience deadly diseases. But their office is important, namely, the secretion of the urine from the blood, and its expulsion.

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It is stopped either by a stone, or an inflammation arising there, or a clot of blood, or something such; when no mischief arises from sympathy, owing to the peculiar nature of the organ affected, but the retention of the urine produces all sorts of dreadful symptoms. Heat, which is acrid, and induces nausea; a heavy pain along the spine at the loins; distention of the parts, especially of those about the hypochondrium; suppression of urine, not entirely, but they pass urine in drops, and have a desire to pass more, for there is the sensation of an overflow. But if the urine become acrid and pungent, coldness, tremblings, spasms, distention and fulness of the hypochondria supervene. This miserable state and the conjoined feeling become similar to that of tympanites produced by indigestion, from the taking of too much food. Pulse, at first, indeed, slow and languid; but, if the evil press harder, small, frequent, tumultuous, and irregular: sleep slight, painful, not continued; and suddenly starting up as if from the stroke of a sharp instrument, they fall over again into a deep sleep as if from fatigue: they are not much deranged in intellect, but talk incoherently; the countenance livid. But if the desire of making water return again, the patients pass a small quantity in drops, along with spasms and great pains, when, for a short time, they are relieved from their sufferings, and again they experience a relapse. Of those that die, they sink most quickly who pass no urine; but the greater part recover, either from the stone dropping down into the bladder along with the urine, or from the inflammation being converted into pus, or from being gradually dispelled. For, if the urine pass easily even in small quantity, they escape death; but for a length of time they waste in constitution; the patients undergo these sufferings while still able to keep up, but gradually fall into a state of consumption. The same seasons, places, and ages induce these affections as induce those in connection with the venæ cavæ.

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Sometimes blood bursts from the kidneys suddenly in large quantity, and flows continuously for many days. None, however, die from the hemorrhage itself, but from the inflammation accompanying the hemorrhage, if the bleeding is stopped; but most frequently they die of strong inflammation induced by the stoppage.

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CHAPTER X. ON THE ACUTE AFFECTIONS ABOUT THE BLADDER +

THE bladder is a dangerous part to suffer in acute diseases, even when it merely sympathizes with other parts; but more dangerous and fatal if the affection begin with itself; for it is very potent to make the other parts sympathise with it, as the nerves and the understanding: for the bladder is a cold and white nerve, at a very great distance from the innate heat, but very near the external cold: for it is situated in the lowest part of the belly, at the greatest distance from the chest. But, also, its office is of vital importance, namely, the passage of the urine.

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Even, then, when the passage is only stopped by stones, or clots, or from any native or foreign mischief, it is of a deadly nature. In women, the phlegmonous tumour of the uterus may compress it; and in men, the straight intestine at the end bowels, called the Rectum. In many cases, too, owing to involuntary restraint from modesty in assemblies and at banquets, being filled it becomes distended; and, from the loss of its contractile power, it no longer evacuates the urine. When, then, the urine is stopped, there is fulness of the parts above, namely, the kidneys; distension of the ureters, grievous pain of the loins, spasms, tremblings, rigors, alienation of mind. But if it suffer from an ulcer or inflammation, there are, indeed, many bad symptoms; but death from the ulcers is by far the most speedy. With regard, however, to the ulceration and purulent abscess, and those other affections which are not very acute, they will be treated of among the chronic diseases; but such as are acute, and prove fatal in fourteen days, or a little earlier or later, such as inflammation, thrombus, or a stone falling down to the neck of the bladder, of these I will now treat. If, therefore, any of these occur, there is retention of urine; swelling in the hypogastric region; acute pain all over the abdomen; distension of the bladder; a sallow sweat on the tenth day; vomitings of phlegm, then of bile; coldness of the whole body, but especially of the feet: but, if the mischief spread farther, there come on fevers attended with hiccup, pulse irregularly frequent and small, redness of the countenance, thirst, distress of mind, delirium, spasms. From deleterious substances, such as cantharides and buprestis, both the bladder is distended with flatus, and the whole belly suffers violence; and all things get worse, and death cannot be long delayed.

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The bladder also sometimes suffers from hemorrhage; the blood there is bright and thin, but the patients never die from it, although it may not be easy to stop. But from the clots and the inflammation there is danger; for the coldness, mortification, gangrene, and the other evils consequent upon it readily prove fatal.

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Winter and autumn bring on these diseases. As to age, manhood, but still more old age. The other seasons and periods of life do not generally produce the diseases, and they very rarely prove fatal. Of all others, infants are most free from danger.

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CHAPTER XI. ON HYSTERICAL SUFFOCATION +

IN the middle of the flanks of women lies the womb, a female viscus, closely resembling an animal; for it is moved of itself hither and thither in the flanks, also upwards in a direct line to below the cartilage of the thorax, and also obliquely to the right or to the left, either to the liver or spleen; and it likewise is subject to prolapsus downwards, and, in a word, it is altogether erratic. It delights, also, in fragrant smells, and advances towards them; and it has an aversion to fetid smells, and flees from them; and, on the whole, the womb is like an animal within an animal.

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When, therefore, it is suddenly carried upwards, and remains above for a considerable time, and violently compresses the intestines, the woman experiences a choking, after the form of epilepsy, but without convulsions. For the liver, diaphragm, lungs and heart, are quickly squeezed within a narrow space; and therefore loss of breathing and of speech seems to be present. And, moreover, the carotids are compressed from sympathy with the heart, and hence there is heaviness of head, loss of sensibility, and deep sleep.

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And in women there also arises another affection resembling this form, with sense of choking and loss of speech, but not proceeding from the womb; for it also happens to men, in the manner of catochus. But those from the uterus are remedied by fetid smells, and the application of fragrant things to the female parts; but in the others these things do no good; and the limbs are moved about in the affection from the womb, but in the other affection not at all. Moreover, voluntary and involuntary tremblings . . . . . . . . . . . but from the application of a pessary to induce abortion, powerful congelation of the womb, the stoppage of a copious hemorrhage, and such like.

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If, therefore, upon the womb’s being moved upwards, she begin to suffer, there is sluggishness in the performance of her offices, prostration of strength, atony, loss of the faculties of her knees, vertigo, and the limbs sink under her; headache, heaviness of the head, and the woman is pained in the veins on each side of the nose.

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But if they fall down they have heartburn . . . . . in the hypochondriac regions; flanks empty, where is the seat of the womb; pulse intermittent, irregular, and failing; strong sense of choking; loss of speech and of sensibility; respiration imperceptible and indistinct; a very sudden and incredible death, for they have nothing deadly in their appearance; in colour like that of life, and for a considerable time after death they are more ruddy than usual; eyes somewhat prominent, bright, not entirely fixed, but yet not very much turned aside.

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But if the uterus be removed back to its seat before the affection come to a conclusion, they escape the suffocation. When the belly rumbles there is moisture about the female parts, respiration thicker and more distinct, a very speedy rousing up from the affection, in like manner as death is very sudden; for as it readily ascends to the higher regions, so it readily recedes. For the uterus is buoyant, but the membranes, its supporters, are humid, and the place is humid in which the uterus lies; and, moreover, it flees from fetid things, and seeks after sweet: wherefore it readily inclines to this side and to that, like a log of wood, and floats upwards and downwards. For this reason the affection occurs in young women, but not in old. For in those in whom the age, mode of life, and understanding is more mobile, the uterus also is of a wandering nature; but in those more advanced in life, the age, mode of living, understanding, and the uterus are of a steady character. Wherefore this suffocation from the womb accompanies females alone.

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But the affections common to men happen also to the uterus, such as inflammation and hemorrhage, and they have the common symptoms; namely, fever, asphexy, coldness, loss of speech. But in hemorrhage the death is even more sudden, being like that of a slaughtered animal.

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CHAPTER XII. ON SATYRIASIS +

THE Satyrs, sacred to Bacchus, in the paintings and statues, have the member erect, as the symbol of the divine performance. It is also a form of disease, in which the patient has erection of the genital organ, the appellation of Satyriasis being derived from its resemblance to the figure of the god.

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It is an unrestrainable impulse to connection; but neither are they at all relieved by these embraces, nor is the tentigo soothed by many and repeated acts of sexual intercourse. Spasms of all the nerves, and tension of all the tendons, groins, and perineum, inflammation and pain of the genital parts, redness of countenance, and a dewy moisture. Wrapped up in silent sorrow, they are stupid, as if grievously afflicted with their calamity. But if the affection overcome the patient’s sense of shame, he will lose all restraint of tongue as regards obscenity, and likewise all restraint in regard to the open performance of the act, being deranged in understanding as to indecency; for they cannot restrain themselves, are thirsty, and vomit much phlegm. Afterwards, froth settles on their lips, as is the case with goats in the season of rutting, and the smell likewise is similar. The urine, after long retention, is white, thick, and like semen; bowels constipated; spontaneous titillations of the sides and arm-pits; they have convulsions, loathe food, or, if presented to them, they snatch it confusedly.

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But if the illness tend to death, they become flatulent, belly protuberant, tension of the tendons and of all the muscles, difficulty of movement, contraction of the limbs, pulse small, weak, and irregular.

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All these symptoms have been sometimes removed by copious discharges from the bowels of phlegm and bile, and by vomiting in like manner, not without danger. The proper cure is deep and very protracted sleep; for much sleep induces coldness, paralysis, and torpor of the nerves; and torpidity and refrigeration cure Satyriasis.

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The affection, for the most part, is formed in spring and summer. Of the periods of life, it occurs principally in boys and striplings, more especially in such as are naturally prone to sexual intercourse. It is a most acute, disgusting, and unseemly ailment. For the most part, the patients die on the seventh day. It is said, that women also suffer from this affection; that they have the same impulse to venery, and the other symptoms the same. I believe, indeed, that lust is engendered in women of a humid temperament, so as to induce a copious discharge of the superfluous humours; but I do not at all believe that they are affected with Satyriasis, for their nature, being cold, is not adapted to it. But neither, also, has woman the parts necessary for erection, like those of a Satyr, whence the affection derives its name; and neither also are men subject to suffocation from the womb, because men have not an uterus.

 diff --git a/data/tlg0719/tlg001/tlg0719.tlg001.perseus-eng2.xml b/data/tlg0719/tlg001/tlg0719.tlg001.perseus-eng2.xml new file mode 100644 index 000000000..bba55f7a5 --- /dev/null +++ b/data/tlg0719/tlg001/tlg0719.tlg001.perseus-eng2.xml @@ -0,0 +1,209 @@ + + + + + + + On the Causes and Symptoms of Acute Diseases + Aretaeus of Cappadocia + Francis Adams + + Gregory Crane + + Prepared under the supervision of + Bridget Almas + Lisa Cerrato + Rashmi Singhal + + National Library of Medicine History of Medicine Division + + + Cultural Heritage Language Technologies + Kansas City Missouri + February 1, 2005 + + Trustees of Tufts University + Medford, MA + Perseus Digital Library Project + Perseus 4.0 + tlg0719.tlg001.perseus-eng2.xml + + Available under a Creative Commons Attribution-ShareAlike 4.0 International License + + + + + + + The Extant Works of Aretaeus, The Cappadocian + Aretaeus of Cappadocia + Francis Adams + + London + Syndenham Society + 1856 + + + Boston + Milford House Inc. + 1972 + + + Internet Archive + + + + + + + +

Data Entry

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This pointer pattern extracts book and chapter.

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This pointer pattern extracts book.

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BOOK I. +
CHAPTER V. ON THE PAROXYSM OF EPILEPTICS +

* * * * sluggishness, vertigo, heaviness of the tendons, plethora and distension of the veins in the neck; and much nausea indeed after food, but also, not unfrequently, with abstinence, there is a faint nausea; and phlegm is often vomited; want of appetite and indigestion after little food: they have flatulence and meteorism in the hypochondria. These symptoms, indeed, are constant.

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But, if it be near the accession of the paroxysm, there are before the sight circular flashes of purple or black colours, or of all mixed together, so as to exhibit the appearance of the rainbow expanded in the heavens; noises in the ears; a heavy smell; they are passionate, and unreasonably peevish. They fall down then, some from any such cause as lowness of spirits, but others from gazing intently on a running stream, a rolling wheel, or a turning top. But sometimes the smell of heavy odours, such as of the gagate stone (jet), makes them fall down. In these cases, the ailment is fixed in the head, and from it the disorder springs; but, in others, it arises also from the nerves remote from the head, which sympathise with the primary organ. Wherefore the great fingers of the hands, and the great toes of the feet are contracted; pain, torpor, and trembling succeed, and a rush of them to the head takes place. If the mischief spread until it reach the head, a crash takes place, in these cases, as if from the stroke of a piece of wood, or of stone; and, when they rise up, they tell how they have been maliciously struck by some person. This deception occurs to those who are attacked with the ailment for the first time. But those to whom the affection has become habitual, whenever the disease recurs, and has already seized the finger, or is commencing in any part, having from experience a foreknowledge of what is about to happen, call, from among those who are present, upon their customary assistants, and entreat them to bind, pull aside, and stretch the affected members; and they themselves tear at their own members, as if pulling out the disease; and such assistance has sometimes put off the attack for a day. But, in many cases, there is the dread as of a wild beast rushing upon them, or the phantasy of a shadow; and thus they have fallen down.

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In the attack, the person lies insensible; the hands are clasped together by the spasm; the legs not only plaited together, but also dashed about hither and thither by the tendons. The calamity bears a resemblance to slaughtered bulls; the neck bent, the head variously distorted, for sometimes it is arched, as it were, forwards, so that the chin rests upon the breast; and sometimes it is retracted to the back, as if forcibly drawn thither by the hair, when it rests on this shoulder or on that. They gape wide, the mouth is dry; the tongue protrudes, so as to incur the risk of a great wound, or of a piece of it being cut off, should the teeth come forcibly together with the spasm; the eyes rolled inwards, the eyelids for the most part are separated, and affected with palpitation; but should they wish to shut the lids they cannot bring them together, insomuch that the white of the eyes can be seen from below. The eyebrows sometimes relaxed towards the mesal space, as in those who are frowning, and sometimes retracted to the temples abnormally, so that the skin about the forehead is greatly stretched, and the wrinkles in the intersuperciliary space disappear: the cheeks are ruddy and quivering; the lips sometimes compressed together to a sharp point, and sometimes separated towards the sides, when they are stretched over the teeth, like as in persons smiling.

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As the illness increases lividity of countenance also supervenes, distension of the vessels in the neck, inability of speech as in suffocation; insensibility even if you call loudly. The utterance a moaning and lamentation; and the respiration a sense of suffocation, as in a person who is throttled; the pulse strong, and quick, and small in the beginning,—great, slow, and feeble in the end, and irregular throughout; tentigo of the genital organs. Such sufferings do they endure towards the end of the attack.

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But when they come to the termination of the illness, there are unconscious discharges of the urine, and watery discharges from the bowels, and in some cases an evacuation also of the semen, from the constriction and compression of the vessels, or from the pruriency of the pain, and titillation of the humours; for in these cases the pains are seated in the nerves. The mouth watery; phlegm copious, thick, cold, and, if you should draw it forth, you might drag out a quantity of it in the form of a thread. But, if with length of time and much pain, the matters within the chest ferment, but the restrained spirit (pneuma) agitates all things, and there is a convulsion and disorder of the same, a flood, as it were, of humours swells up to the organs of respiration, the mouth, and the nose; and if along with the humours the spirit be mixed, it appears like the relief of all the former feelings of suffocation. They accordingly spit out foam, as the sea ejects froth in mighty tempests; and then at length they rise up, the ailment now being at an end. At the termination, they are torpid in their members at first, experience heaviness of the head, and loss of strength, and are languid, pale, spiritless, and dejected, from the suffering and shame of the dreadful malady.

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CHAPTER VI. ON TETANUS +

TETANUS, in all its varieties, is a spasm of an exceedingly painful nature, very swift to prove fatal, but neither easy to be removed. They are affections of the muscles and tendons about the jaws; but the illness is communicated to the whole frame, for all parts are affected sympathetically with the primary organs. There are three forms of the convulsion, namely, in a straight line, backwards, and forwards. Tetanus is in a direct line, when the person labouring under the distention is stretched out straight and inflexible. The contractions forwards and backwards have their appellation from the tension and the place; for that backwards we call Opisthotonos; and that variety we call Emprosthotonos in which the patient is bent forwards by the anterior nerves. For the Greek word τόνος is applied both to a nerve, and to signify tension.

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The causes of these complaints are many; for some are apt to supervene on the wound of a membrane, or of muscles, or of punctured nerves, when, for the most part, the patients die; for, spasm from a wound is fatal. And women also suffer from this spasm after abortion; and, in this case, they seldom recover. Others are attacked with the spasm owing to a severe blow in the neck. Severe cold also sometimes proves a cause; for this reason, winter of all the seasons most especially engenders these affections; next to it, spring and autumn, but least of all summer, unless when preceded by a wound, or when any strange diseases prevail epidemically. Women are more disposed to tetanus than men, because they are of a cold temperament; but they more readily recover, because they are of a humid. With respect to the different ages, children are frequently affected, but do not often die, because the affection is familiar and akin to them; striplings are less liable to suffer, but more readily die; adults least of all, whereas old men are most subject to the disease, and most apt to die; the cause of this is the frigidity and dryness of old age, and the nature of the death. But if the cold be along with humidity, these spasmodic diseases are more innocent, and attended with less danger.

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In all these varieties, then, to speak generally, there is a pain and tension of the tendons and spine, and of the muscles connected with the jaws and cheek; for they fasten the lower jaw to the upper, so that it could not easily be separated even with levers or a wedge. But if one, by forcibly separating the teeth, pour in some liquid, the patients do not drink it but squirt it out, or retain it in the mouth, or it regurgitates by the nostrils; for the isthmus faucium is strongly compressed, and the tonsils being hard and tense, do not coalesce so as to propel that which is swallowed. The face is ruddy, and of mixed colours, the eyes almost immoveable, or are rolled about with difficulty; strong feeling of suffocation; respiration bad, distension of the arms and legs; subsultus of the muscles; the countenance variously distorted; the cheeks and lips tremulous; the jaw quivering, and the teeth rattling, and in certain rare cases even the ears are thus affected. I myself have beheld this and wondered! The urine is retained, so as to induce strong dysuria, or passes spontaneously from contraction of the bladder. These symptoms occur in each variety of the spasms.

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But there are peculiarities in each; in Tetanus there is tension in a straight line of the whole body, which is unbent and inflexible; the legs and arms are straight.

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Opisthotonos bends the patient backward, like a bow, so that the reflected head is lodged between the shoulder-blades; the throat protrudes; the jaw sometimes gapes, but in some rare cases it is fixed in the upper one; respiration stertorous; the belly and chest prominent, and in these there is usually incontinence of urine; the abdomen stretched, and resonant if tapped; the arms strongly bent back in a state of extension; the legs and thighs are bent together, for the legs are bent in the opposite direction to the hams.

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But if they are bent forwards, they are protuberant at the back, the loins being extruded in a line with the back, the whole of the spine being straight; the vertex prone, the head inclining towards the chest; the lower jaw fixed upon the breast bone; the hands clasped together, the lower extremities extended; pains intense; the voice altogether dolorous; they groan, making deep moaning. Should the mischief then seize the chest and the respiratory organs, it readily frees the patient from life; a blessing this, to himself, as being a deliverance from pains, distortion, and deformity; and a contingency less than usual to be lamented by the spectators, were he a son or a father. But should the powers of life still stand out, the respiration, although bad, being still prolonged, the patient is not only bent up into an arch but rolled together like a ball, so that the head rests upon the knees, while the legs and back are bent forwards, so as to convey the impression of the articulation of the knee being dislocated backwards.

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An inhuman calamity! an unseemly sight! a spectacle painful even to the beholder! an incurable malady! owing to the distortion, not to be recognised by the dearest friends; and hence the prayer of the spectators, which formerly would have been reckoned not pious, now becomes good, that the patient may depart from life, as being a deliverance from the pains and unseemly evils attendant on it. But neither can the physician, though present and looking on, furnish any assistance, as regards life, relief from pain or from deformity. For if he should wish to straighten the limbs, he can only do so by cutting and breaking those of a living man. With them, then, who are overpowered by the disease, he can merely sympathise. This is the great misfortune of the physician.

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CHAPTER VII. ON ANGINA, OR QUINSEY +

ANGINA is indeed a very acute affection, for it is a compression of the respiration. But there are two species of it; for it is either an inflammation of the organs of respiration, or an affection of the spirit (pneuma) alone, which contains the cause of the disease in itself.

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The organs affected are, the tonsils, epiglottis, pharynx, uvula, top of the trachea; and, if the inflammation spread, the tongue also, and internal part of the fauces, when they protrude the tongue outside the teeth, owing to its abnormal size; for it fills the whole of the mouth, and the protuberance thereof extends beyond the teeth. This species is called Cynanche, either from its being a common affection of those animals, or from its being a customary practice for dogs to protrude the tongue even in health.

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The opposite symptoms attend the other species; namely, collapse of the organs, and diminution of the natural size, with intense feeling of suffocation, insomuch that it appears to themselves as if the inflammation had disappeared to the internal parts of the thorax, and had seized upon the heart and lungs. This we call Synanche, as if from the disease inclining inwardly and producing suffocation. It appears to me that this is an illness of the spirit (pneuma) itself, which has under-gone a morbid conversion to a hotter and drier state, without any inflammation of the organ itself. Nor is this any great wonder. For in the Charonæan caves the most sudden suffocations occur from no affection of any organ,The Charonæan ditches or pits here mentioned, were in Phrygia. See Strabo, xii. 8. They are mentioned by Galen, de usu partium, vii.; Epid. i.t. xvii. p. 10, ed. Kühn; and Pliny, H.N. vii. 93. Their pestilential exhalations are often noticed by ancient authors. but the persons die from one inspiration, before the body can sustain any injury. But likewise a man will be seized with rabies, from respiring the effluvia of the tongue of a dog, without having been bitten. It is not impossible then, that such a change of the respiration should occur within, since many other phenomena which occur in a man bear a resemblance to external causes, such as juices which become spoiled both within and without. And diseases resemble deleterious substances, and men have similar vomitings from medicines and from fevers. Hence, also, it was not a wonderful thing, that in the plague of Athens, certain persons fancied that poisonous substances had been thrown into the wells in the Piræus by the Peloponnesians; for these persons did not perceive the affinity between a pestilential disease and deleterious substances.

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Cases of Cynanche are attended with inflammation of the tonsils, of the fauces, and of the whole mouth; the tongue protrudes beyond the teeth and lips; they have salivation, the phlegm running out very thick and cold; they have their faces ruddy and swollen; their eyes protuberant, wide open, and red; the drink regurgitates by the nostrils. The pains violent, but obscured by the urgency of the suffocation; the chest and heart are in a state of inflammation; there is a longing for cold air, yet they inspire but little, until they are suffocated from the obstruction of the passage to the chest. In certain cases, there is a ready transference of the disease to the chest, and these die from the metastasis; the fevers feeble, slight, bringing no relief. But if, in any case, there is a turn to the better, abscesses form on either side, near the ears externally, or internally about the tonsils; and if these occur with torpor, and are not very protracted, the patients recover, indeed, but with pain and danger. But, if a particularly large swelling should occur, in such cases as are converted to an abscess, and the abscess is raised to a point, they are quickly suffocated. Such are the peculiar symptoms of cynanche.

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Those of Synanche are, collapse, tenuity, and paleness; the eyes hollow, sunk inwardly; the fauces and uvula retracted upwards, the tonsils approaching one another still more; loss of speech: the feeling of suffocation is much stronger in this species than in the former, the mischief being seated in the chest whence the source of respiration. In the most acute cases, the patients die the same day, in some instances, even before calling in the physician; and in others, although called in, he could afford them no relief, for they died before the physician could apply the resources of his art. In those in which the disease takes a favourable turn, all the parts become inflamed, the inflammation being determined outwardly, so that the disease becomes cynanche in place of synanche. It is also a good thing when a strong swelling, or erysipelas, appears externally on the chest. And the skilful physician diverts the mischief to the chest by means of the cupping-instrument, or by applying mustard to the breast and the parts near the jaws he determines outwardly and discusses the disease. In certain cases, indeed, the evil by these means has been for a time driven outwards, but when so driven out it speedily reverts, and produces suffocation.

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The causes are infinite, more especially exposure to cold, and, less frequently, to heat; blows; fish-bones fixed in the tonsils, cold draughts, intoxication, repletion, and the ills from respiration.

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CHAPTER VIII. ON THE AFFECTIONS ABOUT THE UVULA +

THE solid body suspended from the roof of the mouth between the two tonsils is called columella and gurgulio. Uva is the name of the affection. The columella (uvula) is of a nervous nature, but humid, for it is situated in a humid region. Wherefore this body, the columella, suffers from various affections, for it becomes thickened from inflammation, being elongated and of equal thickness from the base to the extremity, and is attended with redness. Columna is the appellation of this affection. If it be rounded towards the extremity alone, and with its enlargement become livid and darkish, the name of the affection is Uva; for it altogether resembles a grape in figure, colour, and size. A third affection is that of the membranes when they have the appearance of broad sails, or the wings of bats, on this side and on that. This is called Lorum, for the lengthened folds of the membranes resemble thongs. But if the columella terminates in a slender and elongated membrane, having at its extremity a resemblance to the butt-end of a spear, it gets the name of Fimbria. This affection arises spontaneously from a defluxion, like the others, but also from an oblique incision when the surgeon leaves the membrane at one side.Our author alludes here to the surgical operation, excision of the tonsils, described by Paulus Ægineta, vi. 30. But if the organ (uvula) become bifid with two membranes hanging on this side and on that, it has no distinct appellation, but it is an easy matter for any one who sees it to recognise the nature of the disease.

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A sense of suffocation accompanies all these affections, and they can by no means swallow with freedom. There is cough in all the varieties, but especially in those named lorum and fimbria. For a titillation of the trachea is produced by the membrane, and in some cases it secretly instils some liquid into the windpipe, whence they cough. But in uva and columella there is still more dyspnœa and very difficult deglutition; for, in these cases, the fluid is squeezed up to the nostrils, from sympathy of the tonsils. The columella is common in old persons, the uva in the young and in adults; for they abound in blood, and are of a more inflammatory nature. The affections of the membranes are common in puberty and infancy. It is safe to apply the knife in all these varieties; but in the uva, while still red, hemorrhage, pains, and increase of inflammation supervene.

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CHAPTER IX. ON ULCERATIONS ABOUT THE TONSILS +

ULCERS occur on the tonsils; some, indeed, of an ordinary nature, mild and innocuous; but others of an unusual kind, pestilential, and fatal. Such as are clean, small, superficial, without inflammation and without pain, are mild; but such as are broad, hollow, foul, and covered with a white, livid, or black concretion, are pestilential. Aphtha is the name given to these ulcers. But if the concretion has depth, it is an Eschar and is so called: but around the eschar there is formed a great redness, inflammation, and pain of the veins, as in carbuncle; and small pustules form, at first few in number, but others coming out, they coalesce, and a broad ulcer is produced. And if the disease spread outwardly to the mouth, and reach the columella (uvula) and divide it asunder, and if it extend to the tongue, the gums, and the alveoli, the teeth also become loosened and black; and the inflammation seizes the neck; and these die within a few days from the inflammation, fever, fœtid smell, and want of food. But, if it spread to the thorax by the windpipe, it occasions death by suffocation within the space of a day. For the lungs and heart can neither endure such smells, nor ulcerations, nor ichorous discharges, but coughs and dyspnœa supervene.

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The cause of the mischief in the tonsils is the swallowing of cold, rough, hot, acid, and astringent substances; for these parts minister to the chest as to the purposes of voice and respiration; and to the belly for the conveyance of food; and to the stomach for deglutition. But if any affection occur in the internal parts, namely, the belly, the stomach, or the chest, an ascent of the mischief by the eructations takes place to the isthmus faucium, the tonsils, and the parts there; wherefore children, until puberty, especially suffer, for children in particular have large and cold respiration; for there is most heat in them; moreover, they are intemperate in regard to food, have a longing for varied food and cold drink; and they bawl loud both in anger and in sport; and these diseases are familiar to girls until they have their menstrual purgation. The land of Egypt especially engenders it, the air thereof being dry for respiration, and the food diversified, consisting of roots, herbs of many kinds, acrid seeds, and thick drink; namely, the water of the Nile, and the sort of ale prepared from barley. Syria also, and more especially Cœlosyria, engenders these diseases, and hence they have been named Egyptian and Syrian ulcers.

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The manner of death is most piteous; pain sharp and hot as from carbuncle;The term in the original, ἄνθραξ, may either signify a live coal, or the disease Carbuncle. See Paulus Ægineta, iv. 25. It is somewhat doubtful to which of these significations our author applies it here; indeed, the former would be the more emphatic. respiration bad, for their breath smells strongly of putrefaction, as they constantly inhale the same again into their chest; they are in so loathsome a state that they cannot endure the smell of themselves; countenance pale or livid; fever acute, thirst is if from fire, and yet they do not desire drink for fear of the pains it would occasion; for they become sick if it compress the tonsils, or if it return by the nostrils; and if they lie down they rise up again as not being able to endure the recumbent position, and, if they rise up, they are forced in their distress to lie down again; they mostly walk about erect, for in their inability to obtain relief they flee from rest, as if wishing to dispel one pain by another. Inspiration large, as desiring cold air for the purpose of refrigeration, but expiration small, for the ulceration, as if produced by burning, is inflamed by the heat of the respiration. Hoarseness, loss of speech supervene; and these symptoms hurry on from bad to worse, until suddenly falling to the ground they expire.

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CHAPTER X. ON PLEURISY +

UNDER the ribs, the spine, and the internal part of the thorax as far as the clavicles, there is stretched a thin strong membrane, adhering to the bones, which is named succingens. When inflammation occurs in it, and there is heat with cough and parti-coloured sputa, the affection is named Pleurisy. But all these symptoms must harmonise and conspire together as all springing from one cause; for such of them as occur separately from different causes, even if they all occur together, are not called pleurisy. It is accompanied by acute pain of the clavicles; heat acrid; decubitus on the inflamed side easy, for thus the membrane (pleura) remains in its proper seat, but on the opposite side painful; for by its weight, the inflammation and suspension of the membrane, the pain stretches to all its adhesions at the shoulders and clavicles; and in certain cases even to the back and shoulder blade; the ancients called this affection Dorsal pleurisy. It is attended with dyspnœa, insomnolency, anorexia, florid redness of the cheeks, dry cough, difficult expectoration of phlegm, or bilious, or deeply tinged with blood, or yellowish; and these symptoms observe no order, but come and go irregularly; but, worst of all, if the bloody sputa cease, and the patients become delirious; and sometimes they become comatose, and in their somnolency the mind wavers.

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But if the disease take a bad turn, all the symptoms getting worse, they die within the seventh day by falling into syncope; or, if the commencement of the expectoration, and the more intense symptoms occurred with the second hebdomad, they die on the fourteenth day. It sometimes happens that in the intermediate period there is a transference of all the symptoms to the lungs; for the lung attracts to itself, being both porous and hot, and being moved for the attraction of the substances around, when the patient is suddenly suffocated by metastasis of the affection. But if the patient pass this period, and do not die within the twentieth day, he becomes affected with empyema. These, then, are the symptoms if the disease get into a bad state.

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But if it take a favourable turn, there is a profuse hemorrhage by the nostrils, when the disease is suddenly resolved; then follow sleep and expectoration of phlegm, and afterwards of thin, bilious matters; then of still thinner, and again of bloody, thick, and flesh-like; and if, with the bloody, the bile return, and with it the phlegm, the patient’s convalescence is secure; and these symptoms, if they should commence on the third day, with an easy expectoration of smooth, consistent, liquid, and (not) rounded sputa, the resolution takes place on the seventh day, when, after bilious discharges from the bowels, there is freedom of respiration, the mind settled, fever diminishing, and return of appetite. But if these symptoms commence with the second week, the resolution occurs on the fourteenth day.

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But if not so, it is converted into Empyema, as indicated by rigors, pungent pains, the desire of sitting erect, and the respiration becoming worse. It is then to be dreaded, lest, the lungs suddenly attracting the pus, the patient should be thereby suffocated, after having escaped the first and greater evils. But if the abscess creep in between the ribs and separate them, and point outwardly; or, if it burst into an intestine, for the most part the patient recovers.

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Among the seasons of the year winter most especially engenders the disease; next, autumn; spring, less frequently; but summer most rarely. With regard to age, old men are most apt to suffer, and most readily escape from an attack; for neither is there apt to be a great inflammation in an arid frame; nor is there a metastasis to the lungs, for old age is more frigid than any other age, and the respiration small, and the attraction of all things deficient. Young men and adults are not, indeed, very apt to suffer attacks; but neither, also, do they readily recover, for from a slight cause they would not experience even a slight attack of inflammation, and from great attacks there is greater danger. Children are least of all liable to pleurisy, and in their case it is less frequently fatal; for their bodies are rare, secretions copious, perspiration and exhalation abundant; hence neither is a great inflammation formed. This is the felicity of their period of life in the present affection.

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BOOK II. +
CHAPTER I. ON PNEUMONIA +

ANIMALS live by two principal things, food and breath (spirit, pneuma); of these by far the most important is the respiration, for if it be stopped, the man will not endure long, but immediately dies. The organs of it are many, the commencement being the nostrils; the passage, the trachea; the containing vessel, the lungs; the protection and receptacle of the lungs, the thorax. But the other parts, indeed, minister only as instruments to the animal; but the lungs also contain the cause of attraction, for in the midst of them is seated a hot organ, the heart, which is the origin of life and respiration. It imparts to the lungs the desire of drawing in cold air, for it raises a heat in them; but it is the heart which attracts. If, therefore, the heart suffer primarily, death is not far off.

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But if the lungs be affected, from a slight cause there is difficulty of breathing; the patient lives miserably, and death is the issue, unless some one effects a cure. But in a great affection, such as inflammation, there is a sense of suffocation, loss of speech and of breathing, and a speedy death. This is what we call Peripneumonia, being an inflammation of the lungs, with acute fever, when they are attended with heaviness of the chest, freedom from pain, provided the lungs alone are inflamed; for they are naturally insensible, being of loose texture, like wool. But branches of the aspera arteria are spread through them, of a cartilaginous nature, and these, also, are insensible; muscles there are nowhere, and the nerves are small, slender, and minister to motion. This is the cause of the insensibility to pain. But if any of the membranes, by which it is connected with the chest, be inflamed, pain also is present; respiration bad, and hot; they wish to get up into an erect posture, as being the easiest of all postures for the respiration. Ruddy in countenance, but especially the cheeks; the white of the eyes very bright and fatty; the point of the nose flat; the veins in the temples and neck distended; loss of appetite; pulse, at first, large, empty, very frequent, as if forcibly accelerated; heat indeed, externally, feeble, and more humid than natural, but, internally, dry, and very hot, by means of which the breath is hot; there is thirst, dryness of the tongue, desire of cold air, aberration of mind; cough mostly dry, but if anything be brought up it is a frothy phlegm, or slightly tinged with bile, or with a very florid tinge of blood. The blood-stained is of all others the worst.

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But if the disease tend to a fatal termination, there is insomnolency; sleep brief, heavy, of a comatose nature; vain fancies; they are in a doting state of mind, but not violently delirious; they have no knowledge of their present sufferings. If you interrogate them respecting the disease, they will not acknowledge any formidable symptom; the extremities cold; the nails livid, and curved; the pulse small, very frequent, and failing, in which case death is near at hand, for they die mostly on the seventh day.

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But if the disease abate and take a favourable turn, there is a copious hemorrhage from the nose, a discharge from the bowels of much bilious and frothy matters, such as might seem to be expelled from the lungs to the lower belly, provided it readily brings off much in a liquid state. Sometimes there is a determination to the urine. But they recover the most speedily in whose cases all these occur together.

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In certain cases much pus is formed in the lungs, or there is a metastasis from the side, if a greater symptom of convalescence be at hand. But if, indeed, the matter be translated from the side to the intestine or bladder, the patients immediately recover from the peripneumony; but they have a chronic abscess in the side, which, however, gets better. But if the matter burst upon the lungs, some have thereby been suffocated, from the copious effusion and inability to bring it up. But such as escape suffocation from the bursting of the abscess, have a large ulceration in the lungs, and pass into phthisis; and from the abscess and phthisis old persons do not readily recover; but from the peripneumony, youths and adults.

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CHAPTER II. ON THE BRINGING UP OF BLOOD +

THERE are two species of the discharge of blood by the mouth. The one that by the mouth from the head and the vessels there; the passage is by the palate and fauces, where are situated the commencement of the œsophagus and trachea; and with hawking, and small and more urgent cough, they eructate the blood into the mouth; whereas, in that from the mouth, neither does hawking accompany, and it is called Emptysis [or spitting of blood]. But when the discharge is more scanty, and by drops, or when it comes more copiously from the head, or from the mouth, it is no longer called a bringing up, but either the same, or a spitting, or a hemorrhage. But if it ascend from the chest, and the viscera there, the lungs, aspera arteria, the parts about the spine, the discharge from these is not called a spitting, but a bringing up (in Greek, ἀναγωγή, the name being expressive of its coming upwards).Cælius Aurelianus, under the head of Sanguinis fluor, thus explains the term:—Improprium est enim fluorem vocare id quod ascensu quodam non lapsu fertur. Sed hæc Græci versa vice posuerunt, derivationem nominis intuentes. Hi enim anagogen vocant quod magis ex inferioribus ad superiora fluorem significat.—Tard. pass. iii. 9. We are at a loss for a proper vocable in English to express this term. It is usually translated rejectio in Latin, which, however, is not sufficiently expressive. The most suitable in English, which I can think of, is a bringing up.

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The symptoms of both are partly common, small and few in number, such as the seat of them, in which there is a coincidence between the bringing up and the spitting. But the peculiarities of each are great, many, and of vital importance, by which it is easy to distinguish either of them from the other. If, therefore, it came from the head, with a large discharge of blood, greater and more numerous symptoms will arise, but scanty from a slight and small spitting; in these cases, there is heaviness of the head, pain, noises of the ears, redness of countenance, distension of the veins, vertigo; and these are preceded by some obvious cause, such as a blow, exposure to cold, or heat, or intoxication; for drinking of wine speedily fills the head, and speedily empties it, by the bursting of a vessel; but from a slight intoxication there may be spitting, proceeding from rarefaction. Occasionally an habitual hemorrhage from the nostrils is stopped, and being diverted to the palate, produces the semblance of a bringing up of blood. If, therefore, it be from the head, there is titillation of the palate, frequent hawking, and with it a copious spitting takes place; a desire supervenes, and they readily cough. But if it flow into the aspera arteria from the palate, they then bring it up by coughing, and this it is which deceives them into the supposition that it comes from the viscera below. It runs, also, from the head into the stomach, when it is vomited up with nausea, and thus proves a source of deception, as appearing to come from the stomach. The blood brought up by spitting is not very thick, but dark in colour, smooth, consistent, unmixed with other substances; for, being hawked up, it comes immediately upon the tongue in a round shape, being readily separated; and if you examine the roof of the palate, you will find it thickened and ulcerated, and, for the most part, bloody; and a slight and simple plan of treatment will suffice, namely, astringents applied to the palate in a cold state; for by hot, relaxing, and dilating applications the flow is increased, and this is an indication that the spitting is from the head, in which case evacuations are to be made from the head by the veins, the nostrils, or by any other channel of discharge. And these things must be done speedily; for if the blood is discharged a considerable time, the flow will become permanent, and the parts there will contract the habit of receiving the blood. The trachea, also, becomes ulcerated, and the patients cough instead of hawking; and this proves the commencement of a consumption.

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The flow of blood from the chest and viscera below is called a bringing up (in Greek, ἀναγωγή). It is truly of a fatal nature, if it proceed from any of the vital parts which are ruptured—either the vena cava in the heart, which conveys the blood from the liver, or from the large vein which lies along the spine. For from hemorrhage, as from slaughtering or impeded respiration, death is very speedy. But in those cases in which the blood comes from the lungs, the side, or the trachea, they do not die so speedily; but, nevertheless, they become affected with Empyema and Phthisis. Of these the least formidable is that from the trachea. But if the vomiting come from the stomach or bowels, the cases are not of a very fatal nature, even though the hemorrhage be large; neither is the recovery slow and changeable. But if it proceed from the liver and spleen, it is neither readily nor constantly discharged upwards, but the defluxion is more easy into the stomach and intestines. Yet neither is the discharge upwards by the lungs impossible or incredible, for in fevers there occur hemorrhages of blood from the liver and spleen by the nostrils, the blood flowing from the nostril on the same side as the viscus from which it comes. These, then, are the places from which the blood comes in the bringing up, and such the differences as to danger or mortality.

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But the modes are three; for it is brought up either from rupture of a vessel, or from erosion, or from rarefaction. Rupture, then, takes place suddenly, either from a blow, straining at a load, or lifting a weight upward, or a leap from a height, or from bawling aloud, from violent passion, or some other similar cause, when blood is instantly poured forth from the vessel in great quantity.

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But if it proceed from erosion, the patient is to be interrogated if he ever had a cough before, or was affected with dyspnœa, and whether nausea or vomiting ever afflicted him previously. For from such chronic affections the vessels are corroded by a continued, copious, and acrid defluxion. When, therefore, the containing vessels, having been long wasted and attenuated, at length give way, they pour forth blood.

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But the mode by rarefaction is, indeed, unattended by rupture, and on that account the discharge is neither copious nor sudden, nor does it consist of thick blood; for by the rarefaction of the vessels, the thin portion is excreted. But if much collect in a cavity, and be again brought up, it becomes thicker than natural, but yet not very thick, neither black, like a clot; but it is quickly brought up in greater quantity, as being from a collection. This mode of bringing up blood is common with women who have not their monthly purgation, and appears at the periods of the purgation, and stops during the intervals between them; and if the woman is not cured, the discharge upwards of blood will revert for many periods, and also, in certain cases, the vessels burst from fulness.

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And there is a difference of the discharge, whether it be brought up from an artery or a vein. For it is black, thick, and readily coagulates, if from a vein; it is less dangerous, and is more speedily stopped; but if from an artery, it is of a bright yellow colour and thin, does not readily coagulate, the danger is more imminent, and to stop it is not so easy; for the pulsations of the artery provoke the hemorrhage, and the lips of the wound do not coalesce from the frequent movements of the vessel.

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Recovery, if from erosion, is protracted, difficult, and doubtful; for, owing to loss of substance, the parts of the ulcer do not come together, for it is an ulcer, and not a wound; and adhesion takes place more readily in ruptures, for the lips of the wound touch one another. This, then, is another difference as to danger. The mode attended with least danger is that from rarefaction; and in it the styptic and refrigerant method of treatment is sufficient.

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The places are to be indicated from which the blood is brought up; for many of the symptoms are common, deception is easy, and the cure different. Blood, then, from erosion is not readily brought up from the stomach, for the coldness and stypticity of the articles of food and drink bring the parts to a state of condensation. Neither, also, are cases from erosion common, although more so than the former; for acrid defluxions do not adhere for any length of time, but are either brought up or are passed downwards. Rupture is more common in the stomach. If, then, any rupture take place, the hemorrhage is not very great, such as that from the thorax; for the veins there are slender, and the arteries also are small. But in appearance the blood is not very black, not intensely yellowish, smooth, or mixed with saliva, being brought up with nausea and vomiting, slight cough, sometimes with some discharge, and sometimes alone, without any expectoration; for the trachea sympathises with the gullet, being extended along and connected with it. There is pinching or constriction of the ulcer from the things swallowed, more especially if they are very cold, hot, or austere; and in certain cases pain is produced in the stomach, extending as far as the back; vomitings of phlegm, and sometimes, when the disease is long protracted, and there has been long abstinence from food, they bring up a great quantity of them; fevers, not of a continual type, but of an irregular kind.

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But, from the stomach, what is brought up may be black and coagulated, even if it proceed from an artery; but if it proceed from a vein, it is much blacker and much more compact; much nausea and vomiting of pituitous and bilious matter; blood mixed up with the food, provided the man had eaten previously, for both the food and the blood are collected together in the same place; eructations frequent and fœtid, and, if much collect together, there is anxiety of mind and vertigo; but if these be vomited they are relieved. They are prostrate in strength, generally affected with a burning heat, and constant pain of the stomach.

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But from the aspera arteria they bring up scanty and very fluid blood, with a cough; or, if they do not bring it up, they cough incessantly. There is a painful feeling in the throat, either a little below or above; voice hoarse and indistinct.

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But if it be from the lungs, the discharge is copious, especially if from erosion, with much cough, of an intense yellow colour, frothy, rounded; so that what is brought up from one part may be distinguished from what is brought up from another. But the defluxion, though contained in a common vessel, from the chest, is diversified after mixture, and you may distinguish parts of them as being portions of the thorax, and parts which have a fleshy appearance as being portions of the lungs. There is heaviness of the chest, freedom from pain, and much redness of the face, particularly in these cases.

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But if brought up from the thorax, pain stretching to the anterior part of the breast is indicative of the ruptured part; cough intense, expectoration difficult, the blood not very fluid, moderately thick, without froth. But if, in passing, the lung be affected by consent, a certain amount of froth is imparted to it, for the passage from the chest to the trachea is by the lungs.

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But if, indeed, from the side there be discharged with cough blood which is black, smooth, fœtid, stinking, as from putrefaction, with acute pain of the side, many die after the manner of pleuritics with fever.

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A season that is humid and hot engenders these affections. Spring is thus humid and hot. Next the summer; autumn less, but winter least of all. They die in summer mostly from hemorrhage, for great inflammations do not readily occur then; secondly, in spring, from inflammation and ardent fevers; but in autumn, attacks of phthisis readily occur.

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In a word, every discharge of blood upwards, even if small, and although the ruptured vessels may have already united, is attended with lowness of spirits, dejection, and despair of life. For who is so firm in mind as to see himself enduring a state resembling that of a slaughtered animal, and yet have no fear of death? For the largest and most powerful animals, such as bulls, die very quickly from loss of blood. That, however, is no great wonder. But this is a mighty wonder: in the discharge from the lungs alone, which is particularly dangerous, the patients do not despair of themselves, even although near the last. The insensibility of the lungs to pain appears to me to be the cause of this; for pain, even although slight, makes one to fear death, and yet, in most cases, it is more dreadful than pernicious; whereas the absence of pain, even in the great illnesses, is attended with absence of the fear of death, and is more dangerous than dreadful.

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CHAPTER III. ON SYNCOPE +

WELL by all means has the physician, and well have the common people succeeded in the appellation of this affection! It is, indeed, the name of a very acute malady; for what is there greater or more acute than the power of Syncope ? and what other name more appropriate for the designation of this matter? what other organ more important than the heart for life or for death? Neither is it to be doubted that syncope is a disease of the heart, or that it is an injury of the vital powers thereof—such is the rapidity and such the mode of the destruction. For the affection is the solution of the bonds of the vital power, being antagonistic to the constitution of the man; for having seized fast thereon, it does not let go its hold, but brings him to dissolution. Nor is it any great wonder; for other diseases are peculiar to, and prove fatal to, certain organs, in which they are engendered, and to which they attach themselves. Thus pestilential and very malignant buboes derive their origin from the liver, but from no other part; tetanus, in like manner, from the nerves, and epilepsy from the head. Thus, therefore, syncope is a disease of the heart and of life. But such persons as regard it to be an affection of the stomach, because by means of food and wine, and in certain cases by cold substances, the powers have been restored and the mischief expelled—these, it would seem to me, ought to hold phrenitis to be a disease of the hair and skin of the head, since the phrenitics are relieved by the shaving and wetting thereof. But to the heart the vicinity of the stomach is most important, for from it the heart draws both what is suitable and what is unsuitable to itself. And by the lungs the heart draws spirit (pneuma) for respiration, but yet the lungs do not hold a primary place in respiration; for the powers are not in the organs, but there where is the original of life and strength: But the stomach is neither the original nor seat of life; and yet one would be injured by atony thereof: for food which proves injurious to the heart does not hurt the stomach itself, but by it the heart; since those dying in such cases have symptoms of heart-affections, namely, pulse small and feeble, bruit of the heart, with violent palpitation, vertigo, fainting, torpor, loss of tone in their limbs, sweating copious and unrestrainable, coldness of the whole body, insensibility, loss of utterance. How should the stomach endure such symptoms? For those peculiar to it are nausea, vomiting, loss of appetite, hiccup, eructation, acidity; whereas in cardiac affections the patients are more acute in their senses, so that they see and hear better than formerly; they are also in understanding more sound, and in mind more pure, not only regarding present things, but also with regard to futurity they are true prophets. These, then, are the powers, not of the stomach, but of the heart, where is the soul and the nature thereof, and to it is to be referred this affection of its powers.

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But this form of disease is a solution of the natural tone from a cold cause and humidity, and therefore they are not affected with heat, either internally or externally, neither do they suffer from thirst, and their breath is cold even when the disease proceeds from strong and ardent fevers, by which syncope is usually kindled up. For when nature is strong, and of the proper temperament, it rules all and commands all, whether humour, spirit (pneuma), or solid, and, by their good order and symmetry, regulates the man in life; but if the bond of nature—that is to say, its tone—be dissolved, then this affection is produced. The original of it is causus, which is in this form.

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CHAPTER IV. ON CAUSUS, OR ARDENT FEVER +

HEAT, indeed, everywhere, both acrid and subtil, but especially in the internal parts; respiration hot, as if from fire; inhalation of air large; desire of cold; dryness of tongue; parchedness of lips and skin; extremities cold; urine intensely tinged with bile; insomnolency; pulse frequent, small, and feeble; eyes clear, glancing, reddish; healthy colour of the countenance.

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But if the affection increase, all appearances become greater and worse; the pulse very small and very frequent; heat very dry and very acrid; intellect wavering; ignorance of all things; they are thirsty; a desire to touch anything cold, whether a wall, a garment, the floor, or a fluid; hands cold, palms thereof very hot, nails livid; breathing thick; perspiration like dew about the forehead and clavicles.

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But if nature attain the extremity of dryness and of heat, the hot is converted into cold, and the parched into humidity; for extreme intensities of things change to the opposite state. When, therefore, the bonds of life are dissolved, this is syncope. Then is there an irrestrainable sweat over all the body; respiration cold, much vapour about the nostrils; they have no thirst, and yet the other parts are parched except the organs of thirst, namely, the mouth and stomach; the urine thin and watery; belly for the most part dry, yet in certain cases the discharges are scanty and bilious; a redundancy of humours; even the bones, being dissolved, run off; and from all parts, as in a river, there is a current outwards.

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As to the state of the soul, every sense is pure, the intellect acute, the gnostic powers prophetic; for they prognosticate to themselves, in the first place, their own departure from life; then they foretell what will afterwards take place to those present, who fancy sometimes that they are delirious; but these persons wonder at the result of what has been said. Others, also, talk to certain of the dead, perchance they alone perceiving them to be present, in virtue of their acute and pure sense, or perchance from their soul seeing beforehand, and announcing the men with whom they are about to associate. For formerly they were immersed in humours, as if in mud and darkness; but when the disease has drained these off, and taken away the mist from their eyes, they perceive those things which are in the air, and with the naked soul become true prophets. But those who have attained such a degree of refinement in their humours and understanding will scarcely recover, the vital power having been already evaporated into air.

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CHAPTER V. ON CHOLERA +

CHOLERA is a retrograde movement of the materiel in the whole body on the stomach, the belly, and the intestines; a most acute illness. Those matters, then, which collect in the stomach, rush upwards by vomiting; but those humours in the belly, and intestines, by the passages downwards. With regard to appearance, then, those things which are first discharged by vomiting, are watery; but those by the anus, liquid and fetid excrement, (for continued indigestion is the cause of this disease); but if these are washed out, the discharges are pituitous, and then bilious. At first, indeed, they are borne easily, and without pain; but afterwards the stomach is affected with retchings, and the belly with tormina.

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But, if the disease become worse, the tormina get greater; there is fainting, prostration of strength in the limbs, anxiety, loss of appetite; or, if they take anything, with much rumbling and nausea, there is discharged by vomiting bile intensely yellow, and the downward discharges are of like kind; spasm, contractions of the muscles in the legs and arms; the fingers are bent; vertigo, hiccup, livid nails, frigidity, extremities cold, and altogether they are affected with rigors.

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But if the disease tend to death, the patient falls into a sweat; black bile, upwards and downwards; urine retained in the bladder by the spasm; but, in fact, sometimes neither is there any urine collected in the bladder, owing to the metastasis of the fluids to the intestine; loss of utterance; pulse very small, and very frequent in the cases affected with syncope; continual and unavailing strainings to vomit; the bowels troubled with tenesmus, dry, and without juices; a painful and most piteous death from spasm, suffocation, and empty vomiting.

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The season of summer, then, engenders this affection; next autumn; spring, less frequently; winter, least of all. With regard to the ages, then, those of young persons and adults; old age least of all; children more frequently than these, but their complaints are not of a deadly nature.

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CHAPTER VI. ON ILEUS +

AN inflammation takes place in the intestines, creating a deadly pain, for many die of intense tormina; but there is also formed a cold dull flatus (pneuma), which cannot readily pass either upwards or downwards, but remains, for the most part rolled up in the small convolutions of the upper intestines, and hence the disease has got the appellation of Ileus (or Volvulus). But if in addition to the tormina, there be compression and softening of the intestines, and the abdomen protrude greatly, it is called Chordapsus, from the Greek word ἕψησις, which signifies softening, and χορδὴ, which is a name for the intestines; and hence the Mesentery, which contains all the nerves, vessels, and membranes that support the intestines, was called ἐπιχορδὶς by the ancients.Both Petit and Ermerins have animadverted on this singular derivation of the term χορδαψός. As Petit remarks, the true derivation is no doubt from ἅπτεσθαι, and χορδή. The Greeks, it is well known, were very fanciful etymologists, of which we have striking proofs in the Cratylus of Plato.

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The cause of Ileus is a continued corruption of much multifarious and unaccustomed food, and repeated acts of indigestion, especially of articles which are apt to excite Ileus, as the ink of the cuttle-fish. And the same effects may be expected from a blow, or cold, or the drinking of cold water largely and greedily in a state of sweating; and in those cases, in which the gut has descended into the scrotum with fæces, and has not been replaced into the belly, or has been restored to its place with violence, in such cases it is customary for the lower intestines to get inflamed.The substance of all the information to be found in the works of the ancient authorities on the subject of Hernia, may be seen in Paulus Ægineta, b.vi., 65, p. 66, Syd. Soc. Edit. I may mention, however, that although there be nothing in the works of the medical authorities which would lead us to suppose that the ancient surgeons were in the practice of operating to relieve incarcerated Hernia, the following passage in one of Martial’s Epigrams would almost lead us to suppose the contrary, Mitius implicitas Alcon secat enterocelas, Epigr. xi. 84; which might be thus translated, The surgeon Alcon inflicts less pain in cutting for incarcerated intestinal hernia. This affection is customary with children, who are subject to indigestion, and they more readily escape from the mischief, owing to their habits and the humidity of their intestines, for they are loose. Old persons do not readily suffer from the complaint, but rarely recover. The season of summer engenders the disease rather than that of spring; autumn, than winter; but the summer more than both.

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Many therefore die speedily of these tormina. But in other cases pus is formed; and then again, the intestine having become black and putrified, has separated, and thus the patients have died. In these cases, provided the Ileus is mild, there is a twisting pain, copious humours in the stomach, loss of tone, languor, vacant eructations bringing no relief, borborygmi in the bowels, the flatus passing down to the anus, but not making its escape.

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But if the attack of Ileus acquire intensity, there is a determination upwards of everything, flatus, phlegm, and bile; for they vomit all these; they are pale, cold over the whole body; much pain; respiration bad, they are affected with thirst.

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If they are about to die, there is cold sweat, dysuria, anus constricted, so that you could not pass a slender metal plate by it;Perhaps he means a needle. See Testa, Mal. del Cuore, t. iii. vomiting of fæces; the patients are speechless; pulse, at last rare and small, but before death very small, very dense, and failing. These symptoms attend the disease in the small intestines.

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But the same affections occur also in the colon, and the symptoms are similar, as also the issue; some of these escape if pus form in the colon, the reason of which is the fleshy thickness of this intestine. The pain is slender and sharp in the small intestines, but broad and heavy in the colon; the pain also sometimes darts up to the ribs, when the disease puts on the appearance of pleurisy; and these, moreover, are affected with fever; but sometimes it extends to the false ribs, on this side or on that, so that the pain appears to be seated in the liver and spleen; again it affects the loins, for the colon has many convolutions in all directions; but in other cases it fixes on the sacrum, the thighs, and the cremasters of the testicles. But in colic affections, they have rather retchings; and what is vomited is then bilious and oily. And the danger therefrom is so much the less, as the colon is more fleshy, and thicker than the small intestines, and consequently more tolerant of injury.

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CHAPTER VII. ON THE ACUTE AFFECTIONS ABOUT THE LIVER +

IN the affections of the liver, the patients do not die, indeed, more quickly than in those of the heart; but yet they suffer more pain; for the liver is, in a great measure, a concretion of blood. But if the cause of death happen to be situated in its Portæ, they die no less speedily than from the heart; for these parts are tissues formed of membranes, of important and slender nerves, and of large veins. Hence certain of the philosophers have held that the desires of the soul are seated there. In hemorrhage it greatly surpasses all the others; for the liver is made up from the roots of veins. Wherefore a great inflammation does form in it, but not very frequently, nor in its vital parts, for the patient would die previously. But a smaller inflammation often takes place, whence it happens that they escape death, indeed, but experience a more protracted state of disease. For of its office, as regards sanguification, there is no stop nor procrastination, as from it a supply of blood is sent to the heart, and to the parts below the diaphragm.

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If from a greater cause—a stroke, or continued indigestion of much and bad food, and intoxication, or great cold—an inflammation forms in the portal system, a very speedy death is the result. For there is a latent, smothered, and acrid heat; pulse languid; the kind of pain varied, and every way diversified, sometimes darting to the right side, so as to resemble a sharp weapon fixed in the place, and sometimes resembling tormina; again, at other times the pain is deep—nay, very deep; and, intermediate between the pain, atony and loss of utterance. The diaphragm and succingens (pleura) are dragged downwards; for from them the liver is suspended as a weight. For this reason, a strong pain extends to the clavicle on the same side; an ineffectual cough, or only a desire thereof, and when it comes to a conclusion, dry; respiration bad, for the diaphragm does not co-operate with the lungs, by assisting them in contraction and dilatation. They draw in a small breath, but expire a larger; colour, a dark-green, leaden; they loathe food, or if they force themselves to take any, they become flatulent in the epigastrium; eructations bilious, acid, fetid; nausea, retchings, belly mostly loose, discharges bilious, viscid, small in quantity. The affections always go on increasing; mind not very much deranged, but torpid, unsettled, stupid; much timidity; coldness of the extremities, tremblings, rigors, hiccup of a spasmodic nature, jaundice, bile intense, the whole body tinged with bile. But if it appear before the seventh day, it proves fatal in many cases.

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But those who have escaped a fatal termination, either by a hemorrhage, or a rapid discharge from the bowels of bilious matters, or from frequent discharges of intense urine, in these cases, after three weeks, the liver is converted into a purulent abscess. But if it pass considerably this period without an abscess, it ends inevitably in dropsy; the patients are thirsty, drink little, are dried in body, lose fat; there is a desire for acids, and an insensibility to taste.

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Autumn engenders this affection, along with the indigestion produced by much summer-fruit and multifarious food. Of all ages, the adult is most subject to it.

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CHAPTER VIII. ON THE ACUTE DISEASE OF THE VENA CAVA +

FROM the portæ of the liver, there passes a wide vein through the space intermediate between its extremities, which, being always divided into slender and more numerous branches, is distributed at last all over the liver in vessels imperceptible to the sight; and with their extremities anastomose the extremities of other veins, which, at first, are slender and numerous, grow larger and fewer in number, and, at last, they are collected into one large vein; hence, having become two by division, these pass through the liver. The upper one, then, having passed through the first lobe, appears on its convex side; then, having passed the diaphragm, it is inserted into the heart: this is called the vena cava. The other, having passed through the lower lobe, the fifth, to its concave side, makes its exit near the spine, and is extended along it as far as the ischiatic region; and it, also, is called vena cava. It obtains the same name, as being one and the same vein, which derives its origin from the liver. For if one choose, one may pass a plate of metal from the vena cava connected with the heart to that by the spine, and from the spine through the liver to the heart; for it is the same passage leading upwards.

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This vein, then, as I think, is all diseased in acute and strong affections; for it is altogether one vein. But other physicians fancy that only the part along the spine is affected, because there are no manifest symptoms in regard to the portion about the heart; for it is extended through the chest, having no adhesions, but floating in the chest, until, from the diaphragm, it adheres to the heart. If, then, any of the great ailments seize this vein, they are concealed by the thorax surrounding it.

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Wherefore kedmataSee the note on the English translation of Hippocrates, Syd. Soc. Edit., vol. i. p. 216, and the authorities there referred to. The aneurismal varix would apply best to it in this place. It is not unlikely that aortal aneurisms were sometimes confounded with it. On this subject, see further Testa, Malattie del Cuore, t. iii. also form about this vein when a hemorrhage, bursting forth quickly proves fatal, the blood being discharged by the lungs and the arteria aspera, if it burst in the chest; but if, at its origin, the blood is poured into the lower belly, so that the bowels float in it, when the patients die before the blood makes its appearance, the belly being filled with blood.

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Inflammation likewise forms about the vein, and it, also, proves fatal, if it be great; for there is an acrid and pungent heat enclosed in the cavities of both, but little surpassing what is natural, so that to the touch the heat appears to be slight; but the patient fancies himself burning hot; pulse small, very frequent, so as to appear compressed and forcibly accelerated; coldness of the extremities; intense thirst; dryness of the mouth; redness of countenance, along with paleness; he is reddish over the whole body; hypochondriac region hard, and retracted upwards; pain principally on the right side, and palpitation therein, extending to the flanks; and in certain cases, also, of the artery along the spine, provided the pulsation displays itself in the other hypochondriac region; for lying, as it does, on the left side, it sympathises with the other; the exhalation in the general system affording no relief, and not even making the skin soft, for it is dry, shrivelled, and rough; and more especially in the regions of the body where the bones are prominent, such as the back part of the elbow, the knees, or the knuckles. Sleep disturbed; the bowels, in certain cases, discharging nothing, and in others, the discharges small, acrid, bilious; urine, a bright yellow and pungent; not disordered, indeed, in mind, but they are torpid and wasted. Hence, those who have seen this constitution of disease have called it Causus, for the present symptoms are those of a species of Causus; and in autumn there is a tendency to malignity, both in adults and the young, in whom the habit of body is slender, from bad diet and hard labour. These, for the most part, die on the fourteenth day; but when the disease is protracted, they die in double that period. But those who either originally have a slight inflammation, or when a great inflammation is gradually resolved, escape the disease indeed, but never get rid of the mischief; for they labour under causus a long time. But the dangerous symptoms cease, namely, the pains, distension of the hypochondria, the bad pulse, and torpor of the intellect; but still they have nausea, are ill at ease, with distress of mind; and, moreover, these are attended with an accession of causus and thirst, dryness of the tongue and mouth; they inspire largely, drawing in a long and copious breath, as if wishing to draw in the whole atmosphere, for the purpose of refrigeration. And if they drink a large draught of cold water, they are relieved, indeed, for a short time; but then again the thirst is kindled up, and again they drink copiously. And this is the successive course of the malady. And a good physician would give with impunity a copious cold draught, as in other species of causus, and even with less risk, in the case of those labouring under causus from disease of the vena cava. And if either the bowels or the bladder carry off the drink, there is no necessity for inducing vomiting; but if not, after much cold drink much vomiting must be induced. For the patient would burst, if, after drinking so much, he should have no discharges by sweating, by urine, or by the bowels.

+
CHAPTER IX. ON ACUTE AFFECTIONS OF THE KIDNEYS +

THE kidneys, as far as regards the peculiar structure of the organ, are not productive of any great danger, even if they should suffer acutely; for, being of a glandular nature, they are mild and do not experience deadly diseases. But their office is important, namely, the secretion of the urine from the blood, and its expulsion.

+

It is stopped either by a stone, or an inflammation arising there, or a clot of blood, or something such; when no mischief arises from sympathy, owing to the peculiar nature of the organ affected, but the retention of the urine produces all sorts of dreadful symptoms. Heat, which is acrid, and induces nausea; a heavy pain along the spine at the loins; distention of the parts, especially of those about the hypochondrium; suppression of urine, not entirely, but they pass urine in drops, and have a desire to pass more, for there is the sensation of an overflow. But if the urine become acrid and pungent, coldness, tremblings, spasms, distention and fulness of the hypochondria supervene. This miserable state and the conjoined feeling become similar to that of tympanites produced by indigestion, from the taking of too much food. Pulse, at first, indeed, slow and languid; but, if the evil press harder, small, frequent, tumultuous, and irregular: sleep slight, painful, not continued; and suddenly starting up as if from the stroke of a sharp instrument, they fall over again into a deep sleep as if from fatigue: they are not much deranged in intellect, but talk incoherently; the countenance livid. But if the desire of making water return again, the patients pass a small quantity in drops, along with spasms and great pains, when, for a short time, they are relieved from their sufferings, and again they experience a relapse. Of those that die, they sink most quickly who pass no urine; but the greater part recover, either from the stone dropping down into the bladder along with the urine, or from the inflammation being converted into pus, or from being gradually dispelled. For, if the urine pass easily even in small quantity, they escape death; but for a length of time they waste in constitution; the patients undergo these sufferings while still able to keep up, but gradually fall into a state of consumption. The same seasons, places, and ages induce these affections as induce those in connection with the venæ cavæ.

+

Sometimes blood bursts from the kidneys suddenly in large quantity, and flows continuously for many days. None, however, die from the hemorrhage itself, but from the inflammation accompanying the hemorrhage, if the bleeding is stopped; but most frequently they die of strong inflammation induced by the stoppage.

+
CHAPTER X. ON THE ACUTE AFFECTIONS ABOUT THE BLADDER +

THE bladder is a dangerous part to suffer in acute diseases, even when it merely sympathizes with other parts; but more dangerous and fatal if the affection begin with itself; for it is very potent to make the other parts sympathise with it, as the nerves and the understanding: for the bladder is a cold and white nerve, at a very great distance from the innate heat, but very near the external cold: for it is situated in the lowest part of the belly, at the greatest distance from the chest. But, also, its office is of vital importance, namely, the passage of the urine.

+

Even, then, when the passage is only stopped by stones, or clots, or from any native or foreign mischief, it is of a deadly nature. In women, the phlegmonous tumour of the uterus may compress it; and in men, the straight intestine at the end bowels, called the Rectum. In many cases, too, owing to involuntary restraint from modesty in assemblies and at banquets, being filled it becomes distended; and, from the loss of its contractile power, it no longer evacuates the urine. When, then, the urine is stopped, there is fulness of the parts above, namely, the kidneys; distension of the ureters, grievous pain of the loins, spasms, tremblings, rigors, alienation of mind. But if it suffer from an ulcer or inflammation, there are, indeed, many bad symptoms; but death from the ulcers is by far the most speedy. With regard, however, to the ulceration and purulent abscess, and those other affections which are not very acute, they will be treated of among the chronic diseases; but such as are acute, and prove fatal in fourteen days, or a little earlier or later, such as inflammation, thrombus, or a stone falling down to the neck of the bladder, of these I will now treat. If, therefore, any of these occur, there is retention of urine; swelling in the hypogastric region; acute pain all over the abdomen; distension of the bladder; a sallow sweat on the tenth day; vomitings of phlegm, then of bile; coldness of the whole body, but especially of the feet: but, if the mischief spread farther, there come on fevers attended with hiccup, pulse irregularly frequent and small, redness of the countenance, thirst, distress of mind, delirium, spasms. From deleterious substances, such as cantharides and buprestis, both the bladder is distended with flatus, and the whole belly suffers violence; and all things get worse, and death cannot be long delayed.

+

The bladder also sometimes suffers from hemorrhage; the blood there is bright and thin, but the patients never die from it, although it may not be easy to stop. But from the clots and the inflammation there is danger; for the coldness, mortification, gangrene, and the other evils consequent upon it readily prove fatal.

+

Winter and autumn bring on these diseases. As to age, manhood, but still more old age. The other seasons and periods of life do not generally produce the diseases, and they very rarely prove fatal. Of all others, infants are most free from danger.

+
CHAPTER XI. ON HYSTERICAL SUFFOCATION +

IN the middle of the flanks of women lies the womb, a female viscus, closely resembling an animal; for it is moved of itself hither and thither in the flanks, also upwards in a direct line to below the cartilage of the thorax, and also obliquely to the right or to the left, either to the liver or spleen; and it likewise is subject to prolapsus downwards, and, in a word, it is altogether erratic. It delights, also, in fragrant smells, and advances towards them; and it has an aversion to fetid smells, and flees from them; and, on the whole, the womb is like an animal within an animal.

+

When, therefore, it is suddenly carried upwards, and remains above for a considerable time, and violently compresses the intestines, the woman experiences a choking, after the form of epilepsy, but without convulsions. For the liver, diaphragm, lungs and heart, are quickly squeezed within a narrow space; and therefore loss of breathing and of speech seems to be present. And, moreover, the carotids are compressed from sympathy with the heart, and hence there is heaviness of head, loss of sensibility, and deep sleep.

+

And in women there also arises another affection resembling this form, with sense of choking and loss of speech, but not proceeding from the womb; for it also happens to men, in the manner of catochus. But those from the uterus are remedied by fetid smells, and the application of fragrant things to the female parts; but in the others these things do no good; and the limbs are moved about in the affection from the womb, but in the other affection not at all. Moreover, voluntary and involuntary tremblings . . . . . . . . . . . but from the application of a pessary to induce abortion, powerful congelation of the womb, the stoppage of a copious hemorrhage, and such like.

+

If, therefore, upon the womb’s being moved upwards, she begin to suffer, there is sluggishness in the performance of her offices, prostration of strength, atony, loss of the faculties of her knees, vertigo, and the limbs sink under her; headache, heaviness of the head, and the woman is pained in the veins on each side of the nose.

+

But if they fall down they have heartburn . . . . . in the hypochondriac regions; flanks empty, where is the seat of the womb; pulse intermittent, irregular, and failing; strong sense of choking; loss of speech and of sensibility; respiration imperceptible and indistinct; a very sudden and incredible death, for they have nothing deadly in their appearance; in colour like that of life, and for a considerable time after death they are more ruddy than usual; eyes somewhat prominent, bright, not entirely fixed, but yet not very much turned aside.

+

But if the uterus be removed back to its seat before the affection come to a conclusion, they escape the suffocation. When the belly rumbles there is moisture about the female parts, respiration thicker and more distinct, a very speedy rousing up from the affection, in like manner as death is very sudden; for as it readily ascends to the higher regions, so it readily recedes. For the uterus is buoyant, but the membranes, its supporters, are humid, and the place is humid in which the uterus lies; and, moreover, it flees from fetid things, and seeks after sweet: wherefore it readily inclines to this side and to that, like a log of wood, and floats upwards and downwards. For this reason the affection occurs in young women, but not in old. For in those in whom the age, mode of life, and understanding is more mobile, the uterus also is of a wandering nature; but in those more advanced in life, the age, mode of living, understanding, and the uterus are of a steady character. Wherefore this suffocation from the womb accompanies females alone.

+

But the affections common to men happen also to the uterus, such as inflammation and hemorrhage, and they have the common symptoms; namely, fever, asphexy, coldness, loss of speech. But in hemorrhage the death is even more sudden, being like that of a slaughtered animal.

+
CHAPTER XII. ON SATYRIASIS +

THE Satyrs, sacred to Bacchus, in the paintings and statues, have the member erect, as the symbol of the divine performance. It is also a form of disease, in which the patient has erection of the genital organ, the appellation of Satyriasis being derived from its resemblance to the figure of the god.

+

It is an unrestrainable impulse to connection; but neither are they at all relieved by these embraces, nor is the tentigo soothed by many and repeated acts of sexual intercourse. Spasms of all the nerves, and tension of all the tendons, groins, and perineum, inflammation and pain of the genital parts, redness of countenance, and a dewy moisture. Wrapped up in silent sorrow, they are stupid, as if grievously afflicted with their calamity. But if the affection overcome the patient’s sense of shame, he will lose all restraint of tongue as regards obscenity, and likewise all restraint in regard to the open performance of the act, being deranged in understanding as to indecency; for they cannot restrain themselves, are thirsty, and vomit much phlegm. Afterwards, froth settles on their lips, as is the case with goats in the season of rutting, and the smell likewise is similar. The urine, after long retention, is white, thick, and like semen; bowels constipated; spontaneous titillations of the sides and arm-pits; they have convulsions, loathe food, or, if presented to them, they snatch it confusedly.

+

But if the illness tend to death, they become flatulent, belly protuberant, tension of the tendons and of all the muscles, difficulty of movement, contraction of the limbs, pulse small, weak, and irregular.

+

All these symptoms have been sometimes removed by copious discharges from the bowels of phlegm and bile, and by vomiting in like manner, not without danger. The proper cure is deep and very protracted sleep; for much sleep induces coldness, paralysis, and torpor of the nerves; and torpidity and refrigeration cure Satyriasis.

+

The affection, for the most part, is formed in spring and summer. Of the periods of life, it occurs principally in boys and striplings, more especially in such as are naturally prone to sexual intercourse. It is a most acute, disgusting, and unseemly ailment. For the most part, the patients die on the seventh day. It is said, that women also suffer from this affection; that they have the same impulse to venery, and the other symptoms the same. I believe, indeed, that lust is engendered in women of a humid temperament, so as to induce a copious discharge of the superfluous humours; but I do not at all believe that they are affected with Satyriasis, for their nature, being cold, is not adapted to it. But neither, also, has woman the parts necessary for erection, like those of a Satyr, whence the affection derives its name; and neither also are men subject to suffocation from the womb, because men have not an uterus.

+ + diff --git a/data/tlg0719/tlg002/__cts__.xml b/data/tlg0719/tlg002/__cts__.xml index ad7ee9e8a..f945e041e 100644 --- a/data/tlg0719/tlg002/__cts__.xml +++ b/data/tlg0719/tlg002/__cts__.xml @@ -4,12 +4,12 @@ Περὶ αἰτίων καὶ σημείων χρονίων παθῶν - Aretaeus. The Extant Works of Aretaeus, The Cappadocian. Adams, Francis, editor. Boston, MA: Milford House, Inc., 1972 (reprint); London: Sydenham Society, 1856. + Aretaeus. The Extant Works of Aretaeus, The Cappadocian. Adams, Francis, editor. Boston, MA: Milford House, Inc., 1972 (reprint); London: Sydenham Society, 1856. - On the Causes and Symptoms of Chronic Diseases - Aretaeus. The Extant Works of Aretaeus, The Cappadocian. Adams, Francis, translator. Boston, MA: Milford House, Inc., 1972 (reprint); London: Sydenham Society, 1856. + On the Causes and Symptoms of Chronic Diseases + Aretaeus. The Extant Works of Aretaeus, The Cappadocian. Adams, Francis, translator. Boston, MA: Milford House, Inc., 1972 (reprint); London: Sydenham Society, 1856. \ No newline at end of file diff --git a/data/tlg0719/tlg002/tlg0719.tlg002.perseus-eng1.xml b/data/tlg0719/tlg002/tlg0719.tlg002.perseus-eng1.xml index 25fd36888..8fcdb9c99 100644 --- a/data/tlg0719/tlg002/tlg0719.tlg002.perseus-eng1.xml +++ b/data/tlg0719/tlg002/tlg0719.tlg002.perseus-eng1.xml @@ -1,30 +1,54 @@ + - + - De causis et signis diuturnorum morborum - Aretaeus - Francis Adams LL.D. + On the Causes and Symptoms of Chronic Diseases + Aretaeus of Cappadocia + Francis Adams + + Gregory Crane + + Prepared under the supervision of + Bridget Almas + Lisa Cerrato + Rashmi Singhal + National Library of Medicine History of Medicine Division - Cultural Heritage Langauge Technologies + Cultural Heritage Language Technologies Kansas City Missouri - February 1, 2005 + February 1, 2005 + + Trustees of Tufts University + Medford, MA + Perseus Digital Library Project + Perseus 4.0 + tlg0719.tlg002.perseus-eng2.xml + + Available under a Creative Commons Attribution-ShareAlike 4.0 International License + - The Extant Works of Aretaeus, The Cappadocian. - Aretaeus - Francis Adams LL.D. + The Extant Works of Aretaeus, The Cappadocian + Aretaeus of Cappadocia + Francis Adams + + London + Syndenham Society + 1856 + Boston Milford House Inc. - 1972 (Republication of the 1856 edition). + 1972 - + + Internet Archive @@ -35,2337 +59,209 @@ - - - - - - - - - + + +

This pointer pattern extracts book and chapter.

+ + +

This pointer pattern extracts book.

+ - English - Greek + English + Greek + + EpiDoc and CTS conversion, file/encoding cleanup, and general header review. + - - -
- - BOOK I. -
- CHAPTER I. THE PROŒMIUM -

OF chronic diseases the pain is great, the period - of wasting long, and the recovery uncertain; for either they are not - dispelled at all, or the diseases relapse upon any slight error; for neither - have the patients resolution to persevere to the end; or, if they do - persevere, they commit blunders in a prolonged regimen. And if there also be - the suffering from a painful system of cure,--of thirst, of hunger, of - bitter and harsh medicines, of cutting or burning,--of all which there is - sometimes need in protracted diseases, the patients resile as truly - preferring even death itself. Hence, indeed, is developed the talent of the - medical man, his perseverance, his skill in diversifying the treatment, and - conceding such pleasant things as will do no harm, and in giving - encouragement. But the patient also ought to be courageous, and co-operate - with the physician against the disease. For, taking a firm grasp of the - body, the disease not only wastes and corrodes it quickly, but

- -

frequently disorders the senses, nay, even deranges the soul by the - intemperament of the body. Such we know mania and melancholy to be, of which - I will treat afterwards. At the present time I shall give an account of cephalæa.

-
-
- CHAPTER II. ON CEPHALÆA -

IF the head be suddenly seized with pain from a - temporary cause, even if it should endure for several days, the disease is - called Cephalalgia. But if the disease be protracted for a long time, and - with long and frequent periods, or if greater and more untractable symptoms - supervene, we call it Cephalæa.

-

There are infinite varieties of it; for, in certain cases, the pain is - incessant and slight, but not intermittent; but in others it returns - periodically, as in quotidian fevers, or in those which have exacerbations - every alternate day: in others it continues from sunset to noon, and then - completely ceases; or from noon to evening, or still further into night; - this period is not much protracted. And in certain cases the whole head is - pained; and the pain is sometimes on the right and sometimes on the left - side, or the forehead, or the bregma; and these may all occur the same day - in a random manner.

-

But in certain cases, the parts on the right side, or those on the left - solely, so far that a separate temple, or ear, or one eyebrow, or one eye, - or the nose which divides the face into two equal parts; and the pain does - not pass this limit, but remains in the half of the head. This is called Heterocrania, an illness by no means mild, even though - it intermits, and although it appears to be slight. For if at any time it - set in acutely, it occasions unseemly and dreadful symptoms; spasm

- -

and distortion of the countenance take place; the eyes either fixed intently - like horns, or they are rolled inwardly to this side or to that; vertigo, - deep-seated pain of the eyes as far as the meninges; irrestrainable sweat; - sudden pain of the tendons, as of one striking with a club; nausea; vomiting - of bilious matters; collapse of the patient; but, if the affection be - protracted, the patient will die; or, if more slight and not deadly, it - becomes chronic; there is much torpor, heaviness of the head, anxiety, and - ennui. For they flee the light; the darkness - soothes their disease: nor can they bear readily to look upon or hear - anything agreeable; their sense of smell is vitiated, neither does anything - agreeable to smell delight them, and they have also an aversion to fetid - things: the patients, moreover, are weary of life, and wish to die.

-

The cause of these symptoms is coldness with dryness. But if it be protracted - and increase, as regards the pains, the affection becomes Vertigo.

-
-
- CHAPTER III. ON VERTIGO, OR SCOTOMA -

IF darkness possess the eyes, and if the head be - whirled round with dizziness, and the ears ring as from the sound of rivers - rolling along with a great noise, or like the wind when it roars among the - sails, or like the clang of pipes or reeds, or like the rattling of a - carriage, we call the affection Scotoma (or Vertigo); a bad complaint indeed, if a symptom of the - head, but bad likewise if the sequela of cephalæa, or whether it arises of - itself as a chronic disease. For, if these symptoms do not pass off, but the - vertigo persist, or if, in course of time, from the want of any one to - remedy, it is

- -

completed in its own peculiar symptoms, the affection vertigo is formed, from - a humid and cold cause. But if it turn to an incurable condition, it proves - the commencement of other affections--of mania, melancholy, or epilepsy, the - symptoms peculiar to each being superadded. But the mode of vertigo is, - heaviness of the head, sparkles of light in the eyes along with much - darkness, ignorance of themselves and of those around; and, if the disease - go on increasing, the limbs sink below them, and they crawl on the ground; - there is nausea and vomitings of phlegm, or of yellow or black bilious - matter. When connected with yellow bile, mania is formed; when with black, - melancholy; when with phlegm, epilepsy; for it is liable to conversion into - all these diseases.

-
-
- CHAPTER IV. ON EPILEPSY -

EPILEPSY is an illness of various shapes and - horrible; in the paroxysms, brutish, very acute, and deadly; for, at times, - one paroxysm has proved fatal. Or if from habit the patient can endure it, - he lives, indeed, enduring shame, ignominy, and sorrow: and the disease does - not readily pass off, but fixes its abode during the better periods and in - the lovely season of life. It dwells with boys and young men; and, by good - fortune, it is sometimes driven out in another more advanced period of life, - when it takes its departure along with the beauty of youth; and then, having - rendered them deformed, it destroys certain youths from envy, as it were, of - their beauty, either by loss of the faculties of a hand, or by the - distortion of the countenance, or by the deprivation of some one sense. But - if the mischief lurk there until it strike root,

- -

it will not yield either to the physician or the changes of age, so as to - take its departure, but lives with the patient until death. And sometimes - the disease is rendered painful by its convulsions and distortions of the - limbs and of the face; and sometimes it turns the mind distracted. The sight - of a paroxysm is disagreeable, and its departure disgusting with spontaneous - evacuations of the urine and of the bowels.

-

But also it is reckoned a disgraceful form of disease; for it is supposed, - that it is an infliction on persons who have sinned against the Moon: and - hence some have called it the Sacred Disease, and that for more reasons than - one, as from the greatness of the evil, for the Greek word I(ERO\S also signifies great; or because the cure of it is not human, but divine; or from - the opinion that it proceeded from the entrance of a demon into the man: - from some one, or all these causes together, it has been called Sacred.

-

Such symptoms as accompany this disease in its acute form have been already - detailed by me. But if it become inveterate, the patients are not free from - harm even in the intervals, but are languid, spiritless, stupid, inhuman, - unsociable, and not disposed to hold intercourse, nor to be sociable, at any - period of life; sleepless, subject to many horrid dreams, without appetite, - and with bad digestion; pale, of a leaden colour; slow to learn, from - torpidity of the understanding and of the senses; dull of hearing; have - noises and ringing in the head; utterance indistinct and bewildered, either - from the nature of the disease, or from the wounds during the attacks; the - tongue is rolled about in the mouth convulsively in various ways. The - disease also sometimes disturbs the understanding, so that the patient - becomes altogether fatuous. The cause of these affections is coldness with - humidity.

-
- -
- CHAPTER V. ON MELANCHOLY -

BLACK bile, if it make its appearance in acute - diseases of the upper parts of the body, is very dangerous; or, if it pass - downwards, it is not free from danger. But in chronic diseases, if it pass - downward, it terminates in dysentery and pain of the liver. But in women it - serves as a purgation instead of the menses, provided they are not otherwise - in a dangerous condition. But if it be determined upwards to the stomach and - diaphragm, it forms melancholy; for it produces flatulence and eructations - of a fetid and fishy nature, and it sends rumbling wind downwards, and - disturbs the understanding. On this account, in former days, these were - called melancholics and flatulent persons. And yet, in certain of these - cases, there is neither flatulence nor black bile, but mere anger and grief, - and sad dejection of mind; and these were called melancholics, because the - terms bile (XOLH\) - and anger (O)RGH\) - are synonymous in import, and likewise black (ME/LAINA), with much - (POLLH\) and furious (QHRIW/DHS). Homer is - authority for this when he says:--

-

"Then straight to speak uprose The Atreidan chief, who `neath his sway a - wide-spread empire held: Sore vexed was he; his mighty heart in his dark - bosom swelled With rage, and from his eyes the fire like lightning-flashes - broke."

------------------- *TOI=SI D᾿ A)NE/STH *(/HRWS *)ATREI/DHS EU)RUKREI/WN - *)AGAME/MNWN *)AXNU/MENOS· ME/NEOS DE\ ME/GA FRE/NES - A)MFIMELAINAI *PI/MPLANT᾿, O)/SSE DE/ OI( PURI\ LAMPETO/WNTI - E)I/+KTHN.

-

Iliad, i. 101, etc.

-

The melancholics become such when they are overpowered by this evil.

-

It is a lowness of spirits from a single phantasy, without

- -

fever; and it appears to me that melancholy is the commencement and a part of - mania. For in those who are mad, the understanding is turned sometimes to - anger and sometimes to joy, but in the melancholics to sorrow and - despondency only. But they who are mad are so for the greater part of life, - becoming silly, and doing dreadful and disgraceful things; but those - affected with melancholy are not every one of them affected according to one - particular form; but they are either suspicious of poisoning, or flee to the - desert from misanthropy, or turn superstitious, or contract a hatred of - life. Or if at any time a relaxation takes place, in most cases hilarity - supervenes, but these persons go mad.

-

But how, and from what parts of the body, the most of these complaints - originate, I will now explain. If the cause remain in the hypochondriac - regions, it collects about the diaphragm, and the bile passes upwards, or - downwards in cases of melancholy. But if it also affects the head from - sympathy, and the abnormal irritability of temper change to laughter and joy - for the greater part of their life, these become mad rather from the - increase of the disease than from change of the affection.

-

Dryness is the cause of both. Adult men, therefore, are subject to mania and - melancholy, or persons of less age than adults. Women are worse affected - with mania than men. As to age, towards manhood, and those actually in the - prime of life. The seasons of summer and of autumn engender, and spring - brings it to a crisis.

-

The characteristic appearances, then, are not obscure; for the patients are - dull or stern, dejected or unreasonably torpid, without any manifest cause: - such is the commencement of melancholy. And they also become peevish, - dispirited, sleepless, and start up from a disturbed sleep.

-

Unreasonable fear also seizes them, if the disease tend to increase, when - their dreams are true, terrifying, and clear:

- -

for whatever, when awake, they have an aversion to, as being an evil, rushes - upon their visions in sleep. They are prone to change their mind readily; to - become base, mean-spirited, illiberal, and in a little time, perhaps, - simple, extravagant, munificent, not from any virtue of the soul, but from - the changeableness of the disease. But if the illness become more urgent, - hatred, avoidance of the haunts of men, vain lamentations; they complain of - life, and desire to die. In many, the understanding so leads to - insensibility and fatuousness, that they become ignorant of all things, or - forgetful of themselves, and live the life of the inferior animals. The - habit of the body also becomes perverted; colour, a darkish-green, unless - the bile do not pass downward, but is diffused with the blood over the whole - system. They are voracious, indeed, yet emaciated; for in them sleep does - not brace their limbs either by what they have eaten or drunk, but - watchfulness diffuses and determines them outwardly. Therefore the bowels - are dried up, and discharge nothing; or, if they do, the dejections are - dried, round, with a black and bilious fluid, in which they float; urine - scanty, acrid, tinged with bile. They are flatulent about the hypochondriac - region; the eructations fetid, virulent, like brine from salt; and sometimes - an acrid fluid, mixed with bile, floats in the stomach. Pulse for the most - part small, torpid, feeble, dense, like that from cold.

-

A story is told, that a certain person, incurably affected, fell in love with - a girl; and when the physicians could bring him no relief, love cured him. - But I think that he was originally in love, and that he was dejected and - spiritless from being unsuccessful with the girl, and appeared to the common - people to be melancholic. He then did not know that it was love; but when he - imparted the love to the girl, he ceased from his dejection, and dispelled - his passion and sorrow; and with joy he awoke from his lowness of spirits, - and he became restored to understanding, love being his physician.

-
- -
- CHAPTER VI. ON MADNESS -

THE modes of mania are infinite in species, but one - alone in genus. For it is altogether a chronic derangement of the mind, - without fever. For if fever at any time should come on, it would not owe its - peculiarity to the mania, but to some other incident. Thus wine inflames to - delirium in drunkenness; and certain edibles, such as mandragora and - hyoscyamus, induce madness: but these affections are never called mania; - for, springing from a temporary cause, they quickly subside, but madness has - something confirmed in it. To this mania there is no resemblance in the - dotage which is the calamity of old age, for it is a torpor of the senses, - and a stupefaction of the gnostic and intellectual faculties by coldness of - the system. But mania is something hot and dry in cause, and tumultuous in - its acts. And, indeed, dotage commencing with old age never intermits, but - accompanies the patient until death; while mania intermits, and with care - ceases altogether. And there may be an imperfect intermission, if it take - place in mania when the evil is not thoroughly cured by medicine, or is - connected with the temperature of the season. For in certain persons who - seemed to be freed from the complaint, either the season of spring, or some - error in diet, or some incidental heat of passion, has brought on a - relapse.

-

Those prone to the disease, are such as are naturally passionate, irritable, - of active habits, of an easy disposition, joyous, puerile; likewise those - whose disposition inclines to the opposite condition, namely, such as are - sluggish, sorrowful, slow to learn, but patient in labour, and who when they - learn anything, soon forget it; those likewise are more prone to melancholy, - who have formerly been in a mad condition. But in those periods of life with - which much heat and blood are

- -

associated, persons are most given to mania, namely, those about puberty, - young men, and such as possess general vigour. But those in whom the heat is - enkindled by black bile, and whose form of constitution is inclined to - dryness, most readily pass into a state of melancholy. The diet which - disposes to it is associated with voracity, immoderate repletion, - drunkenness, lechery, venereal desires. Women also sometimes become affected - with mania from want of purgation of the system, when the uterus has - attained the development of manhood; but the others do not readily fall into - mania, yet, if they do, their cases are difficult to manage. These are the - causes; and they stir up the disease also, if from any cause an accustomed - evacuation of blood, or of bile, or of sweating be stopped.

-

And they with whose madness joy is associated, laugh, play, dance night and - day, and sometimes go openly to the market crowned, as if victors in some - contest of skill; this form is inoffensive to those around. Others have - madness attended with anger; and these sometimes rend their clothes and kill - their keepers, and lay violent hands upon themselves. This miserable form of - disease is not unattended with danger to those around. But the modes are - infinite in those who are ingenious and docile,--untaught astronomy, - spontaneous philosophy, poetry truly from the muses; for docility has its - good advantages even in diseases. In the uneducated, the common employments - are the carrying of loads, and working at clay,--they are artificers or - masons. They are also given to extraordinary phantasies; for one is afraid - of the fall of the oilcruets ..... and another will not drink, as fancying - himself a brick, and fearing lest he should be dissolved by the liquid.

-

This story also is told:--A certain joiner was a skilful artisan while in the - house, would measure, chop, plane, mortice, and adjust wood, and finish the - work of the house correctly; would associate with the workmen, make a - bargain with them,

- -

and remunerate their work with suitable pay. While on the spot where the work - was performed, he thus possessed his understanding. But if at any time he - went away to the market, the bath, or on any other engagement, having laid - down his tools, he would first groan, then shrug his shoulders as he went - out. But when he had got out of sight of the domestics, or of the work and - the place where it was performed, he became completely mad; yet if he - returned speedily he recovered his reason again; such a bond of connection - was there between the locality and his understanding.

-

The cause of the disease is seated in the head and hypochondriac region, - sometimes commencing in both together, and the one imparting it to the - other. In mania and melancholy, the main cause is seated in the bowels, as - in phrenitis it is mostly seated in the head and the senses. For in these - the senses are perverted, so that they see things not present as if they - were present, and objects which do not appear to others, manifest themselves - to them; whereas persons who are mad see only as others see, but do not form - a correct judgment on what they have seen.

-

If, therefore, the illness be great, they are of a changeable temper, their - senses are acute, they are suspicious, irritable without any cause, and - unreasonably desponding when the disease tends to gloom; but when to - cheerfulness, they are in excellent spirits; yet they are unusually given to - insomnolency; both are changeable in countenance, have headache, or else - heaviness of the head; they are sharp in hearing, but very slow in judgment; - for in certain cases there are noises of the ears, and ringings like those - of trumpets and pipes. But if the disease go on to increase, they are - flatulent, affected with nausea, voracious and greedy in taking food, for - they are watchful, and watchfulness induces gluttony. Yet they are not - emaciated like persons in disease (embonpoint is rather - the condition of melancholics) and they are somewhat pale.

- -

But if any of the viscera get into a state of inflammation, it blunts the - appetite and digestion; the eyes are hollow, and do not wink; before the - eyes are images of an azure or dark colour in those who are turning to - melancholy, but of a redder colour when they are turning to mania, along - with purplecoloured phantasmata, in many cases as if of flashing fire; and - terror seizes them as if from a thunderbolt. In other cases the eyes are red - and blood-shot.

-

At the height of the disease they have impure dreams, and irresistible desire - of venery, without any shame and restraint as to sexual intercourse; and if - roused to anger by admonition or restraint, they become wholly mad. - Wherefore they are affected with madness in various shapes; some run along - unrestrainedly, and, not knowing how, return again to the same spot; some, - after a long time, come back to their relatives; others roar aloud, - bewailing themselves as if they had experienced robbery or violence. Some - flee the haunts of men, and going to the wilderness, live by themselves.

-

If they should attain any relaxation of the evil, they become torpid, dull, - sorrowful; for having come to a knowledge of the disease they are saddened - with their own calamity.

-

ANOTHER SPECIES OF - MANIA.

-

Some cut their limbs in a holy phantasy, as if thereby propitiating peculiar - divinities. This is a madness of the apprehension solely; for in other - respects they are sane. They are roused by the flute, and mirth, or by - drinking, or by the admonition of those around them. This madness is of - divine origin, and if they recover from the madness, they are cheerful and - free of care, as if initiated to the god; but yet they are pale and - attenuated, and long remain weak from the pains of the wounds.Our author, as Petit remarks, evidently refers here to the worship of - Cybele; on which see in particular, the Atys of - Catullus, and Apuleius, viii.

-
- -
- CHAPTER VII. ON PARALYSIS -

Apoplexy, Paraplegia, Paresis, Paralysis, are all - generically the same. For they are all a defect of motion, or of touch, or - of both; sometimes also of understanding, and sometimes of other sense. But - apoplexy is a paralysis of the whole body, of sensation, of understanding - and of motion; wherefore to get rid of a strong attack of apoplexy is - impossible, and of a weak, not easy. But paraplegia is a remission of touch - and motion, but of a part, either of the hand or of the leg. Paralysis for - the most part is the remission (paresis) of motion - only, and of energy.It is difficult to find an appropriate word - either in the Latin or English for the term PA/RESIS. It would seem to be particularly applied to "a - partial loss" either of sensibility or of motion. Alexander, however, - makes little or no distinction between it and paralysis, x. 2. - But if the touch alone is wanting--(but such a case is rare)--the disease is - called Anæsthesia rather than paresis. And when Hippocrates says, "the leg - on the same side was apoplectic," he means to say that it was in a - death-like, useless, and incurable state; for what is strong apoplexy in the - whole body, that he calls paraplegia in the limb. Paresis, properly speaking, is applied to suppression or - incontinence of urine in the bladder. But distortion of the eye-brows, and - of the cheeks, and of the muscles about the jaws and chin to the other side, - if attended with spasm, has got the appellation of Cynic spasm. Loss of tone - in the knees, and of sensibility for a time, with torpor, fainting, and - collapse, we call lipothymia.

-

Wherefore, the parts are sometimes paralysed singly, as one eye-brow, or a - finger, or still larger, a hand, or a leg; and sometimes more together; and - sometimes the right or the left

- -

only, or each by itself, or all together, either entirely or in a less - degree; and the parts only which are distant, homonymous, and in pairs--the - eyes, hands, and legs; and also the parts which cohere, as the nose on one - side, the tongue to the middle line of separation, and the one tonsil, the - isthmus faucium, and the parts concerned in deglutition to one half. I - fancy, also, that sometimes the stomach, the bladder, and the rectum, as far - as its extremity, suffers in like manner; but the internal parts, when in a - paralytic state, are concealed from the sight. Their functions, however, are - but half performed; and from this I conclude, that these parts are half - affected, as being cut in twain by the disease. And, indeed, this thing - teaches us a lesson in respect to the diversity of power and discrimination - between the right side and the left. For the inherent cause is equal; and - means which occasion the affection are common in both cases, whether cold or - indigestion, and yet both do not suffer equally. For Nature is of equal - power in that which is equally paired; but it is impossible that the same - thing should happen where there is an inequality. If, therefore, the - commencement of the affection be below the head, such as the membrane of the - spinal marrow, the parts which are homonymous and connected with it are - paralysed: the right on the right side, and the left on the left side. But - if the head be primarily affected on the right side, the left side of the - body will be paralysed; and the right, if on the left side. The cause of - this is the interchange in the origins of the nerves, for they do not pass - along on the same side, the right on the right side, until their - terminations; but each of them passes over to the other side from that of - its origin, decussating each other in the form of the letter X. To say all - at once, whether all together or separate parts be affected with paralysis - ..... or of both; sometimes the nerves from the head suffer (these, - generally, induce loss of sensibility, but, in a word, they do not readily - occasion loss of sensibility; but if they sympathise with the

- -

parts which are moved, they may undergo, in a small degree, the loss of - motion); and sometimes those which pass from muscle to muscle (from the spinal marrow to the muscles),See - the note on the text. these have the power of motion, and impart - it to those from the head; for the latter possess the greater part of their - motory power from them, but yet have it, to a small extent, of themselves: - the former, too, principally suffer loss of motion, but rarely of themselves - experience anæsthesia; indeed, as appears to me, not at all. And if the - ligaments of nerves, which derive their origin from certain of the bones, - and terminate in others, be loosened or torn, the parts become powerless, - and are impeded in their movements, but do not become insensible.It will readily be understood that our author here refers to the - ligaments proper of the joints. On this use of the term "Nerve," see - Hippocrates "On the articulations," pluries.

-

The varieties of paralysis are these: sometimes the limbs lose their - faculties while in a state of extension, nor can they be brought back into - the state of flexion, when they appear very much lengthened; and sometimes - they are flexed and cannot be extended; or if forcibly extended, like a - piece of wood on a rule, they become shorter than natural. The pupil of the - eye is subject to both these varieties, for sometimes it is much expanded in - magnitude, when we call it Platycoria; but the pupil is - also contracted to a small size, when I call it Phthisis and Mydriasis. The bladder, also, is - paralysed in respect to its peculiar functions; for either it loses its - powers as regards distension, or it loses its retentive powers, or it - becomes contracted in itself, when being filled with urine, it cannot expel - the same. There are six causes of paralytic disorders; for they arise from a - wound, a blow, exposure to cold, indigestion, venery, intoxication. But so - likewise the vehement affections of the soul, such as astonishment, fear, - dejection of spirits, and, in children, frights. Great and unexpected joy - has also occasioned

- -

paralysis, as, likewise, unrestrained laughter, even unto death. These, - indeed, are the primary causes; but the ultimate and vital cause is - refrigeration of the innate heat. It suffers from humidity, or dryness, and - is more incurable than the other; but if also in connection with a wound, - and complete cutting asunder of a nerve, it is incurable. In respect to age, - the old are peculiarly subject, and difficult to cure; in children, the - cases are easily restored. As to seasons, the winter; next, the spring; - afterwards, the autumn; least of all, the summer. Of habits, those naturally - gross, the humid, indolent, brutish.

-

When the affections are confirmed, they are made manifest by loss of motion, - insensibility of heat and cold; and also of plucking the hair, of tickling, - and of touching. It is rare indeed when in them the extremities are painful; - but insensibility to pain is not worse as regards recovery. Wherefore the - disease occurs suddenly; but if at any time it have prolonged onsets, there - supervene heaviness, difficulty of motion, torpor, a sensation of cold, - sometimes an excess of heat, short sleeps, greater phantasies, when they - become suddenly paralytic.

-

But in the Cynic spasm, it is not usual for all parts of the face to be - cramped; but those of the left side are turned to the right, and those of - the right to the left, when there is a considerable distortion of the jaw to - this side or to that, as if the jawbone were dislocated. And in certain of - these cases, also, there is luxation at the joint, when in yawning the jaw - is displaced to the opposite side: strabismus of the affected eye, and - palpitation in the under eyelid; the upper eyelid also palpitates, sometimes - along with the eye, and at other times alone. The lips are distended, each - on its own side; but sometimes both being collapsed, they splutter; in - others, they are closely compressed, and are suddenly separated so as to - expel the common spittle with a noise.

- -

The tongue, also, is drawn aside; for it consists of a muscle and nerves, and - at certain times, along its whole extent, it starts up to the palate, and - makes an unusual sound. The uvula, also, is drawn aside; and if the mouth is - shut, there is an unexpected noise within. And if you separate the mouth, - you will perceive the uvula sometimes attached to the palate through its - whole surface, and sometimes swiftly palpitating with force, like a - bag-fish, when likewise a sound is produced. But there is apt to be - deception in cynic spasms; for to the spectator it appears as if the parts - unaffected were those possessed by the disease; for owing to the tension and - colour of the affected parts, and the enlargement of the eye, they appear as - if they were diseased. But in laughter, speaking, or winking, the true state - of matters becomes manifest; for the parts affected are all drawn aside with - a smack; the lip expresses no smile, and is motionless in talking; the - eyelid is immoveable, the eye fixed, and the sense of touch is lost; while - the sound parts speak, wink, feel, laugh.

-
-
- CHAPTER VIII. ON PHTHISIS -

IF an ulcer form in the lungs from an abscess, or - from a chronic cough, or from the rejection of blood, and if the patient - spit up pus, the disease is called Pye and Phthisis. But if matter form in the chest or side, or - be brought up by the lungs, the name is Empyema. But - if, in addition to these symptoms, the lungs contract an ulcer, being - corroded by the pus passing through it, the disease no longer gets the name - of empyema, but takes that of Phthoe instead of it. It - is accompanied with febrile heat of a continual character, but latent

- -

ceasing, indeed, at no time, but concealed during the day by the sweating and - coldness of the body; for the characteristics of phthoe are, that a febrile - heat is lighted up, which breaks out at night, but during the day again lies - concealed in the viscera, as is manifested by the uneasiness, loss of - strength, and colliquative wasting. For had the febrile heat left the body - during the day, how should not the patient have acquired flesh, strength, - and comfortable feeling? For when it retires inwardly, the bad symptoms are - all still further exacerbated, the pulse small and feeble; insomnolency, - paleness, and all the other symptoms of persons in fever. The varieties of - the sputa are numerous: livid, black, streaked, yellowish-white, or - whitish-green; broad, round; hard, or glutinous; rare, or diffluent; devoid - of smell, fetid. There are all these varieties of pus. But those who test - the fluids, either with fire or water, would appear to me not to be - acquainted with phthoe;Our author would - appear to allude here to certain passages in the pseudo-Hippocratic - treatises, wherein these tests of pus are recommended. See de Morbis, - ii. 47, t. vii. p. 72, ed. Littr・ Coæ prænot. et alibi. See also Paulus - Ægineta, t.i. 452, etc., Syd. Soc. edit. for the sight is more to - be trusted than any other sense, not only with regard to the sputa, but also - respecting the form of the disease. For if one of the common people see a - man pale, weak, affected with cough, and emaciated, he truly augurs that it - is phthoe (consumption). But in those who have no ulcer - in the lungs, but are wasted with chronic fevers--with frequent, hard, and - ineffectual coughing, and bringing up nothing, these, also, are called consumptive, and not without reason. There is present - weight in the chest (for the lungs are insensible of pain),--anxiety, - discomfort, loss of appetite; in the evening coldness, and heat towards - morning; sweat more intolerable than the heat as far as the chest; - expectoration varied, as I have described.

-

Voice hoarse; neck slightly bent, tender, not flexible,

- -

somewhat extended; fingers slender, but joints thick; of the bones alone the - figure remains, for the fleshy parts are wasted; the nails of the fingers - crooked, their pulps are shrivelled and flat, for, owing to the loss of - flesh, they neither retain their tension nor rotundity; and, owing to the - same cause, the nails are bent, namely, because it is the compact flesh at - their points which is intended as a support to them; and the tension thereof - is like that of the solids. Nose sharp, slender; cheeks prominent and red; - eyes hollow, brilliant and glittering; swollen, pale, or livid in the - countenance; the slender parts of the jaws rest on the teeth, as if smiling; - otherwise of a cadaverous aspect. So also in all other respects; slender, - without flesh; the muscles of the arms imperceptible; not a vestige of the - mammæ, the nipples only to be seen; one may not only count the ribs - themselves, but also easily trace them to their terminations; for even the - articulations at the vertebræ are quite visible; and their connections with - the sternum are also manifest; the intercostal spaces are hollow and - rhomboidal, agreeably to the configuration of the bone; hypochondriac region - lank and retracted; the abdomen and flanks contiguous to the spine. Joints - clearly developed, prominent, devoid of flesh, so also with the tibia, - ischium, and humerus; the spine of the vertebræ, formerly hollow, now - protrudes, the muscles on either side being wasted; the whole - shoulder-blades apparent like the wings of birds. If in these cases disorder - of the bowels supervene, they are in a hopeless state. But, if a favourable - change take place, symptoms the opposite of those fatal ones occur.

-

The old seldom suffer from this disease, but very rarely recover from it; the - young, until manhood, become phthisical from spitting of blood, and do - recover, indeed, but not readily; children continue to cough even until the - cough pass into phthoe, and yet readily recover. The - habits most prone to the disease are the slender; those in which the - scapulæ

- -

protrude like folding doors, or like wings; in those which have prominent - throats; and those which are pale and have narrow chests. As to situations, - those which are cold and humid, as being akin to the nature of the - disease.

-
-
- CHAPTER IX. ON PERSONS AFFECTED WITH EMPYEMA. -

THOSE persons in whose cavities above, along the - region of the chest, or, in those below the diaphragm, abscesses of matter - form, if they bring it up, they are said to be affected with Empyema; but if - the matter pass downwards, they are said to labour under Apostemes. And in - the ulcers in the chest, or in the lungs, if phthoe - supervene, or in the pleura, or the sternum, or anywhere below at the - junction of the lungs with the spine -- in all these cases the passage for - the matter upwards is by the lungs. But in the viscera below the diaphragm, - the liver, spleen, and kidneys, it is by the bladder; and in women by the - womb. And I once made an opening into an abscess in the colon on the right - side near the liver, and much pus rushed out, and much also passed by the - kidneys and bladder for several days, and the man recovered.

-

The common causes of all are a blow, indigestion, cold and the like. Of those - in the chest also, chronic cough, pleuritis, peripneumony, and protracted - defluxion; but also the determination of some acute diseases to any one of - them.

-

The humour is sometimes inert, weak, and rests on something else; sometimes - bitingly acrid, and occasioning putrefactions even unto death. And there are - many other varieties, as I shall presently declare. It is a wonder how

- -

from a thin, slender membrane, having no depth, like that which lines the - chest, so much pus should flow; for in many cases there is a great - collection. The cause is an inflammation from redundancy of blood, by which - the membrane is thickened; but from much blood much pus is formed - intermediately. But if it be determined inwards, the ribs being the bones in - this region. . . . . . . I have said above, that another species of phthisis would naturally occur. But if it point - outwards, the bones are separated, for the top of the abscess is raised in - one of the intercostal spaces, when the ribs are pushed to this side or to - that.

-

There are certain symptoms common to all, and certain ones peculiar to each. - A heaviness rather than pain is a common symptom (for the lungs are - insensible), weak fevers, rigor towards evening, sweats in the remission, - insomnolency, swellings in the extremities of the feet, and fingers of the - hands, which at one time abate and at another increase; uncomfortable - feeling; loss of appetite; wasting of the whole body; and if the change be - prolonged, the phthisical habit is formed; for Nature can no longer perform - her office, for the digestion is not as before, nor is there the plump habit - of body; the colour dark; respiration in all cases bad, but worse in those - affecting the upper cavity; but also cough at first as long as the - inflammation is urgent, when the pains also are greater, and rigor, and - heat, and watchfulness, and dyspnœa still more; pulse small, sluggish, - feeble; they are disordered in the intellect; distension of the thorax.

-

But if it be already come to the formation of pus, all the the greatest - symptoms take place. Expectoration small with greater cough, and from an - urgent abscess, at first of pituitous matters, tinged with bile of a darker - colour as if from soot, but likewise tinged with blood, and thick; but if - about to burst, of fleshy and deep-seated matter. And, if it burst, there is - danger of suffocation should much pus be suddenly

- -

poured forth; but if gradually, there is no danger. If then the pus is going - to pass downwards, the upper part, where the abscess is situated, - experiences sharp pain; discharges from the bowels fluid, at first watery - with phlegm, afterwards bloody matter; and then again, substances resembling - flesh floating in a fluid, if it has already burst. Pus follows them either - by the bowels or the urine. Metastasis to the kidneys and bladder peculiarly - favourable.

-

The pus, whether it be carried upwards or downwards, is of various - colours--pale, white, ash-coloured, or livid, black and fetid; or devoid of - smell and very thick; or intermediate; or smooth and consistent; or rough - and unequal, with fleshy substances floating in it, these being round or - broad, readily separated or viscid. To say all in a word respecting the pus, - such kinds as are white, concocted, devoid of smell, smooth, rounded, and - are quickly coughed up, or pass downwards, are of a salutary character; but - such as are very pale, bilious, and inconsistent, are bad. Of these by far - the worst are the livid and black, for they indicate putrefaction and - phagedenic ulcers.

-

Along with these things, it will be proper to know also the habit and other - concomitants of the disease. If at the time of the discharge, he feels - comfortable, and gets rid of the fever; has good digestion, good colour, and - a good appetite, if he coughs up readily, has a good pulse, and good - strength; the patient is free from danger. But if fever supervene, and all - the other symptoms turn worse, he is in a hopeless state. One ought also to - consider the places in which the abscesses are seated. For where the matter - forms in the sternum, it is slowly turned to a suppuration; for the parts - are slender, devoid of flesh and cartilaginous; and such parts do not - readily receive the superfluities of inflammation, but remain a long time - without being formed into pus; for cartilage is of a cold nature, but the - inflammations thereof are

- -

innocuous. The wasting of the constitution is bad; for the suppuration lasts - a long time; the spleen, the liver, the lungs, and diaphragm pass more - quickly into suppuration, but they are dangerous and fatal.

-
-
- CHAPTER X. ON ABSCESSES IN THE LUNGS. -

WHEN, in cases of peripneumonia, the patients - survive, though the inflammation be not discussed, those who escape the - acute stage of the affection have suppurations. The symptoms, then, of an - incipient and of a formed abscess have been stated by me under Empyema. If - formed, then, there is no necessity for the same harsh measures and pains to - procure the rupture and discharge of it as in the solid parts of the body, - as it is readily brought up; for the distension of its pores is required - rather than of the solid texture of its parts; for the lungs being a porous - body and full of perforations like a sponge, it is not injured by the - humour, but transmits it from pore to pore, until it reach the trachea. Thus - the fluid finds a ready outlet, the pus being a flexible and slippery - substance, and the respiration blows the breath (pneuma) upwards. For the most part they recover, unless at any time - one be suffocated by the copious influx of the fluid, when, owing to the - quantity of the pus, the trachea does not admit the air. Others die a - protracted death, after the manner of those labouring under phthisis and empyema. The pus is white and - frothy, being mixed with saliva, but sometimes ash-coloured or blackish. And - sometimes one of the bronchia has been spit up in a case of large - ulceration, if the abscess is deep, when portions of the

- -

viscus are also brought up. Hoarse, breathing short, voice heavy-toned, their - chest becomes broad, and yet they stand in need of its being still broader, - owing to the collection of fluid; the dark parts of the eyes glancing, the - whites are very white and fatty; cheeks ruddy; veins in the forehead - protuberant. There is a marvel in connection with these cases, how the - strength is greater than the condition of the body, and the buoyancy of - spirits surpasses the strength.

-
-
- CHAPTER XI. ON ASTHMA. -

IF from running, gymnastic exercises, or any other - work, the breathing become difficult, it is called Asthma (A)=SQMA); and the - disease Orthopnœa (O)RQO/PNOIA) is also called Asthma, for in the paroxysms the - patients also pant for breath. The disease is called Orthopnœa, because it is only when in an erect position (O)RQI/W| SXH/MATI) that they breathe freely; - for when reclined there is a sense of suffocation. From the confinement in - the breathing, the name Orthopnœa is derived. For the - patient sits erect on account of the breathing; and, if reclined, there is - danger of being suffocated.

-

The lungs suffer, and the parts which assist in respiration, namely the - diaphragm and thorax, sympathise with them. But if the heart be affected, - the patient could not stand out long, for in it is the origin of respiration - and of life.

-

The cause is a coldness and humidity of the spirit (pneuma); but the materiel is a thick and - viscid humour. Women are more subject to the disease than men, because they - are humid and cold. Children recover more readily than these, for nature - in

- -

the increase is very powerful to heat. Men, if they do not readily suffer - from the disease, die of it more speedily. There is a postponement of death - to those in whom the lungs are warmed and heated in the exercise of their - trade, from being wrapped in wool, such as the workers in gypsum, or - braziers, or blacksmiths, or the heaters of baths.

-

The symptoms of its approach are heaviness of the chest; sluggishness to - one's accustomed work, and to every other exertion; difficulty of breathing - in running or on a steep road; they are hoarse and troubled with cough; - flatulence and extraordinary evacuations in the hypochondriac region; - restlessness; heat at night small and imperceptible; nose sharp and ready - for respiration.

-

But if the evil gradually get worse, the cheeks are ruddy; eyes protuberant, - as if from strangulation; a a râle during the waking - state, but the evil much worse in sleep; voice liquid and without resonance; - a desire of much and of cold air; they eagerly go into the open air, since - no house sufficeth for their respiration; they breathe standing, as if - desiring to draw in all the air which they possibly can inhale; and, in - their want of air, they also open the mouth as if thus to enjoy the more of - it; pale in the countenance, except the cheeks, which are ruddy; sweat about - the forehead and clavicles; cough incessant and laborious; expectoration - small, thin, cold, resembling the efflorescence of foam; neck swells with - the inflation of the breath (pneuma); the præcordia - retracted; pulse small, dense, compressed; legs slender: and if these - symptoms increase, they sometimes produce suffocation, after the form of - epilepsy.

-

But if it takes a favourable turn, cough more protracted and rarer; a more - copious expectoration of more fluid matters; discharges from the bowels - plentiful and watery; secretion of urine copious, although unattended with - sediment; voice louder; sleep sufficient; relaxation of the præcordia; - sometimes

- -

a pain comes into the back during the remission; panting rare, soft, hoarse. - Thus they escape a fatal termination. But, during the remissions, although - they may walk about erect, they bear the traces of the affection.

-
-
- CHAPTER XII. ON PNEUMODES. -

PNEUMODES is a species of asthma; and the affection - is connected with the lungs as is the case in asthma. The attendant symptoms - are common, and there is but little difference; for dyspnœa, cough, - insomnolency, and heat are common symptoms, as also loss of appetite and - general emaciation. Moreover, the disease is protracted for a time, yet not - longer than one year; for, if the autumn begin it, the patients die in the - spring or in the summer; or if the winter, they terminate their life towards - the autumn. Old persons also are at certain times readily seized; and being - seized with rigors, it requires but a slight inclination of the scale to lay - them on the bed of death. All labour in particular under want of breath; - pulse small, frequent, feeble. But these symptoms are also common to asthma; - they have this as peculiar; they cough as if going to expectorate, but their - effort is vain, for they bring up nothing; or if anything is forcibly - separated from the lungs, it is a small, white, round substance, resembling - a hailstone.See in particular Galen, de loc. affect. iv.; - Alexander, vi. 1; and Paulus Ægineta, Syd. Soc. Edit. t.i. p. - 474. The thorax is broader, indeed, than natural, but not altered - in shape, and is free from ulceration; yet, though the lungs be free from - suppuration, they are filled with humours, which are, as it were, compacted. - The intervals of the paroxysms in this affection

- -

are greater. Some, indeed, die speedily of suffocation before anything worse - is transferred to the general system. In other cases the affection - terminates in dropsy about the loins, or in anasarca.

-
-
- CHAPTER XIII. ON THE LIVER. -

IN the formation of the body, the liver and spleen - are equally balanced; for these viscera are equal in number, the one on the - right side and the other on the left. They are unequal, however, in power, - as regards health and diseases. In health, indeed, inasmuch as the liver has - the power of nutrition, for "the roots of all the veins unite to form the - liver": but in diseases it has much greater power to restore health and - occasion death. As far, then, as the liver is superior in health, so much - the worse is it in diseases, for it experiences more sudden and violent - inflammations, and has more frequent and more fatal abscesses. In scirrhus, - too, it proves fatal more quickly and with greater pain than the spleen. - Those things which relate to inflammations thereof I have described among - the acute affections.

-

If it be converted into pus, a sharp pain possesses the parts as far as the - clavicle and the tops of the shoulders, for the diaphragm from which the - liver is suspended is dragged down by the weight, and the diaphragm drags - the membrane lining the ribs to which it is attached, and this membrane (the - pleura) is stretched up to the clavicle and top of - the shoulders, which also are dragged down. Along with the abscess there is - acrid heat and rigors; cough dry and very frequent; colour grass-green; and - if the patients be intensely jaundiced, it is of

- -

the white kind; sleep not quite clear of phantasies; on the main, their - understanding settled; or if, from any temporary cause, there be delirium, - it quickly passes off; swelling under the nipples or sides, which deceives - many, as if it proceeded from the peritoneum. But if there be swelling and - pain on pressure below the false ribs, the liver is swelled; for it is - filled by a collection of fluid. But if the collection is not below the - bone, it is a symptom of the membrane (the peritoneum) being affected, and - its boundaries are distinctly circumscribed; for the hand applied in - pressure, after passing the circumference of the liver, sinks down into an - empty space in the abdomen. But the hardness of the peritoneum is undefined, - and no process at its extremity is apparent. If the process incline - inwardly, nature is far superior to the physician; for it is either turned - upon the bowels or the bladder, and far the least dangerous is the passage - by the bladder: but if it incline outwards, it is bad not to make an - incision, for otherwise the liver is corroded by the pus, and death is not - long deferred. But, if you intend to make an incision, there is danger of - hemorrhage, from which the patient may die suddenly; for hemorrhage in the - liver cannot be checked. But if you are reduced to the necessity of making - an incision, heat a cautery in the fire to a bright heat, and push it down - to the pus, for it at the same time cuts and burns: and if the patient - survive, there will run out a white, concocted, smooth, not fetid, very - thick pus, by which the fever and other bad symptoms are diminished, and - altogether the health is restored. But if the pus passes into the - intestines, the belly has watery discharges at first, but afterwards they - resemble the washings of flesh, and, again, they are like those in dysentery - proceeding from ulcerations; but sometimes a bloody ichor, or thrombus is - passed. Bile also is discharged, intensely yellow, or leekgreen, and, - lastly, before death, black.

-

But if the abscess do not suppurate, and the discharges from

- -

the bowels are fetid like putrefaction, the food passes undigested, owing to - the stomach and intestines having lost their tone; for thus the liver, even - though now in good condition, does not perform digestion; along with these - symptoms there is acrid heat, and altogether there is a turn to the worse; - colliquative wasting of the flesh, pulse small, difficulty of breathing, - when at no distance of time their life is at an end. In certain cases, the - dysentery and the ulceration have healed, but the disease changed to dropsy. - But if all these symptoms abate, if pus that is white, smooth, consistent, - and inodorous, is discharged, and the stomach digests the food, there may be - good hopes of the patient. But the best thing is for it to be discharged by - the urine; for the passage by it is safer and less troublesome than the - other.

-

But if, after the inflammation, the liver does not suppurate, the pain does - not go off, its swelling, changing to a hard state, settles down into - scirrhus; in which case, indeed, the pain is not continued, and when present - is dull; and the heat is slight; there is loss of appetite; delight in - bitter tastes, and dislike of sweet; they have rigors; are somewhat pale, - green, swollen about the loins and feet; forehead wrinkled; belly dried up, - or the discharges frequent. The cap of these bad symptoms is dropsy.

-

In the dropsy, provided there is a copious discharge of thick urine, having - much re-crementitious sediment, there is a hope that the dropsical swelling - may run off; but if the urine be thin, without sediment, and scanty, it - conspires with the dropsy. But if nature change to her pristine state, and - burst upon the bowels, along with copious watery discharges, it has also - sometimes cured the dropsy. This mode of cure, however, is dangerous; for - what from the copious evacuations, and the extreme prostration, the patients - have sometimes died of weakness, as from hemorrhage. Sweating, if copious, - carries off the disease with less danger, for dropsical persons

- -

generally have not a moist skin. Such is the termination of the affections in - the liver.

-

But if the liver suppurate . . . . . children, and those till manhood; women - less so. The causes are intemperance, and a protracted disease, especially - from dysentery and colliquative wasting; for it is customary to call these - persons tabid who die emaciated from ulcers of the - liver.

-
-
- CHAPTER XIV. ON THE SPLEEN. -

SCIRRHUS, a chronic disease, is habitual to the - spleen (suppuration does not readily occur in it, and yet it does occur - sometimes), when the pain is not severe, but swelling much greater than the - pain; for it has been seen swelled on the right side as far as the liver in - the whole common space between them, hence many have been deceived in - supposing that it is not an affection of the spleen, but of the membrane, - for it appears to them that the peritonæum is inflamed. It is hard and - unyielding as stone. Such the spleen generally becomes in scirrhus, when - also it is attended with great discomfort.

-

But if it suppurate, it is soft to the touch, yielding to pressure at its - top, when there is a formation of pus; but when it is not suppurated it does - not yield. Sometimes it hangs entire in the abdomen, being moved about to - this side and to that, whilst it remains a small body, and has space to - float in. Nausea, restlessness, especially about the time of breaking.

-

The symptoms of distension are, fevers, pains, and rigors (for generally they - are free of rigors, and of pain when the heat is small, and hence abscess - about the spleen is sometimes latent); for the viscus is porous and - insensible even in health: they are swollen, dropsical, of a dark-green - colour, along

- -

with disquietude, dyspnœa as if from weight of the chest, for the evil is - well marked. Even to its upper parts the abdomen is filled with a flatus - (pneuma), thick, misty, humid in appearance but not - in reality; much desire of coughing comes on, and their expectoration is - small and dry. If there be watery discharges from the bowels, they at first - bring some slight relief; but if they increase, they waste the patient, and - yet nevertheless they do good.

-

But, if it should break, pure concocted pus is never discharged, but whitish - and ashy, sometimes feculent, or livid. If the abscess become deeper, the - fluid is dark, when likewise some of the juice of the melted spleen is - discharged. In certain cases, entire portions of the spleen have been - brought up, for the spleen is of a soluble nature. And if the ulcer does not - heal, but remains for a long time, they lose appetite, become cachectic, - swollen, unseemly to look at, having many ulcers on all parts of the body, - especially on the legs, where the sores are round, livid, hollow, foul, and - difficult to heal. Wasted thereby, they expire.

-

In a small tumour, with hardness and resistance, pain is wanting; on this - account they live a long time. But if overpowered by the affection, dropsy, - phthisis, and wasting of the body necessarily supervene; and this form of - death removes them from life.

-

Children, then, and young persons are most readily affected, and most readily - escape from it. Old persons, indeed, do not often suffer, but they cannot - escape; but certain elderly persons have been cut off by latent disease of - the spleen; for, even with a small swelling, the scale of death has turned - with them. A protracted and consumptive disease induces these affections, - and in young persons inactivity especially, when, after contention and many - exercises, the body has become inactive. As to localities, the marshy; as to - waters, the thick, saltish, and fetid. Of the seasons, autumn is pecularly - malignant.

-
- -
- CHAPTER XV. ON JAUNDICE, OR ICTERUS. -

If a distribution of bile, either yellow, or like the yolk of an egg, or like - saffron, or of a dark-green colour, take place from the viscus, over the - whole system, the affection is called Icterus, a dangerous complaint in - acute diseases, for not only when it appears before the seventh day does it - prove fatal, but even after the seventh day it has proved fatal in - innumerable instances. Rarely the affection has proved a crisis to a fever - towards the end, but itself is not readily discussed.

-

It is formed not only from a cause connected with the liver, as certain - physicians have supposed, but also from the stomach, the spleen, the - kidneys, and the colon. From the liver in this manner: if the liver become - inflamed or contract scirrhus, but remain unchanged with regard to its - functional office, it produces bile, indeed, in the liver, and the bladder, - which is in the liver, secretes it; but if the passages which convey the - bile to the intestine, be obstructed from inflammation or scirrhus, the - bladder gets over-distended, and the bile regurgitates; it therefore becomes - mixed with the blood, and the blood, passing over the whole system, carries - the bile to every part of the body, which acquires the appearance of bile. - But the hardened fæces are white and clayey, as not being tinged with bile, - because the bowels are deprived of this secretion. Hence also the belly is - very much dried up; for it is neither moistened nor stimulated by the bile. - The colour in this species is whitish-green.

-

If jaundice make its appearance in connection with the spleen, it is - dark-green, for its nutriment is black, because the spleen is the strainer - of the black blood, the impurities of which it does not receive nor - elaborate when diseased, but

- -

they are carried all over the body with the blood. Hence patients are - dark-green from icterus in connection with the spleen; but the colour is - darker than usual in the customary discharges from the bowels, for the - superfluity of the nutriment of the spleen becomes recrement from the - bowels.

-

And icterus also is formed in connection with the colon and stomach, provided - their powers of digestion be vitiated; for digestion takes place even in the - colon, and from it a supply of nutriment is sent upwards to the liver. - Provided, then, the liver receive its other food in a cruder state than - usual, it indeed goes through its own work, but leaves that of the other - undone; for in distribution it diffuses the blood which carries the marks of - the inactivity of the colon to all parts of the body. The indigestion in - this case is connected with the formation of the bile in the colon.

-

Thus icterus may be formed in any viscus, not only of those which send - nutriment to the liver, but also of those which receive it from the liver. - For nature sends nutriment to all parts, not only by ducts perceptible to - the senses, but much more so by vapours, which are readily carried from all - parts to all, nature conducting them even through the solid and dense parts. - Wherefore these vapours become tinged with bile, and discolour any part of - the body in which they get lodged. Moreover, in jaundice connected with the - colon, the evacuations are not white; for the liver is not disordered as - regards the function of bile, and is not impeded in the transmission of bile - to the intestines.

-

The general system, likewise, is most powerful in producing icterus; for the - cause is seated in the whole body. It is of this nature: in every part there - is heat for concoction; in every part for the creation and secretion of - humours, different in different places, but in each that which is peculiar - to it: in flesh, indeed, sweat; in the eyes, tears; in the joints and nose, - mucus; in the ears, wax. If the heat, then, fails in the performance

- -

of each of its operations, it is itself converted into that which is acrid - and fiery; but all the fluids become bile, for the products of heat are - bitter, and stained with bile. But if indigestion happens in the blood, the - blood assumes the appearance of bile, but is distributed as nourishment to - all parts, wherefore bile appears everywhere. For it is a dire affection, - the colour being frightful in appearance, and the patients of a golden - colour; for the same thing is not becoming in a man which is beautiful in a - stone. It is superfluous in me to tell whence the name is derived, further - than that it is derived from certain four-footed and terrestrial animals, - called I)KTI/DES, whose eyes are of this - colour.A species of ferret; either the Mustela Erminea or the M. - Furo.

-

There are two species of the affection; for the colour of the whitish-green - species either turns to yellow and saffron, or to livid and black. The cause - of these is the same as the cause of the two kinds of bile; for, of the - latter, one species--namely, the light-coloured--is yellow, thin, and - transparent; but this species is also sometimes tinged so as to resemble - saffron or the yolk of an egg. The other is of a darker character, like - leeks, woad, or wholly black. There are innumerable intermediate varieties - of colour, these being connected with the heat and humours. The viscera, - also, co-operate in this; for the viscus is either a bright-red, like the - liver, or dark-red, like the spleen. When, therefore, the icterus is - connected with any viscus, if from the liver, it bears traces of this - viscus, and if from the spleen, of it; and so, also, with regard to all the - others. But if it possesses no appearance of any, it is an affection of the - general habit. These appear manifest in the white of the eyes especially, - and in the forehead about the temples; and in those naturally of a white - complexion, even from a slight attack, the increased colour is visible.

-

In cases, therefore, of black icterus, the patients are of a

- -

dark-green colour, are subject to rigors, become faintish, inactive, - spiritless; emit a fetid smell, have a bitter taste, breathe with - difficulty, are pinched in the bowels; alvine evacuations like leeks, - darkish, dry, passed with difficulty; urine deeply tinged with black; - without digestion, without appetite; restless, spiritless, melancholic.

-

In the whiter species, the patients are of a light-green colour, and more - cheerful in mind; slow in beginning to take food, but eat spiritedly when - begun; of freer digestion than those of the former species; alvine - discharges, white, dry, clayey; urine bright-yellow, pale, like saffron.

-

In both cases the whole body is itchy; heat at the nostrils, small, indeed, - but pungent; the bilious particles prickly. The taste of bitter things is - not bitter; and yet, strange to tell, it is not sweet; but the taste of - sweet things is bitter. For in the mouth the bile lodged in the tongue, - prevailing over the articles of food, sophisticates the sensation; for the - tongue, having imbibed the bile, does not perceive them, while, during the - season of abstinence from food, the bile remains torpid, neither is the - tongue unpleasantly affected with that to which it is habituated; but the - bile, if heated up by the tastes of the articles of food, impresses the - tongue. When, therefore, the food is bitter, the sensation is of the bitter - things; but when sweet, of the bilious. For the sensation of the bile - anticipates the other, and thus deceives those who suppose that bitter - things appear sweet; for it is not so, but because it is not exacerbated by - the bitter lodged in it from being habituated to the disease, the phantasy - of sweet is created; and there is the same condition in sweet and bitter - tastes; for the bile is the screen of the fallacious tastes.

-

When, therefore, it appears without inflammation of any viscus, it is usually - not dangerous, though protracted; but if prolonged, and the viscus gets - inflamed, it terminates most commonly in dropsy and cachexia. And many have - died

- -

emaciated, without dropsy. It is familiar to adolescents and young men, and - to them it is less dangerous; it is not altogether unusual also with - children, but in them it is not entirely free from danger.

-
-
- CHAPTER XVI. ON CACHEXIA, OR BAD HABIT OF BODY. -

CACHEXIA arises as the conversion of nearly all - diseases; for almost all diseases are its progenitors. But it likewise is - formed by itself, separately from all others, as an original affection of - the noxious kind, by deriving its increase from the administration of many - and improper medicines. And "a bad habit" for a season is common to all - complaints, with many symptoms; and of this its name is significant. There - is emaciation, paleness, swelling, or whatever else happens for the time to - be prevalent in the body. But cachexia is the form of one great affection, - and gives its name to the same. For "the good habit of the patient" (Euhexia) in all respects, as regards digestion, the - formation of blood for distribution, and every natural operation whence - arise good breathing, good strength, and good colour, constitutes the - pristine state of good health. But if its nature become changed to the - weakness of cacochymy, this constitutes cachexia.

-

This disease is difficult to cure, and is a very protracted illness; for it - is engendered during a protracted space of time, and not from one infirmity - of the body, nor in connection with only one viscus; for it is formed by the - conversion of all into a vitiated state. Wherefore those diseases which are - its offspring are incurable, as dropsy, phthisis, or wasting; for, indeed, - the causes of cachexia are akin to those of wasting.

- -

The disease is a protracted and continuous dysentery, and the relapses of - diseases in certain cases. Generally there is sufficient appetite, and - plenty of food is taken; but the distribution thereof takes place in a crude - and undigested condition, for the operation of digestion is not performed - upon the food.

-

The cause of it also may be the suppression of the hemorrhoidal discharge, or - the omission of customary vomiting, inactivity as regards exercises, and - indolence as to great labours. When each of its attendants has ceased to - return, there is heaviness of the whole body, now and then paleness, - flatulence of the stomach, eyes hollow, sleep heavy, and inactivity. But - these symptoms occurring in an erratic form conceal the existence of the - disease; but if they remain and strike root, nor readily give way, they are - significant of a mighty illness. When in an erect posture, then they become - swollen in their feet and legs; but, when reclining, in the parts they lay - upon; and if they change their position, the swelling changes accordingly, - and the course of the cold humour is determined by its weight. For when the - heat evaporates the humidity, if it be not diffused, the humidity again runs - in a liquid state. They have an appetite for much food, and are very - voracious; the distribution is more expeditious than the digestion, of - matters that are crude rather than undigested; but digestion is not at all - performed, nor is it digested in the whole body by nature. For the weakness - of the heat in the belly and in the system is the same, neither is good and - well-coloured blood formed.

-

And when the whole body is filled with crudities, and the desire as to food - is gone, the cachexy having now extended to the stomach, and the affection - having now attained its summit, they become swollen, inactive, and - spiritless towards every exertion. The belly is dried up, and, for the most - part, the alvine discharges are without bile, white, hard, and undigested. - They are parched in person, without perspiration, troubled with

- -

itchiness; sleep at no time settled, but drowsiness in the reclining - position; respiration slow; pulse obscure, feeble, frequent, and very - frequent upon any, even a very small, exertion; respiration in these cases - asthmatic; veins on the temples elevated, with emaciation of the parts - around; but at the wrists the veins much larger and tumid; blood of a - dark-green colour. Along with these, phthisis or tabes induces anasarca or ascites, and from their - progeny there is no escape.

-

With regard to the ages which induce this disease, in the first place, old - age, in which there is no recovery; children are readily affected, and more - readily recover; adults are not very much exposed to the affection, but have - by no means easy recoveries. No one season produces this disease, nor does - it terminate in any one; but autumn indeed conceives it, winter nurses it, - spring brings it to its full growth, and summer despatches it.

-
-
-
- - BOOK II. -
- CHAPTER I. ON DROPSY. -

DROPSY is indeed an affection unseemly to behold - and difficult to endure; for very few escape from it, and they more by - fortune and the gods, than by art; for all the greater ills the gods only - can remedy. For either the disease lurking in a vital organ has changed the - whole system to cachexy, or the general system from some plague that has - gone before has changed the viscera to a Cacochymy, when both co-operate - with one another to increase the illness, and no part is uninjured from - which even a slight assistance might be rendered to Nature. It is a cold and - dense vapour converted into humidity, resembling a mist in the universe; or, - it is the conversion of a humid and cold cause which changes the patient to - such a habit. For a fluid rolling about in the lower belly we do not call - Dropsy, since neither is the affection situated in that place; but when the - tumour, swelling, colour, and the habit melting down to water, conspire in - the disease, it both is, and is called Dropsy. For, even should the water at - any

- -

time burst outwardly, or should one give vent to it, by making an incision in - the hypochondrium, the dropsical affection will still remain confirmed; - wherefore the primary cause of it is cachexia.

-

There are many varieties, each having different names. For if the watery - suffusion float in the flanks, and, owing to its fulness, when tapped it - sound like a drum, the disease is called Tympanites. - But if the water be confined in large quantity in the peritonæum, and the - intestines float in the liquid, it gets the appellation of Ascites. But if the lower belly contain none of these, but the - whole body swell, if in connexion with a white, thick, and cold phlegm, the - disease is called Phlegmatias; but if the fleshy parts - are melted down into a sanguineous, watery, or thin humour, then the species - of dropsy called Anasarca is formed. The constitution - of each of them is bad; but the combination of them is much worse. For - sometimes the variety which forms in the lower belly (Ascites), is associated with that variety in which the fluid is - diffused all over the body. But the most dangerous is that form in which - Tympanites is mixed with Anasarca. For of the dropsies that form in the - lower belly, Tympanites is particularly worse than Ascites. But of those - affecting the whole body, Leucophlegmatia is less than Anasarca. It is mild - then, so to speak of such hopeless diseases, when a smaller affection is - combined with another smaller one. But it is much worse if one of the - smaller enters into combination with one of the greater. But if a complete - mixture of two great affections take place, the product thereof is a greater - evil.

-

The symptoms are very great and very easy to see, to touch, and to hear; in - Ascites, for example, to see the tumidity of the abdomen, and the swelling - about the feet; the face, the arms, and other parts are slender, but the - scrotum and and prepuce swell, and the whole member becomes crooked,

- -

from the inequality of the swelling:--To touch--by strongly applying the hand - and compressing the lower belly; for the fluid will pass to other parts. But - when the patient turns to this side or that, the fluid, in the change of - posture, occasions swelling and fluctuation, the sound of which may be - heard. But if you press the finger firmly on any part, it becomes hollow, - and remains so for a considerable time. These are the appearances of - Ascites.

-

Tympanites may be recognised, not only from the sight of the swelling, but - also by the sound which is heard on percussion. For if you tap with the - hand, the abdomen sounds; neither does the flatus (pneuma) shift its place with the changes of posture; for the - flatus, even although that which contains it should be turned upwards and - downwards, remains always equally the same; but should the flatus (pneuma) be converted into vapour and water (for Ascites - may supervene on Tympanites), it shifts its form, indeed, the one half - running in a fluid state, if the conversion be incomplete.

-

In Anasarca and Leucophlegmatia the lower belly is empty, the patients are - swelled in the face and arms; and likewise, in these cases, whatever parts - are empty in the others, in them become full. For in Leucophlegmatia there - is collected a white, cold, and thick phlegm; with it the whole body is - filled, and the face is swollen, and also the neck and arms; but the abdomen - is full from the swelling; but the mammæ are raised up into a swelling in - the case of such youths as are still in the happy period of life. But, in - Anasarca, there is wasting of the flesh to a fleshy humour, and a bloody - ichor, such as runs from ulcerations of the bowels, and such as flows from - bruises produced by the fall of weights, if the outer skin be scarified. But - the combination of the two has the symptoms of both.

-

In all the species there are present paleness, difficulty of breathing, - occasional cough; they are torpid, with much languor

- -

and loss of appetite; but if they take any food, however small in quantity - and free from flatulence, they become flatulent, and have distension as if - from repletion; skin dry, so that it does not become moist even after the - bath; they are white and effeminate; but in Anasarca they are of a - dark-green colour, and have dark veins; in Ascites and Tympanites these are - prominent, both in the face, and in the wrists, and the abdomen. But in - Anasarca and Leucophlegmatia all the parts are concealed by the swelling; - sleep heavy; they are torpid, with slight dejection of spirit; concern about - trifles; fondness of life; endurance not from good spirits and good hopes - like those in prosperity, but from the nature of the affection. It is not - possible exactly to state the cause; but this is a mighty wonder, how in - certain diseases, not altogether dangerous, the patients are spiritless, - dejected, and wish to die, but in others they have good hopes and are fond - of life. Diseases produce both these contraries.

-

Dropsy sometimes is occasioned suddenly by a copious cold draught, when, on - account of thirst, much cold water is swallowed, and the fluid is - transferred to the peritonæum; by which means the innate heat in the - cavities is congealed, and then the drops which formerly were converted into - air and dissipated, flow into the cavities. If this, therefore, happen, the - cure of these cases is easier before any of the viscera or the whole person - is affected. Moreover flatulent food, indigestion, and the BuprestisThe Meloe vesicatoria. See Paulus Ægineta, - Syd. Soc. edit., t.iii. p. 74; and Dioscorides, ii. 69. have - sometimes occasioned dropsies.

-

It is an illness common to all, men and women, in every period of life, only - that certain ages are more exposed to certain species of the disease; - children to Anasarca and Leucophlegmatia; young men until manhood are - subject to swelling about the lower belly (Ascites?) - Old persons are prone to suffer all kinds, as being deficient in heat, for - old age is cold;

- -

but they are not exposed to collections of humours, and to them, therefore, - Tympanites is the familiar form.

-

All the species, indeed, are unfavourable; for dropsy, in all its forms of - disease, is bad. But of these, leucophlegmatia is the more mild; for in it - there are many and various chances of good fortune, such as an evacuation of - sweat, of urine, or from the bowels, by which the dropsical habit is carried - off. But tympanites is of a difficult nature, and still more so anasarca; - for in this affection the physician would require to change the whole - person, a thing not easy for the gods themselves to accomplish.

-

Sometimes the dropsy forms in a small space, such as the head in - hydrocephalus; or in the lungs alone; or in the liver, or the spleen; or the - womb in women; and this last is easier to cure than any of the others, for - provided its mouth relax from its former constriction, if it contains a - fluid, it discharges the same outwardly, and if a flatus, it is dissipated. - But if the uterus suffer at all in anasarca, for the most part the whole - woman becomes dropsical.

-

This other form of dropsy is known: small and numerous bladders, full of - fluid, are contained in the place where ascites is found; but they also - float in a copious fluid, of which this is a proof; for if you perforate the - abdomen so as to evacuate the fluid, after a small discharge of the fluid, a - bladder within will block up the passage; but if you push the instrument - farther in, the discharge will be renewed. This species, then, is not of a - mild character; for there is no ready passage by which the bladders might - escape. It is said, however, that in certain cases such bladders have come - out by the bowels. I have never seen such a case, and therefore write - nothing of them; for I am unable to tell whether the discharge be from the - colon, or the stomach. What is the mode of their formation? For the passage - whereby all matters may be discharged by the anus is patent; but the - discharge of the water collected

- -

about the loins by the bowels is incredible. For a wounded intestine is not - free from trouble and danger.

-
-
- CHAPTER II. ON DIABETES. -

DIABETES is a wonderful affection, not very - frequent among men, being a melting down of the flesh and limbs into urine. - Its cause is of a cold and humid nature, as in dropsy. The course is the - common one, namely, the kidneys and bladder; for the patients never stop - making water, but the flow is incessant, as if from the opening of - aqueducts. The nature of the disease, then, is chronic, and it takes a long - period to form; but the patient is short-lived, if the constitution of the - disease be completely established; for the melting is rapid, the death - speedy. Moreover, life is disgusting and painful; thirst, unquenchable; - excessive drinking, which, however, is disproportionate to the large - quantity of urine, for more urine is passed; and one cannot stop them either - from drinking or making water. Or if for a time they abstain from drinking, - their mouth becomes parched and their body dry; the viscera seem as if - scorched up; they are affected with nausea, restlessness, and a burning - thirst; and at no distant term they expire. Thirst, as if scorched up with - fire. But by what method could they be restrained from making water? Or how - can shame become more potent than pain? And even if they were to restrain - themselves for a short time, they become swelled in the loins, scrotum, and - hips; and when they give vent, they discharge the collected urine, and the - swellings subside, for the overflow passes to the bladder.

-

If the disease be fully established, it is strongly marked;

- -

but if it be merely coming on, the patients have the mouth parched, saliva - white, frothy, as if from thirst (for the thirst is not yet confirmed), - weight in the hypochondriac region. A sensation of heat or of cold from the - stomach to the bladder is, as it were, the advent of the approaching - disease; they now make a little more water than usual, and there is thirst, - but not yet great.

-

But if it increase still more, the heat is small indeed, but pungent, and - seated in the intestines; the abdomen shrivelled, veins protuberant, general - emaciation, when the quantity of urine and the thirst have already - increased; and when, at the same time, the sensation appears at the - extremity of the member, the patients immediately make water. Hence, the - disease appears to me to have got the name of diabetes, - as if from the Greek word DIABH/THS (which signifies a siphon), because the fluid does not - remain in the body, but uses the man's body as a ladder (DIABA/QRH), whereby to leave it.Altogether, this interpretation is so unsatisfactory, that I was almost - tempted to alter the text quite differently from Wigan and Ermerins, and - to read O(KOI=O/N TIS DIABHSEI/WN, - when the passage might be rendered thus -- "it got the name of diabetes, - as if signifying one having a frequent desire of descending, because the - fluid does not remain in the system, but uses the man's person as a - ladder for its exit." At all events, the reading of Wigan and Ermerins - seems inadmissible; for how can the two comparisons, to a siphon, and to - a ladder, be admitted together? It is possible, however, that DIABA/QRH| is faulty, and that we ought to - read DIABH/TH|. They stand out - for a certain time, though not very long, for they pass urine with pain, and - the emaciation is dreadful; nor does any great portion of the drink get into - the system, and many parts of the flesh pass out along with the urine.

-

The cause of it may be, that some one of the acute diseases may have - terminated in this; and during the crisis the diseases may have left some - malignity lurking in the part. It is not improbable, also, that something - pernicious, derived from the

- -

other diseases which attack the bladder and kidneys, may sometimes prove the - cause of this affection. But if any one is bitten by the dipsas,The dipsas was a species of viper. See Paulus Ægineta, ii. p. - 185. the affection induced by the wound is of this nature; for - the reptile, the dipsas, if it bite one, kindles up an unquenchable thirst. - For they drink copiously, not as a remedy for the thirst, but so as to - produce repletion of the bowels by the insatiable desire of drink. But if - one be pained by the distension of the bowels and feel uncomfortable, and - abstain from drink for a little, he again drinks copiously from thirst, and - thus the evils alternate; for the thirst and the drink conspire together. - Others do not pass urine, nor is there any relief from what is drank. - Wherefore, what from insatiable thirst, an overflow of liquids, and - distension of the belly, the patients have suddenly burst.

-
-
- CHAPTER III. ON THE AFFECTIONS ABOUT THE KIDNEYS. -

THE kidneys are of a glandular nature, but redder - in colour, like the liver, rather than like the mammæ and testicles; for - they, too, are glands, but of a whiter colour. In shape they resemble the - testicles, but are broader, and, at the same time, curved. Their cavities - are small and like sieves, for the percolation of the urine; and these have - attached to each of them nervous canals, like reeds, which are inserted into - the shoulders of the bladder on each side; and the passage of the urine from - each of the kidneys to the bladder is equal.

-

About it, the kidneys, and those passages, many and complicated diseases are - formed, partly acute, proving fatal by hemorrhage, fevers, and inflammation, - as has been described by me;

- -

but partly chronic, others wearing out the patient by wasting, and although - not of a fatal character, incurable, and persisting until death. Wherefore, - the chronic are--abscesses, ulcers, the formation of stones, and - hemorrhoids. The ulcerations from abscess in man are all very protracted, - and difficult to cure.

-

The formation of stones is a long process, the stoppage of them painful, for - the passage of them is not easily accomplished; and in addition to these, - the retention of urine is formidable. But if several small ones stop - together in the passage, or a large one be impacted; and if these occur to - both kidneys, so as to occasion retention of urine and distension of the - parts, the patients die in a few days. Nature, therefore, did well in - forming the cavity of the kidneys oblong, and of equal size with the - ureters, and even a little larger, so that if a stone formed above, it might - have a ready passage to the bladder. On this account, also, the stones have - an oblong form, because, for the most part, they are consolidated in the - ureters; and such in that place as are of unequal thickness are slender - before, owing to the ureters being narrow, but thick behind, because the - kidneys verge downwards. They are formed in the kidneys only, but when in a - heated state; for the stones have no fixed place in the ureters, but the - gravel floats downwards with the urine, and thus is both indicative of the - affection, and furnishes the materiel of it. But if an - unusually large one at any time be detained in the pelvis of the kidney, - pains of the loins, about the regions of the psoœ, as - far as the middle of the ribs, take place, and hence, in many cases, the - pain leads to mistake, as if it proceeded from pleurisy; heaviness of the - hips; painful flexion about the spine, so that they stoop forward with - difficulty; very painful tormina; at the same time, the pains are heavy with - a sense of twisting, for the intestine is convoluted. But if the urine be - retained in large quantity, and with distension, the desire of making water - resembles the pains of labour; they are troubled with flatulence,

- -

which cannot find vent; the fevers are pungent, and of a dry nature. Tongue - parched; the belly, also, dried up; they are emaciated, and lose appetite; - or if they take anything, they cannot readily swallow or digest it. But if - the stone fall down into the ureters, there is shivering, as if from rigor, - the sensation as if from the passing of a stone with violent exertion. And - if it fall down into the bladder, there is an abundant evacuation of watery - urine, flatulent discharges from the bowels, the stomach settled, - eructations, rest from former illnesses; and sometimes blood is poured out - along with the urine, from excoriation of the passage. Another painful - operation is the passage through the member; for if the stone be larger than - the urethra, it is detained for a long time, the bladder is filled behind, - and the ischuria is very painful, for along with the bladder the ureters, - also, are filled. The passage of crooked stones is most difficult, for I - have seen hooked protuberances on certain of these concretions. But, for the - most part, they are oblong, being formed according to the shape of the - passages. In colour, some are white, clayey, as is mostly the case with - children; others are yellow, and saffron-coloured in old persons, in whom - the stones usually form in the kidneys, whereas in children it is rather in - the bladder. The causes of the concretion are two-fold: in old persons, a - cold body and thick blood. For cold concretes thick fluids more readily than - heat, the proof of which is seen in the Thermal springs; for when congealed, - the water gets concreted into a sort of chalk-stones. But in children, the - copious recrement of the blood, being overheated, gives origin to their - formation, like fire.

-

Such are the affections connected with the formation of stones. Certain - persons pass bloody urine periodically: this affection resembles that from - hemorrhoids, and the constitution of the body is alike; they are very pale, - inert, sluggish, without appetite, without digestion; and if the discharge - has taken

- -

place, they are languid and relaxed in their limbs, but light and agile in - their head. But if the periodical evacuation do not take place, they are - afflicted with headache; their eyes become dull, dim, and rolling: hence - many become epileptic; others are swollen, misty, dropsical; and others - again are affected with melancholy and paralysis. These complaints are the - offspring of the stoppage of a customary discharge of blood. If, then, the - blood flow pure and unmixed with urine, for the most part the blood of the - urine flows from the bladder. Sometimes it is discharged in great quantity - from rupture of the kidneys; sometimes it is coagulated, and a thrombus is - formed of extravasated blood; sometimes it is coagulated in the bladder, - when dreadful ischuria comes on.

-

After the rupture there succeed ulcers, which are slow and difficult to heal; - the indication of which is a scab, or red film, like a spider's web, or - white pus passed in the urine, sometimes pure and unmixed, and sometimes - mixed up with the urine. And by these symptoms we may also diagnose - abcesses, if, in addition, fevers and rigors supervene towards evening; - pains about the loins, pruritus; but if it burst, clots of a purulent and - fleshy nature, and now a discharge of white pus. But the ulcers are pungent, - sometimes clear, and sometimes foul. This is indicated by the pus and the - urine, whether fetid or free of smell.

-

Spring, then, induces hemorrhages and abscesses; winter and autumn, stones. - But if along with the stones ulcers be formed, the diseases indeed are - incurable, there is speedy emaciation and death.

-
-
- - CHAPTER IV. ON THOSE IN THE BLADDER. -

OF the diseases in the bladder no one is mild: the - acute proving fatal by inflammation, wounds, spasm, and acute fevers; while - an ulcer, abcess, paralysis, or a large stone, are chronic and incurable. - For it (a large stone?) can neither be broken by a - draught, nor by medicine, nor scraped outwardly, nor cut without danger. For - the small ones of the bladder are to be cut out, but the other proves fatal - the same day, or in a few days, the patients dying from spasms and fevers; - or, if you do not cut him, retention of the urine takes place, and the - patient is consumed slowly with pains, fevers, and wasting. But if the stone - is not very large, there is frequent suppression of urine; for by falling - readily into the neck of the bladder, it prevents the escape of the urine. - Although it be safer to cut in these cases than for the large stones, still - the bladder is cut; and although one should escape the risk of death, still - there is a constant drain of water; and although this may not be dangerous, - to a freeman the incessant flow of urine is intolerable, whether he walk or - whether he sleep; but is particularly disagreeable when he walks. The very - small ones are commonly cut without danger. If the stone adhere to the - bladder, it may be detected with care; and, moreover, such cases prove - troublesome from the pain and weight, even when there is no dysuria, but yet - the patient may have difficulty of making water. You may diagnose all cases - of stone by the sediments of sand in the urine, and, moreover, they have the - genital parts enlarged by handling them; for when they make water, and there - is a stone behind, they are pained, and grasp and drag the genital parts, as - if with the intention of tearing out the stone along with the bladder. The - fundament sympathises by becoming itchy, and the anus is protruded with the - forcing

- -

and straining, from the sensation, as it were, of the passage of the stone. - For the bladder and anus lie close to one another, and when either suffers, - the other suffers likewise. Wherefore, in inflammations of the rectum, the - bladder is affected with ischuria; and in acute pains of the bladder, the - anus passes nothing, even when the bowels are not much dried up. Such are - the sufferings connected with calculi.

-

Hemorrhage, although it may not prove fatal very speedily, yet in the course - of time has wasted many patients. But the clots of blood produced by it are - quickly fatal by inducing ischuria, like as in stones; for even if the blood - be thin, of a bright colour, and not very coagulable, yet the bladder - accumulates it for a length of time, and its heating and boiling (as it - were) coagulates the blood, and thus a thrombus is formed. Ischuria, then, - is most peculiarly fatal. But on these symptoms there supervene acute pain, - acrid heat, a dry tongue, and from these they die delirious.

-

If pain come on from a wound, the wound itself is dangerous; but the sore, - even if not fatal at first, becomes incurable from fever or inflammation; - for the bladder is thin, and of a nervous nature, and such parts do not - readily incarnate nor cicatrise. Moreover, the urine is bilious, acrid, and - corrosive. The ordinary condition of the ulcer is this:--when the bladder is - filled, it is stretched; but when emptied, it contracts: it is in the - condition, then, of a joint in extension and flexion, and no ulcer in a - joint is easy of cure.

-

The bladder also suppurates from an abscess. The symptoms of an abscess of - the bladder are the same as in other cases; for the abscess in forming is - attended with inflammation, fevers, and rigors. The dangers are the same. - But if it discharges urine which is thick, white, and not fetid, the ulcers - from them are mild; but if it spread, they pass urine which is feculent, - mixed with pus, and of a bad smell: of such persons the death is not - distant. The urine, indeed, is pungent, and the

- -

evacuation thereof painful, and the pain darts to the extremity of the - member. All things, even those which are opposed to one another, prove - injurious to them; repletion and inanition, inactivity and exercise, baths - and abstinence from baths, food and abstinence from food, sweet things and - acid things; certain articles being serviceable in certain cases, but - proving injurious in others, not being able to agree in any one.

-
-
- CHAPTER V. ON GONORRHŒA. -

GONORRHŒA is not, indeed, a deadly affection, but - one that is disagreeable and disgusting even to hear of. For if impotence - and paralysis possess both the fluids and genital organs, the semen runs as - if through dead parts, nor can it be stopped even in sleep; for whether - asleep or awake the discharge is irrestrainable, and there is an unconscious - flow of semen. Women also have this disease, but their semen is discharged - with titillation of the parts, and with pleasure, and from immodest desires - of connection with men. But men have not the same prurient feelings; the - fluid which runs off being thin, cold, colourless, and unfruitful. For how - could nature, when congealed, evacuate vivifying semen? And even young - persons, when they suffer from this affection, necessarily become old in - constitution, torpid, relaxed, spiritless, timid, stupid, enfeebled, - shrivelled, inactive, pale, whitish, effeminate, loathe their food, and - become frigid; they have heaviness of the members, torpidity of the legs, - are powerless, and incapable of all exertion. In many cases, this disease is - the way to paralysis; for how could the nervous power not suffer when nature - has become frigid in regard to the generation of life? For it is the semen, - when possessed of

- -

vitality, which makes us to be men, hot, well braced in limbs, hairy, well - voiced, spirited, strong to think and to act, as the characteristics of men - prove. For when the semen is not possessed of its vitality, persons become - shrivelled, have a sharp tone of voice, lose their hair and their beard, and - become effeminate, as the characteristics of eunuchs prove. But if any man - be continent in the emission of semen, he is bold, daring, and strong as - wild beasts, as is proved from such of the athletæ as are continent. For - such as are naturally superior in strength to certain persons, by - incontinency become inferior to their inferiors; while those by nature much - their inferiors by continency become superior to their superiors: but an - animal becomes strong from nothing else than from semen. Vital semen, then, - contributes much to health, strength, courage, and generation. From - satyriasis a transition takes place to an attack of gonorrhœa.

-
-
- CHAPTER VI. ON THE STOMACHIC AFFECTIONS. -

THE stomach is the president of pleasure and - disgust, being an important neighbour to the heart for imparting tone, good - or bad spirits, from the sympathy of the soul. This is the primary power of - the stomach. These things have been described by me in another place. The - offspring of pleasure are, good digestion, good condition, and good colour - of the body; of disgust, their contraries, and also sometimes depression of - spirits, when proper nutrition is wanting; and in melancholic patients, - loathing of food. If, then, this organ be diseased, there is dislike and - abomination of articles of food, not only if administered, but even if the - food is not seen;

- -

nay, the very remembrance of them is attended with nausea, distress, - water-brash, and heart-ache; and in certain cases there is salivation and - vomiting. Even when the body wastes, provided their stomach remain empty, - they bear this pain more easily than that produced by the administration of - food. But if at any time they are compelled by necessity to take food, the - pain is worse than hunger; the act of masticating in the mouth occasions - sufferance, and to drink is a still greater pain. And it is not that they - suffer thus from suitable food, and bear more unusual food well; owing to a - change from that which is natural to the opposite, there is a painful - sensation as to everything, an aversion to, and dislike of, all kinds of - food. Along with these there is pain between the scapulæ, much greater after - the administration of food or drink; loathing, distress, sight dull, noises - of the ears, heaviness of the head, torpidity of the limbs, their joints - sink under them; palpitation in the hypochondriac region; phantasy, as of - the spine being moved towards the lower limbs; they seem as if carried - about, now this way and now that, whether they stand, or lie down, like - reeds or trees shaken by a gale of wind; they belch out a cold and watery - phlegm. But if there be bile in bilious persons, they have dimness of sight, - and no thirst, even when owing to the food they appear thirsty; are - sleepless, torpid, drowsy, not from true sleep, but like those in comatose - affections; emaciated, very pale, feeble, relaxed, imbecile, dispirited, - timid, inactive, quick to passion, very moody; for such persons at times - have fallen into a state of melancholy.

-

These mental emotions necessarily attend the affection when in connection - with the stomach; but certain people, recognising the parts which - sympathise, and from which the most dreadful symptoms arise, reckon the - stomach as the cause. But the contiguity of the heart, which is of all - organs the first, is a strong confirmation of the truth of what I say; - for

- -

the heart is placed in the middle of the lungs, and this intermediate space - comprehends the stomach; and, moreover, both are connected with the spine; - and from this vicinity to the heart arise the heart-ache, prostration of - strength, and symptoms of melancholy.

-

There are other, and, indeed, innumerable causes of this disease; but the - principal is, much pus poured forth by the belly through the stomach. It is - familiar to such persons as from their necessities live on a slender and - hard diet; and to those who, for the sake of education, are laborious and - persevering; whose portion is the love of divine science, along with scanty - food, want of sleep, and the meditation on wise sayings and doings--whose is - the contempt of a full and multifarious diet; to whom hunger is for food, - water for drink, and watchfulness in place of rest; to whom in place of a - soft couch, is a hammock on the ground without bed-clothes, a mean coverlet, - a porous mantle, and the only cover to whose head is the common air; whose - wealth consists in the abundant possession and use of divine thought (for - all these things they account good from love of learning); and, if they take - any food, it is of the most frugal description, and not to gratify the - palate, but solely to preserve life; no quaffing of wine to intoxication; no - recreation; no roving or jaunting about; no bodily exercise nor plumpness of - flesh; for what is there from which the love of learning will not allure - one?--from country, parents, brothers, oneself, even unto death. Hence, to - them, emaciation of the frame; they are ill-complexioned; even in youth they - appear old, and dotards in understanding; in mind cheerless and inflexible; - depraved appetite, speedy satiety of the accustomed slender and ordinary - food, and from want of familiarity with a varied diet, a loathing of all - savoury viands; for if they take any unusual article of food, they are - injured thereby, and straightway abominate food of all kinds. It is a - chronic disease of the stomach. But inflammations,

- -

defluxions, heart-burn, or pain thereof, are not called the Stomachic - affection.

-

Summer brings on this disease, whence springs the complete loss of digestion, - of appetite, and of all the faculties. With regard to the period of life, - old age; for in old men, even without any disease, owing to their being near - the close of life, the appetite is nearly gone.

-
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- CHAPTER VII. ON THE CŒLIAC AFFECTION. -

THE stomach being the digestive organ, labours in - digestion, when diarrhœa seizes the patient. Diarrhœa consists in the - discharge of undigested food in a fluid state; and if this does not proceed - from a slight cause of only one or two days' duration; and if, in addition, - the patient's general system be debilitated by atrophy of the body, the - Cœliac disease of a chronic nature is formed, from atony of the heat which - digests, and refrigeration of the stomach, when the food, indeed, is - dissolved in the heat, but the heat does not digest it, nor convert it into - its proper chyme, but leaves its work half finished, from inability to - complete it; the food then being deprived of this operation, is changed to a - state which is bad in colour, smell, and consistence. For its colour is - white and without bile; it has an offensive smell, and is flatulent; it is - liquid, and wants consistence from not being completely elaborated, and from - no part of the digestive process having been properly done except the - commencement.

-

Wherefore they have flatulence of the stomach, continued eructations, of a - bad smell; but if these pass downwards, the bowels rumble, evacuations are - flatulent, thick, fluid, or

- -

clayey, along with the phantasy, as if a fluid were passing through them; - heavy pain of the stomach now and then, as if from a puncture; the patient - emaciated and atrophied, pale, feeble, incapable of performing any of his - accustomed works. But if he attempt to walk, the limbs fail; the veins in - the temples are prominent, for owing to wasting, the temples are hollow; but - also over all the body the veins are enlarged, for not only does the disease - not digest properly, but it does not even distribute that portion in which - the digestion had commenced for the support of the body; it appears to me, - therefore, to be an affection, not only of the digestion, but also of the - distribution.

-

But if the disease be on the increase, it carries back the matters from the - general system to the belly, when there is wasting of the constitution; the - patients are parched in the mouth, surface dry and devoid of sweat, stomach - sometimes as if burnt up with a coal, and sometimes as if congealed with - ice. Sometimes also, along with the last scybala, there flows bright, pure, - unmixed blood, so as to make it appear that the mouth of a vein has been - opened; for the acrid discharge corrodes the veins. It is a very protracted - and intractable illness; for, even when it would seem to have ceased, it - relapses again without any obvious cause, and comes back upon even a slight - mistake. Now, therefore, it returns periodically.

-

This illness is familiar to old persons, and to women rather than to men. - Children are subject to continued diarrhœa, from an ephemeral intemperance - of food; but in their case the disease is not seated in the cavity of the - stomach. Summer engenders the disease more than any other of the seasons; - autumn next; and the coldest season, winter, also, if the heat be almost - extinguished. This affection, dysentery and lientery, sometimes are - engendered by a chronic disease. But, likewise, a copious draught of cold - water has sometimes given rise to this disease.

-
-
- - CHAPTER VIII. ON COLICS. -

PERSONS in colic are cut off speedily by volvulus - and tormina. There are very many causes of this affection. The symptoms are, - heaviness during abstinence from food, particularly in the part most - affected; much torpor; they are inactive, lose appetite, become emaciated, - sleepless, swollen in countenance. And if the colon be affected in - connection with the spleen, they are of a dark-green colour; but of a - light-green when in connection with the liver, from the sympathy of the - nearest viscera. And if they take food, even in small quantity, and such as - is not flatulent, they become very flatulent, and have a desire to pass - wind, which, however, does not find vent: forced eructations upwards, but - without effect; or, if any should be forcibly expelled, the flatus is fetid - and acid which escapes upwards. The kidneys and bladder sympathise, with - pain and ischuria; but in such cases the symptoms interchange with one - another. But a greater wonder than these, --an unexpected pain has passed - down to the testicles and cremasters; and this sympathetic affection has - escaped the observation of many physicians, who have made an incision into - the cremasters, as if they were the particular cause of the disease. But in - these cases also the symptoms interchange with one another.

-

From this disease are produced other diseases; abscesses and ulcers, of no - mild character; dropsies and phthisis, which are incurable. For the disease - is formed from cold and thick humours, and a copious and glutinous phlegm; - but, also, it comes on with a frigid period of life, a cold season, and a - cold locality, and during a hard winter.

-
-
- - CHAPTER IX. ON DYSENTERY. -

OF the intestines, the upper being thin and bilious - (XOLW/DEA) as far as the cœcum, have got the Greek name XOLW/DES. From these proceed the lower, which are thick and - fleshy, as far as the commencement of the Rectum.

-

Wherefore ulcers form in all of them; and the varieties of these ulcers - constitute Dysentery: on this account, these diseases are complex. For some - of them erode the intestines superficially, producing only excoriation; and - these are innocuous; but they are far more innocent if the affections be low - down. Or if the ulcers be yet a little deeper, they are no longer of a mild - character. But ulcers which are deep and have not stopped spreading, but are - of a phagedænic, painful, spreading, and gangrenous character, are of a - fatal nature; for the small veins get corroded in the course of their - spreading, and there is an oozing of blood in the ulcers. Another larger - species of ulcers: thick edges, rough, unequal, callous, as we would call a - knot in wood: these are difficult to cure, for they do not readily - cicatrise, and the cicatrices are easily dissolved.

-

The causes of dysentery are manifold; but the principal are, indigestion, - continued cold, the administration of acrid things, such as myttôtos,A sort of condiment, containing garlic and - other acrid things. See Pollux, Onomast. vi. onions by - themselves, garlic, food of old and acrid flesh, by which dyspepsia is - produced; also unaccustomed liquids, cyceon,A thick soup prepared from various substances, that is to say, cheese, - wine, etc. It is mentioned both in the Iliad and Odyssey. or zythusOn the composition of the ancient zythi, or Ales, see Appendix to the Edinburgh Greek - Lexicon, in voce, ZU/QOS. (ale), or any similar beverage produced in - any country as a substitute for wine to

- -

quench thirst. But also a blow, exposure to cold, and cold drink, create - ulcerations.

-

The dejections and the circumstances attendant on the ulcers are different in - different cases; for, if superficial, when from above, the discharges are - thin, bilious, devoid of odour except that which they derive from the - intestines; those from the jejunum are rather more coloured, saffron-like, - and fetid. Those dejections which contain the food in a dissolved state but - rough, are sometimes fetid in smell when the ulcers are gangrenous, and - sometimes have the smell as if from scybala. But in the ulcerations from the - parts below, the discharges are watery, thin, and devoid of smell. But if - deeper they are like ichor, reddish, of the colour of dark wine, or like the - washings of flesh; and these are sometimes by themselves and sometimes with - the fæces, these being dissolved in the surrounding fluid, devoid of bile - and of smell; or they are evacuated in a consistent and dry state, - lubricated with the surrounding fluid. But if the ulcers be larger and - smoother, in those above they are bilious, and pinch the parts from which - they come and through which they pass (they even pinch the anus), for the - bile is acrid, more especially if from an ulcer; and the bile is fatty, like - grease. In the deeper ulcers below, a thick clot of blood with phlegm, like - flesh not very fat, or like the scrapings of the bowels: nay, even entire - portions are mixed up with them; they are discharged white, thick, mucous, - like chopped tallow, along with the humour in which they float: these - proceed from the rectum: but sometimes they are merely mucous, prurient, - small, round, pungent, causing frequent dejections and a desire not without - a pleasurable sensation, but with very scanty evacuations: this complaint - gets the appellation of tenesmus. But from the colon - there are discharged pieces of flesh, which are red, large, and have a much - larger circumference. If the ulcers become deep, and the blood thick and - feculent, these are more fetid than

- -

the former; but if the ulcers spread and are phagedænic, and if nothing will - stop them, above, in addition to being intensely bilious, the dejections - become saffron-like, frothy, feculent, blackish, like woad or like leeks, - thicker than the former, fetid like a mortification; food now undigested, as - if only masticated by voracious teeth. But if the under parts are also - corroded, black clots of blood, thick, fleshy, very red, clotted, sometimes, - indeed, black, but at other times of all various colours, fetid, - intolerable; involuntary discharges of fluids. And sometimes a substance of - considerable length, in many respects not to be distinguished from a sound - piece of intestine, has been discharged, and, to those ignorant of the - matter, has caused apprehension about the intestine: but the fact is - this,--the intestines, like the stomach, consist of two coats, which lie - close to one another in an oblique manner; when, therefore, the connection - between them is dissolved, the inner coat, being separated to some length, - protrudes externally, while the outer one remains alone, incarnates, and - gets cicatrised, and the patients recover and live unharmed. It is the lower - gut alone which suffers thus, owing to its fleshy nature. And, if blood be - discharged from any vessel, it runs of a bright red or black colour, pure, - and unmixed with food or scybala; and if a concretion is spread over it like - broad spiders' webs, it coagulates when cold, and no longer would be taken - for a secretion of blood; but being discharged with much flatulence and - noise, it has the appearance of being much larger than its actual amount. - Sometimes, also, a purulent abscess forms in the colon, nowise different - from the other internal ulcers; for the symptoms, the pus, and the mode of - recovery are the same. But if there be hard secretions of matters resembling - flesh, as if pounded, and like rough bodies, the abscess is not of a mild - nature. Sometimes a copious discharge of water takes place from the colon in - the form of dysentery, which has freed many patients from dropsy. In a word, - such are

- -

the ulcers in the intestines; and their forms and the secretions from them as - I have described.

-

I will now describe the symptoms accompanying each of these states of - disease, whether the ulcers be mild or malignant. To speak in general terms, - then, if the excoriation is superficial, whether it be above or below, the - patients are free from pain and from fever, and get better without being - confined to bed, in various ways, by merely some slight changes of diet. But - if ulceration supervene, in the upper bowels there are tormina, which are - pungent, acrid, as if from the presence of a small amount of hot bile; and - occasionally there is suppuration: indeed, for the most part, there is - suppuration, or digestions imperfectly performed, though there is no want of - appetite. But if the ulcers form in the lower part of the bowels, they are - much less dangerous than in those above, for the bowels there are of a much - more fleshy nature than those above. But if those above become hollow and - phagedænic, there are acute fevers, of a latent kind, which smoulder in the - intestines; general coldness, loss of appetite, insomnolency, acid - eructations, nausea, vomiting of bile, vertigo: but if the discharge become - copious, and consist of more bilious matters, the tormina become permanent, - and the other pains increase; sometimes there is prostration of strength, - feebleness of the knees; they have ardent fever, are thirsty, and anxious; - black vomiting, tongue dry, pulse small and feeble. Akin to these are the - fatal symptoms I have stated among those of malignant ulcers; cardiac - affections even to deliquium animi, from which some never recover, but thus - expire. These dangerous symptoms are common also to erosions of the lower - intestines if the ulcers spread, and the discharge be not checked, only that - the tormina and pains are below the umbilicus where the ulcers are situated. - The forms of the secretions are such as I have said; but if they be small at - first, and there be a postponement of their spreading for a long time, - various changes take

- -

place in the ulcers, some subsiding, and others swelling up, like waves in - the sea. Such is the course of these ulcers. But if nature stand out, and - the physician co-operate, the spreading may, indeed, be stopped, and a fatal - termination is not apprehended, but the intestines remain hard and callous, - and the recovery of such cases is protracted.

-

In hemorrhage from the bowels, if it proceed from a large vein or artery, it - is sudden death; for neither is it possible to introduce the hand so as to - reach the ailment, nor to apply any medicine to the sore. And even if the - hemorrhage were restrained by the medicine, the escape from death would not - be certain; for, in some cases, the falling off of a large eschar widens the - mouth of the vein, and when clots form within, and remain there, the disease - is incurable. It is necessary, then, to cure hemorrhages in their - commencement. Its approach, also, for the most part is obvious, although not - in all cases quite apparent: anxiety attends, with restlessness, heaviness - in the part where the rupture is to take place, ruddiness of the countenance - if the blood has not yet burst forth. And if the vein has burst lately, for - the most part the symptoms are alleviated; but if it has been a longer time - ago, this takes place more slowly, and with more difficulty. Such are the - ulcers in the intestines.

-

They occur in the season of summer; next in autumn; less in spring; least of - all in winter. Diarrhœa attacks children and adolescents, but dysentery - adults and young persons. In old age convalescence is difficult, and - cicatrization protracted. Corroding sores are unusual in old persons, but - yet hemorrhage is in accordance with old age.

-
-
- - CHAPTER X. ON LIENTERY. -

IF many thick and hard cicatrices form after - dysenteries, and broad and very deep ulcerations of the upper intestines, - the food passes from them to those below in a fluid state, without - separation of the nutritious part; for the cicatrix shuts up the pores by - which the nutriment is carried upwards. The patient, therefore, is seized - with atrophy, loss of colour and of strength. The affection gets the - appellation of Lientery, this name being applied to a cicatrix of the - intestines. And here the affection is from ulcers. But sometimes the - intestines do not acquire cicatrization, but yet usage and habit reconcile - the intestines to the discharge. For, the heat in these parts, if congealed, - neither at times performs digestion, nor is the nutriment distributed - upwards; but being unchanged, owing to weakness, it fails to undergo any - part of the process. But if the purging, though of vitiated matters, be - temporary, and not confirmed, a simple vomit after food will sometimes - remove the disease. But if the exciting cause be prolonged, and get - confirmed, it does no good.

-

A chronic disease, and cachexia so mild as not to confine the patient to bed, - will engender this disease. But dropsies sometimes have terminated - favourably in this disease; a change from one evil to another, but still a - better change.

-
-
- CHAPTER XI. ON AFFECTIONS OF THE WOMB, OR HYSTERICS. -

THE uterus in women is beneficial for purgation and - parturition, but it is the common source of innumerable and bad

- -

diseases; for not only is it subject to ulcers, inflammation, and the fluor, - but, if the whole organ be suddenly carried upwards, it quickly causes - death. The fatal diseases of an acute nature connected therewith have been - described elsewhere: but the chronic affections are, the two species of fluor; hardness; ulcers, part mild, but part malignant; - prolapsus of the whole, or of part.

-

The fluor, then, is either of a red or white colour; its - appearance indicates this. It is the red if it consist of bright red blood, - and the varieties thereof; or livid, or black and thin, or thick and - coagulated, like a thrombus; or white, like water; or a bright ochre colour, - like bile: in thickness like a thinnish or thin and fetid ichor. The white - flux (or fluor albus) is like pus, and the true form - like white whey; but a clot of blood frequently runs off with the pus. But - there is an infinite variety of forms of it, as regards more or less - quantity. Its periods sometimes agree with those of the menstrual purgation, - but it does not continue the regular time as before; there is not much - blood, but it flows during many days; the interval is for a few days, but is - quite free from discharge. Another variety as to the period: the first - purgation is at the regular time, but it occurs two or three times during - each month. Another variety: a continual flux; small, indeed, every day, but - by no means small during the whole month; for the uterus never closes its - mouth, labouring under relaxation, so as to permit the flow of the fluid: - but if it neither intermits nor diminishes, they die of hemorrhage. The - symptoms are, the woman's colour in accordance with those of the discharge; - sleepless, loathes food, anxious, relaxed, especially in the red flux, and - subject to pains; the discharge fetid in both varieties, but to a greater - and less extent at different times; for the white is worse if the - putrefaction be unusually great; and sometimes the red, if the erosion be - exacerbated. In a word, the black is the worst of all; the livid next; the - pale, the

- -

white, and the purulent, are more protracted, indeed, but less dangerous. Of - these the pale is worse indeed, but much better when mixed with the - customary discharge. Now the customary discharge is red in all its - varieties. But, indeed, the red are worse in old women; but the white are - not at all so to the young; but even to them that which is customary is less - troublesome. Another white fluor: the menstrual discharge white, acrid, and - attended with an agreeable pruritus; along with which the discharge of a - white thick fluid, like semen, is provoked. This species we call female - gonorrhœa. It is a refrigeration of the womb, which therefore becomes - incapable of retaining its fluids; hence, also, the blood changes to a white - colour, for it has not the purple colour of fire. The stomach, also, is - subject to the affection, and vomits phlegm; and also the bowels are - similarly affected in diarrhœa.

-

Ulcers, too, are formed in the womb; some broad and attended with tingling, - which, being close together, are, as it were, a superficial excoriation; pus - thick, without smell, scanty. These ulcers are mild. But there are others - deeper and worse than these, in which the pains are slight, pus somewhat - more abundant, much more fetid, and yet, notwithstanding, these also are - mild. But if they become deeper, and the lips of the sores hard or rough, if - there is a fetid ichor, and pain stronger than in the former case, the ulcer - corrodes the uterus; but sometimes a small piece of flesh is cast off and - discharged, and this sore not coming to cicatrization, either proves fatal - after a long time, or becomes very chronic. This sore gets the appellation - of phagedæna. The sores also are dangerous if in these - cases the pain gets exacerbated, and the woman becomes uneasy. From the sore - there is discharged a putrid matter, intolerable even to themselves; it is - exasperated by touching and by medicines, and irritated by almost any mode - of treatment. The veins in the uterus are swelled up with distension of the - surrounding parts. To the skilled, it is not difficult to

- -

recognise by the touch, for it is not otherwise obvious. Febrile heat, - general restlessness, and hardness is present, as in malignant diseases; the - ulcers, being of a fatal nature, obtain also the appellation of cancers. - Another cancer: no ulceration anywhere, swelling hard and untractable, which - distends the whole uterus; but there are pains also in the other parts which - it drags to it. Both these carcinomatous sores are chronic and deadly; but - the ulcerated is worse than the unulcerated, both in smell and pains, in - life and in death.

-

Sometimes the whole uterus has protruded from its seat, and lodged on the - woman's thighs; an incredible affliction! yet neither has the uterus not - been thus seen, nor are the causes which produce it such as do not occur. - For the membranes which are inserted into the flanks, being the nervous (ligamentous?) supporters of the uterus, are relaxed; - those at the fundus, which are inserted into the loins, are narrow; but - those at its neck, on each side to the flanks, are particularly nervous and - broad, like the sails of a ship. All these, then, give way if the uterus - protrude outwardly, wherefore this procidentia - generally proves fatal; for it takes place from abortion, great concussions, - and laborious parturition. Or if it do not prove fatal, the women live for a - long time, seeing parts which ought not to be seen, and nursing externally - and fondling the womb. It would appear that, of the double membrane of the - womb, the internal lining coat is sometimes torn from the contiguous one, - for there are two transverse plates of the coat; this, then, is thrown off - with the flux, and in abortion and laborious parturition, when it adheres to - the placenta. For if it be forcibly pulled, the coat of the uterus being - stretched, ..... But if the woman do not die, it is either restored to its - seat, or but a small part appears externally, for the woman conceals it with - her thighs. Sometimes the mouth of the womb only, as far as the neck, - protrudes, and retreats inwardly if the uterus be made to smell to a fetid - fumigation; and the

- -

woman also attracts it if she smells to fragrant odours. But by the hands of - the midwife it readily returns inwards when gently pressed, and if anointed - beforehand with the emollient plasters for the womb.

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-
- CHAPTER XII. ON ARTHRITIS AND SCHIATICA. -

ARTHRITIS is a general pain of all the joints; that - of the feet we call Podagra; that of the hip-joint, Schiatica; that of the - hand, Chiragra. The pain then is either sudden, arising from some temporary - cause; or the disease lies concealed for a long time, when the pain and the - disease are kindled up by any slight cause. It is, in short, an affection of - all the nerves, if the ailment being increased extend to all; the first - affected are the nerves which are the ligaments of the joints, and such as - have their origin and insertion in the bones. There is a great wonder in - regard to them; there is not the slightest pain in them, although you should - cut or squeeze them; but if pained of themselves, no other pain is stronger - than this, not iron screws, nor cords, not the wound of a sword, nor burning - fire, for these are often had recourse to as cures for still greater pains; - and if one cut them when they are pained, the smaller pain of the incision - is obscured by the greater; and, if it prevail, they experience pleasure in - forgetting their former sufferings. The teeth and bones are affected - thus.

-

The true reason of this none but the gods indeed can truly understand, but - men may know the probable cause. In a word, it is such as this; any part - which is very compact is insensible to the touch or to a wound, and hence it - is not

- -

painful to the touch or to a wound. For pain consists in an exasperated - sense, but what is compact cannot be exasperated, and hence is not - susceptible of pain. But a spongy part is very sensible, and is exasperated - by an injury. But since dense parts also live by their innate heat, and - possess sensibility by this heat, if then the exciting cause be material, - such as either a sword, or a stone, the material part of the patient is not - pained, for it is dense by nature. But if an intemperament of the innate - heat seize it, there arises a change of the sense; the heat therefore is - pained by itself, being roused within by the impression on the sense. The - pains then are from nature's being increased, or a redundance thereof.

-

Arthritis fixes itself sometimes in one joint and sometimes in another; - sometimes in the hip-joints; and for the most part in these cases the - patient remains lame in it; and the other joints it affects little, and - sometimes does not go to the small joints, as the feet and hands. If it - seizes the greater members which are able to contain the disease, it does - not go beyond these organs; but if it begin from a small one, the attack is - mild and unexpected. The commencement of ischiatic disease is from the thigh - behind, the ham, or the leg. Sometimes the pain appears in the cotyloid - cavity, and again extends to the nates or loins, and has the appearance of - anything rather than an affection of the hip-joint. But the joints begin to - be affected in this way: pain seizes the great toe; then the forepart of the - heel on which we lean; next it comes into the hollow of the foot, but the - ankle swells last; and they blame a wrong cause; some, the friction of a new - shoe; others, a long walk; another again, a stroke or being trod upon; but - no one will of his own accord tell the true one; and the true one appears - incredible to the patients when they hear of it. On this account the disease - gets to an incurable state, because at the commencement, when it is feeble, - the physician is not at

- -

hand to contend with it; but if it has acquired strength from time, all - treatment is useless. In some, then, it remains in the joints of the feet - until death, but in others it spreads over the compass of the whole body. - For the most part, it passes from the feet to the hands. For to the disease - there is no great interval between the hands and the feet, both being of a - similar nature, slender, devoid of flesh, and very near the external cold, - but very far from the internal heat; next the elbow and the knee, and after - these the hip-joint; which is the transition to the muscles of the back and - chest. It is incredible how far the mischief spreads. The vertebræ of the - spine and neck are affected with the pain, and it extends to the extremity - of the os sacrum: there is a general pain of all the parts of the groin, and - a pain peculiar to each part thereof. But likewise the tendons and muscles - are intensely pained; the muscles of the jaws and temples; the kidneys, and - the bladder next in succession. And, what a wonder! at last the nose, the - ears, and the lips, suffer; for every where there are nerves and muscles. A - certain person had pains in the sutures of the head, and not knowing why he - was pained there, he pointed out the shapes of the sutures--the oblique, the - straight, the transverse--both behind and before, and stated that the pain - was narrow and fixed in the bones; for the disease spreads over every - commissure of the bones, in the same manner as in the joints of a foot or of - a hand. Callosities also form in the joints; at first they resemble - abscesses, but afterwards they get more condensed, and the humour being - condensed is difficult to dissolve; at last they are converted into hard, - white tophi, and over the whole there are small tumours, like vari and - larger; but the humour is thick, white, and like hailstones. For it is a - cold disease of the whole (body), like hail; and there appears to be a - difference in regard to heat and cold; for in certain cases there is delight - in things otherwise disagreeable. But, I fancy, that the cause is a - refrigeration

- -

of the innate heat, and that the disease is single; but if it speedily give - way, and the heat re-appears, there is need of refrigeration and it delights - in such things; this is called the hot species. But if the pain remain - internally in the nerves, and the part not becoming heated subside, nor get - swollen, I would call this variety cold, for which there is need of hot - medicines to restore the heat, of which those very acrid are most necessary. - For heat excites the collapsed parts to swelling, and calls forth the - internal heat, when there is need of refrigerants. In proof of this, the - same things are not always expedient in the same cases, for what is - beneficial at one time proves prejudicial in another; in a word, heat is - required in the beginning, and cold at the conclusion. Wherefore Gout does - not often become unremitting; but sometimes it intermits a long time, for it - is slight; hence a person subject to Gout has won the race in the Olympiac - games during the interval of the disease.

-

Men then are more readily affected, but more slightly the women; women more - rarely than men, but more severely. For what is not usual nor cognate, if - from necessity it gets the better engenders a more violent ailment. The most - common age is after thirty-five; but sooner or slower according to the - temperament and regimen of every one. The pains then are dreadful, and the - concomitants worse than the pains; fainting even upon touch, inability of - motion, loss of appetite, thirst, restlessness. But, if they recover partly, - as if escaped from death, they live dissolutely, are incontinent, - open-handed, cheerful, munificent, and luxurious in diet; but partly, as if - they would (not?) again escape from death, they enjoy the present life - abundantly. In many cases the gout has passed into dropsy, and sometimes - into asthma; and from this succession there is no escape.

-
-
- - CHAPTER XIII. ON ELEPHAS, OR ELEPHANTIASIS. -

THERE are many things in common as to form, colour, - size, and mode of life between the affection Elephas and the wild beast the - elephant; but neither does the affection resemble any other affection, nor - the animal any other animal. The wild beast, the elephant, indeed, is very - different from all others; in the first place then, he is the greatest and - the thickest of animals; in size, he is as great as if you were to put one - animal on another, like a tower; in bulk, he is as large as if you should - place several other very large animals side by side. But neither in shape is - he much like unto any other. Then, as to colour, they are all intensely - black, and that over their whole body. One horse, indeed, is very white, - like "the Thracian steeds of Rhesus"; others white-footed, like "the - white-footed horse of Menelaus"; and bay, like "one hundred and fifty"; - others are tawny, as "assuming the shape of a horse having a tawny mane, he - lay down with her." And so it is with oxen, and dogs, and all other reptiles - and animals which live on the earth. But elephants are only of a lurid - colour, "like to night and death." With regard to shape, they have a very - black head, and unseemly face of no marked form, upon a small neck, so that - the head appears to rest upon the shoulders, and even then it is not very - conspicuous. For the ears are large, broad, resembling wings, extending to - the collar-bone and breast-bone, so as to conceal the neck with the ears, - like ships with their sails. The elephant has wonderfully white horns on a - very dark body--others call them teeth--these alone are most white, such as - is nothing else of even any other white animal; and these are not above the - forehead and temples, as is the nature of other horned animals, but in the - mouth and upper jaw, not indeed quite

- -

straight forwards but a little bent upwards, so that it might swallow in a - straight direction, and lift a load in its flat teeth. Moreover the horns - are large, the medium length being as much as a fathom, and some much - larger; that is to say, as long as two fathoms. And the upper jaw from its - lip has a long, ex-osseous, crooked, and serpent-like protuberance; and - there are two perforations at the extremity of this protuberance; and these - by nature are perforated all the way to the lungs, so as to form a double - tube, so that the animal uses this pipe as a nostril for respiration, and - likewise as a hand; for it could take a cup if it please with this - protuberance, and can grasp it round and hold it firmly, and none could it - take by force from the animal, except another stronger elephant. And with - this also it seeks herbage for food; for neither does it live by eating - flesh with its mouth and small teeth. For, its feet being long, raise the - animal considerably above the ground; but its neck also, as I have said, is - small, and therefore it cannot browse on the earth with its mouth; and - moreover the excrescence of the horns in front of the mouth prevents the - mouth from touching the herbage. Wherefore it raises a great load with its - protuberance; then as if with a binder having bound the same with it, he can - convey it to his mouth; whence the ancients properly call it proboscis, for it collects food in front of the animal. But - neither is it able to drink from a lake or river with its mouth, for the - same reason. But, if it is thirsty, it introduces into the water the extreme - nostril of the proboscis, and then, as if inhaling, it draws in much water, - instead of air; and when it has filled its nose, as it were a cup, it pours - the same as a stream of water into its mouth, and then it draws anew and - discharges again, until it fills its belly, as it were a vessel of burden. - It has a rough and very thick skin, containing fissures with prominent - edges, long channels, and other hollow clefts, some transverse, others - oblique, very deep, like

- -

in all respects to a furrowed field. Other animals have naturally hairs for a - mane, but in the elephant this is merely down. There are also innumerable - other differences between it and other animals; for, like man, it bends its - leg backward at the knee; and like woman, it has its dugs at the arm-pits. - But there is no necessity for me now to write concerning the animal, except - in so far as there is any discrepancy between the animal and the disease, - and in so far as the symptoms of the patient resemble the nature of the - animal. The disease is also called Leo, on account of - the resemblance of the eyebrows, as I shall afterwards explain; and Satyriasis, from the redness of the cheeks, and the - irresistible and shameless impulse ad coitum. Moreover - it is also called the Heracleian affection, insomuch as - there is none greater and stronger than it.

-

Wherefore the affection is mighty in power, for it is the most powerful of - all in taking life; and also it is filthy and dreadful to behold, in all - respects like the wild animal, the elephant. And from the disease there is - no escape, for it originates in a deadly cause; it is a refrigeration of the - innate heat, or rather a congelation like a great winter, when the water is - converted into snow, or hail, or ice, or frost. This is the common cause of - death, and of the affection.

-

But the commencement of the disease gives no great indication of it; neither - does it appear as if any unusual ailment had come upon the man; nor does it - display itself upon the surface of the body, so that it might be immediately - seen, and remedies applied at the commencement; but lurking among the - bowels, like a concealed fire it smolders there, and having prevailed over - the internal parts, it afterwards blazes forth on the surface, for the most - part beginning, like a bad signal-fire, on the face, as it were its - watch-tower; but in certain cases from the joint of the elbow, the knee, and - knuckles of the hands and feet. In this way the patient's condition is

- -

hopeless, because the physician, from inattention and ignorance of the - patient's ailment, does not apply his art to the commencement when the - disease is very feeble. For, indeed, they are merely torpid, as if from some - light cause, drowsy, inactive, dry in the bowels, and these symptoms are not - very unusual even in healthy persons. But upon the increase of the - affection, the respiration is fetid from the corruption within of the breath - (pneuma). The air, or something external, would - seem to be the cause of this. Urine thick, muddy, like that of cattle; the - distribution of crude undigested food; and yet of these things there is no - perception nor regard; for neither are they aware whether or not they - digest, thus digestion or indigestion is all one to them, since, for - anything useful and proper to them, digestion is not usual with them. The - distribution, however, is easy, the disease, as it were, greedily attracting - the food for its own nourishment; for this reason the lower belly is very - dry. Tumours prominent, not continuous with one another anywhere, but thick - and rough, and the intermediate space cracked, like the skin of the - elephant. Veins enlarged, not from abundance of blood, but from thickness of - the skin; and for no long time is the situation of them manifest, the whole - surface being elevated equally in the swelling. The hairs on the whole body - die prematurely, on the hands, the thighs, the legs, and again on the pubes; - scanty on the chin, and also the hairs on the head are scarce. And still - more frequently premature hoariness, and sudden baldness; in a very short - time the pubes and chin naked of hair, or if a few hairs should remain, they - are more unseemly than where they are gone. The skin of the head deeply - cracked; wrinkles frequent, deep, rough; tumours on the face hard, sharp; - sometimes white at the top, but more green at the base. Pulse small, dull, - languid, as if moved with difficulty through the mud; veins on the temples - elevated, and also those under the tongue; bowels bilious; tongue - roughened

- -

with vari, resembling hailstones; not unusual for the - whole frame to be full of such (and thus also in unsound victims, the flesh - is full of these tubercles resembling hail). But if the affection be much - raised up from the parts within, and appear upon the extremities, lichens occur on the extremities of the fingers; there - is pruritus on the knees, and the patients rub the itchy parts with - pleasure.

Our author in this place evidently alludes to - mentagra, a malignant disease of the face, - very prevalent in Rome in his time, that is to say, towards the end - of the first and the beginning of the second century. The first - description of it which we possess, is contained in Pliny's Nat. Hist. xxvi., at the beginning, and is to - the following effect: That it was one of the new diseases of the - face, which at one time had spread over most parts of Europe, but - was then mostly confined to Rome: That it had been called by the - Greeks, lichen, but that latterly the Latin - term mentagra had been applied to it. He - further asserts, that it was unknown in former times, and made its - first appearance in Italy during the reign of Tiberius: that the men - of the middle and lower classes, and more especially women, were - exempt from it, the ravages of the disease being confined - principally to the nobility, among whom it was propagated by - kissing. He adds respecting it, that it was cured by caustics, the - effects of which often left unseemly scars on the face. That the - disease had come originally from Egypt, the mother of all such - distempers.

-

Another very interesting account of the disease, under the names of - lichen and mentagra, - is given by Marcellus, the Empiric, in chap. cxix., wherein - elephantiasis, lepra, and other inveterate diseases of the skin are - described. He says that the distemper (vitium) when neglected is apt - to spread all over the face, and to contaminate many persons. He - prescribes various caustic and stimulant applications for it. Along - with it, he gives a very good account of elephantiasis, which, he - remarks, also generally begins in the face with vari and other - appearances, similar to those described by our author. He states - decidedly that the disease is endemical in Egypt, attacking not only - the lower ranks, but even kings themselves.

-

Now it is worthy of remark, that beyond all question this is the - disease to which frequent allusion is made by the poet Martial as - prevailing extensively in Rome, and as being propagated by the - fashionable practice of persons saluting one another, by kissing, in - the streets. The following passages evidently allude to it--Epigr. xi.,8; xii. 59.

-

From all these descriptions, we cannot entertain a doubt, that the - disease, then so prevalent in Rome, was of a malignant and - contagious nature, which attacked principally the face, and was - propagated by kissing ; and, further, that it was a disease of the - same class as elephantiasis. Taking all these circumstances into - account, one may venture to decide pretty confidently, that it was a - disease akin to the Sivvens of Scotland, which - it strikingly resembles in all its characters as described above. - Sivvens, in short, is a species or variety - of syphilis, which is readily communicated both by the mouth, as in - kissing, and per coitum. Further, that - Syphilis, and its congener Sivvens, are the - brood of the ancient elephantiasis, no one at all acquainted with - the history of the latter in ancient, mediæval, and modern times, - will entertain a doubt. See the note to Paulus Ægineta, t. ii., 14, - 15, 16, and the authorities there referred to: also, the History of - Syphilis, as given in Sprengel's and in Renouard's History of - Medicine.

-

The importance of this subject, which has never been satisfactorily - illustrated elsewhere, will be my apology for embracing the present - opportunity of endeavouring to throw some additional light on - it.

And the lichen sometimes

- -

embraces the chin all round; it reddens the cheeks, but is attended with no - great swelling; eyes misty, resembling bronze; eye-brows prominent, thick, - bald, inclining downwards, tumid from contraction of the intermediate space; - colour livid or black; eye-lid, therefore, much retracted to cover the eyes, - as in enraged lions; on this account it is named leontium. Wherefore it is not like to the lions and elephants - only, but also in the eye-lids "resembles swift night." Nose, with black - protuberances, rugged; prominence of the lips thickened, but lower part - livid; nose elongated; teeth not white indeed, but appearing to be so under - a dark body; ears red, black, contracted, resembling the elephant, so that - they appear to have a greater size than usual; ulcers upon the base of the - ears, discharge of ichor, with pruritus; shrivelled all over the body with - rough wrinkles; but likewise deep fissures, like black furrows on the skin; - and for this reason the disease has got the name of elephas. Cracks on the feet and heels, as far as the middle of the - toes; but if the ailment still further increase, the tumours become - ulcerated, so that on the cheeks,

- -

chin, fingers, and knees, there are fetid and incurable ulcers, some of which - are springing up on one part, while others are subsiding on another. - Sometimes, too, certain of the members of the patient will die, so as to - drop off, such as the nose, the fingers, the feet, the privy parts, and the - whole hands; for the ailment does not prove fatal, so as to relieve the - patient from a foul life and dreadful sufferings, until he has been divided - limb from limb. For it is long-lived, like the animal, the elephant. But if - there be a sudden pain of the limbs, it attacks much more grievously, - spreading sometimes to this part, and sometimes to that. Appetite for food - not amiss; taste indiscriminate, neither food nor drink affords pleasure; - aversion to all things from a painful feeling; atrophy; libidinous desires - of a rabid nature; spontaneous lassitude; the figure of each of the limbs - heavy, and even the small limbs are oppressive to the patient. Moreover, the - body is offended with everything, takes delight neither in baths nor - abstinence from them, neither in food nor in abstinence from it, neither in - motion nor in rest, for the disease has established itself in all the parts. - Sleep slight, worse than insomnolency, from its fantasies; strong dyspnœa, - suffocation as if from strangling. In this way certain patients have passed - from life, sleeping the sleep which knows no waking, even until death.

-

When in such a state, who would not flee;--who would not turn from them, even - if a father, a son, or a brother? There is danger, also, from the - communication of the ailment. Many, therefore, have exposed their most - beloved relatives in the wilderness, and on the mountains, some with the - intention of administering to their hunger, but others not so, as wishing - them to die. There is a story that one of those who had come to the - wilderness, having seen a viper creep out of the earth, compelled by hunger, - or wearied out with the affection, as if to exchange one evil for another, - ate the viper alive, and did not die until all his members had become putrid - and dropped

- -

off: and that another person saw a viper creep into a cask of new wine, and - after drinking of the same to satiety, vomit it up, and discharge a great - deal of its venom along with the new wine; but when the viper was smothered - in the new wine, that the man drank of it largely and greedily, seeking thus - to obtain a rescue from life and the disease; but when he had carried the - drinking to satiety and intoxication, he lay down on the ground, at first as - if about to die; but when he awoke from his sleep and intoxication, first of - all his hair fell off, next the fingers and nails, and all the parts melted - away in succession. But as the power was still in the semen, nature formed - the man again, as if from the act of generation: it made other hairs to - grow, and made new nails and clean flesh, and put off the old skin, like the - slough of a reptile; and he was called back, like another new man, to a - growth of life. Thus goes the fable; not very probable, indeed, nor yet - entirely incredible; for that one ill should be overcome by another is - credible. And that from the existing spark nature should renew the man, is - not so incredible as to be held to be a prodigy.

-
-
- + + + +
+
BOOK I. +
CHAPTER I. THE PROŒMIUM +

OF chronic diseases the pain is great, the period of wasting long, and the recovery uncertain; for either they are not dispelled at all, or the diseases relapse upon any slight error; for neither have the patients resolution to persevere to the end; or, if they do persevere, they commit blunders in a prolonged regimen. And if there also be the suffering from a painful system of cure,—of thirst, of hunger, of bitter and harsh medicines, of cutting or burning,—of all which there is sometimes need in protracted diseases, the patients resile as truly preferring even death itself. Hence, indeed, is developed the talent of the medical man, his perseverance, his skill in diversifying the treatment, and conceding such pleasant things as will do no harm, and in giving encouragement. But the patient also ought to be courageous, and co-operate with the physician against the disease. For, taking a firm grasp of the body, the disease not only wastes and corrodes it quickly, but frequently disorders the senses, nay, even deranges the soul by the intemperament of the body. Such we know mania and melancholy to be, of which I will treat afterwards. At the present time I shall give an account of cephalæa.

+
CHAPTER II. ON CEPHALÆA +

IF the head be suddenly seized with pain from a temporary cause, even if it should endure for several days, the disease is called Cephalalgia. But if the disease be protracted for a long time, and with long and frequent periods, or if greater and more untractable symptoms supervene, we call it Cephalæa.

+

There are infinite varieties of it; for, in certain cases, the pain is incessant and slight, but not intermittent; but in others it returns periodically, as in quotidian fevers, or in those which have exacerbations every alternate day: in others it continues from sunset to noon, and then completely ceases; or from noon to evening, or still further into night; this period is not much protracted. And in certain cases the whole head is pained; and the pain is sometimes on the right and sometimes on the left side, or the forehead, or the bregma; and these may all occur the same day in a random manner.

+

But in certain cases, the parts on the right side, or those on the left solely, so far that a separate temple, or ear, or one eyebrow, or one eye, or the nose which divides the face into two equal parts; and the pain does not pass this limit, but remains in the half of the head. This is called Heterocrania, an illness by no means mild, even though it intermits, and although it appears to be slight. For if at any time it set in acutely, it occasions unseemly and dreadful symptoms; spasm and distortion of the countenance take place; the eyes either fixed intently like horns, or they are rolled inwardly to this side or to that; vertigo, deep-seated pain of the eyes as far as the meninges; irrestrainable sweat; sudden pain of the tendons, as of one striking with a club; nausea; vomiting of bilious matters; collapse of the patient; but, if the affection be protracted, the patient will die; or, if more slight and not deadly, it becomes chronic; there is much torpor, heaviness of the head, anxiety, and ennui. For they flee the light; the darkness soothes their disease: nor can they bear readily to look upon or hear anything agreeable; their sense of smell is vitiated, neither does anything agreeable to smell delight them, and they have also an aversion to fetid things: the patients, moreover, are weary of life, and wish to die.

+

The cause of these symptoms is coldness with dryness. But if it be protracted and increase, as regards the pains, the affection becomes Vertigo.

+
CHAPTER III. ON VERTIGO, OR SCOTOMA +

IF darkness possess the eyes, and if the head be whirled round with dizziness, and the ears ring as from the sound of rivers rolling along with a great noise, or like the wind when it roars among the sails, or like the clang of pipes or reeds, or like the rattling of a carriage, we call the affection Scotoma (or Vertigo); a bad complaint indeed, if a symptom of the head, but bad likewise if the sequela of cephalæa, or whether it arises of itself as a chronic disease. For, if these symptoms do not pass off, but the vertigo persist, or if, in course of time, from the want of any one to remedy, it is completed in its own peculiar symptoms, the affection vertigo is formed, from a humid and cold cause. But if it turn to an incurable condition, it proves the commencement of other affections—of mania, melancholy, or epilepsy, the symptoms peculiar to each being superadded. But the mode of vertigo is, heaviness of the head, sparkles of light in the eyes along with much darkness, ignorance of themselves and of those around; and, if the disease go on increasing, the limbs sink below them, and they crawl on the ground; there is nausea and vomitings of phlegm, or of yellow or black bilious matter. When connected with yellow bile, mania is formed; when with black, melancholy; when with phlegm, epilepsy; for it is liable to conversion into all these diseases.

+
CHAPTER IV. ON EPILEPSY +

EPILEPSY is an illness of various shapes and horrible; in the paroxysms, brutish, very acute, and deadly; for, at times, one paroxysm has proved fatal. Or if from habit the patient can endure it, he lives, indeed, enduring shame, ignominy, and sorrow: and the disease does not readily pass off, but fixes its abode during the better periods and in the lovely season of life. It dwells with boys and young men; and, by good fortune, it is sometimes driven out in another more advanced period of life, when it takes its departure along with the beauty of youth; and then, having rendered them deformed, it destroys certain youths from envy, as it were, of their beauty, either by loss of the faculties of a hand, or by the distortion of the countenance, or by the deprivation of some one sense. But if the mischief lurk there until it strike root, it will not yield either to the physician or the changes of age, so as to take its departure, but lives with the patient until death. And sometimes the disease is rendered painful by its convulsions and distortions of the limbs and of the face; and sometimes it turns the mind distracted. The sight of a paroxysm is disagreeable, and its departure disgusting with spontaneous evacuations of the urine and of the bowels.

+

But also it is reckoned a disgraceful form of disease; for it is supposed, that it is an infliction on persons who have sinned against the Moon: and hence some have called it the Sacred Disease, and that for more reasons than one, as from the greatness of the evil, for the Greek word ἱερὸς also signifies great; or because the cure of it is not human, but divine; or from the opinion that it proceeded from the entrance of a demon into the man: from some one, or all these causes together, it has been called Sacred.

+

Such symptoms as accompany this disease in its acute form have been already detailed by me. But if it become inveterate, the patients are not free from harm even in the intervals, but are languid, spiritless, stupid, inhuman, unsociable, and not disposed to hold intercourse, nor to be sociable, at any period of life; sleepless, subject to many horrid dreams, without appetite, and with bad digestion; pale, of a leaden colour; slow to learn, from torpidity of the understanding and of the senses; dull of hearing; have noises and ringing in the head; utterance indistinct and bewildered, either from the nature of the disease, or from the wounds during the attacks; the tongue is rolled about in the mouth convulsively in various ways. The disease also sometimes disturbs the understanding, so that the patient becomes altogether fatuous. The cause of these affections is coldness with humidity.

+
CHAPTER V. ON MELANCHOLY +

BLACK bile, if it make its appearance in acute diseases of the upper parts of the body, is very dangerous; or, if it pass downwards, it is not free from danger. But in chronic diseases, if it pass downward, it terminates in dysentery and pain of the liver. But in women it serves as a purgation instead of the menses, provided they are not otherwise in a dangerous condition. But if it be determined upwards to the stomach and diaphragm, it forms melancholy; for it produces flatulence and eructations of a fetid and fishy nature, and it sends rumbling wind downwards, and disturbs the understanding. On this account, in former days, these were called melancholics and flatulent persons. And yet, in certain of these cases, there is neither flatulence nor black bile, but mere anger and grief, and sad dejection of mind; and these were called melancholics, because the terms bile (χολὴ) and anger (ὀργὴ) are synonymous in import, and likewise black (μέλαινα), with much (πολλὴ) and furious (θηριώδης). Homer is authority for this when he says:—

+

Then straight to speak uprose The Atreidan chief, who `neath his sway a wide-spread empire held: Sore vexed was he; his mighty heart in his dark bosom swelled With rage, and from his eyes the fire like lightning-flashes broke. +—Τοῖσι δ᾿ ἀνέστη +Ἥρως Ἀτρείδης εὐρυκρείων Ἀγαμέμνων +Ἀχνύμενος· μένεος δὲ μέγα φρένες ἀμφιμελαιναι +Πίμπλαντ᾿, ὄσσε δέ οἱ πυρὶ λαμπετόωντι ἐΐκτην. +Iliad, i. 101, etc.

+

The melancholics become such when they are overpowered by this evil.

+

It is a lowness of spirits from a single phantasy, without fever; and it appears to me that melancholy is the commencement and a part of mania. For in those who are mad, the understanding is turned sometimes to anger and sometimes to joy, but in the melancholics to sorrow and despondency only. But they who are mad are so for the greater part of life, becoming silly, and doing dreadful and disgraceful things; but those affected with melancholy are not every one of them affected according to one particular form; but they are either suspicious of poisoning, or flee to the desert from misanthropy, or turn superstitious, or contract a hatred of life. Or if at any time a relaxation takes place, in most cases hilarity supervenes, but these persons go mad.

+

But how, and from what parts of the body, the most of these complaints originate, I will now explain. If the cause remain in the hypochondriac regions, it collects about the diaphragm, and the bile passes upwards, or downwards in cases of melancholy. But if it also affects the head from sympathy, and the abnormal irritability of temper change to laughter and joy for the greater part of their life, these become mad rather from the increase of the disease than from change of the affection.

+

Dryness is the cause of both. Adult men, therefore, are subject to mania and melancholy, or persons of less age than adults. Women are worse affected with mania than men. As to age, towards manhood, and those actually in the prime of life. The seasons of summer and of autumn engender, and spring brings it to a crisis.

+

The characteristic appearances, then, are not obscure; for the patients are dull or stern, dejected or unreasonably torpid, without any manifest cause: such is the commencement of melancholy. And they also become peevish, dispirited, sleepless, and start up from a disturbed sleep.

+

Unreasonable fear also seizes them, if the disease tend to increase, when their dreams are true, terrifying, and clear: for whatever, when awake, they have an aversion to, as being an evil, rushes upon their visions in sleep. They are prone to change their mind readily; to become base, mean-spirited, illiberal, and in a little time, perhaps, simple, extravagant, munificent, not from any virtue of the soul, but from the changeableness of the disease. But if the illness become more urgent, hatred, avoidance of the haunts of men, vain lamentations; they complain of life, and desire to die. In many, the understanding so leads to insensibility and fatuousness, that they become ignorant of all things, or forgetful of themselves, and live the life of the inferior animals. The habit of the body also becomes perverted; colour, a darkish-green, unless the bile do not pass downward, but is diffused with the blood over the whole system. They are voracious, indeed, yet emaciated; for in them sleep does not brace their limbs either by what they have eaten or drunk, but watchfulness diffuses and determines them outwardly. Therefore the bowels are dried up, and discharge nothing; or, if they do, the dejections are dried, round, with a black and bilious fluid, in which they float; urine scanty, acrid, tinged with bile. They are flatulent about the hypochondriac region; the eructations fetid, virulent, like brine from salt; and sometimes an acrid fluid, mixed with bile, floats in the stomach. Pulse for the most part small, torpid, feeble, dense, like that from cold.

+

A story is told, that a certain person, incurably affected, fell in love with a girl; and when the physicians could bring him no relief, love cured him. But I think that he was originally in love, and that he was dejected and spiritless from being unsuccessful with the girl, and appeared to the common people to be melancholic. He then did not know that it was love; but when he imparted the love to the girl, he ceased from his dejection, and dispelled his passion and sorrow; and with joy he awoke from his lowness of spirits, and he became restored to understanding, love being his physician.

+
CHAPTER VI. ON MADNESS +

THE modes of mania are infinite in species, but one alone in genus. For it is altogether a chronic derangement of the mind, without fever. For if fever at any time should come on, it would not owe its peculiarity to the mania, but to some other incident. Thus wine inflames to delirium in drunkenness; and certain edibles, such as mandragora and hyoscyamus, induce madness: but these affections are never called mania; for, springing from a temporary cause, they quickly subside, but madness has something confirmed in it. To this mania there is no resemblance in the dotage which is the calamity of old age, for it is a torpor of the senses, and a stupefaction of the gnostic and intellectual faculties by coldness of the system. But mania is something hot and dry in cause, and tumultuous in its acts. And, indeed, dotage commencing with old age never intermits, but accompanies the patient until death; while mania intermits, and with care ceases altogether. And there may be an imperfect intermission, if it take place in mania when the evil is not thoroughly cured by medicine, or is connected with the temperature of the season. For in certain persons who seemed to be freed from the complaint, either the season of spring, or some error in diet, or some incidental heat of passion, has brought on a relapse.

+

Those prone to the disease, are such as are naturally passionate, irritable, of active habits, of an easy disposition, joyous, puerile; likewise those whose disposition inclines to the opposite condition, namely, such as are sluggish, sorrowful, slow to learn, but patient in labour, and who when they learn anything, soon forget it; those likewise are more prone to melancholy, who have formerly been in a mad condition. But in those periods of life with which much heat and blood are associated, persons are most given to mania, namely, those about puberty, young men, and such as possess general vigour. But those in whom the heat is enkindled by black bile, and whose form of constitution is inclined to dryness, most readily pass into a state of melancholy. The diet which disposes to it is associated with voracity, immoderate repletion, drunkenness, lechery, venereal desires. Women also sometimes become affected with mania from want of purgation of the system, when the uterus has attained the development of manhood; but the others do not readily fall into mania, yet, if they do, their cases are difficult to manage. These are the causes; and they stir up the disease also, if from any cause an accustomed evacuation of blood, or of bile, or of sweating be stopped.

+

And they with whose madness joy is associated, laugh, play, dance night and day, and sometimes go openly to the market crowned, as if victors in some contest of skill; this form is inoffensive to those around. Others have madness attended with anger; and these sometimes rend their clothes and kill their keepers, and lay violent hands upon themselves. This miserable form of disease is not unattended with danger to those around. But the modes are infinite in those who are ingenious and docile,—untaught astronomy, spontaneous philosophy, poetry truly from the muses; for docility has its good advantages even in diseases. In the uneducated, the common employments are the carrying of loads, and working at clay,—they are artificers or masons. They are also given to extraordinary phantasies; for one is afraid of the fall of the oilcruets ..... and another will not drink, as fancying himself a brick, and fearing lest he should be dissolved by the liquid.

+

This story also is told:—A certain joiner was a skilful artisan while in the house, would measure, chop, plane, mortice, and adjust wood, and finish the work of the house correctly; would associate with the workmen, make a bargain with them, and remunerate their work with suitable pay. While on the spot where the work was performed, he thus possessed his understanding. But if at any time he went away to the market, the bath, or on any other engagement, having laid down his tools, he would first groan, then shrug his shoulders as he went out. But when he had got out of sight of the domestics, or of the work and the place where it was performed, he became completely mad; yet if he returned speedily he recovered his reason again; such a bond of connection was there between the locality and his understanding.

+

The cause of the disease is seated in the head and hypochondriac region, sometimes commencing in both together, and the one imparting it to the other. In mania and melancholy, the main cause is seated in the bowels, as in phrenitis it is mostly seated in the head and the senses. For in these the senses are perverted, so that they see things not present as if they were present, and objects which do not appear to others, manifest themselves to them; whereas persons who are mad see only as others see, but do not form a correct judgment on what they have seen.

+

If, therefore, the illness be great, they are of a changeable temper, their senses are acute, they are suspicious, irritable without any cause, and unreasonably desponding when the disease tends to gloom; but when to cheerfulness, they are in excellent spirits; yet they are unusually given to insomnolency; both are changeable in countenance, have headache, or else heaviness of the head; they are sharp in hearing, but very slow in judgment; for in certain cases there are noises of the ears, and ringings like those of trumpets and pipes. But if the disease go on to increase, they are flatulent, affected with nausea, voracious and greedy in taking food, for they are watchful, and watchfulness induces gluttony. Yet they are not emaciated like persons in disease (embonpoint is rather the condition of melancholics) and they are somewhat pale. But if any of the viscera get into a state of inflammation, it blunts the appetite and digestion; the eyes are hollow, and do not wink; before the eyes are images of an azure or dark colour in those who are turning to melancholy, but of a redder colour when they are turning to mania, along with purplecoloured phantasmata, in many cases as if of flashing fire; and terror seizes them as if from a thunderbolt. In other cases the eyes are red and blood-shot.

+

At the height of the disease they have impure dreams, and irresistible desire of venery, without any shame and restraint as to sexual intercourse; and if roused to anger by admonition or restraint, they become wholly mad. Wherefore they are affected with madness in various shapes; some run along unrestrainedly, and, not knowing how, return again to the same spot; some, after a long time, come back to their relatives; others roar aloud, bewailing themselves as if they had experienced robbery or violence. Some flee the haunts of men, and going to the wilderness, live by themselves.

+

If they should attain any relaxation of the evil, they become torpid, dull, sorrowful; for having come to a knowledge of the disease they are saddened with their own calamity.

+

ANOTHER SPECIES OF MANIA.

+

Some cut their limbs in a holy phantasy, as if thereby propitiating peculiar divinities. This is a madness of the apprehension solely; for in other respects they are sane. They are roused by the flute, and mirth, or by drinking, or by the admonition of those around them. This madness is of divine origin, and if they recover from the madness, they are cheerful and free of care, as if initiated to the god; but yet they are pale and attenuated, and long remain weak from the pains of the wounds.Our author, as Petit remarks, evidently refers here to the worship of Cybele; on which see in particular, the Atys of Catullus, and Apuleius, viii.

+
CHAPTER VII. ON PARALYSIS +

Apoplexy, Paraplegia, Paresis, Paralysis, are all generically the same. For they are all a defect of motion, or of touch, or of both; sometimes also of understanding, and sometimes of other sense. But apoplexy is a paralysis of the whole body, of sensation, of understanding and of motion; wherefore to get rid of a strong attack of apoplexy is impossible, and of a weak, not easy. But paraplegia is a remission of touch and motion, but of a part, either of the hand or of the leg. Paralysis for the most part is the remission (paresis) of motion only, and of energy.It is difficult to find an appropriate word either in the Latin or English for the term πάρεσις. It would seem to be particularly applied to a partial loss either of sensibility or of motion. Alexander, however, makes little or no distinction between it and paralysis, x. 2. But if the touch alone is wanting—(but such a case is rare)—the disease is called Anæsthesia rather than paresis. And when Hippocrates says, the leg on the same side was apoplectic, he means to say that it was in a death-like, useless, and incurable state; for what is strong apoplexy in the whole body, that he calls paraplegia in the limb. Paresis, properly speaking, is applied to suppression or incontinence of urine in the bladder. But distortion of the eye-brows, and of the cheeks, and of the muscles about the jaws and chin to the other side, if attended with spasm, has got the appellation of Cynic spasm. Loss of tone in the knees, and of sensibility for a time, with torpor, fainting, and collapse, we call lipothymia.

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Wherefore, the parts are sometimes paralysed singly, as one eye-brow, or a finger, or still larger, a hand, or a leg; and sometimes more together; and sometimes the right or the left only, or each by itself, or all together, either entirely or in a less degree; and the parts only which are distant, homonymous, and in pairs—the eyes, hands, and legs; and also the parts which cohere, as the nose on one side, the tongue to the middle line of separation, and the one tonsil, the isthmus faucium, and the parts concerned in deglutition to one half. I fancy, also, that sometimes the stomach, the bladder, and the rectum, as far as its extremity, suffers in like manner; but the internal parts, when in a paralytic state, are concealed from the sight. Their functions, however, are but half performed; and from this I conclude, that these parts are half affected, as being cut in twain by the disease. And, indeed, this thing teaches us a lesson in respect to the diversity of power and discrimination between the right side and the left. For the inherent cause is equal; and means which occasion the affection are common in both cases, whether cold or indigestion, and yet both do not suffer equally. For Nature is of equal power in that which is equally paired; but it is impossible that the same thing should happen where there is an inequality. If, therefore, the commencement of the affection be below the head, such as the membrane of the spinal marrow, the parts which are homonymous and connected with it are paralysed: the right on the right side, and the left on the left side. But if the head be primarily affected on the right side, the left side of the body will be paralysed; and the right, if on the left side. The cause of this is the interchange in the origins of the nerves, for they do not pass along on the same side, the right on the right side, until their terminations; but each of them passes over to the other side from that of its origin, decussating each other in the form of the letter X. To say all at once, whether all together or separate parts be affected with paralysis ..... or of both; sometimes the nerves from the head suffer (these, generally, induce loss of sensibility, but, in a word, they do not readily occasion loss of sensibility; but if they sympathise with the parts which are moved, they may undergo, in a small degree, the loss of motion); and sometimes those which pass from muscle to muscle (from the spinal marrow to the muscles),See the note on the text. these have the power of motion, and impart it to those from the head; for the latter possess the greater part of their motory power from them, but yet have it, to a small extent, of themselves: the former, too, principally suffer loss of motion, but rarely of themselves experience anæsthesia; indeed, as appears to me, not at all. And if the ligaments of nerves, which derive their origin from certain of the bones, and terminate in others, be loosened or torn, the parts become powerless, and are impeded in their movements, but do not become insensible.It will readily be understood that our author here refers to the ligaments proper of the joints. On this use of the term Nerve, see Hippocrates On the articulations, pluries.

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The varieties of paralysis are these: sometimes the limbs lose their faculties while in a state of extension, nor can they be brought back into the state of flexion, when they appear very much lengthened; and sometimes they are flexed and cannot be extended; or if forcibly extended, like a piece of wood on a rule, they become shorter than natural. The pupil of the eye is subject to both these varieties, for sometimes it is much expanded in magnitude, when we call it Platycoria; but the pupil is also contracted to a small size, when I call it Phthisis and Mydriasis. The bladder, also, is paralysed in respect to its peculiar functions; for either it loses its powers as regards distension, or it loses its retentive powers, or it becomes contracted in itself, when being filled with urine, it cannot expel the same. There are six causes of paralytic disorders; for they arise from a wound, a blow, exposure to cold, indigestion, venery, intoxication. But so likewise the vehement affections of the soul, such as astonishment, fear, dejection of spirits, and, in children, frights. Great and unexpected joy has also occasioned paralysis, as, likewise, unrestrained laughter, even unto death. These, indeed, are the primary causes; but the ultimate and vital cause is refrigeration of the innate heat. It suffers from humidity, or dryness, and is more incurable than the other; but if also in connection with a wound, and complete cutting asunder of a nerve, it is incurable. In respect to age, the old are peculiarly subject, and difficult to cure; in children, the cases are easily restored. As to seasons, the winter; next, the spring; afterwards, the autumn; least of all, the summer. Of habits, those naturally gross, the humid, indolent, brutish.

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When the affections are confirmed, they are made manifest by loss of motion, insensibility of heat and cold; and also of plucking the hair, of tickling, and of touching. It is rare indeed when in them the extremities are painful; but insensibility to pain is not worse as regards recovery. Wherefore the disease occurs suddenly; but if at any time it have prolonged onsets, there supervene heaviness, difficulty of motion, torpor, a sensation of cold, sometimes an excess of heat, short sleeps, greater phantasies, when they become suddenly paralytic.

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But in the Cynic spasm, it is not usual for all parts of the face to be cramped; but those of the left side are turned to the right, and those of the right to the left, when there is a considerable distortion of the jaw to this side or to that, as if the jawbone were dislocated. And in certain of these cases, also, there is luxation at the joint, when in yawning the jaw is displaced to the opposite side: strabismus of the affected eye, and palpitation in the under eyelid; the upper eyelid also palpitates, sometimes along with the eye, and at other times alone. The lips are distended, each on its own side; but sometimes both being collapsed, they splutter; in others, they are closely compressed, and are suddenly separated so as to expel the common spittle with a noise.

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The tongue, also, is drawn aside; for it consists of a muscle and nerves, and at certain times, along its whole extent, it starts up to the palate, and makes an unusual sound. The uvula, also, is drawn aside; and if the mouth is shut, there is an unexpected noise within. And if you separate the mouth, you will perceive the uvula sometimes attached to the palate through its whole surface, and sometimes swiftly palpitating with force, like a bag-fish, when likewise a sound is produced. But there is apt to be deception in cynic spasms; for to the spectator it appears as if the parts unaffected were those possessed by the disease; for owing to the tension and colour of the affected parts, and the enlargement of the eye, they appear as if they were diseased. But in laughter, speaking, or winking, the true state of matters becomes manifest; for the parts affected are all drawn aside with a smack; the lip expresses no smile, and is motionless in talking; the eyelid is immoveable, the eye fixed, and the sense of touch is lost; while the sound parts speak, wink, feel, laugh.

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CHAPTER VIII. ON PHTHISIS +

IF an ulcer form in the lungs from an abscess, or from a chronic cough, or from the rejection of blood, and if the patient spit up pus, the disease is called Pye and Phthisis. But if matter form in the chest or side, or be brought up by the lungs, the name is Empyema. But if, in addition to these symptoms, the lungs contract an ulcer, being corroded by the pus passing through it, the disease no longer gets the name of empyema, but takes that of Phthoe instead of it. It is accompanied with febrile heat of a continual character, but latent ceasing, indeed, at no time, but concealed during the day by the sweating and coldness of the body; for the characteristics of phthoe are, that a febrile heat is lighted up, which breaks out at night, but during the day again lies concealed in the viscera, as is manifested by the uneasiness, loss of strength, and colliquative wasting. For had the febrile heat left the body during the day, how should not the patient have acquired flesh, strength, and comfortable feeling? For when it retires inwardly, the bad symptoms are all still further exacerbated, the pulse small and feeble; insomnolency, paleness, and all the other symptoms of persons in fever. The varieties of the sputa are numerous: livid, black, streaked, yellowish-white, or whitish-green; broad, round; hard, or glutinous; rare, or diffluent; devoid of smell, fetid. There are all these varieties of pus. But those who test the fluids, either with fire or water, would appear to me not to be acquainted with phthoe;Our author would appear to allude here to certain passages in the pseudo-Hippocratic treatises, wherein these tests of pus are recommended. See de Morbis, ii. 47, t. vii. p. 72, ed. Littré; Coæ prænot. et alibi. See also Paulus Ægineta, t.i. 452, etc., Syd. Soc. edit. for the sight is more to be trusted than any other sense, not only with regard to the sputa, but also respecting the form of the disease. For if one of the common people see a man pale, weak, affected with cough, and emaciated, he truly augurs that it is phthoe (consumption). But in those who have no ulcer in the lungs, but are wasted with chronic fevers—with frequent, hard, and ineffectual coughing, and bringing up nothing, these, also, are called consumptive, and not without reason. There is present weight in the chest (for the lungs are insensible of pain),—anxiety, discomfort, loss of appetite; in the evening coldness, and heat towards morning; sweat more intolerable than the heat as far as the chest; expectoration varied, as I have described.

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Voice hoarse; neck slightly bent, tender, not flexible, somewhat extended; fingers slender, but joints thick; of the bones alone the figure remains, for the fleshy parts are wasted; the nails of the fingers crooked, their pulps are shrivelled and flat, for, owing to the loss of flesh, they neither retain their tension nor rotundity; and, owing to the same cause, the nails are bent, namely, because it is the compact flesh at their points which is intended as a support to them; and the tension thereof is like that of the solids. Nose sharp, slender; cheeks prominent and red; eyes hollow, brilliant and glittering; swollen, pale, or livid in the countenance; the slender parts of the jaws rest on the teeth, as if smiling; otherwise of a cadaverous aspect. So also in all other respects; slender, without flesh; the muscles of the arms imperceptible; not a vestige of the mammæ, the nipples only to be seen; one may not only count the ribs themselves, but also easily trace them to their terminations; for even the articulations at the vertebræ are quite visible; and their connections with the sternum are also manifest; the intercostal spaces are hollow and rhomboidal, agreeably to the configuration of the bone; hypochondriac region lank and retracted; the abdomen and flanks contiguous to the spine. Joints clearly developed, prominent, devoid of flesh, so also with the tibia, ischium, and humerus; the spine of the vertebræ, formerly hollow, now protrudes, the muscles on either side being wasted; the whole shoulder-blades apparent like the wings of birds. If in these cases disorder of the bowels supervene, they are in a hopeless state. But, if a favourable change take place, symptoms the opposite of those fatal ones occur.

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The old seldom suffer from this disease, but very rarely recover from it; the young, until manhood, become phthisical from spitting of blood, and do recover, indeed, but not readily; children continue to cough even until the cough pass into phthoe, and yet readily recover. The habits most prone to the disease are the slender; those in which the scapulæ protrude like folding doors, or like wings; in those which have prominent throats; and those which are pale and have narrow chests. As to situations, those which are cold and humid, as being akin to the nature of the disease.

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CHAPTER IX. ON PERSONS AFFECTED WITH EMPYEMA. +

THOSE persons in whose cavities above, along the region of the chest, or, in those below the diaphragm, abscesses of matter form, if they bring it up, they are said to be affected with Empyema; but if the matter pass downwards, they are said to labour under Apostemes. And in the ulcers in the chest, or in the lungs, if phthoe supervene, or in the pleura, or the sternum, or anywhere below at the junction of the lungs with the spine — in all these cases the passage for the matter upwards is by the lungs. But in the viscera below the diaphragm, the liver, spleen, and kidneys, it is by the bladder; and in women by the womb. And I once made an opening into an abscess in the colon on the right side near the liver, and much pus rushed out, and much also passed by the kidneys and bladder for several days, and the man recovered.

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The common causes of all are a blow, indigestion, cold and the like. Of those in the chest also, chronic cough, pleuritis, peripneumony, and protracted defluxion; but also the determination of some acute diseases to any one of them.

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The humour is sometimes inert, weak, and rests on something else; sometimes bitingly acrid, and occasioning putrefactions even unto death. And there are many other varieties, as I shall presently declare. It is a wonder how from a thin, slender membrane, having no depth, like that which lines the chest, so much pus should flow; for in many cases there is a great collection. The cause is an inflammation from redundancy of blood, by which the membrane is thickened; but from much blood much pus is formed intermediately. But if it be determined inwards, the ribs being the bones in this region. . . . . . . I have said above, that another species of phthisis would naturally occur. But if it point outwards, the bones are separated, for the top of the abscess is raised in one of the intercostal spaces, when the ribs are pushed to this side or to that.

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There are certain symptoms common to all, and certain ones peculiar to each. A heaviness rather than pain is a common symptom (for the lungs are insensible), weak fevers, rigor towards evening, sweats in the remission, insomnolency, swellings in the extremities of the feet, and fingers of the hands, which at one time abate and at another increase; uncomfortable feeling; loss of appetite; wasting of the whole body; and if the change be prolonged, the phthisical habit is formed; for Nature can no longer perform her office, for the digestion is not as before, nor is there the plump habit of body; the colour dark; respiration in all cases bad, but worse in those affecting the upper cavity; but also cough at first as long as the inflammation is urgent, when the pains also are greater, and rigor, and heat, and watchfulness, and dyspnœa still more; pulse small, sluggish, feeble; they are disordered in the intellect; distension of the thorax.

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But if it be already come to the formation of pus, all the the greatest symptoms take place. Expectoration small with greater cough, and from an urgent abscess, at first of pituitous matters, tinged with bile of a darker colour as if from soot, but likewise tinged with blood, and thick; but if about to burst, of fleshy and deep-seated matter. And, if it burst, there is danger of suffocation should much pus be suddenly poured forth; but if gradually, there is no danger. If then the pus is going to pass downwards, the upper part, where the abscess is situated, experiences sharp pain; discharges from the bowels fluid, at first watery with phlegm, afterwards bloody matter; and then again, substances resembling flesh floating in a fluid, if it has already burst. Pus follows them either by the bowels or the urine. Metastasis to the kidneys and bladder peculiarly favourable.

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The pus, whether it be carried upwards or downwards, is of various colours—pale, white, ash-coloured, or livid, black and fetid; or devoid of smell and very thick; or intermediate; or smooth and consistent; or rough and unequal, with fleshy substances floating in it, these being round or broad, readily separated or viscid. To say all in a word respecting the pus, such kinds as are white, concocted, devoid of smell, smooth, rounded, and are quickly coughed up, or pass downwards, are of a salutary character; but such as are very pale, bilious, and inconsistent, are bad. Of these by far the worst are the livid and black, for they indicate putrefaction and phagedenic ulcers.

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Along with these things, it will be proper to know also the habit and other concomitants of the disease. If at the time of the discharge, he feels comfortable, and gets rid of the fever; has good digestion, good colour, and a good appetite, if he coughs up readily, has a good pulse, and good strength; the patient is free from danger. But if fever supervene, and all the other symptoms turn worse, he is in a hopeless state. One ought also to consider the places in which the abscesses are seated. For where the matter forms in the sternum, it is slowly turned to a suppuration; for the parts are slender, devoid of flesh and cartilaginous; and such parts do not readily receive the superfluities of inflammation, but remain a long time without being formed into pus; for cartilage is of a cold nature, but the inflammations thereof are innocuous. The wasting of the constitution is bad; for the suppuration lasts a long time; the spleen, the liver, the lungs, and diaphragm pass more quickly into suppuration, but they are dangerous and fatal.

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CHAPTER X. ON ABSCESSES IN THE LUNGS. +

WHEN, in cases of peripneumonia, the patients survive, though the inflammation be not discussed, those who escape the acute stage of the affection have suppurations. The symptoms, then, of an incipient and of a formed abscess have been stated by me under Empyema. If formed, then, there is no necessity for the same harsh measures and pains to procure the rupture and discharge of it as in the solid parts of the body, as it is readily brought up; for the distension of its pores is required rather than of the solid texture of its parts; for the lungs being a porous body and full of perforations like a sponge, it is not injured by the humour, but transmits it from pore to pore, until it reach the trachea. Thus the fluid finds a ready outlet, the pus being a flexible and slippery substance, and the respiration blows the breath (pneuma) upwards. For the most part they recover, unless at any time one be suffocated by the copious influx of the fluid, when, owing to the quantity of the pus, the trachea does not admit the air. Others die a protracted death, after the manner of those labouring under phthisis and empyema. The pus is white and frothy, being mixed with saliva, but sometimes ash-coloured or blackish. And sometimes one of the bronchia has been spit up in a case of large ulceration, if the abscess is deep, when portions of the viscus are also brought up. Hoarse, breathing short, voice heavy-toned, their chest becomes broad, and yet they stand in need of its being still broader, owing to the collection of fluid; the dark parts of the eyes glancing, the whites are very white and fatty; cheeks ruddy; veins in the forehead protuberant. There is a marvel in connection with these cases, how the strength is greater than the condition of the body, and the buoyancy of spirits surpasses the strength.

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CHAPTER XI. ON ASTHMA. +

IF from running, gymnastic exercises, or any other work, the breathing become difficult, it is called Asthma (ἆσθμα); and the disease Orthopnœa (ὀρθόπνοια) is also called Asthma, for in the paroxysms the patients also pant for breath. The disease is called Orthopnœa, because it is only when in an erect position (ὀρθίῳ σχήματι) that they breathe freely; for when reclined there is a sense of suffocation. From the confinement in the breathing, the name Orthopnœa is derived. For the patient sits erect on account of the breathing; and, if reclined, there is danger of being suffocated.

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The lungs suffer, and the parts which assist in respiration, namely the diaphragm and thorax, sympathise with them. But if the heart be affected, the patient could not stand out long, for in it is the origin of respiration and of life.

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The cause is a coldness and humidity of the spirit (pneuma); but the materiel is a thick and viscid humour. Women are more subject to the disease than men, because they are humid and cold. Children recover more readily than these, for nature in the increase is very powerful to heat. Men, if they do not readily suffer from the disease, die of it more speedily. There is a postponement of death to those in whom the lungs are warmed and heated in the exercise of their trade, from being wrapped in wool, such as the workers in gypsum, or braziers, or blacksmiths, or the heaters of baths.

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The symptoms of its approach are heaviness of the chest; sluggishness to one’s accustomed work, and to every other exertion; difficulty of breathing in running or on a steep road; they are hoarse and troubled with cough; flatulence and extraordinary evacuations in the hypochondriac region; restlessness; heat at night small and imperceptible; nose sharp and ready for respiration.

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But if the evil gradually get worse, the cheeks are ruddy; eyes protuberant, as if from strangulation; a a râle during the waking state, but the evil much worse in sleep; voice liquid and without resonance; a desire of much and of cold air; they eagerly go into the open air, since no house sufficeth for their respiration; they breathe standing, as if desiring to draw in all the air which they possibly can inhale; and, in their want of air, they also open the mouth as if thus to enjoy the more of it; pale in the countenance, except the cheeks, which are ruddy; sweat about the forehead and clavicles; cough incessant and laborious; expectoration small, thin, cold, resembling the efflorescence of foam; neck swells with the inflation of the breath (pneuma); the præcordia retracted; pulse small, dense, compressed; legs slender: and if these symptoms increase, they sometimes produce suffocation, after the form of epilepsy.

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But if it takes a favourable turn, cough more protracted and rarer; a more copious expectoration of more fluid matters; discharges from the bowels plentiful and watery; secretion of urine copious, although unattended with sediment; voice louder; sleep sufficient; relaxation of the præcordia; sometimes a pain comes into the back during the remission; panting rare, soft, hoarse. Thus they escape a fatal termination. But, during the remissions, although they may walk about erect, they bear the traces of the affection.

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CHAPTER XII. ON PNEUMODES. +

PNEUMODES is a species of asthma; and the affection is connected with the lungs as is the case in asthma. The attendant symptoms are common, and there is but little difference; for dyspnœa, cough, insomnolency, and heat are common symptoms, as also loss of appetite and general emaciation. Moreover, the disease is protracted for a time, yet not longer than one year; for, if the autumn begin it, the patients die in the spring or in the summer; or if the winter, they terminate their life towards the autumn. Old persons also are at certain times readily seized; and being seized with rigors, it requires but a slight inclination of the scale to lay them on the bed of death. All labour in particular under want of breath; pulse small, frequent, feeble. But these symptoms are also common to asthma; they have this as peculiar; they cough as if going to expectorate, but their effort is vain, for they bring up nothing; or if anything is forcibly separated from the lungs, it is a small, white, round substance, resembling a hailstone.See in particular Galen, de loc. affect. iv.; Alexander, vi. 1; and Paulus Ægineta, Syd. Soc. Edit. t.i. p. 474. The thorax is broader, indeed, than natural, but not altered in shape, and is free from ulceration; yet, though the lungs be free from suppuration, they are filled with humours, which are, as it were, compacted. The intervals of the paroxysms in this affection are greater. Some, indeed, die speedily of suffocation before anything worse is transferred to the general system. In other cases the affection terminates in dropsy about the loins, or in anasarca.

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CHAPTER XIII. ON THE LIVER. +

IN the formation of the body, the liver and spleen are equally balanced; for these viscera are equal in number, the one on the right side and the other on the left. They are unequal, however, in power, as regards health and diseases. In health, indeed, inasmuch as the liver has the power of nutrition, for the roots of all the veins unite to form the liver: but in diseases it has much greater power to restore health and occasion death. As far, then, as the liver is superior in health, so much the worse is it in diseases, for it experiences more sudden and violent inflammations, and has more frequent and more fatal abscesses. In scirrhus, too, it proves fatal more quickly and with greater pain than the spleen. Those things which relate to inflammations thereof I have described among the acute affections.

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If it be converted into pus, a sharp pain possesses the parts as far as the clavicle and the tops of the shoulders, for the diaphragm from which the liver is suspended is dragged down by the weight, and the diaphragm drags the membrane lining the ribs to which it is attached, and this membrane (the pleura) is stretched up to the clavicle and top of the shoulders, which also are dragged down. Along with the abscess there is acrid heat and rigors; cough dry and very frequent; colour grass-green; and if the patients be intensely jaundiced, it is of the white kind; sleep not quite clear of phantasies; on the main, their understanding settled; or if, from any temporary cause, there be delirium, it quickly passes off; swelling under the nipples or sides, which deceives many, as if it proceeded from the peritoneum. But if there be swelling and pain on pressure below the false ribs, the liver is swelled; for it is filled by a collection of fluid. But if the collection is not below the bone, it is a symptom of the membrane (the peritoneum) being affected, and its boundaries are distinctly circumscribed; for the hand applied in pressure, after passing the circumference of the liver, sinks down into an empty space in the abdomen. But the hardness of the peritoneum is undefined, and no process at its extremity is apparent. If the process incline inwardly, nature is far superior to the physician; for it is either turned upon the bowels or the bladder, and far the least dangerous is the passage by the bladder: but if it incline outwards, it is bad not to make an incision, for otherwise the liver is corroded by the pus, and death is not long deferred. But, if you intend to make an incision, there is danger of hemorrhage, from which the patient may die suddenly; for hemorrhage in the liver cannot be checked. But if you are reduced to the necessity of making an incision, heat a cautery in the fire to a bright heat, and push it down to the pus, for it at the same time cuts and burns: and if the patient survive, there will run out a white, concocted, smooth, not fetid, very thick pus, by which the fever and other bad symptoms are diminished, and altogether the health is restored. But if the pus passes into the intestines, the belly has watery discharges at first, but afterwards they resemble the washings of flesh, and, again, they are like those in dysentery proceeding from ulcerations; but sometimes a bloody ichor, or thrombus is passed. Bile also is discharged, intensely yellow, or leekgreen, and, lastly, before death, black.

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But if the abscess do not suppurate, and the discharges from the bowels are fetid like putrefaction, the food passes undigested, owing to the stomach and intestines having lost their tone; for thus the liver, even though now in good condition, does not perform digestion; along with these symptoms there is acrid heat, and altogether there is a turn to the worse; colliquative wasting of the flesh, pulse small, difficulty of breathing, when at no distance of time their life is at an end. In certain cases, the dysentery and the ulceration have healed, but the disease changed to dropsy. But if all these symptoms abate, if pus that is white, smooth, consistent, and inodorous, is discharged, and the stomach digests the food, there may be good hopes of the patient. But the best thing is for it to be discharged by the urine; for the passage by it is safer and less troublesome than the other.

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But if, after the inflammation, the liver does not suppurate, the pain does not go off, its swelling, changing to a hard state, settles down into scirrhus; in which case, indeed, the pain is not continued, and when present is dull; and the heat is slight; there is loss of appetite; delight in bitter tastes, and dislike of sweet; they have rigors; are somewhat pale, green, swollen about the loins and feet; forehead wrinkled; belly dried up, or the discharges frequent. The cap of these bad symptoms is dropsy.

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In the dropsy, provided there is a copious discharge of thick urine, having much re-crementitious sediment, there is a hope that the dropsical swelling may run off; but if the urine be thin, without sediment, and scanty, it conspires with the dropsy. But if nature change to her pristine state, and burst upon the bowels, along with copious watery discharges, it has also sometimes cured the dropsy. This mode of cure, however, is dangerous; for what from the copious evacuations, and the extreme prostration, the patients have sometimes died of weakness, as from hemorrhage. Sweating, if copious, carries off the disease with less danger, for dropsical persons generally have not a moist skin. Such is the termination of the affections in the liver.

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But if the liver suppurate . . . . . children, and those till manhood; women less so. The causes are intemperance, and a protracted disease, especially from dysentery and colliquative wasting; for it is customary to call these persons tabid who die emaciated from ulcers of the liver.

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CHAPTER XIV. ON THE SPLEEN. +

SCIRRHUS, a chronic disease, is habitual to the spleen (suppuration does not readily occur in it, and yet it does occur sometimes), when the pain is not severe, but swelling much greater than the pain; for it has been seen swelled on the right side as far as the liver in the whole common space between them, hence many have been deceived in supposing that it is not an affection of the spleen, but of the membrane, for it appears to them that the peritonæum is inflamed. It is hard and unyielding as stone. Such the spleen generally becomes in scirrhus, when also it is attended with great discomfort.

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But if it suppurate, it is soft to the touch, yielding to pressure at its top, when there is a formation of pus; but when it is not suppurated it does not yield. Sometimes it hangs entire in the abdomen, being moved about to this side and to that, whilst it remains a small body, and has space to float in. Nausea, restlessness, especially about the time of breaking.

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The symptoms of distension are, fevers, pains, and rigors (for generally they are free of rigors, and of pain when the heat is small, and hence abscess about the spleen is sometimes latent); for the viscus is porous and insensible even in health: they are swollen, dropsical, of a dark-green colour, along with disquietude, dyspnœa as if from weight of the chest, for the evil is well marked. Even to its upper parts the abdomen is filled with a flatus (pneuma), thick, misty, humid in appearance but not in reality; much desire of coughing comes on, and their expectoration is small and dry. If there be watery discharges from the bowels, they at first bring some slight relief; but if they increase, they waste the patient, and yet nevertheless they do good.

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But, if it should break, pure concocted pus is never discharged, but whitish and ashy, sometimes feculent, or livid. If the abscess become deeper, the fluid is dark, when likewise some of the juice of the melted spleen is discharged. In certain cases, entire portions of the spleen have been brought up, for the spleen is of a soluble nature. And if the ulcer does not heal, but remains for a long time, they lose appetite, become cachectic, swollen, unseemly to look at, having many ulcers on all parts of the body, especially on the legs, where the sores are round, livid, hollow, foul, and difficult to heal. Wasted thereby, they expire.

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In a small tumour, with hardness and resistance, pain is wanting; on this account they live a long time. But if overpowered by the affection, dropsy, phthisis, and wasting of the body necessarily supervene; and this form of death removes them from life.

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Children, then, and young persons are most readily affected, and most readily escape from it. Old persons, indeed, do not often suffer, but they cannot escape; but certain elderly persons have been cut off by latent disease of the spleen; for, even with a small swelling, the scale of death has turned with them. A protracted and consumptive disease induces these affections, and in young persons inactivity especially, when, after contention and many exercises, the body has become inactive. As to localities, the marshy; as to waters, the thick, saltish, and fetid. Of the seasons, autumn is pecularly malignant.

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CHAPTER XV. ON JAUNDICE, OR ICTERUS. +

If a distribution of bile, either yellow, or like the yolk of an egg, or like saffron, or of a dark-green colour, take place from the viscus, over the whole system, the affection is called Icterus, a dangerous complaint in acute diseases, for not only when it appears before the seventh day does it prove fatal, but even after the seventh day it has proved fatal in innumerable instances. Rarely the affection has proved a crisis to a fever towards the end, but itself is not readily discussed.

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It is formed not only from a cause connected with the liver, as certain physicians have supposed, but also from the stomach, the spleen, the kidneys, and the colon. From the liver in this manner: if the liver become inflamed or contract scirrhus, but remain unchanged with regard to its functional office, it produces bile, indeed, in the liver, and the bladder, which is in the liver, secretes it; but if the passages which convey the bile to the intestine, be obstructed from inflammation or scirrhus, the bladder gets over-distended, and the bile regurgitates; it therefore becomes mixed with the blood, and the blood, passing over the whole system, carries the bile to every part of the body, which acquires the appearance of bile. But the hardened fæces are white and clayey, as not being tinged with bile, because the bowels are deprived of this secretion. Hence also the belly is very much dried up; for it is neither moistened nor stimulated by the bile. The colour in this species is whitish-green.

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If jaundice make its appearance in connection with the spleen, it is dark-green, for its nutriment is black, because the spleen is the strainer of the black blood, the impurities of which it does not receive nor elaborate when diseased, but they are carried all over the body with the blood. Hence patients are dark-green from icterus in connection with the spleen; but the colour is darker than usual in the customary discharges from the bowels, for the superfluity of the nutriment of the spleen becomes recrement from the bowels.

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And icterus also is formed in connection with the colon and stomach, provided their powers of digestion be vitiated; for digestion takes place even in the colon, and from it a supply of nutriment is sent upwards to the liver. Provided, then, the liver receive its other food in a cruder state than usual, it indeed goes through its own work, but leaves that of the other undone; for in distribution it diffuses the blood which carries the marks of the inactivity of the colon to all parts of the body. The indigestion in this case is connected with the formation of the bile in the colon.

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Thus icterus may be formed in any viscus, not only of those which send nutriment to the liver, but also of those which receive it from the liver. For nature sends nutriment to all parts, not only by ducts perceptible to the senses, but much more so by vapours, which are readily carried from all parts to all, nature conducting them even through the solid and dense parts. Wherefore these vapours become tinged with bile, and discolour any part of the body in which they get lodged. Moreover, in jaundice connected with the colon, the evacuations are not white; for the liver is not disordered as regards the function of bile, and is not impeded in the transmission of bile to the intestines.

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The general system, likewise, is most powerful in producing icterus; for the cause is seated in the whole body. It is of this nature: in every part there is heat for concoction; in every part for the creation and secretion of humours, different in different places, but in each that which is peculiar to it: in flesh, indeed, sweat; in the eyes, tears; in the joints and nose, mucus; in the ears, wax. If the heat, then, fails in the performance of each of its operations, it is itself converted into that which is acrid and fiery; but all the fluids become bile, for the products of heat are bitter, and stained with bile. But if indigestion happens in the blood, the blood assumes the appearance of bile, but is distributed as nourishment to all parts, wherefore bile appears everywhere. For it is a dire affection, the colour being frightful in appearance, and the patients of a golden colour; for the same thing is not becoming in a man which is beautiful in a stone. It is superfluous in me to tell whence the name is derived, further than that it is derived from certain four-footed and terrestrial animals, called ἰκτίδες, whose eyes are of this colour.A species of ferret; either the Mustela Erminea or the M. Furo.

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There are two species of the affection; for the colour of the whitish-green species either turns to yellow and saffron, or to livid and black. The cause of these is the same as the cause of the two kinds of bile; for, of the latter, one species—namely, the light-coloured—is yellow, thin, and transparent; but this species is also sometimes tinged so as to resemble saffron or the yolk of an egg. The other is of a darker character, like leeks, woad, or wholly black. There are innumerable intermediate varieties of colour, these being connected with the heat and humours. The viscera, also, co-operate in this; for the viscus is either a bright-red, like the liver, or dark-red, like the spleen. When, therefore, the icterus is connected with any viscus, if from the liver, it bears traces of this viscus, and if from the spleen, of it; and so, also, with regard to all the others. But if it possesses no appearance of any, it is an affection of the general habit. These appear manifest in the white of the eyes especially, and in the forehead about the temples; and in those naturally of a white complexion, even from a slight attack, the increased colour is visible.

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In cases, therefore, of black icterus, the patients are of a dark-green colour, are subject to rigors, become faintish, inactive, spiritless; emit a fetid smell, have a bitter taste, breathe with difficulty, are pinched in the bowels; alvine evacuations like leeks, darkish, dry, passed with difficulty; urine deeply tinged with black; without digestion, without appetite; restless, spiritless, melancholic.

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In the whiter species, the patients are of a light-green colour, and more cheerful in mind; slow in beginning to take food, but eat spiritedly when begun; of freer digestion than those of the former species; alvine discharges, white, dry, clayey; urine bright-yellow, pale, like saffron.

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In both cases the whole body is itchy; heat at the nostrils, small, indeed, but pungent; the bilious particles prickly. The taste of bitter things is not bitter; and yet, strange to tell, it is not sweet; but the taste of sweet things is bitter. For in the mouth the bile lodged in the tongue, prevailing over the articles of food, sophisticates the sensation; for the tongue, having imbibed the bile, does not perceive them, while, during the season of abstinence from food, the bile remains torpid, neither is the tongue unpleasantly affected with that to which it is habituated; but the bile, if heated up by the tastes of the articles of food, impresses the tongue. When, therefore, the food is bitter, the sensation is of the bitter things; but when sweet, of the bilious. For the sensation of the bile anticipates the other, and thus deceives those who suppose that bitter things appear sweet; for it is not so, but because it is not exacerbated by the bitter lodged in it from being habituated to the disease, the phantasy of sweet is created; and there is the same condition in sweet and bitter tastes; for the bile is the screen of the fallacious tastes.

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When, therefore, it appears without inflammation of any viscus, it is usually not dangerous, though protracted; but if prolonged, and the viscus gets inflamed, it terminates most commonly in dropsy and cachexia. And many have died emaciated, without dropsy. It is familiar to adolescents and young men, and to them it is less dangerous; it is not altogether unusual also with children, but in them it is not entirely free from danger.

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CHAPTER XVI. ON CACHEXIA, OR BAD HABIT OF BODY. +

CACHEXIA arises as the conversion of nearly all diseases; for almost all diseases are its progenitors. But it likewise is formed by itself, separately from all others, as an original affection of the noxious kind, by deriving its increase from the administration of many and improper medicines. And a bad habit for a season is common to all complaints, with many symptoms; and of this its name is significant. There is emaciation, paleness, swelling, or whatever else happens for the time to be prevalent in the body. But cachexia is the form of one great affection, and gives its name to the same. For the good habit of the patient (Euhexia) in all respects, as regards digestion, the formation of blood for distribution, and every natural operation whence arise good breathing, good strength, and good colour, constitutes the pristine state of good health. But if its nature become changed to the weakness of cacochymy, this constitutes cachexia.

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This disease is difficult to cure, and is a very protracted illness; for it is engendered during a protracted space of time, and not from one infirmity of the body, nor in connection with only one viscus; for it is formed by the conversion of all into a vitiated state. Wherefore those diseases which are its offspring are incurable, as dropsy, phthisis, or wasting; for, indeed, the causes of cachexia are akin to those of wasting. The disease is a protracted and continuous dysentery, and the relapses of diseases in certain cases. Generally there is sufficient appetite, and plenty of food is taken; but the distribution thereof takes place in a crude and undigested condition, for the operation of digestion is not performed upon the food.

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The cause of it also may be the suppression of the hemorrhoidal discharge, or the omission of customary vomiting, inactivity as regards exercises, and indolence as to great labours. When each of its attendants has ceased to return, there is heaviness of the whole body, now and then paleness, flatulence of the stomach, eyes hollow, sleep heavy, and inactivity. But these symptoms occurring in an erratic form conceal the existence of the disease; but if they remain and strike root, nor readily give way, they are significant of a mighty illness. When in an erect posture, then they become swollen in their feet and legs; but, when reclining, in the parts they lay upon; and if they change their position, the swelling changes accordingly, and the course of the cold humour is determined by its weight. For when the heat evaporates the humidity, if it be not diffused, the humidity again runs in a liquid state. They have an appetite for much food, and are very voracious; the distribution is more expeditious than the digestion, of matters that are crude rather than undigested; but digestion is not at all performed, nor is it digested in the whole body by nature. For the weakness of the heat in the belly and in the system is the same, neither is good and well-coloured blood formed.

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And when the whole body is filled with crudities, and the desire as to food is gone, the cachexy having now extended to the stomach, and the affection having now attained its summit, they become swollen, inactive, and spiritless towards every exertion. The belly is dried up, and, for the most part, the alvine discharges are without bile, white, hard, and undigested. They are parched in person, without perspiration, troubled with itchiness; sleep at no time settled, but drowsiness in the reclining position; respiration slow; pulse obscure, feeble, frequent, and very frequent upon any, even a very small, exertion; respiration in these cases asthmatic; veins on the temples elevated, with emaciation of the parts around; but at the wrists the veins much larger and tumid; blood of a dark-green colour. Along with these, phthisis or tabes induces anasarca or ascites, and from their progeny there is no escape.

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With regard to the ages which induce this disease, in the first place, old age, in which there is no recovery; children are readily affected, and more readily recover; adults are not very much exposed to the affection, but have by no means easy recoveries. No one season produces this disease, nor does it terminate in any one; but autumn indeed conceives it, winter nurses it, spring brings it to its full growth, and summer despatches it.

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BOOK II. +
CHAPTER I. ON DROPSY. +

DROPSY is indeed an affection unseemly to behold and difficult to endure; for very few escape from it, and they more by fortune and the gods, than by art; for all the greater ills the gods only can remedy. For either the disease lurking in a vital organ has changed the whole system to cachexy, or the general system from some plague that has gone before has changed the viscera to a Cacochymy, when both co-operate with one another to increase the illness, and no part is uninjured from which even a slight assistance might be rendered to Nature. It is a cold and dense vapour converted into humidity, resembling a mist in the universe; or, it is the conversion of a humid and cold cause which changes the patient to such a habit. For a fluid rolling about in the lower belly we do not call Dropsy, since neither is the affection situated in that place; but when the tumour, swelling, colour, and the habit melting down to water, conspire in the disease, it both is, and is called Dropsy. For, even should the water at any time burst outwardly, or should one give vent to it, by making an incision in the hypochondrium, the dropsical affection will still remain confirmed; wherefore the primary cause of it is cachexia.

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There are many varieties, each having different names. For if the watery suffusion float in the flanks, and, owing to its fulness, when tapped it sound like a drum, the disease is called Tympanites. But if the water be confined in large quantity in the peritonæum, and the intestines float in the liquid, it gets the appellation of Ascites. But if the lower belly contain none of these, but the whole body swell, if in connexion with a white, thick, and cold phlegm, the disease is called Phlegmatias; but if the fleshy parts are melted down into a sanguineous, watery, or thin humour, then the species of dropsy called Anasarca is formed. The constitution of each of them is bad; but the combination of them is much worse. For sometimes the variety which forms in the lower belly (Ascites), is associated with that variety in which the fluid is diffused all over the body. But the most dangerous is that form in which Tympanites is mixed with Anasarca. For of the dropsies that form in the lower belly, Tympanites is particularly worse than Ascites. But of those affecting the whole body, Leucophlegmatia is less than Anasarca. It is mild then, so to speak of such hopeless diseases, when a smaller affection is combined with another smaller one. But it is much worse if one of the smaller enters into combination with one of the greater. But if a complete mixture of two great affections take place, the product thereof is a greater evil.

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The symptoms are very great and very easy to see, to touch, and to hear; in Ascites, for example, to see the tumidity of the abdomen, and the swelling about the feet; the face, the arms, and other parts are slender, but the scrotum and and prepuce swell, and the whole member becomes crooked, from the inequality of the swelling:—To touch—by strongly applying the hand and compressing the lower belly; for the fluid will pass to other parts. But when the patient turns to this side or that, the fluid, in the change of posture, occasions swelling and fluctuation, the sound of which may be heard. But if you press the finger firmly on any part, it becomes hollow, and remains so for a considerable time. These are the appearances of Ascites.

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Tympanites may be recognised, not only from the sight of the swelling, but also by the sound which is heard on percussion. For if you tap with the hand, the abdomen sounds; neither does the flatus (pneuma) shift its place with the changes of posture; for the flatus, even although that which contains it should be turned upwards and downwards, remains always equally the same; but should the flatus (pneuma) be converted into vapour and water (for Ascites may supervene on Tympanites), it shifts its form, indeed, the one half running in a fluid state, if the conversion be incomplete.

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In Anasarca and Leucophlegmatia the lower belly is empty, the patients are swelled in the face and arms; and likewise, in these cases, whatever parts are empty in the others, in them become full. For in Leucophlegmatia there is collected a white, cold, and thick phlegm; with it the whole body is filled, and the face is swollen, and also the neck and arms; but the abdomen is full from the swelling; but the mammæ are raised up into a swelling in the case of such youths as are still in the happy period of life. But, in Anasarca, there is wasting of the flesh to a fleshy humour, and a bloody ichor, such as runs from ulcerations of the bowels, and such as flows from bruises produced by the fall of weights, if the outer skin be scarified. But the combination of the two has the symptoms of both.

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In all the species there are present paleness, difficulty of breathing, occasional cough; they are torpid, with much languor and loss of appetite; but if they take any food, however small in quantity and free from flatulence, they become flatulent, and have distension as if from repletion; skin dry, so that it does not become moist even after the bath; they are white and effeminate; but in Anasarca they are of a dark-green colour, and have dark veins; in Ascites and Tympanites these are prominent, both in the face, and in the wrists, and the abdomen. But in Anasarca and Leucophlegmatia all the parts are concealed by the swelling; sleep heavy; they are torpid, with slight dejection of spirit; concern about trifles; fondness of life; endurance not from good spirits and good hopes like those in prosperity, but from the nature of the affection. It is not possible exactly to state the cause; but this is a mighty wonder, how in certain diseases, not altogether dangerous, the patients are spiritless, dejected, and wish to die, but in others they have good hopes and are fond of life. Diseases produce both these contraries.

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Dropsy sometimes is occasioned suddenly by a copious cold draught, when, on account of thirst, much cold water is swallowed, and the fluid is transferred to the peritonæum; by which means the innate heat in the cavities is congealed, and then the drops which formerly were converted into air and dissipated, flow into the cavities. If this, therefore, happen, the cure of these cases is easier before any of the viscera or the whole person is affected. Moreover flatulent food, indigestion, and the BuprestisThe Meloe vesicatoria. See Paulus Ægineta, Syd. Soc. edit., t.iii. p. 74; and Dioscorides, ii. 69. have sometimes occasioned dropsies.

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It is an illness common to all, men and women, in every period of life, only that certain ages are more exposed to certain species of the disease; children to Anasarca and Leucophlegmatia; young men until manhood are subject to swelling about the lower belly (Ascites?) Old persons are prone to suffer all kinds, as being deficient in heat, for old age is cold; but they are not exposed to collections of humours, and to them, therefore, Tympanites is the familiar form.

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All the species, indeed, are unfavourable; for dropsy, in all its forms of disease, is bad. But of these, leucophlegmatia is the more mild; for in it there are many and various chances of good fortune, such as an evacuation of sweat, of urine, or from the bowels, by which the dropsical habit is carried off. But tympanites is of a difficult nature, and still more so anasarca; for in this affection the physician would require to change the whole person, a thing not easy for the gods themselves to accomplish.

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Sometimes the dropsy forms in a small space, such as the head in hydrocephalus; or in the lungs alone; or in the liver, or the spleen; or the womb in women; and this last is easier to cure than any of the others, for provided its mouth relax from its former constriction, if it contains a fluid, it discharges the same outwardly, and if a flatus, it is dissipated. But if the uterus suffer at all in anasarca, for the most part the whole woman becomes dropsical.

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This other form of dropsy is known: small and numerous bladders, full of fluid, are contained in the place where ascites is found; but they also float in a copious fluid, of which this is a proof; for if you perforate the abdomen so as to evacuate the fluid, after a small discharge of the fluid, a bladder within will block up the passage; but if you push the instrument farther in, the discharge will be renewed. This species, then, is not of a mild character; for there is no ready passage by which the bladders might escape. It is said, however, that in certain cases such bladders have come out by the bowels. I have never seen such a case, and therefore write nothing of them; for I am unable to tell whether the discharge be from the colon, or the stomach. What is the mode of their formation? For the passage whereby all matters may be discharged by the anus is patent; but the discharge of the water collected about the loins by the bowels is incredible. For a wounded intestine is not free from trouble and danger.

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CHAPTER II. ON DIABETES. +

DIABETES is a wonderful affection, not very frequent among men, being a melting down of the flesh and limbs into urine. Its cause is of a cold and humid nature, as in dropsy. The course is the common one, namely, the kidneys and bladder; for the patients never stop making water, but the flow is incessant, as if from the opening of aqueducts. The nature of the disease, then, is chronic, and it takes a long period to form; but the patient is short-lived, if the constitution of the disease be completely established; for the melting is rapid, the death speedy. Moreover, life is disgusting and painful; thirst, unquenchable; excessive drinking, which, however, is disproportionate to the large quantity of urine, for more urine is passed; and one cannot stop them either from drinking or making water. Or if for a time they abstain from drinking, their mouth becomes parched and their body dry; the viscera seem as if scorched up; they are affected with nausea, restlessness, and a burning thirst; and at no distant term they expire. Thirst, as if scorched up with fire. But by what method could they be restrained from making water? Or how can shame become more potent than pain? And even if they were to restrain themselves for a short time, they become swelled in the loins, scrotum, and hips; and when they give vent, they discharge the collected urine, and the swellings subside, for the overflow passes to the bladder.

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If the disease be fully established, it is strongly marked; but if it be merely coming on, the patients have the mouth parched, saliva white, frothy, as if from thirst (for the thirst is not yet confirmed), weight in the hypochondriac region. A sensation of heat or of cold from the stomach to the bladder is, as it were, the advent of the approaching disease; they now make a little more water than usual, and there is thirst, but not yet great.

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But if it increase still more, the heat is small indeed, but pungent, and seated in the intestines; the abdomen shrivelled, veins protuberant, general emaciation, when the quantity of urine and the thirst have already increased; and when, at the same time, the sensation appears at the extremity of the member, the patients immediately make water. Hence, the disease appears to me to have got the name of diabetes, as if from the Greek word διαβήτης (which signifies a siphon), because the fluid does not remain in the body, but uses the man’s body as a ladder (διαβάθρη), whereby to leave it.Altogether, this interpretation is so unsatisfactory, that I was almost tempted to alter the text quite differently from Wigan and Ermerins, and to read ὁκοῖόν τις διαβησείων, when the passage might be rendered thus — it got the name of diabetes, as if signifying one having a frequent desire of descending, because the fluid does not remain in the system, but uses the man’s person as a ladder for its exit. At all events, the reading of Wigan and Ermerins seems inadmissible; for how can the two comparisons, to a siphon, and to a ladder, be admitted together? It is possible, however, that διαβάθρῃ is faulty, and that we ought to read διαβήτῃ. They stand out for a certain time, though not very long, for they pass urine with pain, and the emaciation is dreadful; nor does any great portion of the drink get into the system, and many parts of the flesh pass out along with the urine.

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The cause of it may be, that some one of the acute diseases may have terminated in this; and during the crisis the diseases may have left some malignity lurking in the part. It is not improbable, also, that something pernicious, derived from the other diseases which attack the bladder and kidneys, may sometimes prove the cause of this affection. But if any one is bitten by the dipsas,The dipsas was a species of viper. See Paulus Ægineta, ii. p. 185. the affection induced by the wound is of this nature; for the reptile, the dipsas, if it bite one, kindles up an unquenchable thirst. For they drink copiously, not as a remedy for the thirst, but so as to produce repletion of the bowels by the insatiable desire of drink. But if one be pained by the distension of the bowels and feel uncomfortable, and abstain from drink for a little, he again drinks copiously from thirst, and thus the evils alternate; for the thirst and the drink conspire together. Others do not pass urine, nor is there any relief from what is drank. Wherefore, what from insatiable thirst, an overflow of liquids, and distension of the belly, the patients have suddenly burst.

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CHAPTER III. ON THE AFFECTIONS ABOUT THE KIDNEYS. +

THE kidneys are of a glandular nature, but redder in colour, like the liver, rather than like the mammæ and testicles; for they, too, are glands, but of a whiter colour. In shape they resemble the testicles, but are broader, and, at the same time, curved. Their cavities are small and like sieves, for the percolation of the urine; and these have attached to each of them nervous canals, like reeds, which are inserted into the shoulders of the bladder on each side; and the passage of the urine from each of the kidneys to the bladder is equal.

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About it, the kidneys, and those passages, many and complicated diseases are formed, partly acute, proving fatal by hemorrhage, fevers, and inflammation, as has been described by me; but partly chronic, others wearing out the patient by wasting, and although not of a fatal character, incurable, and persisting until death. Wherefore, the chronic are—abscesses, ulcers, the formation of stones, and hemorrhoids. The ulcerations from abscess in man are all very protracted, and difficult to cure.

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The formation of stones is a long process, the stoppage of them painful, for the passage of them is not easily accomplished; and in addition to these, the retention of urine is formidable. But if several small ones stop together in the passage, or a large one be impacted; and if these occur to both kidneys, so as to occasion retention of urine and distension of the parts, the patients die in a few days. Nature, therefore, did well in forming the cavity of the kidneys oblong, and of equal size with the ureters, and even a little larger, so that if a stone formed above, it might have a ready passage to the bladder. On this account, also, the stones have an oblong form, because, for the most part, they are consolidated in the ureters; and such in that place as are of unequal thickness are slender before, owing to the ureters being narrow, but thick behind, because the kidneys verge downwards. They are formed in the kidneys only, but when in a heated state; for the stones have no fixed place in the ureters, but the gravel floats downwards with the urine, and thus is both indicative of the affection, and furnishes the materiel of it. But if an unusually large one at any time be detained in the pelvis of the kidney, pains of the loins, about the regions of the psoœ, as far as the middle of the ribs, take place, and hence, in many cases, the pain leads to mistake, as if it proceeded from pleurisy; heaviness of the hips; painful flexion about the spine, so that they stoop forward with difficulty; very painful tormina; at the same time, the pains are heavy with a sense of twisting, for the intestine is convoluted. But if the urine be retained in large quantity, and with distension, the desire of making water resembles the pains of labour; they are troubled with flatulence, which cannot find vent; the fevers are pungent, and of a dry nature. Tongue parched; the belly, also, dried up; they are emaciated, and lose appetite; or if they take anything, they cannot readily swallow or digest it. But if the stone fall down into the ureters, there is shivering, as if from rigor, the sensation as if from the passing of a stone with violent exertion. And if it fall down into the bladder, there is an abundant evacuation of watery urine, flatulent discharges from the bowels, the stomach settled, eructations, rest from former illnesses; and sometimes blood is poured out along with the urine, from excoriation of the passage. Another painful operation is the passage through the member; for if the stone be larger than the urethra, it is detained for a long time, the bladder is filled behind, and the ischuria is very painful, for along with the bladder the ureters, also, are filled. The passage of crooked stones is most difficult, for I have seen hooked protuberances on certain of these concretions. But, for the most part, they are oblong, being formed according to the shape of the passages. In colour, some are white, clayey, as is mostly the case with children; others are yellow, and saffron-coloured in old persons, in whom the stones usually form in the kidneys, whereas in children it is rather in the bladder. The causes of the concretion are two-fold: in old persons, a cold body and thick blood. For cold concretes thick fluids more readily than heat, the proof of which is seen in the Thermal springs; for when congealed, the water gets concreted into a sort of chalk-stones. But in children, the copious recrement of the blood, being overheated, gives origin to their formation, like fire.

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Such are the affections connected with the formation of stones. Certain persons pass bloody urine periodically: this affection resembles that from hemorrhoids, and the constitution of the body is alike; they are very pale, inert, sluggish, without appetite, without digestion; and if the discharge has taken place, they are languid and relaxed in their limbs, but light and agile in their head. But if the periodical evacuation do not take place, they are afflicted with headache; their eyes become dull, dim, and rolling: hence many become epileptic; others are swollen, misty, dropsical; and others again are affected with melancholy and paralysis. These complaints are the offspring of the stoppage of a customary discharge of blood. If, then, the blood flow pure and unmixed with urine, for the most part the blood of the urine flows from the bladder. Sometimes it is discharged in great quantity from rupture of the kidneys; sometimes it is coagulated, and a thrombus is formed of extravasated blood; sometimes it is coagulated in the bladder, when dreadful ischuria comes on.

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After the rupture there succeed ulcers, which are slow and difficult to heal; the indication of which is a scab, or red film, like a spider’s web, or white pus passed in the urine, sometimes pure and unmixed, and sometimes mixed up with the urine. And by these symptoms we may also diagnose abcesses, if, in addition, fevers and rigors supervene towards evening; pains about the loins, pruritus; but if it burst, clots of a purulent and fleshy nature, and now a discharge of white pus. But the ulcers are pungent, sometimes clear, and sometimes foul. This is indicated by the pus and the urine, whether fetid or free of smell.

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Spring, then, induces hemorrhages and abscesses; winter and autumn, stones. But if along with the stones ulcers be formed, the diseases indeed are incurable, there is speedy emaciation and death.

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CHAPTER IV. ON THOSE IN THE BLADDER. +

OF the diseases in the bladder no one is mild: the acute proving fatal by inflammation, wounds, spasm, and acute fevers; while an ulcer, abcess, paralysis, or a large stone, are chronic and incurable. For it (a large stone?) can neither be broken by a draught, nor by medicine, nor scraped outwardly, nor cut without danger. For the small ones of the bladder are to be cut out, but the other proves fatal the same day, or in a few days, the patients dying from spasms and fevers; or, if you do not cut him, retention of the urine takes place, and the patient is consumed slowly with pains, fevers, and wasting. But if the stone is not very large, there is frequent suppression of urine; for by falling readily into the neck of the bladder, it prevents the escape of the urine. Although it be safer to cut in these cases than for the large stones, still the bladder is cut; and although one should escape the risk of death, still there is a constant drain of water; and although this may not be dangerous, to a freeman the incessant flow of urine is intolerable, whether he walk or whether he sleep; but is particularly disagreeable when he walks. The very small ones are commonly cut without danger. If the stone adhere to the bladder, it may be detected with care; and, moreover, such cases prove troublesome from the pain and weight, even when there is no dysuria, but yet the patient may have difficulty of making water. You may diagnose all cases of stone by the sediments of sand in the urine, and, moreover, they have the genital parts enlarged by handling them; for when they make water, and there is a stone behind, they are pained, and grasp and drag the genital parts, as if with the intention of tearing out the stone along with the bladder. The fundament sympathises by becoming itchy, and the anus is protruded with the forcing and straining, from the sensation, as it were, of the passage of the stone. For the bladder and anus lie close to one another, and when either suffers, the other suffers likewise. Wherefore, in inflammations of the rectum, the bladder is affected with ischuria; and in acute pains of the bladder, the anus passes nothing, even when the bowels are not much dried up. Such are the sufferings connected with calculi.

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Hemorrhage, although it may not prove fatal very speedily, yet in the course of time has wasted many patients. But the clots of blood produced by it are quickly fatal by inducing ischuria, like as in stones; for even if the blood be thin, of a bright colour, and not very coagulable, yet the bladder accumulates it for a length of time, and its heating and boiling (as it were) coagulates the blood, and thus a thrombus is formed. Ischuria, then, is most peculiarly fatal. But on these symptoms there supervene acute pain, acrid heat, a dry tongue, and from these they die delirious.

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If pain come on from a wound, the wound itself is dangerous; but the sore, even if not fatal at first, becomes incurable from fever or inflammation; for the bladder is thin, and of a nervous nature, and such parts do not readily incarnate nor cicatrise. Moreover, the urine is bilious, acrid, and corrosive. The ordinary condition of the ulcer is this:—when the bladder is filled, it is stretched; but when emptied, it contracts: it is in the condition, then, of a joint in extension and flexion, and no ulcer in a joint is easy of cure.

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The bladder also suppurates from an abscess. The symptoms of an abscess of the bladder are the same as in other cases; for the abscess in forming is attended with inflammation, fevers, and rigors. The dangers are the same. But if it discharges urine which is thick, white, and not fetid, the ulcers from them are mild; but if it spread, they pass urine which is feculent, mixed with pus, and of a bad smell: of such persons the death is not distant. The urine, indeed, is pungent, and the evacuation thereof painful, and the pain darts to the extremity of the member. All things, even those which are opposed to one another, prove injurious to them; repletion and inanition, inactivity and exercise, baths and abstinence from baths, food and abstinence from food, sweet things and acid things; certain articles being serviceable in certain cases, but proving injurious in others, not being able to agree in any one.

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CHAPTER V. ON GONORRHŒA. +

GONORRHŒA is not, indeed, a deadly affection, but one that is disagreeable and disgusting even to hear of. For if impotence and paralysis possess both the fluids and genital organs, the semen runs as if through dead parts, nor can it be stopped even in sleep; for whether asleep or awake the discharge is irrestrainable, and there is an unconscious flow of semen. Women also have this disease, but their semen is discharged with titillation of the parts, and with pleasure, and from immodest desires of connection with men. But men have not the same prurient feelings; the fluid which runs off being thin, cold, colourless, and unfruitful. For how could nature, when congealed, evacuate vivifying semen? And even young persons, when they suffer from this affection, necessarily become old in constitution, torpid, relaxed, spiritless, timid, stupid, enfeebled, shrivelled, inactive, pale, whitish, effeminate, loathe their food, and become frigid; they have heaviness of the members, torpidity of the legs, are powerless, and incapable of all exertion. In many cases, this disease is the way to paralysis; for how could the nervous power not suffer when nature has become frigid in regard to the generation of life? For it is the semen, when possessed of vitality, which makes us to be men, hot, well braced in limbs, hairy, well voiced, spirited, strong to think and to act, as the characteristics of men prove. For when the semen is not possessed of its vitality, persons become shrivelled, have a sharp tone of voice, lose their hair and their beard, and become effeminate, as the characteristics of eunuchs prove. But if any man be continent in the emission of semen, he is bold, daring, and strong as wild beasts, as is proved from such of the athletæ as are continent. For such as are naturally superior in strength to certain persons, by incontinency become inferior to their inferiors; while those by nature much their inferiors by continency become superior to their superiors: but an animal becomes strong from nothing else than from semen. Vital semen, then, contributes much to health, strength, courage, and generation. From satyriasis a transition takes place to an attack of gonorrhœa.

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CHAPTER VI. ON THE STOMACHIC AFFECTIONS. +

THE stomach is the president of pleasure and disgust, being an important neighbour to the heart for imparting tone, good or bad spirits, from the sympathy of the soul. This is the primary power of the stomach. These things have been described by me in another place. The offspring of pleasure are, good digestion, good condition, and good colour of the body; of disgust, their contraries, and also sometimes depression of spirits, when proper nutrition is wanting; and in melancholic patients, loathing of food. If, then, this organ be diseased, there is dislike and abomination of articles of food, not only if administered, but even if the food is not seen; nay, the very remembrance of them is attended with nausea, distress, water-brash, and heart-ache; and in certain cases there is salivation and vomiting. Even when the body wastes, provided their stomach remain empty, they bear this pain more easily than that produced by the administration of food. But if at any time they are compelled by necessity to take food, the pain is worse than hunger; the act of masticating in the mouth occasions sufferance, and to drink is a still greater pain. And it is not that they suffer thus from suitable food, and bear more unusual food well; owing to a change from that which is natural to the opposite, there is a painful sensation as to everything, an aversion to, and dislike of, all kinds of food. Along with these there is pain between the scapulæ, much greater after the administration of food or drink; loathing, distress, sight dull, noises of the ears, heaviness of the head, torpidity of the limbs, their joints sink under them; palpitation in the hypochondriac region; phantasy, as of the spine being moved towards the lower limbs; they seem as if carried about, now this way and now that, whether they stand, or lie down, like reeds or trees shaken by a gale of wind; they belch out a cold and watery phlegm. But if there be bile in bilious persons, they have dimness of sight, and no thirst, even when owing to the food they appear thirsty; are sleepless, torpid, drowsy, not from true sleep, but like those in comatose affections; emaciated, very pale, feeble, relaxed, imbecile, dispirited, timid, inactive, quick to passion, very moody; for such persons at times have fallen into a state of melancholy.

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These mental emotions necessarily attend the affection when in connection with the stomach; but certain people, recognising the parts which sympathise, and from which the most dreadful symptoms arise, reckon the stomach as the cause. But the contiguity of the heart, which is of all organs the first, is a strong confirmation of the truth of what I say; for the heart is placed in the middle of the lungs, and this intermediate space comprehends the stomach; and, moreover, both are connected with the spine; and from this vicinity to the heart arise the heart-ache, prostration of strength, and symptoms of melancholy.

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There are other, and, indeed, innumerable causes of this disease; but the principal is, much pus poured forth by the belly through the stomach. It is familiar to such persons as from their necessities live on a slender and hard diet; and to those who, for the sake of education, are laborious and persevering; whose portion is the love of divine science, along with scanty food, want of sleep, and the meditation on wise sayings and doings—whose is the contempt of a full and multifarious diet; to whom hunger is for food, water for drink, and watchfulness in place of rest; to whom in place of a soft couch, is a hammock on the ground without bed-clothes, a mean coverlet, a porous mantle, and the only cover to whose head is the common air; whose wealth consists in the abundant possession and use of divine thought (for all these things they account good from love of learning); and, if they take any food, it is of the most frugal description, and not to gratify the palate, but solely to preserve life; no quaffing of wine to intoxication; no recreation; no roving or jaunting about; no bodily exercise nor plumpness of flesh; for what is there from which the love of learning will not allure one?—from country, parents, brothers, oneself, even unto death. Hence, to them, emaciation of the frame; they are ill-complexioned; even in youth they appear old, and dotards in understanding; in mind cheerless and inflexible; depraved appetite, speedy satiety of the accustomed slender and ordinary food, and from want of familiarity with a varied diet, a loathing of all savoury viands; for if they take any unusual article of food, they are injured thereby, and straightway abominate food of all kinds. It is a chronic disease of the stomach. But inflammations, defluxions, heart-burn, or pain thereof, are not called the Stomachic affection.

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Summer brings on this disease, whence springs the complete loss of digestion, of appetite, and of all the faculties. With regard to the period of life, old age; for in old men, even without any disease, owing to their being near the close of life, the appetite is nearly gone.

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CHAPTER VII. ON THE CŒLIAC AFFECTION. +

THE stomach being the digestive organ, labours in digestion, when diarrhœa seizes the patient. Diarrhœa consists in the discharge of undigested food in a fluid state; and if this does not proceed from a slight cause of only one or two days’ duration; and if, in addition, the patient’s general system be debilitated by atrophy of the body, the Cœliac disease of a chronic nature is formed, from atony of the heat which digests, and refrigeration of the stomach, when the food, indeed, is dissolved in the heat, but the heat does not digest it, nor convert it into its proper chyme, but leaves its work half finished, from inability to complete it; the food then being deprived of this operation, is changed to a state which is bad in colour, smell, and consistence. For its colour is white and without bile; it has an offensive smell, and is flatulent; it is liquid, and wants consistence from not being completely elaborated, and from no part of the digestive process having been properly done except the commencement.

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Wherefore they have flatulence of the stomach, continued eructations, of a bad smell; but if these pass downwards, the bowels rumble, evacuations are flatulent, thick, fluid, or clayey, along with the phantasy, as if a fluid were passing through them; heavy pain of the stomach now and then, as if from a puncture; the patient emaciated and atrophied, pale, feeble, incapable of performing any of his accustomed works. But if he attempt to walk, the limbs fail; the veins in the temples are prominent, for owing to wasting, the temples are hollow; but also over all the body the veins are enlarged, for not only does the disease not digest properly, but it does not even distribute that portion in which the digestion had commenced for the support of the body; it appears to me, therefore, to be an affection, not only of the digestion, but also of the distribution.

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But if the disease be on the increase, it carries back the matters from the general system to the belly, when there is wasting of the constitution; the patients are parched in the mouth, surface dry and devoid of sweat, stomach sometimes as if burnt up with a coal, and sometimes as if congealed with ice. Sometimes also, along with the last scybala, there flows bright, pure, unmixed blood, so as to make it appear that the mouth of a vein has been opened; for the acrid discharge corrodes the veins. It is a very protracted and intractable illness; for, even when it would seem to have ceased, it relapses again without any obvious cause, and comes back upon even a slight mistake. Now, therefore, it returns periodically.

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This illness is familiar to old persons, and to women rather than to men. Children are subject to continued diarrhœa, from an ephemeral intemperance of food; but in their case the disease is not seated in the cavity of the stomach. Summer engenders the disease more than any other of the seasons; autumn next; and the coldest season, winter, also, if the heat be almost extinguished. This affection, dysentery and lientery, sometimes are engendered by a chronic disease. But, likewise, a copious draught of cold water has sometimes given rise to this disease.

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CHAPTER VIII. ON COLICS. +

PERSONS in colic are cut off speedily by volvulus and tormina. There are very many causes of this affection. The symptoms are, heaviness during abstinence from food, particularly in the part most affected; much torpor; they are inactive, lose appetite, become emaciated, sleepless, swollen in countenance. And if the colon be affected in connection with the spleen, they are of a dark-green colour; but of a light-green when in connection with the liver, from the sympathy of the nearest viscera. And if they take food, even in small quantity, and such as is not flatulent, they become very flatulent, and have a desire to pass wind, which, however, does not find vent: forced eructations upwards, but without effect; or, if any should be forcibly expelled, the flatus is fetid and acid which escapes upwards. The kidneys and bladder sympathise, with pain and ischuria; but in such cases the symptoms interchange with one another. But a greater wonder than these, —an unexpected pain has passed down to the testicles and cremasters; and this sympathetic affection has escaped the observation of many physicians, who have made an incision into the cremasters, as if they were the particular cause of the disease. But in these cases also the symptoms interchange with one another.

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From this disease are produced other diseases; abscesses and ulcers, of no mild character; dropsies and phthisis, which are incurable. For the disease is formed from cold and thick humours, and a copious and glutinous phlegm; but, also, it comes on with a frigid period of life, a cold season, and a cold locality, and during a hard winter.

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CHAPTER IX. ON DYSENTERY. +

OF the intestines, the upper being thin and bilious (χολώδεα) as far as the cœcum, have got the Greek name χολώδες. From these proceed the lower, which are thick and fleshy, as far as the commencement of the Rectum.

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Wherefore ulcers form in all of them; and the varieties of these ulcers constitute Dysentery: on this account, these diseases are complex. For some of them erode the intestines superficially, producing only excoriation; and these are innocuous; but they are far more innocent if the affections be low down. Or if the ulcers be yet a little deeper, they are no longer of a mild character. But ulcers which are deep and have not stopped spreading, but are of a phagedænic, painful, spreading, and gangrenous character, are of a fatal nature; for the small veins get corroded in the course of their spreading, and there is an oozing of blood in the ulcers. Another larger species of ulcers: thick edges, rough, unequal, callous, as we would call a knot in wood: these are difficult to cure, for they do not readily cicatrise, and the cicatrices are easily dissolved.

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The causes of dysentery are manifold; but the principal are, indigestion, continued cold, the administration of acrid things, such as myttôtos,A sort of condiment, containing garlic and other acrid things. See Pollux, Onomast. vi. onions by themselves, garlic, food of old and acrid flesh, by which dyspepsia is produced; also unaccustomed liquids, cyceon,A thick soup prepared from various substances, that is to say, cheese, wine, etc. It is mentioned both in the Iliad and Odyssey. or zythusOn the composition of the ancient zythi, or Ales, see Appendix to the Edinburgh Greek Lexicon, in voce, ζύθος. (ale), or any similar beverage produced in any country as a substitute for wine to quench thirst. But also a blow, exposure to cold, and cold drink, create ulcerations.

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The dejections and the circumstances attendant on the ulcers are different in different cases; for, if superficial, when from above, the discharges are thin, bilious, devoid of odour except that which they derive from the intestines; those from the jejunum are rather more coloured, saffron-like, and fetid. Those dejections which contain the food in a dissolved state but rough, are sometimes fetid in smell when the ulcers are gangrenous, and sometimes have the smell as if from scybala. But in the ulcerations from the parts below, the discharges are watery, thin, and devoid of smell. But if deeper they are like ichor, reddish, of the colour of dark wine, or like the washings of flesh; and these are sometimes by themselves and sometimes with the fæces, these being dissolved in the surrounding fluid, devoid of bile and of smell; or they are evacuated in a consistent and dry state, lubricated with the surrounding fluid. But if the ulcers be larger and smoother, in those above they are bilious, and pinch the parts from which they come and through which they pass (they even pinch the anus), for the bile is acrid, more especially if from an ulcer; and the bile is fatty, like grease. In the deeper ulcers below, a thick clot of blood with phlegm, like flesh not very fat, or like the scrapings of the bowels: nay, even entire portions are mixed up with them; they are discharged white, thick, mucous, like chopped tallow, along with the humour in which they float: these proceed from the rectum: but sometimes they are merely mucous, prurient, small, round, pungent, causing frequent dejections and a desire not without a pleasurable sensation, but with very scanty evacuations: this complaint gets the appellation of tenesmus. But from the colon there are discharged pieces of flesh, which are red, large, and have a much larger circumference. If the ulcers become deep, and the blood thick and feculent, these are more fetid than the former; but if the ulcers spread and are phagedænic, and if nothing will stop them, above, in addition to being intensely bilious, the dejections become saffron-like, frothy, feculent, blackish, like woad or like leeks, thicker than the former, fetid like a mortification; food now undigested, as if only masticated by voracious teeth. But if the under parts are also corroded, black clots of blood, thick, fleshy, very red, clotted, sometimes, indeed, black, but at other times of all various colours, fetid, intolerable; involuntary discharges of fluids. And sometimes a substance of considerable length, in many respects not to be distinguished from a sound piece of intestine, has been discharged, and, to those ignorant of the matter, has caused apprehension about the intestine: but the fact is this,—the intestines, like the stomach, consist of two coats, which lie close to one another in an oblique manner; when, therefore, the connection between them is dissolved, the inner coat, being separated to some length, protrudes externally, while the outer one remains alone, incarnates, and gets cicatrised, and the patients recover and live unharmed. It is the lower gut alone which suffers thus, owing to its fleshy nature. And, if blood be discharged from any vessel, it runs of a bright red or black colour, pure, and unmixed with food or scybala; and if a concretion is spread over it like broad spiders’ webs, it coagulates when cold, and no longer would be taken for a secretion of blood; but being discharged with much flatulence and noise, it has the appearance of being much larger than its actual amount. Sometimes, also, a purulent abscess forms in the colon, nowise different from the other internal ulcers; for the symptoms, the pus, and the mode of recovery are the same. But if there be hard secretions of matters resembling flesh, as if pounded, and like rough bodies, the abscess is not of a mild nature. Sometimes a copious discharge of water takes place from the colon in the form of dysentery, which has freed many patients from dropsy. In a word, such are the ulcers in the intestines; and their forms and the secretions from them as I have described.

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I will now describe the symptoms accompanying each of these states of disease, whether the ulcers be mild or malignant. To speak in general terms, then, if the excoriation is superficial, whether it be above or below, the patients are free from pain and from fever, and get better without being confined to bed, in various ways, by merely some slight changes of diet. But if ulceration supervene, in the upper bowels there are tormina, which are pungent, acrid, as if from the presence of a small amount of hot bile; and occasionally there is suppuration: indeed, for the most part, there is suppuration, or digestions imperfectly performed, though there is no want of appetite. But if the ulcers form in the lower part of the bowels, they are much less dangerous than in those above, for the bowels there are of a much more fleshy nature than those above. But if those above become hollow and phagedænic, there are acute fevers, of a latent kind, which smoulder in the intestines; general coldness, loss of appetite, insomnolency, acid eructations, nausea, vomiting of bile, vertigo: but if the discharge become copious, and consist of more bilious matters, the tormina become permanent, and the other pains increase; sometimes there is prostration of strength, feebleness of the knees; they have ardent fever, are thirsty, and anxious; black vomiting, tongue dry, pulse small and feeble. Akin to these are the fatal symptoms I have stated among those of malignant ulcers; cardiac affections even to deliquium animi, from which some never recover, but thus expire. These dangerous symptoms are common also to erosions of the lower intestines if the ulcers spread, and the discharge be not checked, only that the tormina and pains are below the umbilicus where the ulcers are situated. The forms of the secretions are such as I have said; but if they be small at first, and there be a postponement of their spreading for a long time, various changes take place in the ulcers, some subsiding, and others swelling up, like waves in the sea. Such is the course of these ulcers. But if nature stand out, and the physician co-operate, the spreading may, indeed, be stopped, and a fatal termination is not apprehended, but the intestines remain hard and callous, and the recovery of such cases is protracted.

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In hemorrhage from the bowels, if it proceed from a large vein or artery, it is sudden death; for neither is it possible to introduce the hand so as to reach the ailment, nor to apply any medicine to the sore. And even if the hemorrhage were restrained by the medicine, the escape from death would not be certain; for, in some cases, the falling off of a large eschar widens the mouth of the vein, and when clots form within, and remain there, the disease is incurable. It is necessary, then, to cure hemorrhages in their commencement. Its approach, also, for the most part is obvious, although not in all cases quite apparent: anxiety attends, with restlessness, heaviness in the part where the rupture is to take place, ruddiness of the countenance if the blood has not yet burst forth. And if the vein has burst lately, for the most part the symptoms are alleviated; but if it has been a longer time ago, this takes place more slowly, and with more difficulty. Such are the ulcers in the intestines.

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They occur in the season of summer; next in autumn; less in spring; least of all in winter. Diarrhœa attacks children and adolescents, but dysentery adults and young persons. In old age convalescence is difficult, and cicatrization protracted. Corroding sores are unusual in old persons, but yet hemorrhage is in accordance with old age.

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CHAPTER X. ON LIENTERY. +

IF many thick and hard cicatrices form after dysenteries, and broad and very deep ulcerations of the upper intestines, the food passes from them to those below in a fluid state, without separation of the nutritious part; for the cicatrix shuts up the pores by which the nutriment is carried upwards. The patient, therefore, is seized with atrophy, loss of colour and of strength. The affection gets the appellation of Lientery, this name being applied to a cicatrix of the intestines. And here the affection is from ulcers. But sometimes the intestines do not acquire cicatrization, but yet usage and habit reconcile the intestines to the discharge. For, the heat in these parts, if congealed, neither at times performs digestion, nor is the nutriment distributed upwards; but being unchanged, owing to weakness, it fails to undergo any part of the process. But if the purging, though of vitiated matters, be temporary, and not confirmed, a simple vomit after food will sometimes remove the disease. But if the exciting cause be prolonged, and get confirmed, it does no good.

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A chronic disease, and cachexia so mild as not to confine the patient to bed, will engender this disease. But dropsies sometimes have terminated favourably in this disease; a change from one evil to another, but still a better change.

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CHAPTER XI. ON AFFECTIONS OF THE WOMB, OR HYSTERICS. +

THE uterus in women is beneficial for purgation and parturition, but it is the common source of innumerable and bad diseases; for not only is it subject to ulcers, inflammation, and the fluor, but, if the whole organ be suddenly carried upwards, it quickly causes death. The fatal diseases of an acute nature connected therewith have been described elsewhere: but the chronic affections are, the two species of fluor; hardness; ulcers, part mild, but part malignant; prolapsus of the whole, or of part.

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The fluor, then, is either of a red or white colour; its appearance indicates this. It is the red if it consist of bright red blood, and the varieties thereof; or livid, or black and thin, or thick and coagulated, like a thrombus; or white, like water; or a bright ochre colour, like bile: in thickness like a thinnish or thin and fetid ichor. The white flux (or fluor albus) is like pus, and the true form like white whey; but a clot of blood frequently runs off with the pus. But there is an infinite variety of forms of it, as regards more or less quantity. Its periods sometimes agree with those of the menstrual purgation, but it does not continue the regular time as before; there is not much blood, but it flows during many days; the interval is for a few days, but is quite free from discharge. Another variety as to the period: the first purgation is at the regular time, but it occurs two or three times during each month. Another variety: a continual flux; small, indeed, every day, but by no means small during the whole month; for the uterus never closes its mouth, labouring under relaxation, so as to permit the flow of the fluid: but if it neither intermits nor diminishes, they die of hemorrhage. The symptoms are, the woman’s colour in accordance with those of the discharge; sleepless, loathes food, anxious, relaxed, especially in the red flux, and subject to pains; the discharge fetid in both varieties, but to a greater and less extent at different times; for the white is worse if the putrefaction be unusually great; and sometimes the red, if the erosion be exacerbated. In a word, the black is the worst of all; the livid next; the pale, the white, and the purulent, are more protracted, indeed, but less dangerous. Of these the pale is worse indeed, but much better when mixed with the customary discharge. Now the customary discharge is red in all its varieties. But, indeed, the red are worse in old women; but the white are not at all so to the young; but even to them that which is customary is less troublesome. Another white fluor: the menstrual discharge white, acrid, and attended with an agreeable pruritus; along with which the discharge of a white thick fluid, like semen, is provoked. This species we call female gonorrhœa. It is a refrigeration of the womb, which therefore becomes incapable of retaining its fluids; hence, also, the blood changes to a white colour, for it has not the purple colour of fire. The stomach, also, is subject to the affection, and vomits phlegm; and also the bowels are similarly affected in diarrhœa.

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Ulcers, too, are formed in the womb; some broad and attended with tingling, which, being close together, are, as it were, a superficial excoriation; pus thick, without smell, scanty. These ulcers are mild. But there are others deeper and worse than these, in which the pains are slight, pus somewhat more abundant, much more fetid, and yet, notwithstanding, these also are mild. But if they become deeper, and the lips of the sores hard or rough, if there is a fetid ichor, and pain stronger than in the former case, the ulcer corrodes the uterus; but sometimes a small piece of flesh is cast off and discharged, and this sore not coming to cicatrization, either proves fatal after a long time, or becomes very chronic. This sore gets the appellation of phagedæna. The sores also are dangerous if in these cases the pain gets exacerbated, and the woman becomes uneasy. From the sore there is discharged a putrid matter, intolerable even to themselves; it is exasperated by touching and by medicines, and irritated by almost any mode of treatment. The veins in the uterus are swelled up with distension of the surrounding parts. To the skilled, it is not difficult to recognise by the touch, for it is not otherwise obvious. Febrile heat, general restlessness, and hardness is present, as in malignant diseases; the ulcers, being of a fatal nature, obtain also the appellation of cancers. Another cancer: no ulceration anywhere, swelling hard and untractable, which distends the whole uterus; but there are pains also in the other parts which it drags to it. Both these carcinomatous sores are chronic and deadly; but the ulcerated is worse than the unulcerated, both in smell and pains, in life and in death.

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Sometimes the whole uterus has protruded from its seat, and lodged on the woman’s thighs; an incredible affliction! yet neither has the uterus not been thus seen, nor are the causes which produce it such as do not occur. For the membranes which are inserted into the flanks, being the nervous (ligamentous?) supporters of the uterus, are relaxed; those at the fundus, which are inserted into the loins, are narrow; but those at its neck, on each side to the flanks, are particularly nervous and broad, like the sails of a ship. All these, then, give way if the uterus protrude outwardly, wherefore this procidentia generally proves fatal; for it takes place from abortion, great concussions, and laborious parturition. Or if it do not prove fatal, the women live for a long time, seeing parts which ought not to be seen, and nursing externally and fondling the womb. It would appear that, of the double membrane of the womb, the internal lining coat is sometimes torn from the contiguous one, for there are two transverse plates of the coat; this, then, is thrown off with the flux, and in abortion and laborious parturition, when it adheres to the placenta. For if it be forcibly pulled, the coat of the uterus being stretched, ..... But if the woman do not die, it is either restored to its seat, or but a small part appears externally, for the woman conceals it with her thighs. Sometimes the mouth of the womb only, as far as the neck, protrudes, and retreats inwardly if the uterus be made to smell to a fetid fumigation; and the woman also attracts it if she smells to fragrant odours. But by the hands of the midwife it readily returns inwards when gently pressed, and if anointed beforehand with the emollient plasters for the womb.

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CHAPTER XII. ON ARTHRITIS AND SCHIATICA. +

ARTHRITIS is a general pain of all the joints; that of the feet we call Podagra; that of the hip-joint, Schiatica; that of the hand, Chiragra. The pain then is either sudden, arising from some temporary cause; or the disease lies concealed for a long time, when the pain and the disease are kindled up by any slight cause. It is, in short, an affection of all the nerves, if the ailment being increased extend to all; the first affected are the nerves which are the ligaments of the joints, and such as have their origin and insertion in the bones. There is a great wonder in regard to them; there is not the slightest pain in them, although you should cut or squeeze them; but if pained of themselves, no other pain is stronger than this, not iron screws, nor cords, not the wound of a sword, nor burning fire, for these are often had recourse to as cures for still greater pains; and if one cut them when they are pained, the smaller pain of the incision is obscured by the greater; and, if it prevail, they experience pleasure in forgetting their former sufferings. The teeth and bones are affected thus.

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The true reason of this none but the gods indeed can truly understand, but men may know the probable cause. In a word, it is such as this; any part which is very compact is insensible to the touch or to a wound, and hence it is not painful to the touch or to a wound. For pain consists in an exasperated sense, but what is compact cannot be exasperated, and hence is not susceptible of pain. But a spongy part is very sensible, and is exasperated by an injury. But since dense parts also live by their innate heat, and possess sensibility by this heat, if then the exciting cause be material, such as either a sword, or a stone, the material part of the patient is not pained, for it is dense by nature. But if an intemperament of the innate heat seize it, there arises a change of the sense; the heat therefore is pained by itself, being roused within by the impression on the sense. The pains then are from nature’s being increased, or a redundance thereof.

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Arthritis fixes itself sometimes in one joint and sometimes in another; sometimes in the hip-joints; and for the most part in these cases the patient remains lame in it; and the other joints it affects little, and sometimes does not go to the small joints, as the feet and hands. If it seizes the greater members which are able to contain the disease, it does not go beyond these organs; but if it begin from a small one, the attack is mild and unexpected. The commencement of ischiatic disease is from the thigh behind, the ham, or the leg. Sometimes the pain appears in the cotyloid cavity, and again extends to the nates or loins, and has the appearance of anything rather than an affection of the hip-joint. But the joints begin to be affected in this way: pain seizes the great toe; then the forepart of the heel on which we lean; next it comes into the hollow of the foot, but the ankle swells last; and they blame a wrong cause; some, the friction of a new shoe; others, a long walk; another again, a stroke or being trod upon; but no one will of his own accord tell the true one; and the true one appears incredible to the patients when they hear of it. On this account the disease gets to an incurable state, because at the commencement, when it is feeble, the physician is not at hand to contend with it; but if it has acquired strength from time, all treatment is useless. In some, then, it remains in the joints of the feet until death, but in others it spreads over the compass of the whole body. For the most part, it passes from the feet to the hands. For to the disease there is no great interval between the hands and the feet, both being of a similar nature, slender, devoid of flesh, and very near the external cold, but very far from the internal heat; next the elbow and the knee, and after these the hip-joint; which is the transition to the muscles of the back and chest. It is incredible how far the mischief spreads. The vertebræ of the spine and neck are affected with the pain, and it extends to the extremity of the os sacrum: there is a general pain of all the parts of the groin, and a pain peculiar to each part thereof. But likewise the tendons and muscles are intensely pained; the muscles of the jaws and temples; the kidneys, and the bladder next in succession. And, what a wonder! at last the nose, the ears, and the lips, suffer; for every where there are nerves and muscles. A certain person had pains in the sutures of the head, and not knowing why he was pained there, he pointed out the shapes of the sutures—the oblique, the straight, the transverse—both behind and before, and stated that the pain was narrow and fixed in the bones; for the disease spreads over every commissure of the bones, in the same manner as in the joints of a foot or of a hand. Callosities also form in the joints; at first they resemble abscesses, but afterwards they get more condensed, and the humour being condensed is difficult to dissolve; at last they are converted into hard, white tophi, and over the whole there are small tumours, like vari and larger; but the humour is thick, white, and like hailstones. For it is a cold disease of the whole (body), like hail; and there appears to be a difference in regard to heat and cold; for in certain cases there is delight in things otherwise disagreeable. But, I fancy, that the cause is a refrigeration of the innate heat, and that the disease is single; but if it speedily give way, and the heat re-appears, there is need of refrigeration and it delights in such things; this is called the hot species. But if the pain remain internally in the nerves, and the part not becoming heated subside, nor get swollen, I would call this variety cold, for which there is need of hot medicines to restore the heat, of which those very acrid are most necessary. For heat excites the collapsed parts to swelling, and calls forth the internal heat, when there is need of refrigerants. In proof of this, the same things are not always expedient in the same cases, for what is beneficial at one time proves prejudicial in another; in a word, heat is required in the beginning, and cold at the conclusion. Wherefore Gout does not often become unremitting; but sometimes it intermits a long time, for it is slight; hence a person subject to Gout has won the race in the Olympiac games during the interval of the disease.

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Men then are more readily affected, but more slightly the women; women more rarely than men, but more severely. For what is not usual nor cognate, if from necessity it gets the better engenders a more violent ailment. The most common age is after thirty-five; but sooner or slower according to the temperament and regimen of every one. The pains then are dreadful, and the concomitants worse than the pains; fainting even upon touch, inability of motion, loss of appetite, thirst, restlessness. But, if they recover partly, as if escaped from death, they live dissolutely, are incontinent, open-handed, cheerful, munificent, and luxurious in diet; but partly, as if they would (not?) again escape from death, they enjoy the present life abundantly. In many cases the gout has passed into dropsy, and sometimes into asthma; and from this succession there is no escape.

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CHAPTER XIII. ON ELEPHAS, OR ELEPHANTIASIS. +

THERE are many things in common as to form, colour, size, and mode of life between the affection Elephas and the wild beast the elephant; but neither does the affection resemble any other affection, nor the animal any other animal. The wild beast, the elephant, indeed, is very different from all others; in the first place then, he is the greatest and the thickest of animals; in size, he is as great as if you were to put one animal on another, like a tower; in bulk, he is as large as if you should place several other very large animals side by side. But neither in shape is he much like unto any other. Then, as to colour, they are all intensely black, and that over their whole body. One horse, indeed, is very white, like the Thracian steeds of Rhesus; others white-footed, like the white-footed horse of Menelaus; and bay, like one hundred and fifty; others are tawny, as assuming the shape of a horse having a tawny mane, he lay down with her. And so it is with oxen, and dogs, and all other reptiles and animals which live on the earth. But elephants are only of a lurid colour, like to night and death. With regard to shape, they have a very black head, and unseemly face of no marked form, upon a small neck, so that the head appears to rest upon the shoulders, and even then it is not very conspicuous. For the ears are large, broad, resembling wings, extending to the collar-bone and breast-bone, so as to conceal the neck with the ears, like ships with their sails. The elephant has wonderfully white horns on a very dark body—others call them teeth—these alone are most white, such as is nothing else of even any other white animal; and these are not above the forehead and temples, as is the nature of other horned animals, but in the mouth and upper jaw, not indeed quite straight forwards but a little bent upwards, so that it might swallow in a straight direction, and lift a load in its flat teeth. Moreover the horns are large, the medium length being as much as a fathom, and some much larger; that is to say, as long as two fathoms. And the upper jaw from its lip has a long, ex-osseous, crooked, and serpent-like protuberance; and there are two perforations at the extremity of this protuberance; and these by nature are perforated all the way to the lungs, so as to form a double tube, so that the animal uses this pipe as a nostril for respiration, and likewise as a hand; for it could take a cup if it please with this protuberance, and can grasp it round and hold it firmly, and none could it take by force from the animal, except another stronger elephant. And with this also it seeks herbage for food; for neither does it live by eating flesh with its mouth and small teeth. For, its feet being long, raise the animal considerably above the ground; but its neck also, as I have said, is small, and therefore it cannot browse on the earth with its mouth; and moreover the excrescence of the horns in front of the mouth prevents the mouth from touching the herbage. Wherefore it raises a great load with its protuberance; then as if with a binder having bound the same with it, he can convey it to his mouth; whence the ancients properly call it proboscis, for it collects food in front of the animal. But neither is it able to drink from a lake or river with its mouth, for the same reason. But, if it is thirsty, it introduces into the water the extreme nostril of the proboscis, and then, as if inhaling, it draws in much water, instead of air; and when it has filled its nose, as it were a cup, it pours the same as a stream of water into its mouth, and then it draws anew and discharges again, until it fills its belly, as it were a vessel of burden. It has a rough and very thick skin, containing fissures with prominent edges, long channels, and other hollow clefts, some transverse, others oblique, very deep, like in all respects to a furrowed field. Other animals have naturally hairs for a mane, but in the elephant this is merely down. There are also innumerable other differences between it and other animals; for, like man, it bends its leg backward at the knee; and like woman, it has its dugs at the arm-pits. But there is no necessity for me now to write concerning the animal, except in so far as there is any discrepancy between the animal and the disease, and in so far as the symptoms of the patient resemble the nature of the animal. The disease is also called Leo, on account of the resemblance of the eyebrows, as I shall afterwards explain; and Satyriasis, from the redness of the cheeks, and the irresistible and shameless impulse ad coitum. Moreover it is also called the Heracleian affection, insomuch as there is none greater and stronger than it.

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Wherefore the affection is mighty in power, for it is the most powerful of all in taking life; and also it is filthy and dreadful to behold, in all respects like the wild animal, the elephant. And from the disease there is no escape, for it originates in a deadly cause; it is a refrigeration of the innate heat, or rather a congelation like a great winter, when the water is converted into snow, or hail, or ice, or frost. This is the common cause of death, and of the affection.

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But the commencement of the disease gives no great indication of it; neither does it appear as if any unusual ailment had come upon the man; nor does it display itself upon the surface of the body, so that it might be immediately seen, and remedies applied at the commencement; but lurking among the bowels, like a concealed fire it smolders there, and having prevailed over the internal parts, it afterwards blazes forth on the surface, for the most part beginning, like a bad signal-fire, on the face, as it were its watch-tower; but in certain cases from the joint of the elbow, the knee, and knuckles of the hands and feet. In this way the patient’s condition is hopeless, because the physician, from inattention and ignorance of the patient’s ailment, does not apply his art to the commencement when the disease is very feeble. For, indeed, they are merely torpid, as if from some light cause, drowsy, inactive, dry in the bowels, and these symptoms are not very unusual even in healthy persons. But upon the increase of the affection, the respiration is fetid from the corruption within of the breath (pneuma). The air, or something external, would seem to be the cause of this. Urine thick, muddy, like that of cattle; the distribution of crude undigested food; and yet of these things there is no perception nor regard; for neither are they aware whether or not they digest, thus digestion or indigestion is all one to them, since, for anything useful and proper to them, digestion is not usual with them. The distribution, however, is easy, the disease, as it were, greedily attracting the food for its own nourishment; for this reason the lower belly is very dry. Tumours prominent, not continuous with one another anywhere, but thick and rough, and the intermediate space cracked, like the skin of the elephant. Veins enlarged, not from abundance of blood, but from thickness of the skin; and for no long time is the situation of them manifest, the whole surface being elevated equally in the swelling. The hairs on the whole body die prematurely, on the hands, the thighs, the legs, and again on the pubes; scanty on the chin, and also the hairs on the head are scarce. And still more frequently premature hoariness, and sudden baldness; in a very short time the pubes and chin naked of hair, or if a few hairs should remain, they are more unseemly than where they are gone. The skin of the head deeply cracked; wrinkles frequent, deep, rough; tumours on the face hard, sharp; sometimes white at the top, but more green at the base. Pulse small, dull, languid, as if moved with difficulty through the mud; veins on the temples elevated, and also those under the tongue; bowels bilious; tongue roughened with vari, resembling hailstones; not unusual for the whole frame to be full of such (and thus also in unsound victims, the flesh is full of these tubercles resembling hail). But if the affection be much raised up from the parts within, and appear upon the extremities, lichens occur on the extremities of the fingers; there is pruritus on the knees, and the patients rub the itchy parts with pleasure. +

Our author in this place evidently alludes to mentagra, a malignant disease of the face, very prevalent in Rome in his time, that is to say, towards the end of the first and the beginning of the second century. The first description of it which we possess, is contained in Pliny’s Nat. Hist. xxvi., at the beginning, and is to the following effect: That it was one of the new diseases of the face, which at one time had spread over most parts of Europe, but was then mostly confined to Rome: That it had been called by the Greeks, lichen, but that latterly the Latin term mentagra had been applied to it. He further asserts, that it was unknown in former times, and made its first appearance in Italy during the reign of Tiberius: that the men of the middle and lower classes, and more especially women, were exempt from it, the ravages of the disease being confined principally to the nobility, among whom it was propagated by kissing. He adds respecting it, that it was cured by caustics, the effects of which often left unseemly scars on the face. That the disease had come originally from Egypt, the mother of all such distempers.

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Another very interesting account of the disease, under the names of lichen and mentagra, is given by Marcellus, the Empiric, in chap. cxix., wherein elephantiasis, lepra, and other inveterate diseases of the skin are described. He says that the distemper (vitium) when neglected is apt to spread all over the face, and to contaminate many persons. He prescribes various caustic and stimulant applications for it. Along with it, he gives a very good account of elephantiasis, which, he remarks, also generally begins in the face with vari and other appearances, similar to those described by our author. He states decidedly that the disease is endemical in Egypt, attacking not only the lower ranks, but even kings themselves.

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Now it is worthy of remark, that beyond all question this is the disease to which frequent allusion is made by the poet Martial as prevailing extensively in Rome, and as being propagated by the fashionable practice of persons saluting one another, by kissing, in the streets. The following passages evidently allude to it—Epigr. xi.,8; xii. 59.

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From all these descriptions, we cannot entertain a doubt, that the disease, then so prevalent in Rome, was of a malignant and contagious nature, which attacked principally the face, and was propagated by kissing ; and, further, that it was a disease of the same class as elephantiasis. Taking all these circumstances into account, one may venture to decide pretty confidently, that it was a disease akin to the Sivvens of Scotland, which it strikingly resembles in all its characters as described above. Sivvens, in short, is a species or variety of syphilis, which is readily communicated both by the mouth, as in kissing, and per coitum. Further, that Syphilis, and its congener Sivvens, are the brood of the ancient elephantiasis, no one at all acquainted with the history of the latter in ancient, mediæval, and modern times, will entertain a doubt. See the note to Paulus Ægineta, t. ii., 14, 15, 16, and the authorities there referred to: also, the History of Syphilis, as given in Sprengel’s and in Renouard’s History of Medicine.

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The importance of this subject, which has never been satisfactorily illustrated elsewhere, will be my apology for embracing the present opportunity of endeavouring to throw some additional light on it.

And the lichen sometimes embraces the chin all round; it reddens the cheeks, but is attended with no great swelling; eyes misty, resembling bronze; eye-brows prominent, thick, bald, inclining downwards, tumid from contraction of the intermediate space; colour livid or black; eye-lid, therefore, much retracted to cover the eyes, as in enraged lions; on this account it is named leontium. Wherefore it is not like to the lions and elephants only, but also in the eye-lids resembles swift night. Nose, with black protuberances, rugged; prominence of the lips thickened, but lower part livid; nose elongated; teeth not white indeed, but appearing to be so under a dark body; ears red, black, contracted, resembling the elephant, so that they appear to have a greater size than usual; ulcers upon the base of the ears, discharge of ichor, with pruritus; shrivelled all over the body with rough wrinkles; but likewise deep fissures, like black furrows on the skin; and for this reason the disease has got the name of elephas. Cracks on the feet and heels, as far as the middle of the toes; but if the ailment still further increase, the tumours become ulcerated, so that on the cheeks, chin, fingers, and knees, there are fetid and incurable ulcers, some of which are springing up on one part, while others are subsiding on another. Sometimes, too, certain of the members of the patient will die, so as to drop off, such as the nose, the fingers, the feet, the privy parts, and the whole hands; for the ailment does not prove fatal, so as to relieve the patient from a foul life and dreadful sufferings, until he has been divided limb from limb. For it is long-lived, like the animal, the elephant. But if there be a sudden pain of the limbs, it attacks much more grievously, spreading sometimes to this part, and sometimes to that. Appetite for food not amiss; taste indiscriminate, neither food nor drink affords pleasure; aversion to all things from a painful feeling; atrophy; libidinous desires of a rabid nature; spontaneous lassitude; the figure of each of the limbs heavy, and even the small limbs are oppressive to the patient. Moreover, the body is offended with everything, takes delight neither in baths nor abstinence from them, neither in food nor in abstinence from it, neither in motion nor in rest, for the disease has established itself in all the parts. Sleep slight, worse than insomnolency, from its fantasies; strong dyspnœa, suffocation as if from strangling. In this way certain patients have passed from life, sleeping the sleep which knows no waking, even until death.

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When in such a state, who would not flee;—who would not turn from them, even if a father, a son, or a brother? There is danger, also, from the communication of the ailment. Many, therefore, have exposed their most beloved relatives in the wilderness, and on the mountains, some with the intention of administering to their hunger, but others not so, as wishing them to die. There is a story that one of those who had come to the wilderness, having seen a viper creep out of the earth, compelled by hunger, or wearied out with the affection, as if to exchange one evil for another, ate the viper alive, and did not die until all his members had become putrid and dropped off: and that another person saw a viper creep into a cask of new wine, and after drinking of the same to satiety, vomit it up, and discharge a great deal of its venom along with the new wine; but when the viper was smothered in the new wine, that the man drank of it largely and greedily, seeking thus to obtain a rescue from life and the disease; but when he had carried the drinking to satiety and intoxication, he lay down on the ground, at first as if about to die; but when he awoke from his sleep and intoxication, first of all his hair fell off, next the fingers and nails, and all the parts melted away in succession. But as the power was still in the semen, nature formed the man again, as if from the act of generation: it made other hairs to grow, and made new nails and clean flesh, and put off the old skin, like the slough of a reptile; and he was called back, like another new man, to a growth of life. Thus goes the fable; not very probable, indeed, nor yet entirely incredible; for that one ill should be overcome by another is credible. And that from the existing spark nature should renew the man, is not so incredible as to be held to be a prodigy.

 diff --git a/data/tlg0719/tlg002/tlg0719.tlg002.perseus-eng2.xml b/data/tlg0719/tlg002/tlg0719.tlg002.perseus-eng2.xml new file mode 100644 index 000000000..bb4ada5fe --- /dev/null +++ b/data/tlg0719/tlg002/tlg0719.tlg002.perseus-eng2.xml @@ -0,0 +1,267 @@ + + + + + + + On the Causes and Symptoms of Chronic Diseases + Aretaeus of Cappadocia + Francis Adams + + Gregory Crane + + Prepared under the supervision of + Bridget Almas + Lisa Cerrato + Rashmi Singhal + + National Library of Medicine History of Medicine Division + + + Cultural Heritage Language Technologies + Kansas City Missouri + February 1, 2005 + + Trustees of Tufts University + Medford, MA + Perseus Digital Library Project + Perseus 4.0 + tlg0719.tlg002.perseus-eng2.xml + + Available under a Creative Commons Attribution-ShareAlike 4.0 International License + + + + + + The Extant Works of Aretaeus, The Cappadocian + Aretaeus of Cappadocia + Francis Adams + + London + Syndenham Society + 1856 + + + Boston + Milford House Inc. + 1972 + + + Internet Archive + + + + + + +

Data Entry

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This pointer pattern extracts book and chapter.

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This pointer pattern extracts book.

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BOOK I. +
CHAPTER I. THE PROŒMIUM +

OF chronic diseases the pain is great, the period of wasting long, and the recovery uncertain; for either they are not dispelled at all, or the diseases relapse upon any slight error; for neither have the patients resolution to persevere to the end; or, if they do persevere, they commit blunders in a prolonged regimen. And if there also be the suffering from a painful system of cure,—of thirst, of hunger, of bitter and harsh medicines, of cutting or burning,—of all which there is sometimes need in protracted diseases, the patients resile as truly preferring even death itself. Hence, indeed, is developed the talent of the medical man, his perseverance, his skill in diversifying the treatment, and conceding such pleasant things as will do no harm, and in giving encouragement. But the patient also ought to be courageous, and co-operate with the physician against the disease. For, taking a firm grasp of the body, the disease not only wastes and corrodes it quickly, but frequently disorders the senses, nay, even deranges the soul by the intemperament of the body. Such we know mania and melancholy to be, of which I will treat afterwards. At the present time I shall give an account of cephalæa.

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CHAPTER II. ON CEPHALÆA +

IF the head be suddenly seized with pain from a temporary cause, even if it should endure for several days, the disease is called Cephalalgia. But if the disease be protracted for a long time, and with long and frequent periods, or if greater and more untractable symptoms supervene, we call it Cephalæa.

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There are infinite varieties of it; for, in certain cases, the pain is incessant and slight, but not intermittent; but in others it returns periodically, as in quotidian fevers, or in those which have exacerbations every alternate day: in others it continues from sunset to noon, and then completely ceases; or from noon to evening, or still further into night; this period is not much protracted. And in certain cases the whole head is pained; and the pain is sometimes on the right and sometimes on the left side, or the forehead, or the bregma; and these may all occur the same day in a random manner.

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But in certain cases, the parts on the right side, or those on the left solely, so far that a separate temple, or ear, or one eyebrow, or one eye, or the nose which divides the face into two equal parts; and the pain does not pass this limit, but remains in the half of the head. This is called Heterocrania, an illness by no means mild, even though it intermits, and although it appears to be slight. For if at any time it set in acutely, it occasions unseemly and dreadful symptoms; spasm and distortion of the countenance take place; the eyes either fixed intently like horns, or they are rolled inwardly to this side or to that; vertigo, deep-seated pain of the eyes as far as the meninges; irrestrainable sweat; sudden pain of the tendons, as of one striking with a club; nausea; vomiting of bilious matters; collapse of the patient; but, if the affection be protracted, the patient will die; or, if more slight and not deadly, it becomes chronic; there is much torpor, heaviness of the head, anxiety, and ennui. For they flee the light; the darkness soothes their disease: nor can they bear readily to look upon or hear anything agreeable; their sense of smell is vitiated, neither does anything agreeable to smell delight them, and they have also an aversion to fetid things: the patients, moreover, are weary of life, and wish to die.

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The cause of these symptoms is coldness with dryness. But if it be protracted and increase, as regards the pains, the affection becomes Vertigo.

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CHAPTER III. ON VERTIGO, OR SCOTOMA +

IF darkness possess the eyes, and if the head be whirled round with dizziness, and the ears ring as from the sound of rivers rolling along with a great noise, or like the wind when it roars among the sails, or like the clang of pipes or reeds, or like the rattling of a carriage, we call the affection Scotoma (or Vertigo); a bad complaint indeed, if a symptom of the head, but bad likewise if the sequela of cephalæa, or whether it arises of itself as a chronic disease. For, if these symptoms do not pass off, but the vertigo persist, or if, in course of time, from the want of any one to remedy, it is completed in its own peculiar symptoms, the affection vertigo is formed, from a humid and cold cause. But if it turn to an incurable condition, it proves the commencement of other affections—of mania, melancholy, or epilepsy, the symptoms peculiar to each being superadded. But the mode of vertigo is, heaviness of the head, sparkles of light in the eyes along with much darkness, ignorance of themselves and of those around; and, if the disease go on increasing, the limbs sink below them, and they crawl on the ground; there is nausea and vomitings of phlegm, or of yellow or black bilious matter. When connected with yellow bile, mania is formed; when with black, melancholy; when with phlegm, epilepsy; for it is liable to conversion into all these diseases.

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CHAPTER IV. ON EPILEPSY +

EPILEPSY is an illness of various shapes and horrible; in the paroxysms, brutish, very acute, and deadly; for, at times, one paroxysm has proved fatal. Or if from habit the patient can endure it, he lives, indeed, enduring shame, ignominy, and sorrow: and the disease does not readily pass off, but fixes its abode during the better periods and in the lovely season of life. It dwells with boys and young men; and, by good fortune, it is sometimes driven out in another more advanced period of life, when it takes its departure along with the beauty of youth; and then, having rendered them deformed, it destroys certain youths from envy, as it were, of their beauty, either by loss of the faculties of a hand, or by the distortion of the countenance, or by the deprivation of some one sense. But if the mischief lurk there until it strike root, it will not yield either to the physician or the changes of age, so as to take its departure, but lives with the patient until death. And sometimes the disease is rendered painful by its convulsions and distortions of the limbs and of the face; and sometimes it turns the mind distracted. The sight of a paroxysm is disagreeable, and its departure disgusting with spontaneous evacuations of the urine and of the bowels.

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But also it is reckoned a disgraceful form of disease; for it is supposed, that it is an infliction on persons who have sinned against the Moon: and hence some have called it the Sacred Disease, and that for more reasons than one, as from the greatness of the evil, for the Greek word ἱερὸς also signifies great; or because the cure of it is not human, but divine; or from the opinion that it proceeded from the entrance of a demon into the man: from some one, or all these causes together, it has been called Sacred.

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Such symptoms as accompany this disease in its acute form have been already detailed by me. But if it become inveterate, the patients are not free from harm even in the intervals, but are languid, spiritless, stupid, inhuman, unsociable, and not disposed to hold intercourse, nor to be sociable, at any period of life; sleepless, subject to many horrid dreams, without appetite, and with bad digestion; pale, of a leaden colour; slow to learn, from torpidity of the understanding and of the senses; dull of hearing; have noises and ringing in the head; utterance indistinct and bewildered, either from the nature of the disease, or from the wounds during the attacks; the tongue is rolled about in the mouth convulsively in various ways. The disease also sometimes disturbs the understanding, so that the patient becomes altogether fatuous. The cause of these affections is coldness with humidity.

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CHAPTER V. ON MELANCHOLY +

BLACK bile, if it make its appearance in acute diseases of the upper parts of the body, is very dangerous; or, if it pass downwards, it is not free from danger. But in chronic diseases, if it pass downward, it terminates in dysentery and pain of the liver. But in women it serves as a purgation instead of the menses, provided they are not otherwise in a dangerous condition. But if it be determined upwards to the stomach and diaphragm, it forms melancholy; for it produces flatulence and eructations of a fetid and fishy nature, and it sends rumbling wind downwards, and disturbs the understanding. On this account, in former days, these were called melancholics and flatulent persons. And yet, in certain of these cases, there is neither flatulence nor black bile, but mere anger and grief, and sad dejection of mind; and these were called melancholics, because the terms bile (χολὴ) and anger (ὀργὴ) are synonymous in import, and likewise black (μέλαινα), with much (πολλὴ) and furious (θηριώδης). Homer is authority for this when he says:—

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Then straight to speak uprose The Atreidan chief, who `neath his sway a wide-spread empire held: Sore vexed was he; his mighty heart in his dark bosom swelled With rage, and from his eyes the fire like lightning-flashes broke. +—Τοῖσι δ᾿ ἀνέστη +Ἥρως Ἀτρείδης εὐρυκρείων Ἀγαμέμνων +Ἀχνύμενος· μένεος δὲ μέγα φρένες ἀμφιμελαιναι +Πίμπλαντ᾿, ὄσσε δέ οἱ πυρὶ λαμπετόωντι ἐΐκτην. +Iliad, i. 101, etc.

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The melancholics become such when they are overpowered by this evil.

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It is a lowness of spirits from a single phantasy, without fever; and it appears to me that melancholy is the commencement and a part of mania. For in those who are mad, the understanding is turned sometimes to anger and sometimes to joy, but in the melancholics to sorrow and despondency only. But they who are mad are so for the greater part of life, becoming silly, and doing dreadful and disgraceful things; but those affected with melancholy are not every one of them affected according to one particular form; but they are either suspicious of poisoning, or flee to the desert from misanthropy, or turn superstitious, or contract a hatred of life. Or if at any time a relaxation takes place, in most cases hilarity supervenes, but these persons go mad.

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But how, and from what parts of the body, the most of these complaints originate, I will now explain. If the cause remain in the hypochondriac regions, it collects about the diaphragm, and the bile passes upwards, or downwards in cases of melancholy. But if it also affects the head from sympathy, and the abnormal irritability of temper change to laughter and joy for the greater part of their life, these become mad rather from the increase of the disease than from change of the affection.

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Dryness is the cause of both. Adult men, therefore, are subject to mania and melancholy, or persons of less age than adults. Women are worse affected with mania than men. As to age, towards manhood, and those actually in the prime of life. The seasons of summer and of autumn engender, and spring brings it to a crisis.

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The characteristic appearances, then, are not obscure; for the patients are dull or stern, dejected or unreasonably torpid, without any manifest cause: such is the commencement of melancholy. And they also become peevish, dispirited, sleepless, and start up from a disturbed sleep.

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Unreasonable fear also seizes them, if the disease tend to increase, when their dreams are true, terrifying, and clear: for whatever, when awake, they have an aversion to, as being an evil, rushes upon their visions in sleep. They are prone to change their mind readily; to become base, mean-spirited, illiberal, and in a little time, perhaps, simple, extravagant, munificent, not from any virtue of the soul, but from the changeableness of the disease. But if the illness become more urgent, hatred, avoidance of the haunts of men, vain lamentations; they complain of life, and desire to die. In many, the understanding so leads to insensibility and fatuousness, that they become ignorant of all things, or forgetful of themselves, and live the life of the inferior animals. The habit of the body also becomes perverted; colour, a darkish-green, unless the bile do not pass downward, but is diffused with the blood over the whole system. They are voracious, indeed, yet emaciated; for in them sleep does not brace their limbs either by what they have eaten or drunk, but watchfulness diffuses and determines them outwardly. Therefore the bowels are dried up, and discharge nothing; or, if they do, the dejections are dried, round, with a black and bilious fluid, in which they float; urine scanty, acrid, tinged with bile. They are flatulent about the hypochondriac region; the eructations fetid, virulent, like brine from salt; and sometimes an acrid fluid, mixed with bile, floats in the stomach. Pulse for the most part small, torpid, feeble, dense, like that from cold.

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A story is told, that a certain person, incurably affected, fell in love with a girl; and when the physicians could bring him no relief, love cured him. But I think that he was originally in love, and that he was dejected and spiritless from being unsuccessful with the girl, and appeared to the common people to be melancholic. He then did not know that it was love; but when he imparted the love to the girl, he ceased from his dejection, and dispelled his passion and sorrow; and with joy he awoke from his lowness of spirits, and he became restored to understanding, love being his physician.

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CHAPTER VI. ON MADNESS +

THE modes of mania are infinite in species, but one alone in genus. For it is altogether a chronic derangement of the mind, without fever. For if fever at any time should come on, it would not owe its peculiarity to the mania, but to some other incident. Thus wine inflames to delirium in drunkenness; and certain edibles, such as mandragora and hyoscyamus, induce madness: but these affections are never called mania; for, springing from a temporary cause, they quickly subside, but madness has something confirmed in it. To this mania there is no resemblance in the dotage which is the calamity of old age, for it is a torpor of the senses, and a stupefaction of the gnostic and intellectual faculties by coldness of the system. But mania is something hot and dry in cause, and tumultuous in its acts. And, indeed, dotage commencing with old age never intermits, but accompanies the patient until death; while mania intermits, and with care ceases altogether. And there may be an imperfect intermission, if it take place in mania when the evil is not thoroughly cured by medicine, or is connected with the temperature of the season. For in certain persons who seemed to be freed from the complaint, either the season of spring, or some error in diet, or some incidental heat of passion, has brought on a relapse.

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Those prone to the disease, are such as are naturally passionate, irritable, of active habits, of an easy disposition, joyous, puerile; likewise those whose disposition inclines to the opposite condition, namely, such as are sluggish, sorrowful, slow to learn, but patient in labour, and who when they learn anything, soon forget it; those likewise are more prone to melancholy, who have formerly been in a mad condition. But in those periods of life with which much heat and blood are associated, persons are most given to mania, namely, those about puberty, young men, and such as possess general vigour. But those in whom the heat is enkindled by black bile, and whose form of constitution is inclined to dryness, most readily pass into a state of melancholy. The diet which disposes to it is associated with voracity, immoderate repletion, drunkenness, lechery, venereal desires. Women also sometimes become affected with mania from want of purgation of the system, when the uterus has attained the development of manhood; but the others do not readily fall into mania, yet, if they do, their cases are difficult to manage. These are the causes; and they stir up the disease also, if from any cause an accustomed evacuation of blood, or of bile, or of sweating be stopped.

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And they with whose madness joy is associated, laugh, play, dance night and day, and sometimes go openly to the market crowned, as if victors in some contest of skill; this form is inoffensive to those around. Others have madness attended with anger; and these sometimes rend their clothes and kill their keepers, and lay violent hands upon themselves. This miserable form of disease is not unattended with danger to those around. But the modes are infinite in those who are ingenious and docile,—untaught astronomy, spontaneous philosophy, poetry truly from the muses; for docility has its good advantages even in diseases. In the uneducated, the common employments are the carrying of loads, and working at clay,—they are artificers or masons. They are also given to extraordinary phantasies; for one is afraid of the fall of the oilcruets ..... and another will not drink, as fancying himself a brick, and fearing lest he should be dissolved by the liquid.

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This story also is told:—A certain joiner was a skilful artisan while in the house, would measure, chop, plane, mortice, and adjust wood, and finish the work of the house correctly; would associate with the workmen, make a bargain with them, and remunerate their work with suitable pay. While on the spot where the work was performed, he thus possessed his understanding. But if at any time he went away to the market, the bath, or on any other engagement, having laid down his tools, he would first groan, then shrug his shoulders as he went out. But when he had got out of sight of the domestics, or of the work and the place where it was performed, he became completely mad; yet if he returned speedily he recovered his reason again; such a bond of connection was there between the locality and his understanding.

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The cause of the disease is seated in the head and hypochondriac region, sometimes commencing in both together, and the one imparting it to the other. In mania and melancholy, the main cause is seated in the bowels, as in phrenitis it is mostly seated in the head and the senses. For in these the senses are perverted, so that they see things not present as if they were present, and objects which do not appear to others, manifest themselves to them; whereas persons who are mad see only as others see, but do not form a correct judgment on what they have seen.

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If, therefore, the illness be great, they are of a changeable temper, their senses are acute, they are suspicious, irritable without any cause, and unreasonably desponding when the disease tends to gloom; but when to cheerfulness, they are in excellent spirits; yet they are unusually given to insomnolency; both are changeable in countenance, have headache, or else heaviness of the head; they are sharp in hearing, but very slow in judgment; for in certain cases there are noises of the ears, and ringings like those of trumpets and pipes. But if the disease go on to increase, they are flatulent, affected with nausea, voracious and greedy in taking food, for they are watchful, and watchfulness induces gluttony. Yet they are not emaciated like persons in disease (embonpoint is rather the condition of melancholics) and they are somewhat pale. But if any of the viscera get into a state of inflammation, it blunts the appetite and digestion; the eyes are hollow, and do not wink; before the eyes are images of an azure or dark colour in those who are turning to melancholy, but of a redder colour when they are turning to mania, along with purplecoloured phantasmata, in many cases as if of flashing fire; and terror seizes them as if from a thunderbolt. In other cases the eyes are red and blood-shot.

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At the height of the disease they have impure dreams, and irresistible desire of venery, without any shame and restraint as to sexual intercourse; and if roused to anger by admonition or restraint, they become wholly mad. Wherefore they are affected with madness in various shapes; some run along unrestrainedly, and, not knowing how, return again to the same spot; some, after a long time, come back to their relatives; others roar aloud, bewailing themselves as if they had experienced robbery or violence. Some flee the haunts of men, and going to the wilderness, live by themselves.

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If they should attain any relaxation of the evil, they become torpid, dull, sorrowful; for having come to a knowledge of the disease they are saddened with their own calamity.

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ANOTHER SPECIES OF MANIA.

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Some cut their limbs in a holy phantasy, as if thereby propitiating peculiar divinities. This is a madness of the apprehension solely; for in other respects they are sane. They are roused by the flute, and mirth, or by drinking, or by the admonition of those around them. This madness is of divine origin, and if they recover from the madness, they are cheerful and free of care, as if initiated to the god; but yet they are pale and attenuated, and long remain weak from the pains of the wounds.Our author, as Petit remarks, evidently refers here to the worship of Cybele; on which see in particular, the Atys of Catullus, and Apuleius, viii.

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CHAPTER VII. ON PARALYSIS +

Apoplexy, Paraplegia, Paresis, Paralysis, are all generically the same. For they are all a defect of motion, or of touch, or of both; sometimes also of understanding, and sometimes of other sense. But apoplexy is a paralysis of the whole body, of sensation, of understanding and of motion; wherefore to get rid of a strong attack of apoplexy is impossible, and of a weak, not easy. But paraplegia is a remission of touch and motion, but of a part, either of the hand or of the leg. Paralysis for the most part is the remission (paresis) of motion only, and of energy.It is difficult to find an appropriate word either in the Latin or English for the term πάρεσις. It would seem to be particularly applied to a partial loss either of sensibility or of motion. Alexander, however, makes little or no distinction between it and paralysis, x. 2. But if the touch alone is wanting—(but such a case is rare)—the disease is called Anæsthesia rather than paresis. And when Hippocrates says, the leg on the same side was apoplectic, he means to say that it was in a death-like, useless, and incurable state; for what is strong apoplexy in the whole body, that he calls paraplegia in the limb. Paresis, properly speaking, is applied to suppression or incontinence of urine in the bladder. But distortion of the eye-brows, and of the cheeks, and of the muscles about the jaws and chin to the other side, if attended with spasm, has got the appellation of Cynic spasm. Loss of tone in the knees, and of sensibility for a time, with torpor, fainting, and collapse, we call lipothymia.

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Wherefore, the parts are sometimes paralysed singly, as one eye-brow, or a finger, or still larger, a hand, or a leg; and sometimes more together; and sometimes the right or the left only, or each by itself, or all together, either entirely or in a less degree; and the parts only which are distant, homonymous, and in pairs—the eyes, hands, and legs; and also the parts which cohere, as the nose on one side, the tongue to the middle line of separation, and the one tonsil, the isthmus faucium, and the parts concerned in deglutition to one half. I fancy, also, that sometimes the stomach, the bladder, and the rectum, as far as its extremity, suffers in like manner; but the internal parts, when in a paralytic state, are concealed from the sight. Their functions, however, are but half performed; and from this I conclude, that these parts are half affected, as being cut in twain by the disease. And, indeed, this thing teaches us a lesson in respect to the diversity of power and discrimination between the right side and the left. For the inherent cause is equal; and means which occasion the affection are common in both cases, whether cold or indigestion, and yet both do not suffer equally. For Nature is of equal power in that which is equally paired; but it is impossible that the same thing should happen where there is an inequality. If, therefore, the commencement of the affection be below the head, such as the membrane of the spinal marrow, the parts which are homonymous and connected with it are paralysed: the right on the right side, and the left on the left side. But if the head be primarily affected on the right side, the left side of the body will be paralysed; and the right, if on the left side. The cause of this is the interchange in the origins of the nerves, for they do not pass along on the same side, the right on the right side, until their terminations; but each of them passes over to the other side from that of its origin, decussating each other in the form of the letter X. To say all at once, whether all together or separate parts be affected with paralysis ..... or of both; sometimes the nerves from the head suffer (these, generally, induce loss of sensibility, but, in a word, they do not readily occasion loss of sensibility; but if they sympathise with the parts which are moved, they may undergo, in a small degree, the loss of motion); and sometimes those which pass from muscle to muscle (from the spinal marrow to the muscles),See the note on the text. these have the power of motion, and impart it to those from the head; for the latter possess the greater part of their motory power from them, but yet have it, to a small extent, of themselves: the former, too, principally suffer loss of motion, but rarely of themselves experience anæsthesia; indeed, as appears to me, not at all. And if the ligaments of nerves, which derive their origin from certain of the bones, and terminate in others, be loosened or torn, the parts become powerless, and are impeded in their movements, but do not become insensible.It will readily be understood that our author here refers to the ligaments proper of the joints. On this use of the term Nerve, see Hippocrates On the articulations, pluries.

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The varieties of paralysis are these: sometimes the limbs lose their faculties while in a state of extension, nor can they be brought back into the state of flexion, when they appear very much lengthened; and sometimes they are flexed and cannot be extended; or if forcibly extended, like a piece of wood on a rule, they become shorter than natural. The pupil of the eye is subject to both these varieties, for sometimes it is much expanded in magnitude, when we call it Platycoria; but the pupil is also contracted to a small size, when I call it Phthisis and Mydriasis. The bladder, also, is paralysed in respect to its peculiar functions; for either it loses its powers as regards distension, or it loses its retentive powers, or it becomes contracted in itself, when being filled with urine, it cannot expel the same. There are six causes of paralytic disorders; for they arise from a wound, a blow, exposure to cold, indigestion, venery, intoxication. But so likewise the vehement affections of the soul, such as astonishment, fear, dejection of spirits, and, in children, frights. Great and unexpected joy has also occasioned paralysis, as, likewise, unrestrained laughter, even unto death. These, indeed, are the primary causes; but the ultimate and vital cause is refrigeration of the innate heat. It suffers from humidity, or dryness, and is more incurable than the other; but if also in connection with a wound, and complete cutting asunder of a nerve, it is incurable. In respect to age, the old are peculiarly subject, and difficult to cure; in children, the cases are easily restored. As to seasons, the winter; next, the spring; afterwards, the autumn; least of all, the summer. Of habits, those naturally gross, the humid, indolent, brutish.

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When the affections are confirmed, they are made manifest by loss of motion, insensibility of heat and cold; and also of plucking the hair, of tickling, and of touching. It is rare indeed when in them the extremities are painful; but insensibility to pain is not worse as regards recovery. Wherefore the disease occurs suddenly; but if at any time it have prolonged onsets, there supervene heaviness, difficulty of motion, torpor, a sensation of cold, sometimes an excess of heat, short sleeps, greater phantasies, when they become suddenly paralytic.

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But in the Cynic spasm, it is not usual for all parts of the face to be cramped; but those of the left side are turned to the right, and those of the right to the left, when there is a considerable distortion of the jaw to this side or to that, as if the jawbone were dislocated. And in certain of these cases, also, there is luxation at the joint, when in yawning the jaw is displaced to the opposite side: strabismus of the affected eye, and palpitation in the under eyelid; the upper eyelid also palpitates, sometimes along with the eye, and at other times alone. The lips are distended, each on its own side; but sometimes both being collapsed, they splutter; in others, they are closely compressed, and are suddenly separated so as to expel the common spittle with a noise.

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The tongue, also, is drawn aside; for it consists of a muscle and nerves, and at certain times, along its whole extent, it starts up to the palate, and makes an unusual sound. The uvula, also, is drawn aside; and if the mouth is shut, there is an unexpected noise within. And if you separate the mouth, you will perceive the uvula sometimes attached to the palate through its whole surface, and sometimes swiftly palpitating with force, like a bag-fish, when likewise a sound is produced. But there is apt to be deception in cynic spasms; for to the spectator it appears as if the parts unaffected were those possessed by the disease; for owing to the tension and colour of the affected parts, and the enlargement of the eye, they appear as if they were diseased. But in laughter, speaking, or winking, the true state of matters becomes manifest; for the parts affected are all drawn aside with a smack; the lip expresses no smile, and is motionless in talking; the eyelid is immoveable, the eye fixed, and the sense of touch is lost; while the sound parts speak, wink, feel, laugh.

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CHAPTER VIII. ON PHTHISIS +

IF an ulcer form in the lungs from an abscess, or from a chronic cough, or from the rejection of blood, and if the patient spit up pus, the disease is called Pye and Phthisis. But if matter form in the chest or side, or be brought up by the lungs, the name is Empyema. But if, in addition to these symptoms, the lungs contract an ulcer, being corroded by the pus passing through it, the disease no longer gets the name of empyema, but takes that of Phthoe instead of it. It is accompanied with febrile heat of a continual character, but latent ceasing, indeed, at no time, but concealed during the day by the sweating and coldness of the body; for the characteristics of phthoe are, that a febrile heat is lighted up, which breaks out at night, but during the day again lies concealed in the viscera, as is manifested by the uneasiness, loss of strength, and colliquative wasting. For had the febrile heat left the body during the day, how should not the patient have acquired flesh, strength, and comfortable feeling? For when it retires inwardly, the bad symptoms are all still further exacerbated, the pulse small and feeble; insomnolency, paleness, and all the other symptoms of persons in fever. The varieties of the sputa are numerous: livid, black, streaked, yellowish-white, or whitish-green; broad, round; hard, or glutinous; rare, or diffluent; devoid of smell, fetid. There are all these varieties of pus. But those who test the fluids, either with fire or water, would appear to me not to be acquainted with phthoe;Our author would appear to allude here to certain passages in the pseudo-Hippocratic treatises, wherein these tests of pus are recommended. See de Morbis, ii. 47, t. vii. p. 72, ed. Littré; Coæ prænot. et alibi. See also Paulus Ægineta, t.i. 452, etc., Syd. Soc. edit. for the sight is more to be trusted than any other sense, not only with regard to the sputa, but also respecting the form of the disease. For if one of the common people see a man pale, weak, affected with cough, and emaciated, he truly augurs that it is phthoe (consumption). But in those who have no ulcer in the lungs, but are wasted with chronic fevers—with frequent, hard, and ineffectual coughing, and bringing up nothing, these, also, are called consumptive, and not without reason. There is present weight in the chest (for the lungs are insensible of pain),—anxiety, discomfort, loss of appetite; in the evening coldness, and heat towards morning; sweat more intolerable than the heat as far as the chest; expectoration varied, as I have described.

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Voice hoarse; neck slightly bent, tender, not flexible, somewhat extended; fingers slender, but joints thick; of the bones alone the figure remains, for the fleshy parts are wasted; the nails of the fingers crooked, their pulps are shrivelled and flat, for, owing to the loss of flesh, they neither retain their tension nor rotundity; and, owing to the same cause, the nails are bent, namely, because it is the compact flesh at their points which is intended as a support to them; and the tension thereof is like that of the solids. Nose sharp, slender; cheeks prominent and red; eyes hollow, brilliant and glittering; swollen, pale, or livid in the countenance; the slender parts of the jaws rest on the teeth, as if smiling; otherwise of a cadaverous aspect. So also in all other respects; slender, without flesh; the muscles of the arms imperceptible; not a vestige of the mammæ, the nipples only to be seen; one may not only count the ribs themselves, but also easily trace them to their terminations; for even the articulations at the vertebræ are quite visible; and their connections with the sternum are also manifest; the intercostal spaces are hollow and rhomboidal, agreeably to the configuration of the bone; hypochondriac region lank and retracted; the abdomen and flanks contiguous to the spine. Joints clearly developed, prominent, devoid of flesh, so also with the tibia, ischium, and humerus; the spine of the vertebræ, formerly hollow, now protrudes, the muscles on either side being wasted; the whole shoulder-blades apparent like the wings of birds. If in these cases disorder of the bowels supervene, they are in a hopeless state. But, if a favourable change take place, symptoms the opposite of those fatal ones occur.

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The old seldom suffer from this disease, but very rarely recover from it; the young, until manhood, become phthisical from spitting of blood, and do recover, indeed, but not readily; children continue to cough even until the cough pass into phthoe, and yet readily recover. The habits most prone to the disease are the slender; those in which the scapulæ protrude like folding doors, or like wings; in those which have prominent throats; and those which are pale and have narrow chests. As to situations, those which are cold and humid, as being akin to the nature of the disease.

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CHAPTER IX. ON PERSONS AFFECTED WITH EMPYEMA. +

THOSE persons in whose cavities above, along the region of the chest, or, in those below the diaphragm, abscesses of matter form, if they bring it up, they are said to be affected with Empyema; but if the matter pass downwards, they are said to labour under Apostemes. And in the ulcers in the chest, or in the lungs, if phthoe supervene, or in the pleura, or the sternum, or anywhere below at the junction of the lungs with the spine — in all these cases the passage for the matter upwards is by the lungs. But in the viscera below the diaphragm, the liver, spleen, and kidneys, it is by the bladder; and in women by the womb. And I once made an opening into an abscess in the colon on the right side near the liver, and much pus rushed out, and much also passed by the kidneys and bladder for several days, and the man recovered.

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The common causes of all are a blow, indigestion, cold and the like. Of those in the chest also, chronic cough, pleuritis, peripneumony, and protracted defluxion; but also the determination of some acute diseases to any one of them.

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The humour is sometimes inert, weak, and rests on something else; sometimes bitingly acrid, and occasioning putrefactions even unto death. And there are many other varieties, as I shall presently declare. It is a wonder how from a thin, slender membrane, having no depth, like that which lines the chest, so much pus should flow; for in many cases there is a great collection. The cause is an inflammation from redundancy of blood, by which the membrane is thickened; but from much blood much pus is formed intermediately. But if it be determined inwards, the ribs being the bones in this region. . . . . . . I have said above, that another species of phthisis would naturally occur. But if it point outwards, the bones are separated, for the top of the abscess is raised in one of the intercostal spaces, when the ribs are pushed to this side or to that.

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There are certain symptoms common to all, and certain ones peculiar to each. A heaviness rather than pain is a common symptom (for the lungs are insensible), weak fevers, rigor towards evening, sweats in the remission, insomnolency, swellings in the extremities of the feet, and fingers of the hands, which at one time abate and at another increase; uncomfortable feeling; loss of appetite; wasting of the whole body; and if the change be prolonged, the phthisical habit is formed; for Nature can no longer perform her office, for the digestion is not as before, nor is there the plump habit of body; the colour dark; respiration in all cases bad, but worse in those affecting the upper cavity; but also cough at first as long as the inflammation is urgent, when the pains also are greater, and rigor, and heat, and watchfulness, and dyspnœa still more; pulse small, sluggish, feeble; they are disordered in the intellect; distension of the thorax.

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But if it be already come to the formation of pus, all the the greatest symptoms take place. Expectoration small with greater cough, and from an urgent abscess, at first of pituitous matters, tinged with bile of a darker colour as if from soot, but likewise tinged with blood, and thick; but if about to burst, of fleshy and deep-seated matter. And, if it burst, there is danger of suffocation should much pus be suddenly poured forth; but if gradually, there is no danger. If then the pus is going to pass downwards, the upper part, where the abscess is situated, experiences sharp pain; discharges from the bowels fluid, at first watery with phlegm, afterwards bloody matter; and then again, substances resembling flesh floating in a fluid, if it has already burst. Pus follows them either by the bowels or the urine. Metastasis to the kidneys and bladder peculiarly favourable.

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The pus, whether it be carried upwards or downwards, is of various colours—pale, white, ash-coloured, or livid, black and fetid; or devoid of smell and very thick; or intermediate; or smooth and consistent; or rough and unequal, with fleshy substances floating in it, these being round or broad, readily separated or viscid. To say all in a word respecting the pus, such kinds as are white, concocted, devoid of smell, smooth, rounded, and are quickly coughed up, or pass downwards, are of a salutary character; but such as are very pale, bilious, and inconsistent, are bad. Of these by far the worst are the livid and black, for they indicate putrefaction and phagedenic ulcers.

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Along with these things, it will be proper to know also the habit and other concomitants of the disease. If at the time of the discharge, he feels comfortable, and gets rid of the fever; has good digestion, good colour, and a good appetite, if he coughs up readily, has a good pulse, and good strength; the patient is free from danger. But if fever supervene, and all the other symptoms turn worse, he is in a hopeless state. One ought also to consider the places in which the abscesses are seated. For where the matter forms in the sternum, it is slowly turned to a suppuration; for the parts are slender, devoid of flesh and cartilaginous; and such parts do not readily receive the superfluities of inflammation, but remain a long time without being formed into pus; for cartilage is of a cold nature, but the inflammations thereof are innocuous. The wasting of the constitution is bad; for the suppuration lasts a long time; the spleen, the liver, the lungs, and diaphragm pass more quickly into suppuration, but they are dangerous and fatal.

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CHAPTER X. ON ABSCESSES IN THE LUNGS. +

WHEN, in cases of peripneumonia, the patients survive, though the inflammation be not discussed, those who escape the acute stage of the affection have suppurations. The symptoms, then, of an incipient and of a formed abscess have been stated by me under Empyema. If formed, then, there is no necessity for the same harsh measures and pains to procure the rupture and discharge of it as in the solid parts of the body, as it is readily brought up; for the distension of its pores is required rather than of the solid texture of its parts; for the lungs being a porous body and full of perforations like a sponge, it is not injured by the humour, but transmits it from pore to pore, until it reach the trachea. Thus the fluid finds a ready outlet, the pus being a flexible and slippery substance, and the respiration blows the breath (pneuma) upwards. For the most part they recover, unless at any time one be suffocated by the copious influx of the fluid, when, owing to the quantity of the pus, the trachea does not admit the air. Others die a protracted death, after the manner of those labouring under phthisis and empyema. The pus is white and frothy, being mixed with saliva, but sometimes ash-coloured or blackish. And sometimes one of the bronchia has been spit up in a case of large ulceration, if the abscess is deep, when portions of the viscus are also brought up. Hoarse, breathing short, voice heavy-toned, their chest becomes broad, and yet they stand in need of its being still broader, owing to the collection of fluid; the dark parts of the eyes glancing, the whites are very white and fatty; cheeks ruddy; veins in the forehead protuberant. There is a marvel in connection with these cases, how the strength is greater than the condition of the body, and the buoyancy of spirits surpasses the strength.

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CHAPTER XI. ON ASTHMA. +

IF from running, gymnastic exercises, or any other work, the breathing become difficult, it is called Asthma (ἆσθμα); and the disease Orthopnœa (ὀρθόπνοια) is also called Asthma, for in the paroxysms the patients also pant for breath. The disease is called Orthopnœa, because it is only when in an erect position (ὀρθίῳ σχήματι) that they breathe freely; for when reclined there is a sense of suffocation. From the confinement in the breathing, the name Orthopnœa is derived. For the patient sits erect on account of the breathing; and, if reclined, there is danger of being suffocated.

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The lungs suffer, and the parts which assist in respiration, namely the diaphragm and thorax, sympathise with them. But if the heart be affected, the patient could not stand out long, for in it is the origin of respiration and of life.

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The cause is a coldness and humidity of the spirit (pneuma); but the materiel is a thick and viscid humour. Women are more subject to the disease than men, because they are humid and cold. Children recover more readily than these, for nature in the increase is very powerful to heat. Men, if they do not readily suffer from the disease, die of it more speedily. There is a postponement of death to those in whom the lungs are warmed and heated in the exercise of their trade, from being wrapped in wool, such as the workers in gypsum, or braziers, or blacksmiths, or the heaters of baths.

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The symptoms of its approach are heaviness of the chest; sluggishness to one’s accustomed work, and to every other exertion; difficulty of breathing in running or on a steep road; they are hoarse and troubled with cough; flatulence and extraordinary evacuations in the hypochondriac region; restlessness; heat at night small and imperceptible; nose sharp and ready for respiration.

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But if the evil gradually get worse, the cheeks are ruddy; eyes protuberant, as if from strangulation; a a râle during the waking state, but the evil much worse in sleep; voice liquid and without resonance; a desire of much and of cold air; they eagerly go into the open air, since no house sufficeth for their respiration; they breathe standing, as if desiring to draw in all the air which they possibly can inhale; and, in their want of air, they also open the mouth as if thus to enjoy the more of it; pale in the countenance, except the cheeks, which are ruddy; sweat about the forehead and clavicles; cough incessant and laborious; expectoration small, thin, cold, resembling the efflorescence of foam; neck swells with the inflation of the breath (pneuma); the præcordia retracted; pulse small, dense, compressed; legs slender: and if these symptoms increase, they sometimes produce suffocation, after the form of epilepsy.

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But if it takes a favourable turn, cough more protracted and rarer; a more copious expectoration of more fluid matters; discharges from the bowels plentiful and watery; secretion of urine copious, although unattended with sediment; voice louder; sleep sufficient; relaxation of the præcordia; sometimes a pain comes into the back during the remission; panting rare, soft, hoarse. Thus they escape a fatal termination. But, during the remissions, although they may walk about erect, they bear the traces of the affection.

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CHAPTER XII. ON PNEUMODES. +

PNEUMODES is a species of asthma; and the affection is connected with the lungs as is the case in asthma. The attendant symptoms are common, and there is but little difference; for dyspnœa, cough, insomnolency, and heat are common symptoms, as also loss of appetite and general emaciation. Moreover, the disease is protracted for a time, yet not longer than one year; for, if the autumn begin it, the patients die in the spring or in the summer; or if the winter, they terminate their life towards the autumn. Old persons also are at certain times readily seized; and being seized with rigors, it requires but a slight inclination of the scale to lay them on the bed of death. All labour in particular under want of breath; pulse small, frequent, feeble. But these symptoms are also common to asthma; they have this as peculiar; they cough as if going to expectorate, but their effort is vain, for they bring up nothing; or if anything is forcibly separated from the lungs, it is a small, white, round substance, resembling a hailstone.See in particular Galen, de loc. affect. iv.; Alexander, vi. 1; and Paulus Ægineta, Syd. Soc. Edit. t.i. p. 474. The thorax is broader, indeed, than natural, but not altered in shape, and is free from ulceration; yet, though the lungs be free from suppuration, they are filled with humours, which are, as it were, compacted. The intervals of the paroxysms in this affection are greater. Some, indeed, die speedily of suffocation before anything worse is transferred to the general system. In other cases the affection terminates in dropsy about the loins, or in anasarca.

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CHAPTER XIII. ON THE LIVER. +

IN the formation of the body, the liver and spleen are equally balanced; for these viscera are equal in number, the one on the right side and the other on the left. They are unequal, however, in power, as regards health and diseases. In health, indeed, inasmuch as the liver has the power of nutrition, for the roots of all the veins unite to form the liver: but in diseases it has much greater power to restore health and occasion death. As far, then, as the liver is superior in health, so much the worse is it in diseases, for it experiences more sudden and violent inflammations, and has more frequent and more fatal abscesses. In scirrhus, too, it proves fatal more quickly and with greater pain than the spleen. Those things which relate to inflammations thereof I have described among the acute affections.

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If it be converted into pus, a sharp pain possesses the parts as far as the clavicle and the tops of the shoulders, for the diaphragm from which the liver is suspended is dragged down by the weight, and the diaphragm drags the membrane lining the ribs to which it is attached, and this membrane (the pleura) is stretched up to the clavicle and top of the shoulders, which also are dragged down. Along with the abscess there is acrid heat and rigors; cough dry and very frequent; colour grass-green; and if the patients be intensely jaundiced, it is of the white kind; sleep not quite clear of phantasies; on the main, their understanding settled; or if, from any temporary cause, there be delirium, it quickly passes off; swelling under the nipples or sides, which deceives many, as if it proceeded from the peritoneum. But if there be swelling and pain on pressure below the false ribs, the liver is swelled; for it is filled by a collection of fluid. But if the collection is not below the bone, it is a symptom of the membrane (the peritoneum) being affected, and its boundaries are distinctly circumscribed; for the hand applied in pressure, after passing the circumference of the liver, sinks down into an empty space in the abdomen. But the hardness of the peritoneum is undefined, and no process at its extremity is apparent. If the process incline inwardly, nature is far superior to the physician; for it is either turned upon the bowels or the bladder, and far the least dangerous is the passage by the bladder: but if it incline outwards, it is bad not to make an incision, for otherwise the liver is corroded by the pus, and death is not long deferred. But, if you intend to make an incision, there is danger of hemorrhage, from which the patient may die suddenly; for hemorrhage in the liver cannot be checked. But if you are reduced to the necessity of making an incision, heat a cautery in the fire to a bright heat, and push it down to the pus, for it at the same time cuts and burns: and if the patient survive, there will run out a white, concocted, smooth, not fetid, very thick pus, by which the fever and other bad symptoms are diminished, and altogether the health is restored. But if the pus passes into the intestines, the belly has watery discharges at first, but afterwards they resemble the washings of flesh, and, again, they are like those in dysentery proceeding from ulcerations; but sometimes a bloody ichor, or thrombus is passed. Bile also is discharged, intensely yellow, or leekgreen, and, lastly, before death, black.

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But if the abscess do not suppurate, and the discharges from the bowels are fetid like putrefaction, the food passes undigested, owing to the stomach and intestines having lost their tone; for thus the liver, even though now in good condition, does not perform digestion; along with these symptoms there is acrid heat, and altogether there is a turn to the worse; colliquative wasting of the flesh, pulse small, difficulty of breathing, when at no distance of time their life is at an end. In certain cases, the dysentery and the ulceration have healed, but the disease changed to dropsy. But if all these symptoms abate, if pus that is white, smooth, consistent, and inodorous, is discharged, and the stomach digests the food, there may be good hopes of the patient. But the best thing is for it to be discharged by the urine; for the passage by it is safer and less troublesome than the other.

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But if, after the inflammation, the liver does not suppurate, the pain does not go off, its swelling, changing to a hard state, settles down into scirrhus; in which case, indeed, the pain is not continued, and when present is dull; and the heat is slight; there is loss of appetite; delight in bitter tastes, and dislike of sweet; they have rigors; are somewhat pale, green, swollen about the loins and feet; forehead wrinkled; belly dried up, or the discharges frequent. The cap of these bad symptoms is dropsy.

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In the dropsy, provided there is a copious discharge of thick urine, having much re-crementitious sediment, there is a hope that the dropsical swelling may run off; but if the urine be thin, without sediment, and scanty, it conspires with the dropsy. But if nature change to her pristine state, and burst upon the bowels, along with copious watery discharges, it has also sometimes cured the dropsy. This mode of cure, however, is dangerous; for what from the copious evacuations, and the extreme prostration, the patients have sometimes died of weakness, as from hemorrhage. Sweating, if copious, carries off the disease with less danger, for dropsical persons generally have not a moist skin. Such is the termination of the affections in the liver.

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But if the liver suppurate . . . . . children, and those till manhood; women less so. The causes are intemperance, and a protracted disease, especially from dysentery and colliquative wasting; for it is customary to call these persons tabid who die emaciated from ulcers of the liver.

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CHAPTER XIV. ON THE SPLEEN. +

SCIRRHUS, a chronic disease, is habitual to the spleen (suppuration does not readily occur in it, and yet it does occur sometimes), when the pain is not severe, but swelling much greater than the pain; for it has been seen swelled on the right side as far as the liver in the whole common space between them, hence many have been deceived in supposing that it is not an affection of the spleen, but of the membrane, for it appears to them that the peritonæum is inflamed. It is hard and unyielding as stone. Such the spleen generally becomes in scirrhus, when also it is attended with great discomfort.

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But if it suppurate, it is soft to the touch, yielding to pressure at its top, when there is a formation of pus; but when it is not suppurated it does not yield. Sometimes it hangs entire in the abdomen, being moved about to this side and to that, whilst it remains a small body, and has space to float in. Nausea, restlessness, especially about the time of breaking.

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The symptoms of distension are, fevers, pains, and rigors (for generally they are free of rigors, and of pain when the heat is small, and hence abscess about the spleen is sometimes latent); for the viscus is porous and insensible even in health: they are swollen, dropsical, of a dark-green colour, along with disquietude, dyspnœa as if from weight of the chest, for the evil is well marked. Even to its upper parts the abdomen is filled with a flatus (pneuma), thick, misty, humid in appearance but not in reality; much desire of coughing comes on, and their expectoration is small and dry. If there be watery discharges from the bowels, they at first bring some slight relief; but if they increase, they waste the patient, and yet nevertheless they do good.

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But, if it should break, pure concocted pus is never discharged, but whitish and ashy, sometimes feculent, or livid. If the abscess become deeper, the fluid is dark, when likewise some of the juice of the melted spleen is discharged. In certain cases, entire portions of the spleen have been brought up, for the spleen is of a soluble nature. And if the ulcer does not heal, but remains for a long time, they lose appetite, become cachectic, swollen, unseemly to look at, having many ulcers on all parts of the body, especially on the legs, where the sores are round, livid, hollow, foul, and difficult to heal. Wasted thereby, they expire.

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In a small tumour, with hardness and resistance, pain is wanting; on this account they live a long time. But if overpowered by the affection, dropsy, phthisis, and wasting of the body necessarily supervene; and this form of death removes them from life.

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Children, then, and young persons are most readily affected, and most readily escape from it. Old persons, indeed, do not often suffer, but they cannot escape; but certain elderly persons have been cut off by latent disease of the spleen; for, even with a small swelling, the scale of death has turned with them. A protracted and consumptive disease induces these affections, and in young persons inactivity especially, when, after contention and many exercises, the body has become inactive. As to localities, the marshy; as to waters, the thick, saltish, and fetid. Of the seasons, autumn is pecularly malignant.

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CHAPTER XV. ON JAUNDICE, OR ICTERUS. +

If a distribution of bile, either yellow, or like the yolk of an egg, or like saffron, or of a dark-green colour, take place from the viscus, over the whole system, the affection is called Icterus, a dangerous complaint in acute diseases, for not only when it appears before the seventh day does it prove fatal, but even after the seventh day it has proved fatal in innumerable instances. Rarely the affection has proved a crisis to a fever towards the end, but itself is not readily discussed.

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It is formed not only from a cause connected with the liver, as certain physicians have supposed, but also from the stomach, the spleen, the kidneys, and the colon. From the liver in this manner: if the liver become inflamed or contract scirrhus, but remain unchanged with regard to its functional office, it produces bile, indeed, in the liver, and the bladder, which is in the liver, secretes it; but if the passages which convey the bile to the intestine, be obstructed from inflammation or scirrhus, the bladder gets over-distended, and the bile regurgitates; it therefore becomes mixed with the blood, and the blood, passing over the whole system, carries the bile to every part of the body, which acquires the appearance of bile. But the hardened fæces are white and clayey, as not being tinged with bile, because the bowels are deprived of this secretion. Hence also the belly is very much dried up; for it is neither moistened nor stimulated by the bile. The colour in this species is whitish-green.

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If jaundice make its appearance in connection with the spleen, it is dark-green, for its nutriment is black, because the spleen is the strainer of the black blood, the impurities of which it does not receive nor elaborate when diseased, but they are carried all over the body with the blood. Hence patients are dark-green from icterus in connection with the spleen; but the colour is darker than usual in the customary discharges from the bowels, for the superfluity of the nutriment of the spleen becomes recrement from the bowels.

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And icterus also is formed in connection with the colon and stomach, provided their powers of digestion be vitiated; for digestion takes place even in the colon, and from it a supply of nutriment is sent upwards to the liver. Provided, then, the liver receive its other food in a cruder state than usual, it indeed goes through its own work, but leaves that of the other undone; for in distribution it diffuses the blood which carries the marks of the inactivity of the colon to all parts of the body. The indigestion in this case is connected with the formation of the bile in the colon.

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Thus icterus may be formed in any viscus, not only of those which send nutriment to the liver, but also of those which receive it from the liver. For nature sends nutriment to all parts, not only by ducts perceptible to the senses, but much more so by vapours, which are readily carried from all parts to all, nature conducting them even through the solid and dense parts. Wherefore these vapours become tinged with bile, and discolour any part of the body in which they get lodged. Moreover, in jaundice connected with the colon, the evacuations are not white; for the liver is not disordered as regards the function of bile, and is not impeded in the transmission of bile to the intestines.

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The general system, likewise, is most powerful in producing icterus; for the cause is seated in the whole body. It is of this nature: in every part there is heat for concoction; in every part for the creation and secretion of humours, different in different places, but in each that which is peculiar to it: in flesh, indeed, sweat; in the eyes, tears; in the joints and nose, mucus; in the ears, wax. If the heat, then, fails in the performance of each of its operations, it is itself converted into that which is acrid and fiery; but all the fluids become bile, for the products of heat are bitter, and stained with bile. But if indigestion happens in the blood, the blood assumes the appearance of bile, but is distributed as nourishment to all parts, wherefore bile appears everywhere. For it is a dire affection, the colour being frightful in appearance, and the patients of a golden colour; for the same thing is not becoming in a man which is beautiful in a stone. It is superfluous in me to tell whence the name is derived, further than that it is derived from certain four-footed and terrestrial animals, called ἰκτίδες, whose eyes are of this colour.A species of ferret; either the Mustela Erminea or the M. Furo.

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There are two species of the affection; for the colour of the whitish-green species either turns to yellow and saffron, or to livid and black. The cause of these is the same as the cause of the two kinds of bile; for, of the latter, one species—namely, the light-coloured—is yellow, thin, and transparent; but this species is also sometimes tinged so as to resemble saffron or the yolk of an egg. The other is of a darker character, like leeks, woad, or wholly black. There are innumerable intermediate varieties of colour, these being connected with the heat and humours. The viscera, also, co-operate in this; for the viscus is either a bright-red, like the liver, or dark-red, like the spleen. When, therefore, the icterus is connected with any viscus, if from the liver, it bears traces of this viscus, and if from the spleen, of it; and so, also, with regard to all the others. But if it possesses no appearance of any, it is an affection of the general habit. These appear manifest in the white of the eyes especially, and in the forehead about the temples; and in those naturally of a white complexion, even from a slight attack, the increased colour is visible.

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In cases, therefore, of black icterus, the patients are of a dark-green colour, are subject to rigors, become faintish, inactive, spiritless; emit a fetid smell, have a bitter taste, breathe with difficulty, are pinched in the bowels; alvine evacuations like leeks, darkish, dry, passed with difficulty; urine deeply tinged with black; without digestion, without appetite; restless, spiritless, melancholic.

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In the whiter species, the patients are of a light-green colour, and more cheerful in mind; slow in beginning to take food, but eat spiritedly when begun; of freer digestion than those of the former species; alvine discharges, white, dry, clayey; urine bright-yellow, pale, like saffron.

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In both cases the whole body is itchy; heat at the nostrils, small, indeed, but pungent; the bilious particles prickly. The taste of bitter things is not bitter; and yet, strange to tell, it is not sweet; but the taste of sweet things is bitter. For in the mouth the bile lodged in the tongue, prevailing over the articles of food, sophisticates the sensation; for the tongue, having imbibed the bile, does not perceive them, while, during the season of abstinence from food, the bile remains torpid, neither is the tongue unpleasantly affected with that to which it is habituated; but the bile, if heated up by the tastes of the articles of food, impresses the tongue. When, therefore, the food is bitter, the sensation is of the bitter things; but when sweet, of the bilious. For the sensation of the bile anticipates the other, and thus deceives those who suppose that bitter things appear sweet; for it is not so, but because it is not exacerbated by the bitter lodged in it from being habituated to the disease, the phantasy of sweet is created; and there is the same condition in sweet and bitter tastes; for the bile is the screen of the fallacious tastes.

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When, therefore, it appears without inflammation of any viscus, it is usually not dangerous, though protracted; but if prolonged, and the viscus gets inflamed, it terminates most commonly in dropsy and cachexia. And many have died emaciated, without dropsy. It is familiar to adolescents and young men, and to them it is less dangerous; it is not altogether unusual also with children, but in them it is not entirely free from danger.

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CHAPTER XVI. ON CACHEXIA, OR BAD HABIT OF BODY. +

CACHEXIA arises as the conversion of nearly all diseases; for almost all diseases are its progenitors. But it likewise is formed by itself, separately from all others, as an original affection of the noxious kind, by deriving its increase from the administration of many and improper medicines. And a bad habit for a season is common to all complaints, with many symptoms; and of this its name is significant. There is emaciation, paleness, swelling, or whatever else happens for the time to be prevalent in the body. But cachexia is the form of one great affection, and gives its name to the same. For the good habit of the patient (Euhexia) in all respects, as regards digestion, the formation of blood for distribution, and every natural operation whence arise good breathing, good strength, and good colour, constitutes the pristine state of good health. But if its nature become changed to the weakness of cacochymy, this constitutes cachexia.

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This disease is difficult to cure, and is a very protracted illness; for it is engendered during a protracted space of time, and not from one infirmity of the body, nor in connection with only one viscus; for it is formed by the conversion of all into a vitiated state. Wherefore those diseases which are its offspring are incurable, as dropsy, phthisis, or wasting; for, indeed, the causes of cachexia are akin to those of wasting. The disease is a protracted and continuous dysentery, and the relapses of diseases in certain cases. Generally there is sufficient appetite, and plenty of food is taken; but the distribution thereof takes place in a crude and undigested condition, for the operation of digestion is not performed upon the food.

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The cause of it also may be the suppression of the hemorrhoidal discharge, or the omission of customary vomiting, inactivity as regards exercises, and indolence as to great labours. When each of its attendants has ceased to return, there is heaviness of the whole body, now and then paleness, flatulence of the stomach, eyes hollow, sleep heavy, and inactivity. But these symptoms occurring in an erratic form conceal the existence of the disease; but if they remain and strike root, nor readily give way, they are significant of a mighty illness. When in an erect posture, then they become swollen in their feet and legs; but, when reclining, in the parts they lay upon; and if they change their position, the swelling changes accordingly, and the course of the cold humour is determined by its weight. For when the heat evaporates the humidity, if it be not diffused, the humidity again runs in a liquid state. They have an appetite for much food, and are very voracious; the distribution is more expeditious than the digestion, of matters that are crude rather than undigested; but digestion is not at all performed, nor is it digested in the whole body by nature. For the weakness of the heat in the belly and in the system is the same, neither is good and well-coloured blood formed.

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And when the whole body is filled with crudities, and the desire as to food is gone, the cachexy having now extended to the stomach, and the affection having now attained its summit, they become swollen, inactive, and spiritless towards every exertion. The belly is dried up, and, for the most part, the alvine discharges are without bile, white, hard, and undigested. They are parched in person, without perspiration, troubled with itchiness; sleep at no time settled, but drowsiness in the reclining position; respiration slow; pulse obscure, feeble, frequent, and very frequent upon any, even a very small, exertion; respiration in these cases asthmatic; veins on the temples elevated, with emaciation of the parts around; but at the wrists the veins much larger and tumid; blood of a dark-green colour. Along with these, phthisis or tabes induces anasarca or ascites, and from their progeny there is no escape.

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With regard to the ages which induce this disease, in the first place, old age, in which there is no recovery; children are readily affected, and more readily recover; adults are not very much exposed to the affection, but have by no means easy recoveries. No one season produces this disease, nor does it terminate in any one; but autumn indeed conceives it, winter nurses it, spring brings it to its full growth, and summer despatches it.

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BOOK II. +
CHAPTER I. ON DROPSY. +

DROPSY is indeed an affection unseemly to behold and difficult to endure; for very few escape from it, and they more by fortune and the gods, than by art; for all the greater ills the gods only can remedy. For either the disease lurking in a vital organ has changed the whole system to cachexy, or the general system from some plague that has gone before has changed the viscera to a Cacochymy, when both co-operate with one another to increase the illness, and no part is uninjured from which even a slight assistance might be rendered to Nature. It is a cold and dense vapour converted into humidity, resembling a mist in the universe; or, it is the conversion of a humid and cold cause which changes the patient to such a habit. For a fluid rolling about in the lower belly we do not call Dropsy, since neither is the affection situated in that place; but when the tumour, swelling, colour, and the habit melting down to water, conspire in the disease, it both is, and is called Dropsy. For, even should the water at any time burst outwardly, or should one give vent to it, by making an incision in the hypochondrium, the dropsical affection will still remain confirmed; wherefore the primary cause of it is cachexia.

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There are many varieties, each having different names. For if the watery suffusion float in the flanks, and, owing to its fulness, when tapped it sound like a drum, the disease is called Tympanites. But if the water be confined in large quantity in the peritonæum, and the intestines float in the liquid, it gets the appellation of Ascites. But if the lower belly contain none of these, but the whole body swell, if in connexion with a white, thick, and cold phlegm, the disease is called Phlegmatias; but if the fleshy parts are melted down into a sanguineous, watery, or thin humour, then the species of dropsy called Anasarca is formed. The constitution of each of them is bad; but the combination of them is much worse. For sometimes the variety which forms in the lower belly (Ascites), is associated with that variety in which the fluid is diffused all over the body. But the most dangerous is that form in which Tympanites is mixed with Anasarca. For of the dropsies that form in the lower belly, Tympanites is particularly worse than Ascites. But of those affecting the whole body, Leucophlegmatia is less than Anasarca. It is mild then, so to speak of such hopeless diseases, when a smaller affection is combined with another smaller one. But it is much worse if one of the smaller enters into combination with one of the greater. But if a complete mixture of two great affections take place, the product thereof is a greater evil.

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The symptoms are very great and very easy to see, to touch, and to hear; in Ascites, for example, to see the tumidity of the abdomen, and the swelling about the feet; the face, the arms, and other parts are slender, but the scrotum and and prepuce swell, and the whole member becomes crooked, from the inequality of the swelling:—To touch—by strongly applying the hand and compressing the lower belly; for the fluid will pass to other parts. But when the patient turns to this side or that, the fluid, in the change of posture, occasions swelling and fluctuation, the sound of which may be heard. But if you press the finger firmly on any part, it becomes hollow, and remains so for a considerable time. These are the appearances of Ascites.

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Tympanites may be recognised, not only from the sight of the swelling, but also by the sound which is heard on percussion. For if you tap with the hand, the abdomen sounds; neither does the flatus (pneuma) shift its place with the changes of posture; for the flatus, even although that which contains it should be turned upwards and downwards, remains always equally the same; but should the flatus (pneuma) be converted into vapour and water (for Ascites may supervene on Tympanites), it shifts its form, indeed, the one half running in a fluid state, if the conversion be incomplete.

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In Anasarca and Leucophlegmatia the lower belly is empty, the patients are swelled in the face and arms; and likewise, in these cases, whatever parts are empty in the others, in them become full. For in Leucophlegmatia there is collected a white, cold, and thick phlegm; with it the whole body is filled, and the face is swollen, and also the neck and arms; but the abdomen is full from the swelling; but the mammæ are raised up into a swelling in the case of such youths as are still in the happy period of life. But, in Anasarca, there is wasting of the flesh to a fleshy humour, and a bloody ichor, such as runs from ulcerations of the bowels, and such as flows from bruises produced by the fall of weights, if the outer skin be scarified. But the combination of the two has the symptoms of both.

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In all the species there are present paleness, difficulty of breathing, occasional cough; they are torpid, with much languor and loss of appetite; but if they take any food, however small in quantity and free from flatulence, they become flatulent, and have distension as if from repletion; skin dry, so that it does not become moist even after the bath; they are white and effeminate; but in Anasarca they are of a dark-green colour, and have dark veins; in Ascites and Tympanites these are prominent, both in the face, and in the wrists, and the abdomen. But in Anasarca and Leucophlegmatia all the parts are concealed by the swelling; sleep heavy; they are torpid, with slight dejection of spirit; concern about trifles; fondness of life; endurance not from good spirits and good hopes like those in prosperity, but from the nature of the affection. It is not possible exactly to state the cause; but this is a mighty wonder, how in certain diseases, not altogether dangerous, the patients are spiritless, dejected, and wish to die, but in others they have good hopes and are fond of life. Diseases produce both these contraries.

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Dropsy sometimes is occasioned suddenly by a copious cold draught, when, on account of thirst, much cold water is swallowed, and the fluid is transferred to the peritonæum; by which means the innate heat in the cavities is congealed, and then the drops which formerly were converted into air and dissipated, flow into the cavities. If this, therefore, happen, the cure of these cases is easier before any of the viscera or the whole person is affected. Moreover flatulent food, indigestion, and the BuprestisThe Meloe vesicatoria. See Paulus Ægineta, Syd. Soc. edit., t.iii. p. 74; and Dioscorides, ii. 69. have sometimes occasioned dropsies.

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It is an illness common to all, men and women, in every period of life, only that certain ages are more exposed to certain species of the disease; children to Anasarca and Leucophlegmatia; young men until manhood are subject to swelling about the lower belly (Ascites?) Old persons are prone to suffer all kinds, as being deficient in heat, for old age is cold; but they are not exposed to collections of humours, and to them, therefore, Tympanites is the familiar form.

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All the species, indeed, are unfavourable; for dropsy, in all its forms of disease, is bad. But of these, leucophlegmatia is the more mild; for in it there are many and various chances of good fortune, such as an evacuation of sweat, of urine, or from the bowels, by which the dropsical habit is carried off. But tympanites is of a difficult nature, and still more so anasarca; for in this affection the physician would require to change the whole person, a thing not easy for the gods themselves to accomplish.

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Sometimes the dropsy forms in a small space, such as the head in hydrocephalus; or in the lungs alone; or in the liver, or the spleen; or the womb in women; and this last is easier to cure than any of the others, for provided its mouth relax from its former constriction, if it contains a fluid, it discharges the same outwardly, and if a flatus, it is dissipated. But if the uterus suffer at all in anasarca, for the most part the whole woman becomes dropsical.

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This other form of dropsy is known: small and numerous bladders, full of fluid, are contained in the place where ascites is found; but they also float in a copious fluid, of which this is a proof; for if you perforate the abdomen so as to evacuate the fluid, after a small discharge of the fluid, a bladder within will block up the passage; but if you push the instrument farther in, the discharge will be renewed. This species, then, is not of a mild character; for there is no ready passage by which the bladders might escape. It is said, however, that in certain cases such bladders have come out by the bowels. I have never seen such a case, and therefore write nothing of them; for I am unable to tell whether the discharge be from the colon, or the stomach. What is the mode of their formation? For the passage whereby all matters may be discharged by the anus is patent; but the discharge of the water collected about the loins by the bowels is incredible. For a wounded intestine is not free from trouble and danger.

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CHAPTER II. ON DIABETES. +

DIABETES is a wonderful affection, not very frequent among men, being a melting down of the flesh and limbs into urine. Its cause is of a cold and humid nature, as in dropsy. The course is the common one, namely, the kidneys and bladder; for the patients never stop making water, but the flow is incessant, as if from the opening of aqueducts. The nature of the disease, then, is chronic, and it takes a long period to form; but the patient is short-lived, if the constitution of the disease be completely established; for the melting is rapid, the death speedy. Moreover, life is disgusting and painful; thirst, unquenchable; excessive drinking, which, however, is disproportionate to the large quantity of urine, for more urine is passed; and one cannot stop them either from drinking or making water. Or if for a time they abstain from drinking, their mouth becomes parched and their body dry; the viscera seem as if scorched up; they are affected with nausea, restlessness, and a burning thirst; and at no distant term they expire. Thirst, as if scorched up with fire. But by what method could they be restrained from making water? Or how can shame become more potent than pain? And even if they were to restrain themselves for a short time, they become swelled in the loins, scrotum, and hips; and when they give vent, they discharge the collected urine, and the swellings subside, for the overflow passes to the bladder.

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If the disease be fully established, it is strongly marked; but if it be merely coming on, the patients have the mouth parched, saliva white, frothy, as if from thirst (for the thirst is not yet confirmed), weight in the hypochondriac region. A sensation of heat or of cold from the stomach to the bladder is, as it were, the advent of the approaching disease; they now make a little more water than usual, and there is thirst, but not yet great.

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But if it increase still more, the heat is small indeed, but pungent, and seated in the intestines; the abdomen shrivelled, veins protuberant, general emaciation, when the quantity of urine and the thirst have already increased; and when, at the same time, the sensation appears at the extremity of the member, the patients immediately make water. Hence, the disease appears to me to have got the name of diabetes, as if from the Greek word διαβήτης (which signifies a siphon), because the fluid does not remain in the body, but uses the man’s body as a ladder (διαβάθρη), whereby to leave it.Altogether, this interpretation is so unsatisfactory, that I was almost tempted to alter the text quite differently from Wigan and Ermerins, and to read ὁκοῖόν τις διαβησείων, when the passage might be rendered thus — it got the name of diabetes, as if signifying one having a frequent desire of descending, because the fluid does not remain in the system, but uses the man’s person as a ladder for its exit. At all events, the reading of Wigan and Ermerins seems inadmissible; for how can the two comparisons, to a siphon, and to a ladder, be admitted together? It is possible, however, that διαβάθρῃ is faulty, and that we ought to read διαβήτῃ. They stand out for a certain time, though not very long, for they pass urine with pain, and the emaciation is dreadful; nor does any great portion of the drink get into the system, and many parts of the flesh pass out along with the urine.

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The cause of it may be, that some one of the acute diseases may have terminated in this; and during the crisis the diseases may have left some malignity lurking in the part. It is not improbable, also, that something pernicious, derived from the other diseases which attack the bladder and kidneys, may sometimes prove the cause of this affection. But if any one is bitten by the dipsas,The dipsas was a species of viper. See Paulus Ægineta, ii. p. 185. the affection induced by the wound is of this nature; for the reptile, the dipsas, if it bite one, kindles up an unquenchable thirst. For they drink copiously, not as a remedy for the thirst, but so as to produce repletion of the bowels by the insatiable desire of drink. But if one be pained by the distension of the bowels and feel uncomfortable, and abstain from drink for a little, he again drinks copiously from thirst, and thus the evils alternate; for the thirst and the drink conspire together. Others do not pass urine, nor is there any relief from what is drank. Wherefore, what from insatiable thirst, an overflow of liquids, and distension of the belly, the patients have suddenly burst.

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CHAPTER III. ON THE AFFECTIONS ABOUT THE KIDNEYS. +

THE kidneys are of a glandular nature, but redder in colour, like the liver, rather than like the mammæ and testicles; for they, too, are glands, but of a whiter colour. In shape they resemble the testicles, but are broader, and, at the same time, curved. Their cavities are small and like sieves, for the percolation of the urine; and these have attached to each of them nervous canals, like reeds, which are inserted into the shoulders of the bladder on each side; and the passage of the urine from each of the kidneys to the bladder is equal.

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About it, the kidneys, and those passages, many and complicated diseases are formed, partly acute, proving fatal by hemorrhage, fevers, and inflammation, as has been described by me; but partly chronic, others wearing out the patient by wasting, and although not of a fatal character, incurable, and persisting until death. Wherefore, the chronic are—abscesses, ulcers, the formation of stones, and hemorrhoids. The ulcerations from abscess in man are all very protracted, and difficult to cure.

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The formation of stones is a long process, the stoppage of them painful, for the passage of them is not easily accomplished; and in addition to these, the retention of urine is formidable. But if several small ones stop together in the passage, or a large one be impacted; and if these occur to both kidneys, so as to occasion retention of urine and distension of the parts, the patients die in a few days. Nature, therefore, did well in forming the cavity of the kidneys oblong, and of equal size with the ureters, and even a little larger, so that if a stone formed above, it might have a ready passage to the bladder. On this account, also, the stones have an oblong form, because, for the most part, they are consolidated in the ureters; and such in that place as are of unequal thickness are slender before, owing to the ureters being narrow, but thick behind, because the kidneys verge downwards. They are formed in the kidneys only, but when in a heated state; for the stones have no fixed place in the ureters, but the gravel floats downwards with the urine, and thus is both indicative of the affection, and furnishes the materiel of it. But if an unusually large one at any time be detained in the pelvis of the kidney, pains of the loins, about the regions of the psoœ, as far as the middle of the ribs, take place, and hence, in many cases, the pain leads to mistake, as if it proceeded from pleurisy; heaviness of the hips; painful flexion about the spine, so that they stoop forward with difficulty; very painful tormina; at the same time, the pains are heavy with a sense of twisting, for the intestine is convoluted. But if the urine be retained in large quantity, and with distension, the desire of making water resembles the pains of labour; they are troubled with flatulence, which cannot find vent; the fevers are pungent, and of a dry nature. Tongue parched; the belly, also, dried up; they are emaciated, and lose appetite; or if they take anything, they cannot readily swallow or digest it. But if the stone fall down into the ureters, there is shivering, as if from rigor, the sensation as if from the passing of a stone with violent exertion. And if it fall down into the bladder, there is an abundant evacuation of watery urine, flatulent discharges from the bowels, the stomach settled, eructations, rest from former illnesses; and sometimes blood is poured out along with the urine, from excoriation of the passage. Another painful operation is the passage through the member; for if the stone be larger than the urethra, it is detained for a long time, the bladder is filled behind, and the ischuria is very painful, for along with the bladder the ureters, also, are filled. The passage of crooked stones is most difficult, for I have seen hooked protuberances on certain of these concretions. But, for the most part, they are oblong, being formed according to the shape of the passages. In colour, some are white, clayey, as is mostly the case with children; others are yellow, and saffron-coloured in old persons, in whom the stones usually form in the kidneys, whereas in children it is rather in the bladder. The causes of the concretion are two-fold: in old persons, a cold body and thick blood. For cold concretes thick fluids more readily than heat, the proof of which is seen in the Thermal springs; for when congealed, the water gets concreted into a sort of chalk-stones. But in children, the copious recrement of the blood, being overheated, gives origin to their formation, like fire.

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Such are the affections connected with the formation of stones. Certain persons pass bloody urine periodically: this affection resembles that from hemorrhoids, and the constitution of the body is alike; they are very pale, inert, sluggish, without appetite, without digestion; and if the discharge has taken place, they are languid and relaxed in their limbs, but light and agile in their head. But if the periodical evacuation do not take place, they are afflicted with headache; their eyes become dull, dim, and rolling: hence many become epileptic; others are swollen, misty, dropsical; and others again are affected with melancholy and paralysis. These complaints are the offspring of the stoppage of a customary discharge of blood. If, then, the blood flow pure and unmixed with urine, for the most part the blood of the urine flows from the bladder. Sometimes it is discharged in great quantity from rupture of the kidneys; sometimes it is coagulated, and a thrombus is formed of extravasated blood; sometimes it is coagulated in the bladder, when dreadful ischuria comes on.

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After the rupture there succeed ulcers, which are slow and difficult to heal; the indication of which is a scab, or red film, like a spider’s web, or white pus passed in the urine, sometimes pure and unmixed, and sometimes mixed up with the urine. And by these symptoms we may also diagnose abcesses, if, in addition, fevers and rigors supervene towards evening; pains about the loins, pruritus; but if it burst, clots of a purulent and fleshy nature, and now a discharge of white pus. But the ulcers are pungent, sometimes clear, and sometimes foul. This is indicated by the pus and the urine, whether fetid or free of smell.

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Spring, then, induces hemorrhages and abscesses; winter and autumn, stones. But if along with the stones ulcers be formed, the diseases indeed are incurable, there is speedy emaciation and death.

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CHAPTER IV. ON THOSE IN THE BLADDER. +

OF the diseases in the bladder no one is mild: the acute proving fatal by inflammation, wounds, spasm, and acute fevers; while an ulcer, abcess, paralysis, or a large stone, are chronic and incurable. For it (a large stone?) can neither be broken by a draught, nor by medicine, nor scraped outwardly, nor cut without danger. For the small ones of the bladder are to be cut out, but the other proves fatal the same day, or in a few days, the patients dying from spasms and fevers; or, if you do not cut him, retention of the urine takes place, and the patient is consumed slowly with pains, fevers, and wasting. But if the stone is not very large, there is frequent suppression of urine; for by falling readily into the neck of the bladder, it prevents the escape of the urine. Although it be safer to cut in these cases than for the large stones, still the bladder is cut; and although one should escape the risk of death, still there is a constant drain of water; and although this may not be dangerous, to a freeman the incessant flow of urine is intolerable, whether he walk or whether he sleep; but is particularly disagreeable when he walks. The very small ones are commonly cut without danger. If the stone adhere to the bladder, it may be detected with care; and, moreover, such cases prove troublesome from the pain and weight, even when there is no dysuria, but yet the patient may have difficulty of making water. You may diagnose all cases of stone by the sediments of sand in the urine, and, moreover, they have the genital parts enlarged by handling them; for when they make water, and there is a stone behind, they are pained, and grasp and drag the genital parts, as if with the intention of tearing out the stone along with the bladder. The fundament sympathises by becoming itchy, and the anus is protruded with the forcing and straining, from the sensation, as it were, of the passage of the stone. For the bladder and anus lie close to one another, and when either suffers, the other suffers likewise. Wherefore, in inflammations of the rectum, the bladder is affected with ischuria; and in acute pains of the bladder, the anus passes nothing, even when the bowels are not much dried up. Such are the sufferings connected with calculi.

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Hemorrhage, although it may not prove fatal very speedily, yet in the course of time has wasted many patients. But the clots of blood produced by it are quickly fatal by inducing ischuria, like as in stones; for even if the blood be thin, of a bright colour, and not very coagulable, yet the bladder accumulates it for a length of time, and its heating and boiling (as it were) coagulates the blood, and thus a thrombus is formed. Ischuria, then, is most peculiarly fatal. But on these symptoms there supervene acute pain, acrid heat, a dry tongue, and from these they die delirious.

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If pain come on from a wound, the wound itself is dangerous; but the sore, even if not fatal at first, becomes incurable from fever or inflammation; for the bladder is thin, and of a nervous nature, and such parts do not readily incarnate nor cicatrise. Moreover, the urine is bilious, acrid, and corrosive. The ordinary condition of the ulcer is this:—when the bladder is filled, it is stretched; but when emptied, it contracts: it is in the condition, then, of a joint in extension and flexion, and no ulcer in a joint is easy of cure.

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The bladder also suppurates from an abscess. The symptoms of an abscess of the bladder are the same as in other cases; for the abscess in forming is attended with inflammation, fevers, and rigors. The dangers are the same. But if it discharges urine which is thick, white, and not fetid, the ulcers from them are mild; but if it spread, they pass urine which is feculent, mixed with pus, and of a bad smell: of such persons the death is not distant. The urine, indeed, is pungent, and the evacuation thereof painful, and the pain darts to the extremity of the member. All things, even those which are opposed to one another, prove injurious to them; repletion and inanition, inactivity and exercise, baths and abstinence from baths, food and abstinence from food, sweet things and acid things; certain articles being serviceable in certain cases, but proving injurious in others, not being able to agree in any one.

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CHAPTER V. ON GONORRHŒA. +

GONORRHŒA is not, indeed, a deadly affection, but one that is disagreeable and disgusting even to hear of. For if impotence and paralysis possess both the fluids and genital organs, the semen runs as if through dead parts, nor can it be stopped even in sleep; for whether asleep or awake the discharge is irrestrainable, and there is an unconscious flow of semen. Women also have this disease, but their semen is discharged with titillation of the parts, and with pleasure, and from immodest desires of connection with men. But men have not the same prurient feelings; the fluid which runs off being thin, cold, colourless, and unfruitful. For how could nature, when congealed, evacuate vivifying semen? And even young persons, when they suffer from this affection, necessarily become old in constitution, torpid, relaxed, spiritless, timid, stupid, enfeebled, shrivelled, inactive, pale, whitish, effeminate, loathe their food, and become frigid; they have heaviness of the members, torpidity of the legs, are powerless, and incapable of all exertion. In many cases, this disease is the way to paralysis; for how could the nervous power not suffer when nature has become frigid in regard to the generation of life? For it is the semen, when possessed of vitality, which makes us to be men, hot, well braced in limbs, hairy, well voiced, spirited, strong to think and to act, as the characteristics of men prove. For when the semen is not possessed of its vitality, persons become shrivelled, have a sharp tone of voice, lose their hair and their beard, and become effeminate, as the characteristics of eunuchs prove. But if any man be continent in the emission of semen, he is bold, daring, and strong as wild beasts, as is proved from such of the athletæ as are continent. For such as are naturally superior in strength to certain persons, by incontinency become inferior to their inferiors; while those by nature much their inferiors by continency become superior to their superiors: but an animal becomes strong from nothing else than from semen. Vital semen, then, contributes much to health, strength, courage, and generation. From satyriasis a transition takes place to an attack of gonorrhœa.

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CHAPTER VI. ON THE STOMACHIC AFFECTIONS. +

THE stomach is the president of pleasure and disgust, being an important neighbour to the heart for imparting tone, good or bad spirits, from the sympathy of the soul. This is the primary power of the stomach. These things have been described by me in another place. The offspring of pleasure are, good digestion, good condition, and good colour of the body; of disgust, their contraries, and also sometimes depression of spirits, when proper nutrition is wanting; and in melancholic patients, loathing of food. If, then, this organ be diseased, there is dislike and abomination of articles of food, not only if administered, but even if the food is not seen; nay, the very remembrance of them is attended with nausea, distress, water-brash, and heart-ache; and in certain cases there is salivation and vomiting. Even when the body wastes, provided their stomach remain empty, they bear this pain more easily than that produced by the administration of food. But if at any time they are compelled by necessity to take food, the pain is worse than hunger; the act of masticating in the mouth occasions sufferance, and to drink is a still greater pain. And it is not that they suffer thus from suitable food, and bear more unusual food well; owing to a change from that which is natural to the opposite, there is a painful sensation as to everything, an aversion to, and dislike of, all kinds of food. Along with these there is pain between the scapulæ, much greater after the administration of food or drink; loathing, distress, sight dull, noises of the ears, heaviness of the head, torpidity of the limbs, their joints sink under them; palpitation in the hypochondriac region; phantasy, as of the spine being moved towards the lower limbs; they seem as if carried about, now this way and now that, whether they stand, or lie down, like reeds or trees shaken by a gale of wind; they belch out a cold and watery phlegm. But if there be bile in bilious persons, they have dimness of sight, and no thirst, even when owing to the food they appear thirsty; are sleepless, torpid, drowsy, not from true sleep, but like those in comatose affections; emaciated, very pale, feeble, relaxed, imbecile, dispirited, timid, inactive, quick to passion, very moody; for such persons at times have fallen into a state of melancholy.

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These mental emotions necessarily attend the affection when in connection with the stomach; but certain people, recognising the parts which sympathise, and from which the most dreadful symptoms arise, reckon the stomach as the cause. But the contiguity of the heart, which is of all organs the first, is a strong confirmation of the truth of what I say; for the heart is placed in the middle of the lungs, and this intermediate space comprehends the stomach; and, moreover, both are connected with the spine; and from this vicinity to the heart arise the heart-ache, prostration of strength, and symptoms of melancholy.

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There are other, and, indeed, innumerable causes of this disease; but the principal is, much pus poured forth by the belly through the stomach. It is familiar to such persons as from their necessities live on a slender and hard diet; and to those who, for the sake of education, are laborious and persevering; whose portion is the love of divine science, along with scanty food, want of sleep, and the meditation on wise sayings and doings—whose is the contempt of a full and multifarious diet; to whom hunger is for food, water for drink, and watchfulness in place of rest; to whom in place of a soft couch, is a hammock on the ground without bed-clothes, a mean coverlet, a porous mantle, and the only cover to whose head is the common air; whose wealth consists in the abundant possession and use of divine thought (for all these things they account good from love of learning); and, if they take any food, it is of the most frugal description, and not to gratify the palate, but solely to preserve life; no quaffing of wine to intoxication; no recreation; no roving or jaunting about; no bodily exercise nor plumpness of flesh; for what is there from which the love of learning will not allure one?—from country, parents, brothers, oneself, even unto death. Hence, to them, emaciation of the frame; they are ill-complexioned; even in youth they appear old, and dotards in understanding; in mind cheerless and inflexible; depraved appetite, speedy satiety of the accustomed slender and ordinary food, and from want of familiarity with a varied diet, a loathing of all savoury viands; for if they take any unusual article of food, they are injured thereby, and straightway abominate food of all kinds. It is a chronic disease of the stomach. But inflammations, defluxions, heart-burn, or pain thereof, are not called the Stomachic affection.

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Summer brings on this disease, whence springs the complete loss of digestion, of appetite, and of all the faculties. With regard to the period of life, old age; for in old men, even without any disease, owing to their being near the close of life, the appetite is nearly gone.

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CHAPTER VII. ON THE CŒLIAC AFFECTION. +

THE stomach being the digestive organ, labours in digestion, when diarrhœa seizes the patient. Diarrhœa consists in the discharge of undigested food in a fluid state; and if this does not proceed from a slight cause of only one or two days’ duration; and if, in addition, the patient’s general system be debilitated by atrophy of the body, the Cœliac disease of a chronic nature is formed, from atony of the heat which digests, and refrigeration of the stomach, when the food, indeed, is dissolved in the heat, but the heat does not digest it, nor convert it into its proper chyme, but leaves its work half finished, from inability to complete it; the food then being deprived of this operation, is changed to a state which is bad in colour, smell, and consistence. For its colour is white and without bile; it has an offensive smell, and is flatulent; it is liquid, and wants consistence from not being completely elaborated, and from no part of the digestive process having been properly done except the commencement.

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Wherefore they have flatulence of the stomach, continued eructations, of a bad smell; but if these pass downwards, the bowels rumble, evacuations are flatulent, thick, fluid, or clayey, along with the phantasy, as if a fluid were passing through them; heavy pain of the stomach now and then, as if from a puncture; the patient emaciated and atrophied, pale, feeble, incapable of performing any of his accustomed works. But if he attempt to walk, the limbs fail; the veins in the temples are prominent, for owing to wasting, the temples are hollow; but also over all the body the veins are enlarged, for not only does the disease not digest properly, but it does not even distribute that portion in which the digestion had commenced for the support of the body; it appears to me, therefore, to be an affection, not only of the digestion, but also of the distribution.

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But if the disease be on the increase, it carries back the matters from the general system to the belly, when there is wasting of the constitution; the patients are parched in the mouth, surface dry and devoid of sweat, stomach sometimes as if burnt up with a coal, and sometimes as if congealed with ice. Sometimes also, along with the last scybala, there flows bright, pure, unmixed blood, so as to make it appear that the mouth of a vein has been opened; for the acrid discharge corrodes the veins. It is a very protracted and intractable illness; for, even when it would seem to have ceased, it relapses again without any obvious cause, and comes back upon even a slight mistake. Now, therefore, it returns periodically.

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This illness is familiar to old persons, and to women rather than to men. Children are subject to continued diarrhœa, from an ephemeral intemperance of food; but in their case the disease is not seated in the cavity of the stomach. Summer engenders the disease more than any other of the seasons; autumn next; and the coldest season, winter, also, if the heat be almost extinguished. This affection, dysentery and lientery, sometimes are engendered by a chronic disease. But, likewise, a copious draught of cold water has sometimes given rise to this disease.

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CHAPTER VIII. ON COLICS. +

PERSONS in colic are cut off speedily by volvulus and tormina. There are very many causes of this affection. The symptoms are, heaviness during abstinence from food, particularly in the part most affected; much torpor; they are inactive, lose appetite, become emaciated, sleepless, swollen in countenance. And if the colon be affected in connection with the spleen, they are of a dark-green colour; but of a light-green when in connection with the liver, from the sympathy of the nearest viscera. And if they take food, even in small quantity, and such as is not flatulent, they become very flatulent, and have a desire to pass wind, which, however, does not find vent: forced eructations upwards, but without effect; or, if any should be forcibly expelled, the flatus is fetid and acid which escapes upwards. The kidneys and bladder sympathise, with pain and ischuria; but in such cases the symptoms interchange with one another. But a greater wonder than these, —an unexpected pain has passed down to the testicles and cremasters; and this sympathetic affection has escaped the observation of many physicians, who have made an incision into the cremasters, as if they were the particular cause of the disease. But in these cases also the symptoms interchange with one another.

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From this disease are produced other diseases; abscesses and ulcers, of no mild character; dropsies and phthisis, which are incurable. For the disease is formed from cold and thick humours, and a copious and glutinous phlegm; but, also, it comes on with a frigid period of life, a cold season, and a cold locality, and during a hard winter.

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CHAPTER IX. ON DYSENTERY. +

OF the intestines, the upper being thin and bilious (χολώδεα) as far as the cœcum, have got the Greek name χολώδες. From these proceed the lower, which are thick and fleshy, as far as the commencement of the Rectum.

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Wherefore ulcers form in all of them; and the varieties of these ulcers constitute Dysentery: on this account, these diseases are complex. For some of them erode the intestines superficially, producing only excoriation; and these are innocuous; but they are far more innocent if the affections be low down. Or if the ulcers be yet a little deeper, they are no longer of a mild character. But ulcers which are deep and have not stopped spreading, but are of a phagedænic, painful, spreading, and gangrenous character, are of a fatal nature; for the small veins get corroded in the course of their spreading, and there is an oozing of blood in the ulcers. Another larger species of ulcers: thick edges, rough, unequal, callous, as we would call a knot in wood: these are difficult to cure, for they do not readily cicatrise, and the cicatrices are easily dissolved.

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The causes of dysentery are manifold; but the principal are, indigestion, continued cold, the administration of acrid things, such as myttôtos,A sort of condiment, containing garlic and other acrid things. See Pollux, Onomast. vi. onions by themselves, garlic, food of old and acrid flesh, by which dyspepsia is produced; also unaccustomed liquids, cyceon,A thick soup prepared from various substances, that is to say, cheese, wine, etc. It is mentioned both in the Iliad and Odyssey. or zythusOn the composition of the ancient zythi, or Ales, see Appendix to the Edinburgh Greek Lexicon, in voce, ζύθος. (ale), or any similar beverage produced in any country as a substitute for wine to quench thirst. But also a blow, exposure to cold, and cold drink, create ulcerations.

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The dejections and the circumstances attendant on the ulcers are different in different cases; for, if superficial, when from above, the discharges are thin, bilious, devoid of odour except that which they derive from the intestines; those from the jejunum are rather more coloured, saffron-like, and fetid. Those dejections which contain the food in a dissolved state but rough, are sometimes fetid in smell when the ulcers are gangrenous, and sometimes have the smell as if from scybala. But in the ulcerations from the parts below, the discharges are watery, thin, and devoid of smell. But if deeper they are like ichor, reddish, of the colour of dark wine, or like the washings of flesh; and these are sometimes by themselves and sometimes with the fæces, these being dissolved in the surrounding fluid, devoid of bile and of smell; or they are evacuated in a consistent and dry state, lubricated with the surrounding fluid. But if the ulcers be larger and smoother, in those above they are bilious, and pinch the parts from which they come and through which they pass (they even pinch the anus), for the bile is acrid, more especially if from an ulcer; and the bile is fatty, like grease. In the deeper ulcers below, a thick clot of blood with phlegm, like flesh not very fat, or like the scrapings of the bowels: nay, even entire portions are mixed up with them; they are discharged white, thick, mucous, like chopped tallow, along with the humour in which they float: these proceed from the rectum: but sometimes they are merely mucous, prurient, small, round, pungent, causing frequent dejections and a desire not without a pleasurable sensation, but with very scanty evacuations: this complaint gets the appellation of tenesmus. But from the colon there are discharged pieces of flesh, which are red, large, and have a much larger circumference. If the ulcers become deep, and the blood thick and feculent, these are more fetid than the former; but if the ulcers spread and are phagedænic, and if nothing will stop them, above, in addition to being intensely bilious, the dejections become saffron-like, frothy, feculent, blackish, like woad or like leeks, thicker than the former, fetid like a mortification; food now undigested, as if only masticated by voracious teeth. But if the under parts are also corroded, black clots of blood, thick, fleshy, very red, clotted, sometimes, indeed, black, but at other times of all various colours, fetid, intolerable; involuntary discharges of fluids. And sometimes a substance of considerable length, in many respects not to be distinguished from a sound piece of intestine, has been discharged, and, to those ignorant of the matter, has caused apprehension about the intestine: but the fact is this,—the intestines, like the stomach, consist of two coats, which lie close to one another in an oblique manner; when, therefore, the connection between them is dissolved, the inner coat, being separated to some length, protrudes externally, while the outer one remains alone, incarnates, and gets cicatrised, and the patients recover and live unharmed. It is the lower gut alone which suffers thus, owing to its fleshy nature. And, if blood be discharged from any vessel, it runs of a bright red or black colour, pure, and unmixed with food or scybala; and if a concretion is spread over it like broad spiders’ webs, it coagulates when cold, and no longer would be taken for a secretion of blood; but being discharged with much flatulence and noise, it has the appearance of being much larger than its actual amount. Sometimes, also, a purulent abscess forms in the colon, nowise different from the other internal ulcers; for the symptoms, the pus, and the mode of recovery are the same. But if there be hard secretions of matters resembling flesh, as if pounded, and like rough bodies, the abscess is not of a mild nature. Sometimes a copious discharge of water takes place from the colon in the form of dysentery, which has freed many patients from dropsy. In a word, such are the ulcers in the intestines; and their forms and the secretions from them as I have described.

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I will now describe the symptoms accompanying each of these states of disease, whether the ulcers be mild or malignant. To speak in general terms, then, if the excoriation is superficial, whether it be above or below, the patients are free from pain and from fever, and get better without being confined to bed, in various ways, by merely some slight changes of diet. But if ulceration supervene, in the upper bowels there are tormina, which are pungent, acrid, as if from the presence of a small amount of hot bile; and occasionally there is suppuration: indeed, for the most part, there is suppuration, or digestions imperfectly performed, though there is no want of appetite. But if the ulcers form in the lower part of the bowels, they are much less dangerous than in those above, for the bowels there are of a much more fleshy nature than those above. But if those above become hollow and phagedænic, there are acute fevers, of a latent kind, which smoulder in the intestines; general coldness, loss of appetite, insomnolency, acid eructations, nausea, vomiting of bile, vertigo: but if the discharge become copious, and consist of more bilious matters, the tormina become permanent, and the other pains increase; sometimes there is prostration of strength, feebleness of the knees; they have ardent fever, are thirsty, and anxious; black vomiting, tongue dry, pulse small and feeble. Akin to these are the fatal symptoms I have stated among those of malignant ulcers; cardiac affections even to deliquium animi, from which some never recover, but thus expire. These dangerous symptoms are common also to erosions of the lower intestines if the ulcers spread, and the discharge be not checked, only that the tormina and pains are below the umbilicus where the ulcers are situated. The forms of the secretions are such as I have said; but if they be small at first, and there be a postponement of their spreading for a long time, various changes take place in the ulcers, some subsiding, and others swelling up, like waves in the sea. Such is the course of these ulcers. But if nature stand out, and the physician co-operate, the spreading may, indeed, be stopped, and a fatal termination is not apprehended, but the intestines remain hard and callous, and the recovery of such cases is protracted.

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In hemorrhage from the bowels, if it proceed from a large vein or artery, it is sudden death; for neither is it possible to introduce the hand so as to reach the ailment, nor to apply any medicine to the sore. And even if the hemorrhage were restrained by the medicine, the escape from death would not be certain; for, in some cases, the falling off of a large eschar widens the mouth of the vein, and when clots form within, and remain there, the disease is incurable. It is necessary, then, to cure hemorrhages in their commencement. Its approach, also, for the most part is obvious, although not in all cases quite apparent: anxiety attends, with restlessness, heaviness in the part where the rupture is to take place, ruddiness of the countenance if the blood has not yet burst forth. And if the vein has burst lately, for the most part the symptoms are alleviated; but if it has been a longer time ago, this takes place more slowly, and with more difficulty. Such are the ulcers in the intestines.

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They occur in the season of summer; next in autumn; less in spring; least of all in winter. Diarrhœa attacks children and adolescents, but dysentery adults and young persons. In old age convalescence is difficult, and cicatrization protracted. Corroding sores are unusual in old persons, but yet hemorrhage is in accordance with old age.

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CHAPTER X. ON LIENTERY. +

IF many thick and hard cicatrices form after dysenteries, and broad and very deep ulcerations of the upper intestines, the food passes from them to those below in a fluid state, without separation of the nutritious part; for the cicatrix shuts up the pores by which the nutriment is carried upwards. The patient, therefore, is seized with atrophy, loss of colour and of strength. The affection gets the appellation of Lientery, this name being applied to a cicatrix of the intestines. And here the affection is from ulcers. But sometimes the intestines do not acquire cicatrization, but yet usage and habit reconcile the intestines to the discharge. For, the heat in these parts, if congealed, neither at times performs digestion, nor is the nutriment distributed upwards; but being unchanged, owing to weakness, it fails to undergo any part of the process. But if the purging, though of vitiated matters, be temporary, and not confirmed, a simple vomit after food will sometimes remove the disease. But if the exciting cause be prolonged, and get confirmed, it does no good.

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A chronic disease, and cachexia so mild as not to confine the patient to bed, will engender this disease. But dropsies sometimes have terminated favourably in this disease; a change from one evil to another, but still a better change.

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CHAPTER XI. ON AFFECTIONS OF THE WOMB, OR HYSTERICS. +

THE uterus in women is beneficial for purgation and parturition, but it is the common source of innumerable and bad diseases; for not only is it subject to ulcers, inflammation, and the fluor, but, if the whole organ be suddenly carried upwards, it quickly causes death. The fatal diseases of an acute nature connected therewith have been described elsewhere: but the chronic affections are, the two species of fluor; hardness; ulcers, part mild, but part malignant; prolapsus of the whole, or of part.

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The fluor, then, is either of a red or white colour; its appearance indicates this. It is the red if it consist of bright red blood, and the varieties thereof; or livid, or black and thin, or thick and coagulated, like a thrombus; or white, like water; or a bright ochre colour, like bile: in thickness like a thinnish or thin and fetid ichor. The white flux (or fluor albus) is like pus, and the true form like white whey; but a clot of blood frequently runs off with the pus. But there is an infinite variety of forms of it, as regards more or less quantity. Its periods sometimes agree with those of the menstrual purgation, but it does not continue the regular time as before; there is not much blood, but it flows during many days; the interval is for a few days, but is quite free from discharge. Another variety as to the period: the first purgation is at the regular time, but it occurs two or three times during each month. Another variety: a continual flux; small, indeed, every day, but by no means small during the whole month; for the uterus never closes its mouth, labouring under relaxation, so as to permit the flow of the fluid: but if it neither intermits nor diminishes, they die of hemorrhage. The symptoms are, the woman’s colour in accordance with those of the discharge; sleepless, loathes food, anxious, relaxed, especially in the red flux, and subject to pains; the discharge fetid in both varieties, but to a greater and less extent at different times; for the white is worse if the putrefaction be unusually great; and sometimes the red, if the erosion be exacerbated. In a word, the black is the worst of all; the livid next; the pale, the white, and the purulent, are more protracted, indeed, but less dangerous. Of these the pale is worse indeed, but much better when mixed with the customary discharge. Now the customary discharge is red in all its varieties. But, indeed, the red are worse in old women; but the white are not at all so to the young; but even to them that which is customary is less troublesome. Another white fluor: the menstrual discharge white, acrid, and attended with an agreeable pruritus; along with which the discharge of a white thick fluid, like semen, is provoked. This species we call female gonorrhœa. It is a refrigeration of the womb, which therefore becomes incapable of retaining its fluids; hence, also, the blood changes to a white colour, for it has not the purple colour of fire. The stomach, also, is subject to the affection, and vomits phlegm; and also the bowels are similarly affected in diarrhœa.

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Ulcers, too, are formed in the womb; some broad and attended with tingling, which, being close together, are, as it were, a superficial excoriation; pus thick, without smell, scanty. These ulcers are mild. But there are others deeper and worse than these, in which the pains are slight, pus somewhat more abundant, much more fetid, and yet, notwithstanding, these also are mild. But if they become deeper, and the lips of the sores hard or rough, if there is a fetid ichor, and pain stronger than in the former case, the ulcer corrodes the uterus; but sometimes a small piece of flesh is cast off and discharged, and this sore not coming to cicatrization, either proves fatal after a long time, or becomes very chronic. This sore gets the appellation of phagedæna. The sores also are dangerous if in these cases the pain gets exacerbated, and the woman becomes uneasy. From the sore there is discharged a putrid matter, intolerable even to themselves; it is exasperated by touching and by medicines, and irritated by almost any mode of treatment. The veins in the uterus are swelled up with distension of the surrounding parts. To the skilled, it is not difficult to recognise by the touch, for it is not otherwise obvious. Febrile heat, general restlessness, and hardness is present, as in malignant diseases; the ulcers, being of a fatal nature, obtain also the appellation of cancers. Another cancer: no ulceration anywhere, swelling hard and untractable, which distends the whole uterus; but there are pains also in the other parts which it drags to it. Both these carcinomatous sores are chronic and deadly; but the ulcerated is worse than the unulcerated, both in smell and pains, in life and in death.

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Sometimes the whole uterus has protruded from its seat, and lodged on the woman’s thighs; an incredible affliction! yet neither has the uterus not been thus seen, nor are the causes which produce it such as do not occur. For the membranes which are inserted into the flanks, being the nervous (ligamentous?) supporters of the uterus, are relaxed; those at the fundus, which are inserted into the loins, are narrow; but those at its neck, on each side to the flanks, are particularly nervous and broad, like the sails of a ship. All these, then, give way if the uterus protrude outwardly, wherefore this procidentia generally proves fatal; for it takes place from abortion, great concussions, and laborious parturition. Or if it do not prove fatal, the women live for a long time, seeing parts which ought not to be seen, and nursing externally and fondling the womb. It would appear that, of the double membrane of the womb, the internal lining coat is sometimes torn from the contiguous one, for there are two transverse plates of the coat; this, then, is thrown off with the flux, and in abortion and laborious parturition, when it adheres to the placenta. For if it be forcibly pulled, the coat of the uterus being stretched, ..... But if the woman do not die, it is either restored to its seat, or but a small part appears externally, for the woman conceals it with her thighs. Sometimes the mouth of the womb only, as far as the neck, protrudes, and retreats inwardly if the uterus be made to smell to a fetid fumigation; and the woman also attracts it if she smells to fragrant odours. But by the hands of the midwife it readily returns inwards when gently pressed, and if anointed beforehand with the emollient plasters for the womb.

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CHAPTER XII. ON ARTHRITIS AND SCHIATICA. +

ARTHRITIS is a general pain of all the joints; that of the feet we call Podagra; that of the hip-joint, Schiatica; that of the hand, Chiragra. The pain then is either sudden, arising from some temporary cause; or the disease lies concealed for a long time, when the pain and the disease are kindled up by any slight cause. It is, in short, an affection of all the nerves, if the ailment being increased extend to all; the first affected are the nerves which are the ligaments of the joints, and such as have their origin and insertion in the bones. There is a great wonder in regard to them; there is not the slightest pain in them, although you should cut or squeeze them; but if pained of themselves, no other pain is stronger than this, not iron screws, nor cords, not the wound of a sword, nor burning fire, for these are often had recourse to as cures for still greater pains; and if one cut them when they are pained, the smaller pain of the incision is obscured by the greater; and, if it prevail, they experience pleasure in forgetting their former sufferings. The teeth and bones are affected thus.

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The true reason of this none but the gods indeed can truly understand, but men may know the probable cause. In a word, it is such as this; any part which is very compact is insensible to the touch or to a wound, and hence it is not painful to the touch or to a wound. For pain consists in an exasperated sense, but what is compact cannot be exasperated, and hence is not susceptible of pain. But a spongy part is very sensible, and is exasperated by an injury. But since dense parts also live by their innate heat, and possess sensibility by this heat, if then the exciting cause be material, such as either a sword, or a stone, the material part of the patient is not pained, for it is dense by nature. But if an intemperament of the innate heat seize it, there arises a change of the sense; the heat therefore is pained by itself, being roused within by the impression on the sense. The pains then are from nature’s being increased, or a redundance thereof.

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Arthritis fixes itself sometimes in one joint and sometimes in another; sometimes in the hip-joints; and for the most part in these cases the patient remains lame in it; and the other joints it affects little, and sometimes does not go to the small joints, as the feet and hands. If it seizes the greater members which are able to contain the disease, it does not go beyond these organs; but if it begin from a small one, the attack is mild and unexpected. The commencement of ischiatic disease is from the thigh behind, the ham, or the leg. Sometimes the pain appears in the cotyloid cavity, and again extends to the nates or loins, and has the appearance of anything rather than an affection of the hip-joint. But the joints begin to be affected in this way: pain seizes the great toe; then the forepart of the heel on which we lean; next it comes into the hollow of the foot, but the ankle swells last; and they blame a wrong cause; some, the friction of a new shoe; others, a long walk; another again, a stroke or being trod upon; but no one will of his own accord tell the true one; and the true one appears incredible to the patients when they hear of it. On this account the disease gets to an incurable state, because at the commencement, when it is feeble, the physician is not at hand to contend with it; but if it has acquired strength from time, all treatment is useless. In some, then, it remains in the joints of the feet until death, but in others it spreads over the compass of the whole body. For the most part, it passes from the feet to the hands. For to the disease there is no great interval between the hands and the feet, both being of a similar nature, slender, devoid of flesh, and very near the external cold, but very far from the internal heat; next the elbow and the knee, and after these the hip-joint; which is the transition to the muscles of the back and chest. It is incredible how far the mischief spreads. The vertebræ of the spine and neck are affected with the pain, and it extends to the extremity of the os sacrum: there is a general pain of all the parts of the groin, and a pain peculiar to each part thereof. But likewise the tendons and muscles are intensely pained; the muscles of the jaws and temples; the kidneys, and the bladder next in succession. And, what a wonder! at last the nose, the ears, and the lips, suffer; for every where there are nerves and muscles. A certain person had pains in the sutures of the head, and not knowing why he was pained there, he pointed out the shapes of the sutures—the oblique, the straight, the transverse—both behind and before, and stated that the pain was narrow and fixed in the bones; for the disease spreads over every commissure of the bones, in the same manner as in the joints of a foot or of a hand. Callosities also form in the joints; at first they resemble abscesses, but afterwards they get more condensed, and the humour being condensed is difficult to dissolve; at last they are converted into hard, white tophi, and over the whole there are small tumours, like vari and larger; but the humour is thick, white, and like hailstones. For it is a cold disease of the whole (body), like hail; and there appears to be a difference in regard to heat and cold; for in certain cases there is delight in things otherwise disagreeable. But, I fancy, that the cause is a refrigeration of the innate heat, and that the disease is single; but if it speedily give way, and the heat re-appears, there is need of refrigeration and it delights in such things; this is called the hot species. But if the pain remain internally in the nerves, and the part not becoming heated subside, nor get swollen, I would call this variety cold, for which there is need of hot medicines to restore the heat, of which those very acrid are most necessary. For heat excites the collapsed parts to swelling, and calls forth the internal heat, when there is need of refrigerants. In proof of this, the same things are not always expedient in the same cases, for what is beneficial at one time proves prejudicial in another; in a word, heat is required in the beginning, and cold at the conclusion. Wherefore Gout does not often become unremitting; but sometimes it intermits a long time, for it is slight; hence a person subject to Gout has won the race in the Olympiac games during the interval of the disease.

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Men then are more readily affected, but more slightly the women; women more rarely than men, but more severely. For what is not usual nor cognate, if from necessity it gets the better engenders a more violent ailment. The most common age is after thirty-five; but sooner or slower according to the temperament and regimen of every one. The pains then are dreadful, and the concomitants worse than the pains; fainting even upon touch, inability of motion, loss of appetite, thirst, restlessness. But, if they recover partly, as if escaped from death, they live dissolutely, are incontinent, open-handed, cheerful, munificent, and luxurious in diet; but partly, as if they would (not?) again escape from death, they enjoy the present life abundantly. In many cases the gout has passed into dropsy, and sometimes into asthma; and from this succession there is no escape.

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CHAPTER XIII. ON ELEPHAS, OR ELEPHANTIASIS. +

THERE are many things in common as to form, colour, size, and mode of life between the affection Elephas and the wild beast the elephant; but neither does the affection resemble any other affection, nor the animal any other animal. The wild beast, the elephant, indeed, is very different from all others; in the first place then, he is the greatest and the thickest of animals; in size, he is as great as if you were to put one animal on another, like a tower; in bulk, he is as large as if you should place several other very large animals side by side. But neither in shape is he much like unto any other. Then, as to colour, they are all intensely black, and that over their whole body. One horse, indeed, is very white, like the Thracian steeds of Rhesus; others white-footed, like the white-footed horse of Menelaus; and bay, like one hundred and fifty; others are tawny, as assuming the shape of a horse having a tawny mane, he lay down with her. And so it is with oxen, and dogs, and all other reptiles and animals which live on the earth. But elephants are only of a lurid colour, like to night and death. With regard to shape, they have a very black head, and unseemly face of no marked form, upon a small neck, so that the head appears to rest upon the shoulders, and even then it is not very conspicuous. For the ears are large, broad, resembling wings, extending to the collar-bone and breast-bone, so as to conceal the neck with the ears, like ships with their sails. The elephant has wonderfully white horns on a very dark body—others call them teeth—these alone are most white, such as is nothing else of even any other white animal; and these are not above the forehead and temples, as is the nature of other horned animals, but in the mouth and upper jaw, not indeed quite straight forwards but a little bent upwards, so that it might swallow in a straight direction, and lift a load in its flat teeth. Moreover the horns are large, the medium length being as much as a fathom, and some much larger; that is to say, as long as two fathoms. And the upper jaw from its lip has a long, ex-osseous, crooked, and serpent-like protuberance; and there are two perforations at the extremity of this protuberance; and these by nature are perforated all the way to the lungs, so as to form a double tube, so that the animal uses this pipe as a nostril for respiration, and likewise as a hand; for it could take a cup if it please with this protuberance, and can grasp it round and hold it firmly, and none could it take by force from the animal, except another stronger elephant. And with this also it seeks herbage for food; for neither does it live by eating flesh with its mouth and small teeth. For, its feet being long, raise the animal considerably above the ground; but its neck also, as I have said, is small, and therefore it cannot browse on the earth with its mouth; and moreover the excrescence of the horns in front of the mouth prevents the mouth from touching the herbage. Wherefore it raises a great load with its protuberance; then as if with a binder having bound the same with it, he can convey it to his mouth; whence the ancients properly call it proboscis, for it collects food in front of the animal. But neither is it able to drink from a lake or river with its mouth, for the same reason. But, if it is thirsty, it introduces into the water the extreme nostril of the proboscis, and then, as if inhaling, it draws in much water, instead of air; and when it has filled its nose, as it were a cup, it pours the same as a stream of water into its mouth, and then it draws anew and discharges again, until it fills its belly, as it were a vessel of burden. It has a rough and very thick skin, containing fissures with prominent edges, long channels, and other hollow clefts, some transverse, others oblique, very deep, like in all respects to a furrowed field. Other animals have naturally hairs for a mane, but in the elephant this is merely down. There are also innumerable other differences between it and other animals; for, like man, it bends its leg backward at the knee; and like woman, it has its dugs at the arm-pits. But there is no necessity for me now to write concerning the animal, except in so far as there is any discrepancy between the animal and the disease, and in so far as the symptoms of the patient resemble the nature of the animal. The disease is also called Leo, on account of the resemblance of the eyebrows, as I shall afterwards explain; and Satyriasis, from the redness of the cheeks, and the irresistible and shameless impulse ad coitum. Moreover it is also called the Heracleian affection, insomuch as there is none greater and stronger than it.

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Wherefore the affection is mighty in power, for it is the most powerful of all in taking life; and also it is filthy and dreadful to behold, in all respects like the wild animal, the elephant. And from the disease there is no escape, for it originates in a deadly cause; it is a refrigeration of the innate heat, or rather a congelation like a great winter, when the water is converted into snow, or hail, or ice, or frost. This is the common cause of death, and of the affection.

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But the commencement of the disease gives no great indication of it; neither does it appear as if any unusual ailment had come upon the man; nor does it display itself upon the surface of the body, so that it might be immediately seen, and remedies applied at the commencement; but lurking among the bowels, like a concealed fire it smolders there, and having prevailed over the internal parts, it afterwards blazes forth on the surface, for the most part beginning, like a bad signal-fire, on the face, as it were its watch-tower; but in certain cases from the joint of the elbow, the knee, and knuckles of the hands and feet. In this way the patient’s condition is hopeless, because the physician, from inattention and ignorance of the patient’s ailment, does not apply his art to the commencement when the disease is very feeble. For, indeed, they are merely torpid, as if from some light cause, drowsy, inactive, dry in the bowels, and these symptoms are not very unusual even in healthy persons. But upon the increase of the affection, the respiration is fetid from the corruption within of the breath (pneuma). The air, or something external, would seem to be the cause of this. Urine thick, muddy, like that of cattle; the distribution of crude undigested food; and yet of these things there is no perception nor regard; for neither are they aware whether or not they digest, thus digestion or indigestion is all one to them, since, for anything useful and proper to them, digestion is not usual with them. The distribution, however, is easy, the disease, as it were, greedily attracting the food for its own nourishment; for this reason the lower belly is very dry. Tumours prominent, not continuous with one another anywhere, but thick and rough, and the intermediate space cracked, like the skin of the elephant. Veins enlarged, not from abundance of blood, but from thickness of the skin; and for no long time is the situation of them manifest, the whole surface being elevated equally in the swelling. The hairs on the whole body die prematurely, on the hands, the thighs, the legs, and again on the pubes; scanty on the chin, and also the hairs on the head are scarce. And still more frequently premature hoariness, and sudden baldness; in a very short time the pubes and chin naked of hair, or if a few hairs should remain, they are more unseemly than where they are gone. The skin of the head deeply cracked; wrinkles frequent, deep, rough; tumours on the face hard, sharp; sometimes white at the top, but more green at the base. Pulse small, dull, languid, as if moved with difficulty through the mud; veins on the temples elevated, and also those under the tongue; bowels bilious; tongue roughened with vari, resembling hailstones; not unusual for the whole frame to be full of such (and thus also in unsound victims, the flesh is full of these tubercles resembling hail). But if the affection be much raised up from the parts within, and appear upon the extremities, lichens occur on the extremities of the fingers; there is pruritus on the knees, and the patients rub the itchy parts with pleasure. +

Our author in this place evidently alludes to mentagra, a malignant disease of the face, very prevalent in Rome in his time, that is to say, towards the end of the first and the beginning of the second century. The first description of it which we possess, is contained in Pliny’s Nat. Hist. xxvi., at the beginning, and is to the following effect: That it was one of the new diseases of the face, which at one time had spread over most parts of Europe, but was then mostly confined to Rome: That it had been called by the Greeks, lichen, but that latterly the Latin term mentagra had been applied to it. He further asserts, that it was unknown in former times, and made its first appearance in Italy during the reign of Tiberius: that the men of the middle and lower classes, and more especially women, were exempt from it, the ravages of the disease being confined principally to the nobility, among whom it was propagated by kissing. He adds respecting it, that it was cured by caustics, the effects of which often left unseemly scars on the face. That the disease had come originally from Egypt, the mother of all such distempers.

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Another very interesting account of the disease, under the names of lichen and mentagra, is given by Marcellus, the Empiric, in chap. cxix., wherein elephantiasis, lepra, and other inveterate diseases of the skin are described. He says that the distemper (vitium) when neglected is apt to spread all over the face, and to contaminate many persons. He prescribes various caustic and stimulant applications for it. Along with it, he gives a very good account of elephantiasis, which, he remarks, also generally begins in the face with vari and other appearances, similar to those described by our author. He states decidedly that the disease is endemical in Egypt, attacking not only the lower ranks, but even kings themselves.

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Now it is worthy of remark, that beyond all question this is the disease to which frequent allusion is made by the poet Martial as prevailing extensively in Rome, and as being propagated by the fashionable practice of persons saluting one another, by kissing, in the streets. The following passages evidently allude to it—Epigr. xi.,8; xii. 59.

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From all these descriptions, we cannot entertain a doubt, that the disease, then so prevalent in Rome, was of a malignant and contagious nature, which attacked principally the face, and was propagated by kissing ; and, further, that it was a disease of the same class as elephantiasis. Taking all these circumstances into account, one may venture to decide pretty confidently, that it was a disease akin to the Sivvens of Scotland, which it strikingly resembles in all its characters as described above. Sivvens, in short, is a species or variety of syphilis, which is readily communicated both by the mouth, as in kissing, and per coitum. Further, that Syphilis, and its congener Sivvens, are the brood of the ancient elephantiasis, no one at all acquainted with the history of the latter in ancient, mediæval, and modern times, will entertain a doubt. See the note to Paulus Ægineta, t. ii., 14, 15, 16, and the authorities there referred to: also, the History of Syphilis, as given in Sprengel’s and in Renouard’s History of Medicine.

+

The importance of this subject, which has never been satisfactorily illustrated elsewhere, will be my apology for embracing the present opportunity of endeavouring to throw some additional light on it.

And the lichen sometimes embraces the chin all round; it reddens the cheeks, but is attended with no great swelling; eyes misty, resembling bronze; eye-brows prominent, thick, bald, inclining downwards, tumid from contraction of the intermediate space; colour livid or black; eye-lid, therefore, much retracted to cover the eyes, as in enraged lions; on this account it is named leontium. Wherefore it is not like to the lions and elephants only, but also in the eye-lids resembles swift night. Nose, with black protuberances, rugged; prominence of the lips thickened, but lower part livid; nose elongated; teeth not white indeed, but appearing to be so under a dark body; ears red, black, contracted, resembling the elephant, so that they appear to have a greater size than usual; ulcers upon the base of the ears, discharge of ichor, with pruritus; shrivelled all over the body with rough wrinkles; but likewise deep fissures, like black furrows on the skin; and for this reason the disease has got the name of elephas. Cracks on the feet and heels, as far as the middle of the toes; but if the ailment still further increase, the tumours become ulcerated, so that on the cheeks, chin, fingers, and knees, there are fetid and incurable ulcers, some of which are springing up on one part, while others are subsiding on another. Sometimes, too, certain of the members of the patient will die, so as to drop off, such as the nose, the fingers, the feet, the privy parts, and the whole hands; for the ailment does not prove fatal, so as to relieve the patient from a foul life and dreadful sufferings, until he has been divided limb from limb. For it is long-lived, like the animal, the elephant. But if there be a sudden pain of the limbs, it attacks much more grievously, spreading sometimes to this part, and sometimes to that. Appetite for food not amiss; taste indiscriminate, neither food nor drink affords pleasure; aversion to all things from a painful feeling; atrophy; libidinous desires of a rabid nature; spontaneous lassitude; the figure of each of the limbs heavy, and even the small limbs are oppressive to the patient. Moreover, the body is offended with everything, takes delight neither in baths nor abstinence from them, neither in food nor in abstinence from it, neither in motion nor in rest, for the disease has established itself in all the parts. Sleep slight, worse than insomnolency, from its fantasies; strong dyspnœa, suffocation as if from strangling. In this way certain patients have passed from life, sleeping the sleep which knows no waking, even until death.

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When in such a state, who would not flee;—who would not turn from them, even if a father, a son, or a brother? There is danger, also, from the communication of the ailment. Many, therefore, have exposed their most beloved relatives in the wilderness, and on the mountains, some with the intention of administering to their hunger, but others not so, as wishing them to die. There is a story that one of those who had come to the wilderness, having seen a viper creep out of the earth, compelled by hunger, or wearied out with the affection, as if to exchange one evil for another, ate the viper alive, and did not die until all his members had become putrid and dropped off: and that another person saw a viper creep into a cask of new wine, and after drinking of the same to satiety, vomit it up, and discharge a great deal of its venom along with the new wine; but when the viper was smothered in the new wine, that the man drank of it largely and greedily, seeking thus to obtain a rescue from life and the disease; but when he had carried the drinking to satiety and intoxication, he lay down on the ground, at first as if about to die; but when he awoke from his sleep and intoxication, first of all his hair fell off, next the fingers and nails, and all the parts melted away in succession. But as the power was still in the semen, nature formed the man again, as if from the act of generation: it made other hairs to grow, and made new nails and clean flesh, and put off the old skin, like the slough of a reptile; and he was called back, like another new man, to a growth of life. Thus goes the fable; not very probable, indeed, nor yet entirely incredible; for that one ill should be overcome by another is credible. And that from the existing spark nature should renew the man, is not so incredible as to be held to be a prodigy.

+ + diff --git a/data/tlg0719/tlg002/tlg0719.tlg002.perseus-grc2.xml b/data/tlg0719/tlg002/tlg0719.tlg002.perseus-grc2.xml index 4e9c59d77..8e7bdbca3 100644 --- a/data/tlg0719/tlg002/tlg0719.tlg002.perseus-grc2.xml +++ b/data/tlg0719/tlg002/tlg0719.tlg002.perseus-grc2.xml @@ -165,7 +165,7 @@
Κεφ. η′. περὶ Φθίσιος. -

ἢν ἕλκος ἐξ ἀποστάσιος ἐν τῷ πνεύμονι γένηται, ἢ ἐκ βηχὸς χρονίης, ἢ ἀναγωγῆς αἵματος, καὶ ἀναβήσσῃ πῦον, πύη, Ermerins does not appear to me to be warranted in substituting φθόη for πύη, contrary to the authority of all the MSS. Moreover, it seems to be excluded from this place by the terms in which our author applies φθόη to a particular state of the diseased parts — ἀλλὰ φθόην μεταλαμβάνει; i.e. but the disease assumes the peculiar name of phthoe. He is right, however, in following the suggestion of Petit, and substituting ἕλκος for ἐντὸς at the commencement. καὶ φθίσις κικλήσκεται· ἢν δὲ θώρηξ ἢ πλευρὸν ἐμπυήσῃ, ἐπανάγηται δὲ διὰ τοῦ πνεύμονος, ἐμπύη ἥδε τοὔνομα.I am not aware that the term ἐμπύη occurs elsewhere. Hippocrates and Galen, I believe, universally use the substantive ἐμπύημα, or the adjective ἔμπυοι- - the latter being their more common practice. ἢν δὲ ἐπὶ τοῖσι καὶ ὁ πνεύμων ἕλκος ἵσχῃ, ἀναβρωθεὶς ὑπὸ τοῦ διενεχθέντος πύου, τοὔνομα οὐκέτι ἐμπύη, ἀλλὰ φθόην μεταλαμβάνει· ξύνεστι δὲ καὶ πῦρ ξυνεχὲς, ὡς μὴ δοκέειν,At first I was inclined to adopt the alteration of Ermerins, who substitutes μοι for μὴ; but, after reading Caelius Aurelianus’s description of Phthisis, I was convinced that μὴ is the preferable reading. The words of Aurelianus are: Sequitur autem αεgrotantes febricula latens, etc. λῆγον μὲν οὔκοτε, λῆθον δὲ διʼ ἡμέρης ἱδρῶτι καὶ ψύξι τοῦ σκήνεος. καὶ γὰρ καὶ τὰ ἴδια φθόης ἐστὶ, ἢν ἡ θέρμη ζωπυρῇ, καὶ ἐς νύκτα ἐκλάμπῃ, ἡμέρην δὲ αὖθις ἐν τοῖσι σπλάγχνοισι φωλεύει· δηλοῖ δὲ ἡ δυσφορίη, καὶ ἡ ἀδυναμίη, καὶ αἱ ξυντήξιες. ἢν γὰρ ἀπεδίδρησκε τοῦ σκήνεος διʼ ἡμέρης τὸ πῦρ, πῶς οὐκ ἂν ἐσαρκοῦ τό τε καὶ ἠδύνατο, καὶ εὐφόρως εἶχεν ὥνθρωπος; εὖτε γὰρ ἀνάγει, ἐπὶ μᾶλλον τὰ δεινὰ αὐξέεται.I am not satisfied with ἀνάγει in this sentence; but have not been able to find a proper substitute for it. The translation of Crassus is most suitable to the context: ut enim recessit, etc. Qu. ἀνέθῃ? σφυγμοὶ σμικροὶ καὶ ἀμυδροὶ, ἀγρυπνὴ, ἄχροια, καὶ τἄλλα πάντα ὁκόσα οἱ πυρεταίνοντες· ἰδέαι δὲ ὑγρῶν μυρίαι, πελιδνῶν, μελάνων κατακορέων , ἢ ὠχρολεύκων , ἢ λευκοχλωρέων· πλατέων, στρογγύλων· σκληρῶν, δυσλύτων, ἢ μανῶν, λυομένων· ἢ ἀνόσμων, ἢ κακωδέων· ἅπαντα δὲ τάδε πύου ἔασι ἰδέαι. ὁκόσοι γὰρ ἢ πυρὶ ἢ ὕδατι τὰ ὑγρὰ τεκμαίρονται, οὐ κάρτα μοι δοκέουσι φθόην οἵδε γιγνώσκειν· πιστοτέρη γὰρ ἡ ὄψις ἁπάσης ἄλλης αἰσθήσιος, οὐ τῶν ἀναγομένων μοῦνον, ἀλλὰ καὶ τοῦ εἴδεος τοῦ νοσέοντος. ἢν γὰρ καὶ δημότης ἴδῃ τὸν ἄνθρωπον ὠχρὸν, ἀδρανῆ, ἀναβήσσοντα, ξυντετηκότα, ἀτρεκέα μαντεύεται φθόην· ἀτὰρ ἠδὲ ὁκόσοισι μὲν ἕλκος μὲν οὐκ ἔστι ἐν πνεύμονι, ξυντετήκασι δὲ πυρετοῖσι χρονίοισι, πυκνὰ δὲ καὶ σκληρὰ καὶ ἀτελέα βήσσουσι, καὶ ἀνάγουσι οὐδὲν, καὶ τούσδε φθισικοὺς κικλήσκουσι, οὐ πάνυ ἀσήμως. ξύνεστι δὲ τοῦ θώρηκος βάρος· πλεύμων γὰρ ἄπονος,In all the MSS. and editions, except that of Ermerins, we read ἄτονος, which is unsuitable to the place. ἄση, δυσφορίη, ἀποσιτίη, ἑσπέρῃ περίψυξις, καὶ θέρμη ἐς τὴν ἕω· ἱδρὼς ἄχρι θώρηκος τῆς θέρμης δυσφορώτερος· βηχὸς ἀναγωγαὶ ποικίλαι, ὁκοίας ἔλεξα.

+

ἢν ἕλκος ἐξ ἀποστάσιος ἐν τῷ πνεύμονι γένηται, ἢ ἐκ βηχὸς χρονίης, ἢ ἀναγωγῆς αἵματος, καὶ ἀναβήσσῃ πῦον, πύη, Ermerins does not appear to me to be warranted in substituting φθόη for πύη, contrary to the authority of all the MSS. Moreover, it seems to be excluded from this place by the terms in which our author applies φθόη to a particular state of the diseased parts — ἀλλὰ φθόην μεταλαμβάνει; i.e. but the disease assumes the peculiar name of phthoe. He is right, however, in following the suggestion of Petit, and substituting ἕλκος for ἐντὸς at the commencement. καὶ φθίσις κικλήσκεται· ἢν δὲ θώρηξ ἢ πλευρὸν ἐμπυήσῃ, ἐπανάγηται δὲ διὰ τοῦ πνεύμονος, ἐμπύη ἥδε τοὔνομα.I am not aware that the term ἐμπύη occurs elsewhere. Hippocrates and Galen, I believe, universally use the substantive ἐμπύημα, or the adjective ἔμπυοι- — the latter being their more common practice. ἢν δὲ ἐπὶ τοῖσι καὶ ὁ πνεύμων ἕλκος ἵσχῃ, ἀναβρωθεὶς ὑπὸ τοῦ διενεχθέντος πύου, τοὔνομα οὐκέτι ἐμπύη, ἀλλὰ φθόην μεταλαμβάνει· ξύνεστι δὲ καὶ πῦρ ξυνεχὲς, ὡς μὴ δοκέειν,At first I was inclined to adopt the alteration of Ermerins, who substitutes μοι for μὴ; but, after reading Caelius Aurelianus’s description of Phthisis, I was convinced that μὴ is the preferable reading. The words of Aurelianus are: Sequitur autem αεgrotantes febricula latens, etc. λῆγον μὲν οὔκοτε, λῆθον δὲ διʼ ἡμέρης ἱδρῶτι καὶ ψύξι τοῦ σκήνεος. καὶ γὰρ καὶ τὰ ἴδια φθόης ἐστὶ, ἢν ἡ θέρμη ζωπυρῇ, καὶ ἐς νύκτα ἐκλάμπῃ, ἡμέρην δὲ αὖθις ἐν τοῖσι σπλάγχνοισι φωλεύει· δηλοῖ δὲ ἡ δυσφορίη, καὶ ἡ ἀδυναμίη, καὶ αἱ ξυντήξιες. ἢν γὰρ ἀπεδίδρησκε τοῦ σκήνεος διʼ ἡμέρης τὸ πῦρ, πῶς οὐκ ἂν ἐσαρκοῦ τό τε καὶ ἠδύνατο, καὶ εὐφόρως εἶχεν ὥνθρωπος; εὖτε γὰρ ἀνάγει, ἐπὶ μᾶλλον τὰ δεινὰ αὐξέεται.I am not satisfied with ἀνάγει in this sentence; but have not been able to find a proper substitute for it. The translation of Crassus is most suitable to the context: ut enim recessit, etc. Qu. ἀνέθῃ? σφυγμοὶ σμικροὶ καὶ ἀμυδροὶ, ἀγρυπνὴ, ἄχροια, καὶ τἄλλα πάντα ὁκόσα οἱ πυρεταίνοντες· ἰδέαι δὲ ὑγρῶν μυρίαι, πελιδνῶν, μελάνων κατακορέων , ἢ ὠχρολεύκων , ἢ λευκοχλωρέων· πλατέων, στρογγύλων· σκληρῶν, δυσλύτων, ἢ μανῶν, λυομένων· ἢ ἀνόσμων, ἢ κακωδέων· ἅπαντα δὲ τάδε πύου ἔασι ἰδέαι. ὁκόσοι γὰρ ἢ πυρὶ ἢ ὕδατι τὰ ὑγρὰ τεκμαίρονται, οὐ κάρτα μοι δοκέουσι φθόην οἵδε γιγνώσκειν· πιστοτέρη γὰρ ἡ ὄψις ἁπάσης ἄλλης αἰσθήσιος, οὐ τῶν ἀναγομένων μοῦνον, ἀλλὰ καὶ τοῦ εἴδεος τοῦ νοσέοντος. ἢν γὰρ καὶ δημότης ἴδῃ τὸν ἄνθρωπον ὠχρὸν, ἀδρανῆ, ἀναβήσσοντα, ξυντετηκότα, ἀτρεκέα μαντεύεται φθόην· ἀτὰρ ἠδὲ ὁκόσοισι μὲν ἕλκος μὲν οὐκ ἔστι ἐν πνεύμονι, ξυντετήκασι δὲ πυρετοῖσι χρονίοισι, πυκνὰ δὲ καὶ σκληρὰ καὶ ἀτελέα βήσσουσι, καὶ ἀνάγουσι οὐδὲν, καὶ τούσδε φθισικοὺς κικλήσκουσι, οὐ πάνυ ἀσήμως. ξύνεστι δὲ τοῦ θώρηκος βάρος· πλεύμων γὰρ ἄπονος,In all the MSS. and editions, except that of Ermerins, we read ἄτονος, which is unsuitable to the place. ἄση, δυσφορίη, ἀποσιτίη, ἑσπέρῃ περίψυξις, καὶ θέρμη ἐς τὴν ἕω· ἱδρὼς ἄχρι θώρηκος τῆς θέρμης δυσφορώτερος· βηχὸς ἀναγωγαὶ ποικίλαι, ὁκοίας ἔλεξα.

φωνὴ βραγχώδης· αὐχὴν ὑποσκόλιος, Ῥαδινὸς, οὐκ εὐπαράγωγος· ὁκοῖόν τι ξυντετα μένος· δάκτυλοι ἰσχνοὶ, τὰ δὲ ἄρθρα παχέα· ὀστέων μούνων ἡ ἰδέη· σμύχονται γὰρ καὶ σάρκες· ὄνυχες γρυποὶ δακτύλων, αἱ κοιλίαι Ῥυσαὶ καὶ πλατέες· Ermerins, on his own authority, substitutes πλατέαι; but the other reading is in accordance with a well-known Ionic usage. All the recent translators have fallen into the mistake of applying this passage to the abdomen; whereas a careful examination of the context will show that it is out of the question in this place. Crassus more correctly renders it thus: digitorum ventres rugosi et lati. Κοιλίαι in this place evidently applies to the pulps of the fingers. ὑπʼ ἀσαρκίας γὰρ οὔτε τὴν περιταινίην οὔτε τὸ στρογγύλον ἴσχουσι. διὰ τόδε καὶ ὄνυχες γρυποί· ἥδε γὰρ ἡ ἀνακωχὴ, καὶ ἡ ὑπόστασις αὐτέων, ἥτις ἐν τῇσι κορυφῇσι πεπλησμένη εἵνεκεν αὐτῶν· ἔστι καὶ ὁ τόνος, ὥσπερ καὶ τὰ στερεά·In this passage we are under obligations to Ermerins; in particular for supplying τόνος instead of πόνος. I have not adopted his other alterations. Ῥὶς ὀξείη, ἰσχνὴ, μῆλα ὑπερίσχοντα καὶ ἐρυθρὰ, ὀφθαλμοὶ κοῖλοι, στιλπνοὶ, γανόωντες· οἰδαλέοι, καὶ ὠχροὶ, ἢ πελιδνοὶ τὰ πρόσωπα. γνάθων τὰ λεπτὰ τοῖσι ὀδοῦσι προσιζάνσει μειδιῶσι ἴκελον, τὰ πάντα νεκρώδεες. ὧδε καὶ τὰ πάντα ἴσχει· ἰσχνοὶ, ἄσαρκοι, βραχιόνων μύες ἄδηλοι, μαζῶν οὐδὲ ἴχνη, ἐκφανέες δὲ μοῦναι θηλαί. πλευρὰς οὐ καταλέξαι μοῦνον εὔσημον, ἀλλὰ καὶ ὅπη κραίνουσι, ἐσιδεῖν Ῥηΐδιον· οὐδὲ γὰρ αἱ πρὸς τοὺς σπονδύλους συναθρώσιες εὐξύγκρυπτοι· δῆλαι δὲ καὶ αἱ εἰς τὸ στέρνον ἐπιβολαί· τὰ μέσα τῶν πλευρέων κοῖλα, Ῥομβοειδέα.This word is most probably a false reading. See Wigan and Ermerins. The latter reads ῥοιβοειδέα, one of Wigan’s conjectural emendations. Ῥοικοειδέα and ῥεβοειδέα have also been suggested. If I thought myself warranted to make any change in the reading, it would be to adopt ῥαιβοειδέα. See Foes, Oec. Hipp.; and Galen, t. i. pp. 224, 246, ed. Daremberg. ὡς ἐς τὴν τῶν ὀστέων περιαγωγὴν ὑποχόνδρια λαγαρὰ, ἀνεσπασμένα, ἐπιγάστριον τῇ Ῥάχει προσφυὲς καὶ λαγών. ἄρθρα ἐναργῆ, ἔξαρθρα, ἀσαρκώδεα, καὶ ἡ κνήμη, ἰσχίον τε καὶ βραχίων. ὑπερίσχει ἡ ἄκανθα τῶν σπονδύλων ἡ πρόσθεν κοίλη τῶν ἑκατέρων ἐκτετηκότων μνῶν· ὡμοπλάται ἐκφανέες ὅλαι, ὅκως πτέρυγες ὀρνίθων. τουτέοισι ἢν κοιλίη ἐκταραχθῇ, ἀνέλπιστοι· ἢν δὲ ἐς ὑγείην τρέπηται, τὰ ἐναντία τοῖσι ὀλεθρίοισι ἐπιφοιτῇ.

γηραιοὶ μὲν οὐ ξυνεχέες πάσχειν·The change of οὖν into οὐ, as made by Ermerins, is indispensable. διαδιδρήσκουσι δὲ ἥκιστα· νέοι δὲ μέχρι ἀκμῆς ἀπὸ αἵματος ἀναγωγῆς φθινώδεες γίγνονται, καὶ ὑγιάζον ται μὲν, οὐ Ῥηϊδίως δέ· παιδία ξυνεχῶς τῇ βηχὶ μέχρι φθόης κοτὲ Ῥηϊδίως ὑγιάζεται· ἕξιες δὲ Ῥαδινοὶ, σανιδώδεες , πτερυγώδεες, ἐξεχέβρογχοι, λευκοὶ, ἀραιότεροι τὸν θώρηκα· χῶραι δὲ ψυχραὶ καὶ ὑγραὶ, ὁκόσαι τῷ εἴδεϊ τοῦ πάθεος ἀδελφαί.

diff --git a/data/tlg0719/tlg003/__cts__.xml b/data/tlg0719/tlg003/__cts__.xml index df0d61d88..ad01e8e72 100644 --- a/data/tlg0719/tlg003/__cts__.xml +++ b/data/tlg0719/tlg003/__cts__.xml @@ -4,6 +4,11 @@ Ὀξέων νούσων θεραπευτικόν - Aretaeus. The Extant Works of Aretaeus, The Cappadocian. Adams, Francis, editor. Boston, MA: Milford House, Inc., 1972 (reprint); London: Sydenham Society, 1856. + Aretaeus. The Extant Works of Aretaeus, The Cappadocian. Adams, Francis, editor. Boston, MA: Milford House, Inc., 1972 (reprint); London: Sydenham Society, 1856. + + + On the Therapeutics of Acute Diseases + Aretaeus. The Extant Works of Aretaeus, The Cappadocian. Adams, Francis, translator. Boston, MA: Milford House, Inc., 1972 (reprint); London: Sydenham Society, 1856. + \ No newline at end of file diff --git a/data/tlg0719/tlg003/tlg0719.tlg003.perseus-eng1.xml b/data/tlg0719/tlg003/tlg0719.tlg003.perseus-eng1.xml index 18bf68273..caa8e55e9 100644 --- a/data/tlg0719/tlg003/tlg0719.tlg003.perseus-eng1.xml +++ b/data/tlg0719/tlg003/tlg0719.tlg003.perseus-eng1.xml @@ -1,30 +1,54 @@ + - + - De curatione acutorum morborum - Aretaeus - Francis Adams LL.D. + On the Therapeutics of Acute Diseases + Aretaeus of Cappadocia + Francis Adams + + Gregory Crane + + Prepared under the supervision of + Bridget Almas + Lisa Cerrato + Rashmi Singhal + National Library of Medicine History of Medicine Division - Cultural Heritage Langauge Technologies + Cultural Heritage Language Technologies Kansas City Missouri - February 1, 2005 + February 1, 2005 + + Trustees of Tufts University + Medford, MA + Perseus Digital Library Project + Perseus 4.0 + tlg0719.tlg003.perseus-eng2.xml + + Available under a Creative Commons Attribution-ShareAlike 4.0 International License + - The Extant Works of Aretaeus, The Cappadocian. - Aretaeus - Francis Adams LL.D. + The Extant Works of Aretaeus, The Cappadocian + Aretaeus of Cappadocia + Francis Adams + + London + Syndenham Society + 1856 + Boston Milford House Inc. - 1972 (Republication of the 1856 edition). + 1972 - + + Internet Archive @@ -35,2181 +59,168 @@ - - - - - - - - - + + +

This pointer pattern extracts book and chapter.

+ + +

This pointer pattern extracts book.

+ - English - Greek + English + Greek + French - + + + EpiDoc and CTS conversion, file/encoding cleanup, and general header review. + - - -
- - 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.

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

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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.

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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.

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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.

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

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

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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

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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.

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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

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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.

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

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*)/ALLOI *PAIW=NOS - POLUFARMA/KOU E)/RGON E)/XONTES *)IHTROI/· KAI\ TOI=S - OU)DE\N E)/PESTI TE/LOS· *POLLA/KI D᾿ E)X O)LI/GHS O)DU/NHS - ME/GA GI/GNETAI A)/LGOS, *KOU)/K A)/N TIS LU/SAIT' H)/PIA - FA/RMAKA DOU/S· *TO\N DE\ KAKAI=S NOU/SOISI KUKW/MENON - A)RGALE/AIS TE *AYA/MENOS XEIROI=N AI)=YA TI/QHS' - U(GIH=.

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.

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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

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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.

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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.

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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.

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But if the distension of the inflammation do not properly

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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.

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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,

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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.

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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.

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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

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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.

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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.

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- 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,

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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.

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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 cneorosDaphne Cneorum - L. 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.

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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

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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.

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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.

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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

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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.

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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 potionsPropomata, or whets. See Paulus Ægineta, vol. iii. p. - 544. They correspond to the Liqueurs of the present - day, but were taken at the beginning of a feast. Comp. Horat. Sat. ii. - 4, ll. 24--27. 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 - agrostisProbably the Triticum - repens. are acrid, but possessed of expulsive qualities, for - indeed they evacuate flatus and urine.

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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

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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.

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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.

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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 lemnestisAn - efflorescence collecting about reeds in salt lakes. The same as A)DA/RKH, for which see the Appendix to - Dunbar's Greek Lexicon. and euphorbium, with oil of must. It - is

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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.

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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,Probably the fruit of the Daphne cnidium. - 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.

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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),

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or thapsia,Thapsia Garganica L., a species - of deadly carrot. 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.

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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.

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- CHAPTER III. THE CURE OF MARASMUS. I agree with the preceding - editors in thinking that this chapter is merely a portion of the last - one. - -

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.

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- - 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,

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or compression, there must be no procrastination, for in certain cases this - alone is sufficient for the cure and to save life.

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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.

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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

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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.

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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

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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.

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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.

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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.

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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

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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.

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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.

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- - 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.

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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

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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.

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- 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

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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

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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,A double vessel was a smaller vessel, to - which heat was applied by placing it in a larger. It was called balneum mariœ by the alchemists. It is frequently - made mention of in the works of the ancient writers on pharmacy. See, in - particular, Galen, sec. loc. vii. 2; De Sanit. tuend iv. 8; Meth. Med. - viii. 5; Dioscorid. ii. 95; Oribasius Meth. Med. viii. 6, and the - learned note of Daremberg. 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.

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But if the spasm be connected with a wound, it is dangerous,

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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,I - would remind the professional reader, that the Cyrenaic silphium was a - superior kind of assa-fœtida, which at one time - grew copiously in the region of Cyrene. See Paulus Ægineta, Syd. Soc. - Edit., t. iii. 337. 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

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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.

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- 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.

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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.

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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

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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,The wild rue, or Peganum harmala. See Dioscorides, iii. 46. - 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?).

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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

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wound do not coalesce; for they are both cartilaginous, and not of a nature - to unite.On the Ancient History of Laryngotomy, see Paulus - Ægineta, t. ii., pp. 301--303, Syd. Soc. Edit. I would avail myself of - the present opportunity of bringing into the notice of my learned - readers the very accurate and elegant edition of the Sixth Book of - Paulus Ægineta, lately published in Paris by Dr. RＯ・Brian. As regards - the text, it is everything that could be desired; and the translation - which accompanies it is generally correct. * * * * * * * * * * * - * * * * * * * * * * * * * * *

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- 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.

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If, then, the patients be young, we must open the vein at the elbow, and - evacuate copiously by a larger incision than usual;

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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,Auklandia Costus L. See Paulus Ægineta, t. iii. p.190. - and cyperus;Cyperus rotundus L. See Paulus - Ægineta, t. iii. p. 204. 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.

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- - 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,Native Sulphate of Copper. See Paulus Ægineta, t. iii. pp. 401, - 402. with cadmiaCalamine. See Paulus Ægineta, t. iii. - p. 150. 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,

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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.

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- 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,

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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.

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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

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barley. The next place to it is held by chondrus,Spelt, Triticum spelta, deprived of its husks and broken - down into granules. See Paul. Ægin. t. i. p.123, Syd. Soc. Edit. - 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.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. 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

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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.

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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.See Paul. Ægin. t. - iii. p. 241. 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;Probably the Cachrys - libanotis. See Dioscorides, M. M. iii. 78; and appendix to - Dunbar's Greek Lexicon under LIBANWTI/S.

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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.

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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

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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.

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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

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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.

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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.

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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.

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- - 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

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veins widen the compass of the lungs for the passage of the breath.

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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.

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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.

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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

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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.

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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.

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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.

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- - 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.

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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?

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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.It is to be - understood that by rarefaction our author means - exhalation; that is to say, increased action of the exhalants. - 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

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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.

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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

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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.

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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

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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

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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.

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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.

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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

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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.

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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.

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- - 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,Allusion is here - made to Hippocrates Aph. i. In the Aphorism it is "the attendants and - externals" (TOU\S PARE/ONTAS KAI\ TA\ - E)/XWQEN), which our author condenses into "things - present" (TA\ PARE/ONTA); and this is - no doubt the reason why in this instance the neuter plural is construed - with a verb plural. See the text. 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.

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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

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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.

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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.

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

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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.

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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

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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.

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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

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mastich,--and let these things be mixed up with a cerate composed of - nard.No doubt the Indian nard, namely, Patrinia Jatamansi, Don. 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

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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,A fragrant oil prepared from must. See Paulus - Ægineta, t.iii. p. 596. or Sicyonian oil, along with pepper, - castor, natron, and cachry,The fruit of the Cachrys libanotis, L. See Dioscorides, iii. 79. 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.

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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

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

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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;The author appears to refer to the common - way of trying the specific gravity of milk, by pouring a small quantity - on the nail. See Paulus Ægineta, i. 3, Syd. Soc. Ed. and by these - means the patient is to be brought back to convalescence and his accustomed - habits.

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- 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

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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.

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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.

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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

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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.

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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.

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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.

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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.

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- 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

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he foresees that present symptoms cannot be escaped from, to lull the patient - asleep with narcotics and anæsthetics.

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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 (propomataSee Bekker's Charicles, p. 248; - and Paulus Ægineta, t. iii. p. 546.) of the decoction of cumin, - or of rue, and of sison;The Sison amomum, - Stone parsley, or German amomum. See Dioscorid. M. M. iii. 57; Galen. de - Simpl.vii.; and Paulus Ægineta, t. iii. p. 339. or along with - these some of the anodyne medicines. Of these there are very

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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.

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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.

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

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

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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.

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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.

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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

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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.

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The food should be light, digestible, possessed of diuretic qualities, and - which will quickly pass through the bowels; such as granulated seeds of - spelt (alicaSee, in particular, Dr. - Daremberg's elaborate dissertation on the XO/NDROS, ap. Oribasium, t.i. p. 559.) 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.

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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.

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- - 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.

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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

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mallows, are sufficient to rouse and stimulate the bowels. The extremities, - namely, the feet and hands, are to be warmed with gleucinum,The - ointment or oil from must. See Paulus Ægineta, t.iii. p.596. 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.

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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.

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- - 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.

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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,I am at a loss to decide what herb this was. It is not noticed - either by Theophrastus or Dioscorides. Indeed, I am not aware that it - occurs elsewhere, except in the work of Trallian, viii.4. Petit, I know - not on what authority, suggests that it is the asplenium - ceterach. Liddel and Scott identify it with the KE/STRON, but do not give their grounds for - holding this opinion. 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.This process is very circumstantially described by - Oribasius under the name of KATEI/LHSLS Med. Coll.x.18. Dr. Daremberg translates it, - l'enroulement avec les bandes. 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,A species of wild cinnamon or - cassia-tree. See Edinburgh Greek Lexicon, Appendix, under the - term. 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,The Saponaria officinalis. 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,Doubtful whether he means the Solanum nigrum or Physalis somnifera. See - Paulus Ægineta, t. iii. p. 359. 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.

-
-
+ + + +
+
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 friezeThe Greek word ἄχναι would appear to have been applied like frieze in English, both to the nap on woollen cloth, and in architecture, to ornaments of sculpture on a flat face. Our author evidently uses it in the latter sense; but I suspect the translators fail to recognise it. For the former meaning, see Erotian, and Föes Œc. Hippocr. Modern lexicographers do not seem acquainted with this use of the term. See Liddel and Scott’s; and Dunbar’s Lexicons. 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. AlicaAs this term is of frequent occurrence in the works of our author, as in those of Hippocrates, it may be proper to mention, once for all, that the χόνδρος of the Greeks and the alica of the Romans was the species of grain called Spelt (Triticum Spelta) broken down into rough granules; that is to say, it was coarsely ground Spelt. 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;All the Greek and Arabian authorities on dietetics hold, that fishes caught among rocks are particularly excellent. See Paulus Ægineta, t. i. p. 159. 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.This passage savours much of magnetical manipulation. The following verses of Solon have been quoted as referring to the same subject :— + + Ἄλλοι Παιῶνος πολυφαρμάκου ἔργον ἔχοντες + Ἰητροί· καὶ τοῖς οὐδὲν ἔπεστι τέλος· + Πολλάκι δ᾿ ἐχ ὀλίγης ὀδύνης μέγα γίγνεται ἄλγος, + Κοὔκ ἄν τις λύσαιτ’ ἤπια φάρμακα δούς· + Τὸν δὲ κακαῖς νούσοισι κυκώμενον ἀργαλέαις τε + Ἀψάμενος χειροῖν αἶψα τίθησ’ ὑγιῆ. 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.

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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.

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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.

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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.

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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.

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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.

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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 cneorosDaphne Cneorum L. 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.

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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.

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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.

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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.

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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 potionsPropomata, or whets. See Paulus Ægineta, vol. iii. p. 544. They correspond to the Liqueurs of the present day, but were taken at the beginning of a feast. Comp. Horat. Sat. ii. 4, ll. 24—27. 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 agrostisProbably the Triticum repens. are acrid, but possessed of expulsive qualities, for indeed they evacuate flatus and urine.

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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.

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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.

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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 lemnestisAn efflorescence collecting about reeds in salt lakes. The same as ἀδάρκη, for which see the Appendix to Dunbar’s Greek Lexicon. 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.

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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,Probably the fruit of the Daphne cnidium. 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.

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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,Thapsia Garganica L., a species of deadly carrot. 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.

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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.

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CHAPTER III. THE CURE OF MARASMUS. I agree with the preceding editors in thinking that this chapter is merely a portion of the last one. +

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.

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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.

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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.

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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.

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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.

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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.

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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.

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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.

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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.

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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.

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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.

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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,A double vessel was a smaller vessel, to which heat was applied by placing it in a larger. It was called balneum mariœ by the alchemists. It is frequently made mention of in the works of the ancient writers on pharmacy. See, in particular, Galen, sec. loc. vii. 2; De Sanit. tuend iv. 8; Meth. Med. viii. 5; Dioscorid. ii. 95; Oribasius Meth. Med. viii. 6, and the learned note of Daremberg. 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.

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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,I would remind the professional reader, that the Cyrenaic silphium was a superior kind of assa-fœtida, which at one time grew copiously in the region of Cyrene. See Paulus Ægineta, Syd. Soc. Edit., t. iii. 337. 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.

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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.

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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,The wild rue, or Peganum harmala. See Dioscorides, iii. 46. 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?).

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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.On the Ancient History of Laryngotomy, see Paulus Ægineta, t. ii., pp. 301—303, Syd. Soc. Edit. I would avail myself of the present opportunity of bringing into the notice of my learned readers the very accurate and elegant edition of the Sixth Book of Paulus Ægineta, lately published in Paris by Dr. RＯ・Brian. As regards the text, it is everything that could be desired; and the translation which accompanies it is generally correct. * * * * * * * * * * * * * * * * * * * * * * * * * *

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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.

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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,Auklandia Costus L. See Paulus Ægineta, t. iii. p.190. and cyperus;Cyperus rotundus L. See Paulus Ægineta, t. iii. p. 204. 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.

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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,Native Sulphate of Copper. See Paulus Ægineta, t. iii. pp. 401, 402. with cadmiaCalamine. See Paulus Ægineta, t. iii. p. 150. 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.

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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.

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

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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.See Paul. Ægin. t. iii. p. 241. 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;Probably the Cachrys libanotis. See Dioscorides, M. M. iii. 78; and appendix to Dunbar’s Greek Lexicon under λιβανωτίς. 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.

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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.

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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.

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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.

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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.

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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.

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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.

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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.

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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.

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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.

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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.

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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.

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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?

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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.It is to be understood that by rarefaction our author means exhalation; that is to say, increased action of the exhalants. 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.

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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.

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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.

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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.

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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.

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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.

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

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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.

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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.

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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.

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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.

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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.No doubt the Indian nard, namely, Patrinia Jatamansi, Don. 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,A fragrant oil prepared from must. See Paulus Ægineta, t.iii. p. 596. or Sicyonian oil, along with pepper, castor, natron, and cachry,The fruit of the Cachrys libanotis, L. See Dioscorides, iii. 79. 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.

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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.

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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;The author appears to refer to the common way of trying the specific gravity of milk, by pouring a small quantity on the nail. See Paulus Ægineta, i. 3, Syd. Soc. Ed. and by these means the patient is to be brought back to convalescence and his accustomed habits.

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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.

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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.

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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.

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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.

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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.

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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.

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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.

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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 (propomataSee Bekker’s Charicles, p. 248; and Paulus Ægineta, t. iii. p. 546.) of the decoction of cumin, or of rue, and of sison;The Sison amomum, Stone parsley, or German amomum. See Dioscorid. M. M. iii. 57; Galen. de Simpl.vii.; and Paulus Ægineta, t. iii. p. 339. 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.

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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.

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

THE formation of the blood is in the liver, and hence the distribution of it over the whole system. And the entire liver is, as it were, a concretion of blood. Wherefore the inflammations there are most acute; for nutrition is seated in this place. If, therefore, inflammation form anywhere else, it is not remarkably acute; for it is an influx of blood that is inflamed; but in the liver there is no necessity for its coming from another quarter. For if any obstruction shut the outlets, the liver becomes inflamed by being deprived of its efflux, since the entrance of the food to the liver still continues patent; for there is no other passage of the food but this from the stomach and intestines to the whole body.

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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.

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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.

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The food should be light, digestible, possessed of diuretic qualities, and which will quickly pass through the bowels; such as granulated seeds of spelt (alicaSee, in particular, Dr. Daremberg’s elaborate dissertation on the χόνδρος, ap. Oribasium, t.i. p. 559.) 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.

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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.

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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.

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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,The ointment or oil from must. See Paulus Ægineta, t.iii. p.596. 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.

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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.

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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.

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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.

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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,I am at a loss to decide what herb this was. It is not noticed either by Theophrastus or Dioscorides. Indeed, I am not aware that it occurs elsewhere, except in the work of Trallian, viii.4. Petit, I know not on what authority, suggests that it is the asplenium ceterach. Liddel and Scott identify it with the κέστρον, but do not give their grounds for holding this opinion. 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.

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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:

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for there, by far,

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On wretched men most cruel pains inflicts the god of war.

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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.This process is very circumstantially described by Oribasius under the name of κατείλησλς Med. Coll.x.18. Dr. Daremberg translates it, l’enroulement avec les bandes. 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.

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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.

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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.

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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,A species of wild cinnamon or cassia-tree. See Edinburgh Greek Lexicon, Appendix, under the term. 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,The Saponaria officinalis. 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.

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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.

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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,Doubtful whether he means the Solanum nigrum or Physalis somnifera. See Paulus Ægineta, t. iii. p. 359. 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.

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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.

 diff --git a/data/tlg0719/tlg003/tlg0719.tlg003.perseus-eng2.xml b/data/tlg0719/tlg003/tlg0719.tlg003.perseus-eng2.xml new file mode 100644 index 000000000..e5db4f510 --- /dev/null +++ b/data/tlg0719/tlg003/tlg0719.tlg003.perseus-eng2.xml @@ -0,0 +1,226 @@ + + + + + + + On the Therapeutics of Acute Diseases + Aretaeus of Cappadocia + Francis Adams + + Gregory Crane + + Prepared under the supervision of + Bridget Almas + Lisa Cerrato + Rashmi Singhal + + National Library of Medicine History of Medicine Division + + + Cultural Heritage Language Technologies + Kansas City Missouri + February 1, 2005 + + Trustees of Tufts University + Medford, MA + Perseus Digital Library Project + Perseus 4.0 + tlg0719.tlg003.perseus-eng2.xml + + Available under a Creative Commons Attribution-ShareAlike 4.0 International License + + + + + + The Extant Works of Aretaeus, The Cappadocian + Aretaeus of Cappadocia + Francis Adams + + London + Syndenham Society + 1856 + + + Boston + Milford House Inc. + 1972 + + + Internet Archive + + + + + + +

Data Entry

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This pointer pattern extracts book and chapter.

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This pointer pattern extracts book.

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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.

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

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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.

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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. AlicaAs this term is of frequent occurrence in the works of our author, as in those of Hippocrates, it may be proper to mention, once for all, that the χόνδρος of the Greeks and the alica of the Romans was the species of grain called Spelt (Triticum Spelta) broken down into rough granules; that is to say, it was coarsely ground Spelt. 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;All the Greek and Arabian authorities on dietetics hold, that fishes caught among rocks are particularly excellent. See Paulus Ægineta, t. i. p. 159. 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.

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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.

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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.This passage savours much of magnetical manipulation. The following verses of Solon have been quoted as referring to the same subject :— + + Ἄλλοι Παιῶνος πολυφαρμάκου ἔργον ἔχοντες + Ἰητροί· καὶ τοῖς οὐδὲν ἔπεστι τέλος· + Πολλάκι δ᾿ ἐχ ὀλίγης ὀδύνης μέγα γίγνεται ἄλγος, + Κοὔκ ἄν τις λύσαιτ’ ἤπια φάρμακα δούς· + Τὸν δὲ κακαῖς νούσοισι κυκώμενον ἀργαλέαις τε + Ἀψάμενος χειροῖν αἶψα τίθησ’ ὑγιῆ. 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.

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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.

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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.

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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.

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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.

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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.

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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.

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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.

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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.

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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.

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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 cneorosDaphne Cneorum L. 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.

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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.

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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.

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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.

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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 potionsPropomata, or whets. See Paulus Ægineta, vol. iii. p. 544. They correspond to the Liqueurs of the present day, but were taken at the beginning of a feast. Comp. Horat. Sat. ii. 4, ll. 24—27. 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 agrostisProbably the Triticum repens. are acrid, but possessed of expulsive qualities, for indeed they evacuate flatus and urine.

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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.

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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.

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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 lemnestisAn efflorescence collecting about reeds in salt lakes. The same as ἀδάρκη, for which see the Appendix to Dunbar’s Greek Lexicon. 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.

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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,Probably the fruit of the Daphne cnidium. 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.

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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,Thapsia Garganica L., a species of deadly carrot. 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.

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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.

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CHAPTER III. THE CURE OF MARASMUS. I agree with the preceding editors in thinking that this chapter is merely a portion of the last one. +

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.

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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.

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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.

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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.

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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.

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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.

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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.

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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.

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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.

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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.

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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.

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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,A double vessel was a smaller vessel, to which heat was applied by placing it in a larger. It was called balneum mariœ by the alchemists. It is frequently made mention of in the works of the ancient writers on pharmacy. See, in particular, Galen, sec. loc. vii. 2; De Sanit. tuend iv. 8; Meth. Med. viii. 5; Dioscorid. ii. 95; Oribasius Meth. Med. viii. 6, and the learned note of Daremberg. 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.

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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,I would remind the professional reader, that the Cyrenaic silphium was a superior kind of assa-fœtida, which at one time grew copiously in the region of Cyrene. See Paulus Ægineta, Syd. Soc. Edit., t. iii. 337. 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.

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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.

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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,The wild rue, or Peganum harmala. See Dioscorides, iii. 46. 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?).

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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.On the Ancient History of Laryngotomy, see Paulus Ægineta, t. ii., pp. 301—303, Syd. Soc. Edit. I would avail myself of the present opportunity of bringing into the notice of my learned readers the very accurate and elegant edition of the Sixth Book of Paulus Ægineta, lately published in Paris by Dr. RＯ・Brian. As regards the text, it is everything that could be desired; and the translation which accompanies it is generally correct. * * * * * * * * * * * * * * * * * * * * * * * * * *

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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.

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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,Auklandia Costus L. See Paulus Ægineta, t. iii. p.190. and cyperus;Cyperus rotundus L. See Paulus Ægineta, t. iii. p. 204. 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.

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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,Native Sulphate of Copper. See Paulus Ægineta, t. iii. pp. 401, 402. with cadmiaCalamine. See Paulus Ægineta, t. iii. p. 150. 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.

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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.

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

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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.See Paul. Ægin. t. iii. p. 241. 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;Probably the Cachrys libanotis. See Dioscorides, M. M. iii. 78; and appendix to Dunbar’s Greek Lexicon under λιβανωτίς. 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.

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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.

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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.

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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.

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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.

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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.

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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.

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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.

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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.

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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.

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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.

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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.

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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?

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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.It is to be understood that by rarefaction our author means exhalation; that is to say, increased action of the exhalants. 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.

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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.

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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.

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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.

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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.

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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.

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

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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.

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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.

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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.

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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.

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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.No doubt the Indian nard, namely, Patrinia Jatamansi, Don. 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,A fragrant oil prepared from must. See Paulus Ægineta, t.iii. p. 596. or Sicyonian oil, along with pepper, castor, natron, and cachry,The fruit of the Cachrys libanotis, L. See Dioscorides, iii. 79. 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.

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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.

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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;The author appears to refer to the common way of trying the specific gravity of milk, by pouring a small quantity on the nail. See Paulus Ægineta, i. 3, Syd. Soc. Ed. and by these means the patient is to be brought back to convalescence and his accustomed habits.

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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.

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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.

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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.

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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.

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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.

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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.

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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.

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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 (propomataSee Bekker’s Charicles, p. 248; and Paulus Ægineta, t. iii. p. 546.) of the decoction of cumin, or of rue, and of sison;The Sison amomum, Stone parsley, or German amomum. See Dioscorid. M. M. iii. 57; Galen. de Simpl.vii.; and Paulus Ægineta, t. iii. p. 339. 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.

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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.

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

THE formation of the blood is in the liver, and hence the distribution of it over the whole system. And the entire liver is, as it were, a concretion of blood. Wherefore the inflammations there are most acute; for nutrition is seated in this place. If, therefore, inflammation form anywhere else, it is not remarkably acute; for it is an influx of blood that is inflamed; but in the liver there is no necessity for its coming from another quarter. For if any obstruction shut the outlets, the liver becomes inflamed by being deprived of its efflux, since the entrance of the food to the liver still continues patent; for there is no other passage of the food but this from the stomach and intestines to the whole body.

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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.

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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.

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The food should be light, digestible, possessed of diuretic qualities, and which will quickly pass through the bowels; such as granulated seeds of spelt (alicaSee, in particular, Dr. Daremberg’s elaborate dissertation on the χόνδρος, ap. Oribasium, t.i. p. 559.) 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.

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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.

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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.

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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,The ointment or oil from must. See Paulus Ægineta, t.iii. p.596. 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.

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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.

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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.

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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.

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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,I am at a loss to decide what herb this was. It is not noticed either by Theophrastus or Dioscorides. Indeed, I am not aware that it occurs elsewhere, except in the work of Trallian, viii.4. Petit, I know not on what authority, suggests that it is the asplenium ceterach. Liddel and Scott identify it with the κέστρον, but do not give their grounds for holding this opinion. 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.This process is very circumstantially described by Oribasius under the name of κατείλησλς Med. Coll.x.18. Dr. Daremberg translates it, l’enroulement avec les bandes. 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,A species of wild cinnamon or cassia-tree. See Edinburgh Greek Lexicon, Appendix, under the term. 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,The Saponaria officinalis. 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,Doubtful whether he means the Solanum nigrum or Physalis somnifera. See Paulus Ægineta, t. iii. p. 359. 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.

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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.

+ + diff --git a/data/tlg0719/tlg004/__cts__.xml b/data/tlg0719/tlg004/__cts__.xml index c87098bb3..763b91bb9 100644 --- a/data/tlg0719/tlg004/__cts__.xml +++ b/data/tlg0719/tlg004/__cts__.xml @@ -4,6 +4,11 @@ Χρονίων νούσων θεραπευτικών - Aretaeus. The Extant Works of Aretaeus, The Cappadocian. Adams, Francis, editor. Boston, MA: Milford House, Inc., 1972 (reprint); London: Sydenham Society, 1856. + Aretaeus. The Extant Works of Aretaeus, The Cappadocian. Adams, Francis, editor. Boston, MA: Milford House, Inc., 1972 (reprint); London: Sydenham Society, 1856. + + + On the Cure of Chronic Diseases + Aretaeus. The Extant Works of Aretaeus, The Cappadocian. Adams, Francis, translator. Boston, MA: Milford House, Inc., 1972 (reprint); London: Sydenham Society, 1856. + \ No newline at end of file diff --git a/data/tlg0719/tlg004/tlg0719.tlg004.perseus-eng1.xml b/data/tlg0719/tlg004/tlg0719.tlg004.perseus-eng1.xml index 17cb997b5..6eec0896a 100644 --- a/data/tlg0719/tlg004/tlg0719.tlg004.perseus-eng1.xml +++ b/data/tlg0719/tlg004/tlg0719.tlg004.perseus-eng1.xml @@ -1,30 +1,54 @@ + - + - De curatione diuturnorum morborum - Aretaeus - Francis Adams LL.D. + On the Cure of Chronic Diseases + Aretaeus of Cappadocia + Francis Adams + + Gregory Crane + + Prepared under the supervision of + Bridget Almas + Lisa Cerrato + Rashmi Singhal + National Library of Medicine History of Medicine Division - Cultural Heritage Langauge Technologies + Cultural Heritage Language Technologies Kansas City Missouri - February 1, 2005 + February 1, 2005 + + Trustees of Tufts University + Medford, MA + Perseus Digital Library Project + Perseus 4.0 + tlg0719.tlg004.perseus-eng2.xml + + Available under a Creative Commons Attribution-ShareAlike 4.0 International License + - The Extant Works of Aretaeus, The Cappadocian. - Aretaeus - Francis Adams LL.D. + The Extant Works of Aretaeus, The Cappadocian + Aretaeus of Cappadocia + Francis Adams + + London + Syndenham Society + 1856 + Boston Milford House Inc. - 1972 (Republication of the 1856 edition). + 1972 - + + Internet Archive @@ -35,1129 +59,96 @@ - - - - - - - - - + + +

This pointer pattern extracts book and chapter.

+ + +

This pointer pattern extracts book.

+ - English - Greek + English + Greek + + EpiDoc and CTS conversion, file/encoding cleanup, and general header review. + - - -
- - BOOK I. -
- CHAPTER I. THE PROŒMIUM. -

IN chronic diseases, the postponement of medical - treatment is a bad thing; for, by procrastination, they pass into incurable - affections, being of such a nature that they do not readily go off if they - once attack; and if protracted by time, they will become strong, and end - only in death. Small diseases also are succeeded by greater, so that - although devoid of danger at first, their progeny proves deadly. Wherefore - neither should the patient conceal his complaint, from the shame of - exposure, nor shrink from fear of the treatment; nor should the physician be - inactive, for thus both would conspire to render the disease incurable. Some - patients, from ignorance of the present and what will come at last, are - content to live on with the disease. For since in most cases they do not - die, so neither do they fear death, nor, for this reason, do they entrust - themselves to the physician. Cephalæa, of which I am about to treat in the - first place, is a proof of these statements.

-
-
- - CHAPTER II. CURE OF CEPHALÆA. -

THE head, inasmuch as it is necessary towards life, - so is it also very dangerous in disease. And the onset of diseases about it - is quite tolerable, being attended with slight pain, noises in the ears, and - heaviness; but if they acquire increase, they become fatal at last. - Wherefore even slight pains should not be overlooked, and, in certain cases, - they have been cured by slight remedies. But if prolonged for a longer - space, as greater sufferings supervene, we must open the vein at the elbow. - But, for two days previous, the patient must get wine to drink, and the - quantity of blood abstracted must be regulated by the strength; and it is - best not to make the whole evacuation at once, so that the strength may bear - the amount thereof; and the disease is rather removed by the repetition of - the means. The same rule applies to all chronic diseases. During an interval - of three or four days, a fuller diet is to be given, and then the purgative - hiera is to be taken in a draught; for it, in an especial manner, draws the - pabulum of the disease from the head. The quantity of the medicine given is - to be to the amount of four or five drams. And if well purged, we are to - administer the bath, give wine, and improve the strength. Then again we are - to open the straight vein (temporal?) on the forehead, - for abstraction by it is most efficacious; the amount, about a hemina (half-pint?) or a little more. But we must not evacuate - further, for we must avoid emptying the vessels. Then, having removed the - hair with a razor, we are first to apply one cupping-instrument to the - vertex, and another between the scapulæ, without drawing blood; but along - with the instrument applied to the vertex,

- -

we are to scarify unsparingly, for the purpose of attracting the redundant - fluid and of making an incision in the deep-seated parts. For remedial means - applied even to the bones are beneficial in cephalæa. When the wounds are - cicatrised, we are to excise a portion of the arteries;See - Paulus Ægineta, b. vi. 5. (of these there are two, one behind the - ears, at a little distance from them, being obvious from their pulsations; - the others in front of the ear, and close to it, for they lie close to the - antitragus; and these also are discovered by their pulsations); we are to - incise the larger ones at the bones, for they afford relief. Adjacent to - them are others, very slender, which there is no benefit from excising. The - mode of operating has been described under operative surgery. This is the - great remedy in cephalæa, epilepsy, vertigo, and, in fine, in all the - diseases of the head.

-

In all cases we are to bring off phlegm, first evacuating the bowels, either - by a purgative draught, or by a clyster; and sometimes from the nostrils by - sternutatories; and sometimes from the mouth by sialogogues. Among the kinds - of sternutatories are pepper, the root of soapwort, and the testicle of the - beaver; these may all be used together; having levigated and sifted them, we - are to blow the powder in, either with a reed or the thick stalk of a goose - quill. Euphorbium is more active and stronger than these when mixed with any - of them. It is also mixed up with the oils, such as gleucinum, the Sicyonian, or the ointment from storax. It is made - into a liquid form as an injection, and it is injected by means of a nasal - pipe; the instrument consists of two pipes united together by one outlet, so - that we can inject by both at the same time. For to dilate each nostril - separately is a thing which could not be borne, as the head gets quickly - filled, and thus contracts a sharp pain. The medicines which evacuate phlegm - from the mouth are, mustard, the granum cnidium,

- -

pepper, stavesacre, these either together or separately; and one may - masticate these substances and spit out constantly; and give them mixed up - with water or honeyed-water, rinse the mouth, and press them back to the - tonsils with stretching of the neck, thus wash out along with the breath in - expiration;This is rather an obscure description of the - simple process of gargling. See the note of - Petit. and when you have evacuated phlegm as much as you think - proper, you must bathe and foment the head with a very large quantity of hot - water to promote perspiration, for the obstructions become strong.

-

Supper should be spare; but wine also is to be given, to restore the tone of - the stomach, for it also suffers in this complaint. When, in the meantime, - you have re-established the strength, you will require to give a common - clyster having sprinkled upon it much natron, or dissolving it in two drams - of the resin of the turpentine tree. On the next day we are to abstract - blood from the inside of the nostrils, and for this purpose push into them - the long instrument named Katidion, or the one named - Toryne, or, in want of these, we must take the - thick quill of a goose, and having scooped the nervous part of it into teeth - like a saw, we are to push it down the nostrils as far as the ethmoid cells, - then shake it with both hands so that the part may be scarified by its - teeth. Thus we shall have a ready and copious flow of blood; for slender - veins terminate there, and the parts are soft and easily cut. The common - people have many modes of scarification, by rough herbs, and the dried - leaves of the bay, which they introduce with the fingers and move - strongly.On this practice, see Paulus Ægineta, tom. i. p. - 326, Syd. Soc. Edit. Having evacuated to a sufficient amount--say - to the amount of half a hemina--we are to wipe the parts with sponges and - oxycrate, or blow in some styptic powder, gall, fissil alum, or the flower - of the wild pomegranate.

- -

Whether the pain remain, or cease after these things, we must go on to the - conclusion of the system of treatment; for the mischief is apt to return, - and frequently lurks in the seat of the disease. Wherefore, having removed - the hair with a razor (and this also is beneficial to the head), we are to - burn with heated cauteries, superficially, down to the muscles; or if you - wish to carry the burning to the bone, you must avoid the muscles, for the - muscles when burnt occasion convulsions. And if you burn superficially you - must foment the part with plenty of fragrant sweet wine, along with - rose-oil; a linen cloth wetted with this is to be spread over the eschars - until the third day. But, if the eschars be deep, having pounded the hairy - leaves of leeks with salt, and spread upon a linen rag, we are to apply it. - On the third day, we are to put the cerate from rose-oil upon the - superficial eschars, and lentil with honey upon the deeper. The medicinal - applications to be made to the wound will be described in another place. - Some have made an incision in the skin above the forehead, at the coronal - suture, down to the bone, and having scraped it, or cut out a portion down - to the diploe, have afterwards brought the part to incarnation. Some have - perforated the bone, even to the meningx. These are bold remedies, but are - to be used, if, after all, the cephalæa continue, and the patient be - courageous, and the tone of the body good.On this heroic method of treating diseases of the head, see - Paulus Ægineta, t.ii. pp. 248-250, and 258, Syd. Soc. Edit. Before - making trial of it, I would recommend the reader to consult the part of - De Haen's works there referred to.

-

But, if they progress gradually, they are to take exercises in the erect - state of the body for the benefit of the chest and shoulders; the chironomy,See Oribasius, vi. 30, and p.663, - ed. Bussemaker and Daremberg. the throwing of the halteres; leaping, and the well-regulated contortions of the body - accompanying

- -

it; friction, first and last of the limbs, of the head in the middle of the - process.

-

The process of pitchingSee Paulus Ægineta, t.i. p. 82, Syd. Soc. - Edit. is to be frequently applied to the head; and also - rubefacients, sometimes rubbing in mustard with double quantity of bread, so - that the heat may not be intolerable; and sometimes other medicines are to - be so used, like the compound from lemnestis, euphorbium, and pellitory. The - juice of thapsia, and the medicines made with it which produce swelling of - the skin, and an eruption resembling vari, are beneficial both for allaying - present pain and contributing to eradicate the evil.

-

The diet in both kinds of the complaint should be light; little drink, water - for drink, especially before giving any medicine; complete abstinence from - acrid things, such as onions, garlic, the juice of silphium, but not - altogether from mustard, for its acrimony, in addition to its being - stomachic, is not unpleasant to the head, dissolving phlegm, and exhaling or - discharging downwards. Of pulse, the worst is the common bean and its - species, the common peas, and the species called ochrys,The pisum ochrys. - and the common kidney-beans; next to them are the lentils, which have indeed - certain good properties for promoting digestion and secretion, but induce - fulness of the head and occasion pain; only when boiled with pepper they are - not to be rejected. Granulated spelt (alica) when - washed, is pleasant along with wine and honey, so as to sweeten, and, in - like manner, their soups, and with plain broths. The seeds of carui, - coriander, anise, and parsley, in the Lydian sauceSee Hesychius, - under KHRUKEI/A and -- KH, Athen. Deip. p. 516, Ed. Casaub. - are excellent. But, of these articles, the best are the herbs mint and - penny-royal, with the fragrant things which have some diuretic and - carminative properties. Of fleshes, all such

- -

as are old are bad; of the recently killed, that of the hen is good; of - birds, the wood pigeon, the common pigeon, and such others as are not very - fat; the extremities of the swine; the roasted hare; that of the ox and of - the sheep is incrassant and fills the head; the kid is not altogether bad. - Milk and cheese occasion headache. Of fishes, those found among rocks, and - those things that are best in each particular country. Of potherbs, such as - promote the urinary and alvine discharges, the mallow, the blite, the beet, - and asparagus; but the kale is also acrid. Among raw articles, the lettuce - is the best of all. Roots are bad, even when boiled, such as radishes, - navews, and parsnips, which are diuretic, but occasion repletion; the garden - parsnip indeed is flatulent and swells up the stomach. Wine which is white, - thin, and sweet, is to be admitted, if it have some astringency, so as not - to bind the bowels. All articles of the dessert occasion headache, except - dates of every species. In autumn the fig and grape are wholesome, and - whatever other fruit is very good at any particular season. Repletion of all - things, even of such as are proper, is bad; and so, also, indigestion is - bad. Lassitude is less injurious than indigestion, but still it is hurtful. - The morning walk after evacuation of the bowels, but so as not to affect the - breathing nor induce weariness; and it is also very good after supper. - Prolonged gestation, not exposed to wind or sun, is good for the head; but - the dog-star is bad for it. Sexual intercourse is a self-inflicted evil to - the head and nerves. A journey from a cold to a warmer climate, or from a - humid to a drier, is proper; also a sea-voyage, and passing one's life at - sea; and if one lives by the sea-side it is a good thing to bathe in the - sea-water, to tumble on the sands, and to reside close by the sea.

-

The remedies for heterocrania are the same; for it is - well to apply to a portion of the head the same remedies as are proper for - the whole of it. In all cases in which the disease is not

- -

removed by these means, we are to use hellebore, as being the last and most - potent of all methods of treatment.

-
-
- CHAPTER III. CURE OF VERTIGO. -

VERTIGO arises as the successor of cephalæa; but - also springs up as a primary affection from certain causes, as the - suppression of the hemorrhoidal flux; and if blood which used to flow from - the nose has ceased to flow; or if the body has not perspired properly, - either by sweating, or labour, when it had been used to labour. If then it - arise as the consequence of cephalæa, we must do for its cure those things - which have been described under cephalæa; and I will afterwards state - certain other more powerful means which must be tried ultimately. But if the - disease happen from the suppression of any of the humours, we must excite - the customary secretion; for the recurrence of nature promotes recovery. If - it be delayed, and the disease increases, in the other suppressions, those - by the nose or sweats, we are to open the vein at the elbow; but in plethora - of the liver, spleen, or any of the viscera in the middle of the body, - cupping affords relief, but as much blood as is taken from a vein, so much - is to be thus abstracted from them; for it is the nutriment of the exciting - cause, in like manner as the belly. After this the remedies of the head are - to be applied, opening the straight vein on the forehead, or those at the - canthi on either side of the nose; a cupping-instrument is to be fastened to - the vertex, the (temporal?) arteries are to be excised, - the head shaven, rubefacients applied to it, phlegm evacuated from the - nostrils by sternutatories, or from the mouth as I have stated--all these - things are to be

- -

done in the order described under cephalæa, except that the juice of - sow-bread or of pimpernel is to be used as an injection into the nose.

-

But when you have exhausted all the remedies for cephalæa, the more violent - means which are applicable for vertigo are to be used; we must use the - emetics after supper, and those from radishes, which is also required as a - preparation for the hellebore; for the stomach is to be trained beforehand - to the more violent emetics. But the phlegm now becomes thinner, and fit for - solution in the hellebore. There are several modes of giving the hellebore; - to the stronger sort of patients it is to be given to the size of a sesame,The sesamum - orientale, or oily-grain of the East. See Appendix to the - Edinburgh Greek Lexicon. or a little larger; or, in slices, with - washed chondrus or lentil, the dose, about two drams. In the case of feebler - and more slender persons, the decoction with honey, to the amount of two or - three spoonfuls, is to be given. The manner of preparing it will be - described else-where. In the interval between each remedy, the patient is to - be supported, in order that he may be able to endure what is to be given in - the intermediate periods.

-

The patient is to be assisted during the paroxysms thus:--The legs are to be - bound above the ankles and knees; and the wrists, and the arms below the - shoulders at the elbows. The head is to be bathed with rose-oil and vinegar; - but in the oil we must boil wild-thyme, cow-parsnip, ivy, or something such. - Friction of the extremities and face. Smelling to vinegar, penny-royal, and - mint, and these things with vinegar. Separation of the jaws, for sometimes - the jaws are locked together; the tonsils to be tickled to provoke vomiting; - for by the discharge of phlegm they are sometimes roused from their gloom. - These things, then, are to be done, in order to alleviate the paroxysm and - dispel the gloomy condition.

- -

With regard to the regimen during the whole period of the treatment and - afterwards, I hold as follows:--Much sleep is bad, and likewise - insomnolency; for truly much sleep stupefies the senses of the head. From a - redundance of vapours there is disinclination to every exertion; and these - are also the cause of the weight in the head, the noises, and the flashes of - light, which are the marks of the disease. Insomnolency induces dyspepsia, - atrophy, and wearies out the body; the spirits flag, and the understanding - is unsettled; and for these reasons such patients readily pass into mania - and melancholy. Moderate sleep is suitable for the proper digestion of the - food and refreshment from the labours of the day; care and perseverance in - these respects; and particular attention is to be paid to the evacuation of - the bowels, for the belly is the greater source of the bodily perspiration. - Next, friction of the limbs, by means of rough towels, so as to produce - rubefaction; then, of the back and sides; last, of the head. Afterwards, - exercise in walking, gentle at first and in the end; carried to running in - the middle; rest and tranquillity of the breathing (pneuma) after the walking. They are to practise vociferation, - using grave tones, for sharp occasion distension of the head, palpitation of - the temples, pulsatory movements of the brain, fulness of the eyes, and - noises in the ears. Sounds of medium intensity are beneficial to the head. - Then the season of gestation should be regulated so as to promote the - expulsion of the weight in the head; it should be prolonged, yet not so as - to induce fatigue; neither should gestation be made in tortuous places, nor - where there are frequent bendings of the road, for these are provocative of - vertigo. But let the walks be straight, long, and smooth. If then the - patients have been in the habit of taking lunch, we must only allow of a - little bread, so as to be no impediment to the exercises; for digestion - should take place previously. The head and the hands, and the frictions - thereof, are to be attended to; in the latter it

- -

is to be gently performed for the restoration of the heat, for plumpness, and - strength. Then the head is to be rubbed while the patient stands erect below - a person of higher stature than himself. Gymnastics skilfully performed - which tend to distension of the neck, and strong exercise of the hands. It - is proper, also, by raising the head, to exercise the eyes at chironomy, or at throwing the quoit, or contending at - boxing. The exercise both with the large and the small ball is bad, for the - rolling of the head and eyes, and the intense fixing of them, occasion - vertigo. Leaping and running are very excellent; for everything that is keen - is beneficial to the limbs, and gives tone to the general system.For an account of most of the ancient exercises mentioned by our - author, see Paulus Ægineta, t. i. p. 22--27, Syd. Soc. Edit. The - cold bath is better than no bath at all; no bath at all is better than the - hot bath: the cold bath is very powerful as an astringent, incrassant, and - desiccant of the head, which is the condition of health; while the warm bath - is most powerful to humectate, relax, and create mistiness; for these are - the causes of disease of the head, and such also are south winds, which - occasion dulness of hearing. There should be rest after exercises, to allay - the perturbation. Pinching of the head, even to the extent of producing - excoriation of the skin.

-

Whetters made of water, or of wine diluted with water, should be given before - a meal. Lunch should be slight: laxatives from the capillary leaves of - pot-herbs,--of mallow, of beet, and of blite. A condiment of a stomachic - nature, which is pleasant to the mouth, laxative of the bowels, and not - calculated to induce heaviness of the head, is made of thyme, or of savory, - or of mustard. Eggs, hot in winter, and cold in summer, stripped of their - shell, not roasted; olives, dates, pickled meat in season. Granulated spelt - washed, with some of the sweet things, so as to give it a relish, is to be - chosen; and, with

- -

these, salts. Solitude, rest as regards hearing and speaking. Promenades in a - well-ventilated place, rendered agreeable by trees or herbs. But if it be - come to supper-time, they are again especially to take the cold bath, having - been slightly anointed with oil; or, otherwise, the limbs only. The supper - should be of frumentaceous articles, such as pastry, or a soup from chondrus - (granulated spelt), or a carminative ptisan, rendered easy of digestion by - boiling. The medicines used for seasoning of the ptisan, pepper, - penny-royal, mint, a small proportion of onions or of leeks, not so much as - to float on the stomach; the acrid part of vinegar is suitable; of fleshes, - the parts of fat animals which are not fat; of swine, the feet and head; all - winged animals--you must select from the great variety of them what is - suitable; the hare and the other kinds of venison are proper; the hen is - easily procured, and suitable. All articles of the dessert create headaches, - except the date, or figs in the summer season, or the grape if the patient - be free from flatulence; and of sweetmeats, such as are well seasoned, - without fat, and light. Walking, exhilaration; in solitude, resignation to - sleep.

-
-
- CHAPTER IV. CURE OF EPILEPSY. -

OF remedies, whatever is great and most powerful is - needed for epilepsy, so as to find an escape not only from a painful - affection, and one dangerous at each attack, but from the disgust and - opprobrium of this calamity. For it appears to me, that if the patients who - endure such sufferings were to look at one another in the paroxysms, they - would no longer submit to live. But the want of sensibility and of seeing - conceals from

- -

every one what is dreadful and disgusting in his own case. It is best that - the method of cure should follow the alleviation of nature, when, with the - changes of age, she changes greatly the man. For if the diet akin to the - ailment, and on which the disease subsisted, be changed, the disease no - longer seizes the man, but takes its departure along with that in which it - delighted.See Hippocrat. Aph. ii. 45.

-

If, then, it seize on the head, it settles there; to it, therefore, we are to - do those things which have been described by me under cephalæa, regarding - the abstraction of blood (and also the purgings) from the veins at the - elbow, the straight vein at the forehead, and by cupping; but the - abstraction is not to be carried the length of deliquium animi; for - deliquium has a tendency to induce the disease; we are to open all the - ordinary arteries before and behind the ears, and we are also to practise - purgings, which are more potent than all these things, by the purgative hiera and those medicines which draw off phlegm from - the head; but the medicines should be particularly powerful, for the habit - of such persons renders them tolerant of pains, and their goodness of - spirits and good hopes render them strong in endurance. It is necessary, - also, to apply heat to the head, for it is effectual. In the first place, we - must perforate the bone as far as the diploe, and then use cerates and - cataplasms until the meninx separate from the bone. The exposed bones are to - be perforated with the trepan if still any small portion prevent its - spontaneous removal, when the meninx there is found black and thickened; and - when, having gone through the process of putrefaction and cleansing under - the bold treatment of the physician, the wound comes to complete - cicatrization, the patients escape from the disease. In all cases we are to - use rubefacient applications to the head; namely, the common ones, as - described by

- -

me formerly; and a still more powerful one is that from cantharides, but for - three days before using it the patient must drink milk as a protection of - the bladder, for cantharides are very injurious to the bladder. These are - the remedies when the head is the part affected.

-

But if the cause be seated in the middle parts, and if these induce the - disease (this, however, very rarely happens, for, as in a mighty ailment, - the middle parts of the body rather sympathise with the head, which is the - origin of the disease), but however it may be, we must open the vein at the - elbow in these cases also; for the flow by it is from the viscera. But such - patients, more than the others, are to be purged with the hiera, cneoron,The rock-rose, or Daphne cneorum, L. and the granum - cnidium,Seed of the Daphne - cnidium. See Paulus Ægineta, t. iii. p. 179. for these - are phlegmagogues. But the most suitable remedy in these cases is cupping. - Of epithemes and cataplasms the components are well known, and it would be - superfluous to describe them on all occasions, except in so far as to know - the powers of them; namely, that by such means we must attenuate, promote - exhalation, and render the secretions and perspirations healthy. We are also - to use digestive, heating, desiccant, and diuretic articles, both in food - and in medicine. But the best of all things is castor, taken frequently - during the month in honeyed-water, and the compound medicines which possess - the same powers, as the compound medicine from vipers, and the still more - complex one of Mithridates, and also that of Vestinus; for these things - promote digestion, form healthy juices, and are diuretic; for whatever - simple medicines you could describe are contained in these powerful - compositions -- cinnamon. cassia, the leaves of melabathrum, pepper, and all - the varieties of seseli; and which of the most potent medicines will you not - find in them? It is told, that the brain of a vulture, and the heart of a - raw cormorant, and the domestic weasel, when

- -

eaten, remove the disease; but I have never tried these things. However, I - have seen persons holding a cup below the wound of a man recently - slaughtered, and drinking a draught of the blood! O the present, the mighty - necessity, which compels one to remedy the evil by such a wicked - abomination! And whether even they recovered by this means no one could tell - me for certain. There is another story of the liver of a man having been - eaten. However, I leave these things to be described by those who would bear - to try such means.

-

It is necessary to regulate the diet, in respect to everything that is to be - done either by others or by the patient himself. Now nothing must be - omitted, nor anything unnecessarily done; and more especially we must - administer everything which will do the slightest good, or even that will do - no harm; for many unseemly sights, sounds, and tastes, and multitudes of - smells, are tests of the disease. Everything, therefore, is to be - particularly attended to. Much sleep induces fatness, torpor, and mistiness - of the senses, but moderate sleep is good. An evacuation of the bowels, - especially of flatulence and phlegm, is very good after sleep. Promenades - long, straight, without tortuosities, in a well ventilated place, under - trees of myrtle and laurel, or among acrid and fragrant herbs, such as - calamint, penny-royal, thyme, and mint; so much the better if wild and - indigenous, but if not, among cultivated; in these places, prolonged - gestation, which also should be straight. It is a good thing to take - journeys, but not by a river side, so that he may not gaze upon the stream - (for the current of a river occasions vertigo), nor where he may see - anything turned round, such as a rolling-top, for he is too weak to preserve - the animal spirits (pneuma) steady, which are, - therefore, whirled about in a circle, and this circular motion is - provocative of vertigo and of epilepsy. After the gestation, a gentle walk, - then rest so as to induce tranquillity of the agitation created by the - gestation. After these, the exercises

- -

of the arms, their extremities being rubbed with a towel made of raw flax. - Not much oil to be used in the inunction. The friction to be protracted, and - harder than usual for condensation, since most of them are bloated and fat: - the head to be rubbed in the middle of the process, while the patient stands - erect. The exercises of the neck and shoulders, chironomy, and the others mentioned by me under the treatment of - Vertigo, with sufficient fulness of detail; only the exercises should be - sharper, so as to induce sweat and heat, for all these attenuate. During the - whole of his life he should cultivate a keen temper without - irascibility.

-

All kinds of food derived from gross pulse are bad; but we are to give - frumentaceous things, the drier sorts of bread, washed alica, and the drinks - prepared from them. The medicines added for relish the same as before; but - there should be more of acrid things, such as pepper, ginger, and lovage. - Sauces of vinegar and cumin are both pleasant and useful. From fleshes in - particular the patient is to be entirely restricted, or at least during the - cure; for the restoration, those things are to be allowed which are - naturally light, such as all sorts of winged animals, with the exception of - the duck, and such as are light in digestion, such as hares, swines' feet, - and pickled fish, after which thirst is good. A white, thin, fragrant, and - diuretic wine is to be drunk in small quantity. Of boiled pot-herbs, such as - are possessed of acrid powers, attenuate and prove diuretic, as the cabbage, - asparagus, and nettle; of raw, the lettuce in the season of summer. The - cucumber and ripe melon are unsuitable to a strong man; but certain persons - may have just a tasting of them. But being of a cold and humid nature, much - of them is bad. The seasonable use may be granted of the green fig and the - grape. Promenades; after these, recreation to dispel grief.

-

Passion is bad, as also sexual enjoyment; for the act itself bears the - symptoms of the disease. Certain physicians have

- -

fallen into a mistake respecting coition; for seeing that the physical change - to manhood produces a beneficial effect, they have done violence to the - nature of children by unseasonable coition, as if thus to bring them sooner - to manhood. Such persons are ignorant of the spontaneous law of nature by - which all cures are accomplished; for along with every age she produces that - which is proper for it in due seasons. At a given time there is the maturity - of semen, of the beard, of hoary hairs; for on the one hand what physician - could alter Nature's original change in regard to the semen, and, on the - other, the appointed time for each? But they also offend against the nature - of the disease; for being previously injured by the unseasonableness of the - act, they are not possessed of seasonable powers at the proper commencement - of the age for coition.

-

The patients ought to reside in hot and dry places, for the disease is of a - cold and humid nature.

-
-
- CHAPTER V. CURE OF MELANCHOLY. -

IN cases of melancholy, there is need of - consideration in regard to the abstraction of blood, from which the disease - arises, but it also springs from cacochymy in no small amount thereof. When, - therefore, the disease seizes a person in early life, and during the season - of spring we are to open the median vein at the right elbow, so that there - may be a seasonable flow from the liver; for this viscus is the fountain of - the blood, and the source of the formation of the bile, both which are the - pabulum of melancholy. We must open a vein even if the patients be spare and - have deficient blood, but abstract little, so that the strength may feel the - evacuation

- -

but may not be shaken thereby; for even though the blood be thick, bilious, - coagulated, and black as the lees of oil, yet still it is the seat and the - pabulum of Nature. If, then, you abstract more than enough, Nature, by the - loss of nourishment, is ejected from her seat. But if the patient has much - blood, for the most part in such cases it is not much vitiated, but still we - must open a vein, and not abstract all the blood required the same day, but - after an interval, or, if the whole is taken the same day, the strength will - indicate the amount. During the interval, the patient is to be allowed a - fuller diet than usual, in order to prepare him for enduring the evacuation; - for we must assist the stomach, it being in a state of disease, and distress - from the black bile lodging there. Wherefore, having kept the patient on a - restricted diet for one day previously, we must give black hellebore to the - amount of two drams with honeyed-water, for it evacuates black bile. And - likewise the capillary leaves of Attic thyme, for it also evacuates black - bile. But it is best to mix them together, and give a part of each, to the - amount of two drams altogether. After the purging we are to administer the - bath, and give a little wine and any other seasoner in the food; for purging - fatigues the powers of the stomach. We are, then, to come down to the middle - parts, and having first relaxed by cataplasms and bathing, we are to apply a - cupping-instrument over the liver and stomach, or the mouth of it; for this - evacuation is much more seasonable than venesection. We are also to apply it - to the back between the scapulæ, for to this place the stomach is adjacent. - Then again we are to recruit; and if the strength be restored by the - regimen, we are to shave the head, and afterwards apply the - cupping-instrument to it, for the primary and greatest cause of the disease - is in the nerves. But neither are the senses free from injury, for hence are - their departure and commencement. Wherefore these also are changed, by - participating in the affection. Some, likewise,

- -

from alienation of the senses have perverted feelings. It is necessary, then, - especially to cure the stomach as being disordered of itself, and from black - bile being lodged in it. Wherefore we must give to drink continuously of the - juice of wormwood from a small amount to a cupful (cyathus), for it prevents the formation of bile. Aloe also is a - good thing, for it brings down the bile into the lower gut. If, then, the - disease be of recent origin, and the patient be not much changed, he will - require no other treatment in these circumstances. There is a necessity, - however, for the remaining part of the regimen to the restoration of the - habits, and the complete purification of the affection, and the - strengthening of the powers, so that the diseases may not relapse. I will - explain afterwards the course of life during convalescence.

-

But if the disease, having yielded a little to these means, should be seen - relapsing, there will be need of greater remedies. Let there, then, be no - procrastination of time, but if the disease appear after suppression of the - catamenial discharge in women, or the hemorrhoidal flux in men, we must - stimulate the parts to throw off their accustomed evacuation. But if it is - delayed and does not come, the blood having taken another direction, and if - the disease progress rapidly, we must make evacuations, beginning from the - ankles. And if you cannot get away from this place so much blood as you - require, you must also open the vein at the elbow. And after pursuing the - restorative process for three or four days, we are to give the purgative - medicine, the hiera. Then we are to apply the cupping-instrument to the - middle parts of the body, bringing it near to the liver, and do those things - which speedily prove effectual; for melancholy does not yield to small - remedies, and, if long continued, it remains fixed in a spot. And if the - disease lodge in all parts of the body,--in the senses, the understanding, - the blood, and the bile,--and if it seize on the nerves, and turn to an - incurable

- -

condition, it engenders in the system a progeny of other diseases,--spasms, - mania, paralysis. And if they arise from melancholy, the newly-formed - diseases are incurable. Wherefore we are to use hellebore for the cure of - the ailment. But before the administration of the hellebore, we must train - the stomach to vomiting, attenuate the humours, and render the whole system - freely perspirable; emetics will accomplish these things sometimes those - which are given with an empty stomach, and sometimes those which consist of - radishes. I will describe the mode and materials of it; and I will also - describe the species of hellebore and the modes of using it; and how we - ought to judge of everything beforehand, and how to render assistance during - the operation of the emetics. It cannot be doubted that by these means the - disease has either been entirely removed or had intervals of several years. - For generally melancholy is again engendered. But if it be firmly - established, we are no longer to hesitate, but must have recourse to - everything relating to the hellebore. It is impossible, indeed, to make all - the sick well, for a physician would thus be superior to a god; but the - physician can produce respite from pain, intervals in diseases, and render - them latent. In such cases, the physician can either decline and deny his - assistance, alleging as an excuse the incurable nature of the disease, or - continue to the last to render his services. The hiera from aloe is to be - given again and again; for this is the important medicine in melancholy, - being the remedy for the stomach, the liver, and the purging of bile. But - experience has proved, that the seed of mallow, to the amount of a dram, - when taken in a drink with water answers excellently. But there are many - other simple medicines which are useful, some in one case, and some in - another.

-

After these sufferings, the patient is to be recruited. For, in certain - cases, during the time of this treatment, the disease has been removed; but - if the patient come to a renewal of his

- -

flesh and of his strength, all traces of the disease become eradicated. For - the strength of nature produces health, but her weakness, disease. Let the - patient, then, proceed to the process of restoration by frequenting the - natural hot baths; for the medicinal substances in them are beneficial, such - as bitumen, or sulphur, or alum, and many others besides these which are - possessed of remedial powers. For, after the parching heat of the disease, - and the annoyance of the treatment, dilution is a good thing. Moreover, rare - and soft flesh most readily throws off the disease; but in melancholy the - flesh is dry and dense. An oily liniment, by gentle friction, with much oil - containing . . . . . . . . . . . . washed bread, with something sweet, as - the Cretan must, and the Scybelitic from Pamphylia, or wine and honey which - have been mixed up together for some time. Eggs, both cold and hot, which - have been stripped of their shells. Of fleshes, such as are not fatty, and - are detergent. Of swine, the feet and the parts about the head. Of fowls, - the wings, which are not fatty. Of wild animals, hares, goats, and deer. Of - autumnal fruits, whatever is excellent in its kind. When the stomach rejects - the food, we must consider beforehand that what is taken be not vomited up. - Wherefore, before giving food, we are to administer honeyed-water to the - amount of half a cyathus, which, being drunk, is vomited up again for - cleansing the stomach. For, in this way, the food remains in the stomach. - Medicines which are purgative of the necessary discharges are--the fruit of - the pine, of the nettle, and seeds of the coccalus,Galen identifies the KO/KKALOS of Hippocrates (de vict. - Acut.) with KW=NOS, or the - fruit of the pinus pinea. Our author would seem to - make them distinct substances. There being several species of the pine - tribe, it is not always easy to distinguish them from one - another. and pepper; bitter almonds; and let honey give it - consistence. But if you wish to dry, the best thing is myrrh, or the root of - iris, the medicine from vipers, and that of Vestinus, of Mithridates, - and

- -

many others. For the epithemes, the materiel of - cataplasms, melilot and poppies, and the tear (gum?) of turpentine, and - hyssop, and the oil of roses, or of vine-flowers; wax should give - consistence to all these. Liniments of oil; gestation, promenades, and - whatever promotes the reproduction of flesh, and the strength of the powers, - and the restoration of nature to its pristine state of * * * * * * * * * * * - * * * * * * * * * * * * * * * *

-
-
- CHAPTER VIII. CURE OF PHTHISIS. -

. . . . . as in a ship and in a calm. And if the patient have it fortunately - at his command, gestation and living on the sea will be beneficial. For the - sea-water contributes something desiccant to the ulcers. After the - gestation, having rested, the patient is now to be anointed with fat oil. - After the frictions . . . . . . . . . . . from a small dose gradually up to - five or six heminæ, or even much more; or if not, as much as one can, for - often this alone sufficeth in place of all food. For milk is pleasant to - take, is easy to drink, gives solid nourishment, and is more familiar than - any other food to one from a child. In colour it is pleasant to see: as a - medicine it seems to lubricate the windpipe, to clean, as if with a feather, - the bronchi, and to bring off phlegm, improve the breathing, and facilitate - the discharges downwards. To ulcers it is a sweet medicine, and milder than - anything else. If one, then, will only drink plenty of this, he will not - stand in need of anything else. For it is a good thing that, in a disease, - milk should prove both food and medicine. And, indeed, the races of men - called Galactophagi

- -

use no food from grain. But yet it is a very good thing to use porridge, - pastry, washed groats of spelt (alica), and the other - edibles prepared with milk. And if other food is required, let it be of the - same nature, as the juice of ptisan, well-concocted and plain; but it is to - be so seasoned as that it may become easy to swallow; or if anything be - added as a seasoner, let it be something medicinal, as the hair (capillary leaves?) of lovage, penny-royal, mint, and a - little of salts, vinegar, or honey. If the stomach suffer from dyspepsia, - this is to be given; but if there be no such necessity, ptisan is of all - things the best. One may also change the ptisan for alica, for this is less - flatulent, and of easier digestion, and becomes detergent if, when used in - the ptisan, the grain be bruised. When the sputa are unusually fluid, the - bean cleanses the ulcers, but is flatulent. The pea and the pisum ochrys, in so far as they are less flatulent, are in the - same degree inferior as cleansers of the ulcers. Forming a judgment, then, - from present symptoms, select accordingly. Their condiments are to be such - as described respecting the ptisan. Eggs from the fire, in a liquid state, - but hot; they are best when newly laid, before the * * * * * * * * * * * * * - * * * * * * * * *

-
-
- CHAPTER XIII. CURE OF THE LIVER. -

. . . in the liver the ulcer may be dangerous. But the most troublesome is a - defluxion of pus on the stomach, when it makes the stomach its route in the - course of being distributed upwards. For the food is the cause of life, but - the stomach is

- -

the leader in the process of nutrition, and it also sometimes conveys - medicines to the internal parts. If, then, in addition to all the other - evils, a difficulty of deglutition come on, the patient must speedily die of - disease and famine. But the indications by which it is discovered in what - direction the pus will be diverted are diversified. If it pass by the - intestines, there are tormina, watery discharges from the bowels, phlegm, - and bile; then clots of blood floating in a fluid, or a thin discharge like - the washings of raw flesh. But, if it pass by the bladder, there is a weight - in the kidneys and loins; at first, therefore, the evacuations are copious, - and tinged with bile; then turbid, which do not deposit their sediment, nor - get settled. In all cases the sediment should become white. But if it be - determined upwards to the stomach, nausea, loss of appetite, vomitings of - phlegm or of bile, deliquium, and vertigo supervene, until it burst.

-

This, then, is to be especially avoided, as being a bad course. But if the - defluxion of pus be more violent, we must take every means, assisting the - stomach by food, and medicines, and regimen, all in a mild way. We must - administer the medicines for bursting the abscess; give to drink of the herb - hyssop with honeyed-water, and the juice of the hair of horehound, and this - with honeyed-water and the juice of the wormwood. These things must be given - before food to dilute the fluids, to lubricate the parts, and facilitate the - rupture of the abscesses. We are also to give the milk of an ass, which is - soft, not bilious, nutritious, does not admit of being made into cheese, - which is the perfection of milk. We should gratify the patient in regard to - food and drink. And we are even to give things inferior to other more - beneficial articles (for we thereby afford a passage to the fluid which - occasions nausea and loathing of food, and many are hurt by the transit of - the pus), lest they should come to loathe their food. And if they should - take anything, they readily

- -

vomit. It is necessary, also, in the other defluxions, to have especial care - of the stomach, for it is the passage to all sorts of medicine. It is - necessary to keep in mind the liver, which is the root of the - ulcerations.See the note on the text. The sense would be - evidently much improved by reading "blood-vessels" in place of - "ulcerations." But if the defluxion be to the bladder, we are to - promote it by diuretics, as the root of asarabacca, valerian, maiden-hair, - spignel, in drinks; for these things are to be given to drink in - honeyed-water. The compound medicine of Vestinus is also very good, and that - from alkekengi, and such others as from trial have acquired reputation. But - if you determine to draw off the discharge by the bowels, you can do this - with milk, especially that of the ass, or otherwise of the goat or sheep. - Give, also, juices of a lubricating nature and detergent, as the juice of - ptisan; condiments, as pepper, ginger, and lovage. In a word, with regard to - every method of diet in any case of abscess tending to rupture, the food - should consist of things having wholesome juices, of savoury things, things - of easy digestion, either juices, or the gruels with milk, starch, pastry - with milk * * * * * * * * * * *

-
-
- CHAPTER XIV. CURE OF THE SPLEEN. -

RESOLUTION of scirrhus of the spleen is not easy to - accomplish. But if the diseases engendered by it come on, as dropsy and - cachexia, the ailment tends to an incurable condition . . . . . . . the - physician to cure the scirrhus; we must try then to avert it when it is - coming on, and to remove it when just commencing; and attend to the - inflammations, and if the

- -

scirrhus be the substitute . . . . . . . . are brought by suppuration . . . . - . the abscess. For these, if the inflammation . . . . . we are to use the - remedies described by me among the acute diseases. But if, while you are - doing everything, the scirrhus remain in an inflammatory state, you must use - also the means resembling fire to soften the hardness; lotions of vinegar, - oil, and honey; but, instead of wool, use compresses of linen; add to them, - in powder, nut-ben sifted; and to the most emollient cataplasms * * * * * * - * * * * * *

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- - OF ARETÆUS, THE CAPPADOCIAN, ON THE THERAPEUTICS OF CHRONIC DISEASE BOOK - II. -

* * * * * * * *

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- CHAPTER II. CURE OF DIABETES. -

THE affection of diabetes is a species of dropsy, - both in cause and in condition, differing only in the place by which the - humour runs. For, indeed, in ascites the receptacle is the peritonæum, and - it has no outlet, but remains there and accumulates. But in diabetes, the - flow of the humour from the affected part and the melting are the same, but - the defluxion is determined to the kidneys and bladder; and in dropsical - cases this is the outlet when the disease takes a favourable turn; and it is - good when it proves a solution of the cause, and not merely a lightening of - the burden. In the latter disease the thirst is greater; for the fluid - running off dries the body.

- -

But the remedies for the stoppage of the melting are the same as those for - dropsy. For the thirst there is need of a powerful remedy, for in kind it is - the greatest of all sufferings; and when a fluid is drunk, it stimulates the - discharge of urine; and sometimes as it flows off it melts and carries away - with it the particles of the body. Medicines, then, which cure thirst are - required, for the thirst is great with an insatiable desire of drink, so - that no amount of fluid would be sufficient to cure the thirst. We must, - therefore, by all means strengthen the stomach, which is the fountain of the - thirst. When, therefore, you have purged with the hiera, use as epithemes - the nard, mastich, dates, and raw quinces; the juice of these with nard and - rose-oil is very good for lotions; their pulp, with mastich and dates, form - a cataplasm. And the mixture of these with wax and the nard ointment is - good; or the juice of acacia and of hypocistis, both for lotions and - cataplasms.

-

But the water used as drink is to be boiled with autumn fruit. The food is to - be milk, and with it the cereals, starch, groats of spelt (alica), gruels. Astringent wines to give tone to the stomach, and - these but little diluted, in order to dissipate and clear away the other - humours; for thirst is engendered by saltish things. But wine, which is at - the same time astringent and cooling, proves beneficial by inducing a change - and good temperament; for to impart strength, sweet wine is like blood, - which also it forms. The compound medicines are the same, as that from - vipers, the Mithridate, that from autumn fruit, and the others which are - useful in dropsy. But the whole regimen and course of life is the same.

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- - CHAPTER III. CURE OF CALCULUS AND ULCERATION OF THE KIDNEYS. -

WHATEVER relates to inflammation, hemorrhage, and - such other affections about the kidneys as quickly prove fatal, has been - treated of under the Acute Diseases. But regarding ulceration thereof, and - the formation of stones, and the many other affections which accompany old - persons until death, I am now especially to treat, mostly in order to effect - their cure; but, if not, to show how they may be alleviated.

-

Wherefore, then, it is impossible to eradicate the disposition to form - stones. It were easier to render the uterus unfruitful, than to destroy the - tendency to engender stones in kidneys wherein it is already formed. We must - strive, then, to facilitate the passage of them. If, therefore, the calculi - be fixed in a place, I will tell what the remedies are which facilitate - their passage; for they are attended with great pain, and sometimes patients - die with tormina, volvulus of the colon, and retention of urine; for the - kidneys and colon are adjacent to one another. Wherefore if there be a - stoppage of the stones, and, along with it, retention of urine and tormina, - we are to open the vein at the ankle, on the same side as the kidney - affected; for the flow of blood from the kidneys relieves the constriction - of the calculi, for inflammation detains them by binding all the parts; and - an evacuation of the vessels produces resolution of the inflammation. We are - also to bathe the loins where the region of the kidneys is placed. Let the - oil which is used either be old, or if recent, let rue be boiled in it. The - hair of dill is also diuretic, and rosemary, and marjoram. With these you - are to bathe the parts as if with plain water; for mere inunction is a small - affair. But you are also to foment with these things,

- -

by means of the bladders of cattle filled with the oil of camomile. The - materials of the cataplasms along with meal are to be the same. Dry-cupping - also has sometimes removed the stoppage of the stones; but in the case of - inflammation, it is best to have recourse to scarifications. If, when you - have done these things, the calculi still remain fixed, you must place the - patient in a bath of oil: for this at once fulfils every indication, it - relaxes by its heat, in so far lubricates; while its acrimony stimulates to - a desire of making water. These are the means which contribute to the - expulsion of calculi. The patient is to take drinks prepared from the roots - of certain simple medicines, as valerian, spignel, and asarabacca; and - herbs, the prionitis, parsley, and water-parsnip: and - of compounds such ointments as contain nard, cassia, myrrh, cinnamon * * * * - * * * * * for the cicatrization mustard, and eschars produced by fire, and - epithemes as formerly described by me. A regulated diet, unction with oil, - sailing and living on the sea,--all these things are remedies for affections - of the kidneys. * * * * * * * *

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- CHAPTER V. CURE OF GONORRHŒA. -

FROM the unseemly nature of the affection, and from - the danger attending the colliquative wasting, and in consideration of the - want of it for the propagation of the species, we must not be slow to stop a - flow of semen, as being the cause of all sorts of evil. In the first place, - therefore, we are to treat it like a common defluxion, by astringents - applied to the parts about the bladder and the seat of the flux, and with - refrigerants

- -

to the loins, groin, genital parts, and testicles, so that the semen may not - flow copiously; and then again, apply calefacients to the whole system, so - as to dry up the passages; this is to be done by styptics and lotions; wool - then from the sheep with its sordes, and for oil, the rose ointment, or that - from vine flowers, with a light-coloured and fragrant wine; but, gradually - warming, by means of common oil, and melilot boiled with it, and marjoram, - and rosemary or flea-bane; and a very excellent thing is the hair of dill, - and still more, the rue. Use these for the cataplasms, with the meal of - barley and vetches, and of hedge-mustard seed, and natron; but honey is to - be added, so as to make all combine and mix together. Such also are the - cataplasms which redden, and raise pustules, and thereby produce derivation - of the flux, and warm the parts. Such is the Green plaster, and that from - the fruit of the bay. Frequent draughts too are to be given, prepared from - castor and winter cherry,Physalis - alkekengi. See under STRU/XNOS, in Appendix to the Edinburgh Greek - Lexicon. to the amount of one dram, and the decoction of mint; of - compounds, that from the two peppers, that of Symphon, that of Philo, the - liquid medicine from the wild creature the skink, that of Vestinus, that - from the reptiles the vipers. Every attention is to be paid to diet, and he - is to be permitted and encouraged to take gymnastics, promenades, and - gestation; for these things impart warmth to the constitution, which is - needed in this affection. And if the patient be temperate as to venereal - matters, and take the cold bath, it may be hoped that he will quickly - acquire his virility.

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- - CHAPTER VI. CURE OF STOMACHICS. -

IN the other affections, after the treatment, the - diet contributes to the strength and force of the body, by good digestion; - but in stomachics alone it is at fault.Although Ermerins thinks - otherwise, I must say I agree with Wigan, that something is wanting near - the beginning of this chapter. How it should be, I will now - declare. For gestation, promenades, gymnastics, the exercise of the voice, - and food of easy digestion, are sufficient to counteract the vitiated - appetite of the stomach; but it is impossible that these things could remove - protracted indigestion, and convert the emaciated condition of the body to - embonpoint. But in these cases, much more than - usual, the patients should be indulged, and everything done towards them - liberally, the physician gratifying their appetites whenever the objects of - them are not very prejudicial; for this is the best course, provided they - have no desire of those things which would do them much good. Medicines are - to be given in the liquid form--decoctions, as of wormwood; and nard - ointment and the Theriac, and the fruit of stone-parsley, and of ginger, and - of pepper, and of hartwort;Tordyllium - officinale. these things are of a digestive nature. And - an epitheme is to be applied to the breast for the purpose of astringency, - containing nard, mastich, aloe, the acacias, and the juice of quinces, and - the pulps of the apples bruised with dates, so as to form an astringent - epitheme. Also such other things as have been enumerated by me under - diabetes, for the cure of the thirst. For the same causes produce thirst in - them, and yet in stomachics the tone of the stomach is not inclined to - thirst.

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- - CHAPTER VII. CURE OF CŒLIACS. -

IF the stomach be irretentive of the food, and if - it pass through undigested, unchanged and crude, so that nothing ascends - into the body, we call such persons cœliacs; being - connected with refrigeration of the innate heat which performs digestion, - along with atony of the faculty of distribution.

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In the first place then, the stomach is to be relieved from its sufferings by - rest and abstinence from food, for in this way the natural powers are - restored. And if there also be a feeling of fulness in the stomach, we are - to administer emetics, in the fasting state, with water or honeyed-water; - and the abdomen is to be enveloped and bathed, for the purpose of - astringency, with unwashed wool from the sheep, with oily things, as the unguentum rosaceum, œnanthemum, and melinum, or what is best, with that from the lentisk, with - hypocistis and the unripe grape.For all these compositions, see - Paulus Ægineta, t. iii. pp. 589-599, Syd. Soc. Edit. But, along - with these, cataplasms, hot to the touch, but astringent in powers. And if - there be distension or inflammation anywhere about the liver or mouth of the - stomach, we are to apply the cupping-instrument, and scarify; and there are - cases in which this alone is sufficient. But when, by means of cerates, the - wounds have cicatrised and ended in hardness, we are to apply leeches to it, - then digestive epithemes, such as that from seeds, if you possess the root - of the chamæleon. The best thing here is the fruit of the bay, and the - Malagma by name the Green, and mine--the Mystery. For these soften, - irritate, rouse heat, discuss flatulence of the bowels, of which there is - need for the sake of astringency. But likewise mustard, lemnestis, - euphorbium, and all such

- -

prevent refrigeration indeed, and procure resuscitation of the heat. Such - medicines also the patient must drink for astringency. In the first place, - there is need . . . . . . . . . . the juice of plaintain with water made - astringent by myrtles or quinces. The stone of an unripe grape is also a - very good thing, and wines of a very astringent character. Then the - medicines which warm the bowels, namely such potions as are made with - ginger, and pepper, and the fruit of the wild parsley which is found among - rocks, and the very digestive medicine made from the reptiles the vipers. - But if it does not yield at all or slightly to these means, use emetics from - radishes; and if you will put into them the root of the white hellebore, for - a single night, the purging will thus become very strong, for purging away - and removing the cold humours and for kindling up the heat.

-

And likewise the diet and manner of life should be moderate. Sleep by night, - by day walks, vociferation, gestation among myrtles, bays, or thyme; for the - exhalation and respiration of such things prove a digestive remedy. - Gymnastics, friction, chironomy, exercises of the chest and abdomen by - throwing the halteres. Propomata; for bread alone - contributes little towards strength. After these, rubefacients, walking * * - * * * * * * * * * * * * * * * * * * * * * * *

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- CHAPTER XII. CURE OF ARTHRITIS AND ISCHIATIC DISEASES. -

. . . . . . from food and radishes frequently. Then to have recourse to the - hellebore. The diet after these the same as

- -

in the other affections, and after the diet, anointing with oil and the cold - sea-bath. These in an especial manner are the common remedies in all - arthritic diseases, for in gouty cases hellebore is the great remedy, yet - only in the first attacks of the affection. But if it has subsisted for a - long time already, and also if it appear to have been transmitted from the - patient's forefathers, the disease sticks to him until death. But for the - paroxysms in the joints, we are to do this: let unscoured wool from the - sheep be applied; bathe with rose-oil and wine; and in certain case sponging - with oxycrate has done good. Then as a cataplasm, bread with the cooling - parts of gourd and pompion, and simple cucumber, and the herb plantain and - rose leaves. And the sideritisSideritis scordioides. mitigates pain, along - with bread, also lichen, and the root of comfrey, and the herb cinque-foil, - and the species of horehound having narrow leaves: of this the decoction - makes a fomentation which allays pain, and it forms a cataplasm with crumbs - of bread or barley-meal. And the part of citrons which is not fit for food, - is excellent with toasted barley-meal. Dried figs and almonds with some of - the flours. These form the materiel for refrigeration; - and, indeed, this is sometimes beneficial to one, and sometimes to another. - In certain cases calefacients are beneficial, and the same is sometimes - useful to another. It is said that the following application is powerfully - anodyne; let a goat feed on the herb iris, and when it is filled therewith, - having waited until the food it has taken be digested in the stomach, let - the goat be slaughtered, and bury the feet in fæces within the belly. The - medicines for the disease are innumerable; for the calamity renders the - patients themselves expert druggists. But the medicines of the physicians - will be described in works devoted to these things.

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- - CHAPTER XIII. CURE OF ELEPHAS. -

THE remedies ought to be greater than the diseases, - for the relief of them. But what method of cure could be able to overcome - such a malady as elephas? For the illness does not attack one part or - viscus, nor prevail only internally or externally, but inwardly it possesses - the whole person, and outwardly, covers the whole surface--a spectacle - unseemly and dreadful to behold! for it is the semblance of the wild animal. - And, moreover, there is a danger in living or associating with it no less - than with the plague, for the infection is thereby communicated by the - respiration. Wherefore what sufficient remedy for it shall we find in - medicine? But yet it is proper to apply every medicine and method of diet, - -- even iron and fire, -- and these, indeed, if you apply to a recent - disease there is hope of a cure. But if fully developed, and if it has - firmly established itself in the inward parts, and, moreover, has attacked - the face, the patient is in a hopeless condition.

-

Wherefore we are to open the veins at the elbow, and on both sides; and also - those at the ankles, but not the same day, for an interval is better both in - order to procure a greater flow of blood, and for the resuscitation of the - strength; for it is necessary to evacuate the blood frequently and - copiously, as being the nutriment of the disease, but the good portion of it - which is the natural nourishment is small. Wherefore while abstracting the - vitiated portion, consisting of melted matters, we must form an estimate of - the suitable part mixed up with it, until the disease has given way from - want of pabulum; for the new part being incorporated with the body, in the - course of a long time, obliterates the old. Then we are to

- -

give the hiera in a potion not once only, but let everything be done several - times after recovery and recurrence. And let the other medicinal purgation - by the food be practised; and let the treatment be that which I have - described under Ischiatic disease, and let the patient drink undivided - milk--and that in great quantity--for opening the bowels. Let it receive the - fifth part of water, so that the whole of the milk may pass through. They - are quickly to be treated with emetics, at first those given when fasting, - next, those after food, then those by radishes. Let all things be done - frequently and continuously; administering the hellebore at all seasons, but - especially in spring and autumn, giving it every alternate day, and again - next year. And if the disease has acquired strength, we must give whatever - liquid medicines any one has had experience of; for it is a good thing to - administer medicines frequently as a remedy. And I will now describe those - with which I am acquainted. Mix one cyathus of cedriaProbably - gum vernix. See Paulus Ægineta, t. iii. p. - 452. and two of brassica, and give. Another: Of the juice of - sideritis,Probably the sideritis scordioides - L. See Appendix to Dunbar's Lexicon in - voce. of trefoil one cyathus, of wine and honey two - cyathi. Another: Of the shavings of an elephant's tooth one dram with wine, - to the amount of two cyathi. But likewise the flesh of the wild reptiles, - the vipers, formed into pastils,Or Troches. See Paulus Ægineta - t. iii. p. 535. are taken in a draught. From their heads and tail - we must cut off to the extent of four fingers' breadth, and boil the - remainder to the separation of the back-bones; and having formed the flesh - into pastils, they are to be cooled in the shade; and these are to be given - in a draught in like manner as the squill. The vipers, too, are to be used - as a seasoner of food at supper, and are to be prepared as fishes. But if - the compound medicine from vipers be at hand, it is to

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be drunk in preference to all others, for it contains together the virtues of - all the others, so to cleanse the body and smooth down its asperities. There - are many other medicines . . . . . . of the Celts, which are men called - Gauls, those alkaline substances made into balls, with which they cleanse - their clothes, called soap, with which it is a very excellent thing to - cleanse the body in the bath. And purslain and houseleek with vinegar, and - also the decoction of the roots of dock with the sulphur vivum proves an - excellent detergent. The compound medicine from levigated alcyonium,A marine zoophyte. See Appendix to the Edinburgh Greek Lexicon, - and Paulus Ægineta, tom. iii., Syd. Soc. Ed. natron, the burnt - lees of wine, alum, sulphur vivum, costus, iris, and pepper, these things - are all to be mixed together in each case according to the power, but in - proportionate quantities, and this compound is to be sprinkled on the body - and rubbed in. For the callous protuberances of the face, we are to rub in - the ashes of vine branches, mixed up with the suet of some wild animal, as - the lion, the panther, the bear; or if these are not at hand, of the - barnacle goose;See Appendix to the Edinburgh Greek Lexicon in - NH=SSA: also Aristot. H. N. viii. - 5, and Ælian. N. A. v. 30. The remark which follows turns on this point, - that the bird in question called the XHNALW/PHX, is to quadrupeds what the ape is to man. See - the ingenious observations of Petit. for like in the unlike, as - the ape to man, is most excellent. Also the ammoniac perfume with vinegar - and the juice of plantain, or of knot-grass, and hypocistis and lycium.An electuary from the Berberis lycium. See - Paulus Ægineta, in voce. It has been re-introduced - lately from India in Ophthalmic practice. But if the flesh be in - a livid state, scarifications are to be previously made for the evacuation - of the humours. But if you wish to soothe the parts excoriated by the acrid - defluxions, the decoction of fenugreek, or the juice of ptisan, will form an - excellent detergent application; also the oil of roses or of lentisk. - Continued

- -

baths are appropriate for humectating the body, and for dispelling the - depraved humours.

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The food should be pure, wholesome, of easy digestion, and plain; and the - regimen every way well adjusted, as regards sleeping, walking, and places of - residence. As to exercises, running, tumbling, and the exercise with the - leather-bag;See Oribasius Med. Collect., vi. 33, and Paulus - Ægineta, t.i. p. 24. all these with well-regulated intensity, but - not so as to induce lassitude. Let vociferation also be produced, as being a - seasonable exercise of the breath (pneuma). The - clothing should be clean, not only to gratify the sight, but because filthy - things irritate the skin. While fasting, the patients are to drink the wine - of wormwood. Barley-bread is a very excellent thing, and a sausage in due - season, and a little of mallows or cabbage half-boiled, with soup of cumin. - For supper, the root of parsnip and granulated spelt (alica), with wine and old honey adapted for the mixing; and such - marine articles as loosen the bowels--the soups of limpets, oysters, - sea-urchins, and such fishes as inhabit rocky places. And of land animals, - such as are wild, as the hare and the boar. Of winged animals, all sorts of - partridges, wood-pigeons, domestic-pigeons, and the best which every - district produces. Of fruits, those of summer; sweet wines are preferable to - such as are strong. The natural hot-baths of a sulphureous nature, a - protracted residence in the waters, and a sea-voyage.

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Courses of Hellebore:--White hellebore is purgative of - the upper intestines, but the black of the lower; and the white is not only - emetic, but of all purgatives the most powerful, not from the quantity and - variety of the excretion--for this cholera can accomplish--nor from the - retching and violence attending the vomitings, for in this respect - sea-sickness is preferable; but from a power and quality of no mean - description, by which it restores the sick to health, even with little - purging

- -

and small retching. But also of all chronic diseases when firmly rooted, if - all other remedies fail, this is the only cure. For in power the white - hellebore resembles fire; and whatever fire accomplishes by burning, still - more does hellebore effect by penetrating internally--out of dyspnœa - inducing freedom of breathing; out of paleness, good colour; and out of - emaciation, plumpness of flesh.

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BOOK I. +
CHAPTER I. THE PROŒMIUM. +

IN chronic diseases, the postponement of medical treatment is a bad thing; for, by procrastination, they pass into incurable affections, being of such a nature that they do not readily go off if they once attack; and if protracted by time, they will become strong, and end only in death. Small diseases also are succeeded by greater, so that although devoid of danger at first, their progeny proves deadly. Wherefore neither should the patient conceal his complaint, from the shame of exposure, nor shrink from fear of the treatment; nor should the physician be inactive, for thus both would conspire to render the disease incurable. Some patients, from ignorance of the present and what will come at last, are content to live on with the disease. For since in most cases they do not die, so neither do they fear death, nor, for this reason, do they entrust themselves to the physician. Cephalæa, of which I am about to treat in the first place, is a proof of these statements.

+
CHAPTER II. CURE OF CEPHALÆA. +

THE head, inasmuch as it is necessary towards life, so is it also very dangerous in disease. And the onset of diseases about it is quite tolerable, being attended with slight pain, noises in the ears, and heaviness; but if they acquire increase, they become fatal at last. Wherefore even slight pains should not be overlooked, and, in certain cases, they have been cured by slight remedies. But if prolonged for a longer space, as greater sufferings supervene, we must open the vein at the elbow. But, for two days previous, the patient must get wine to drink, and the quantity of blood abstracted must be regulated by the strength; and it is best not to make the whole evacuation at once, so that the strength may bear the amount thereof; and the disease is rather removed by the repetition of the means. The same rule applies to all chronic diseases. During an interval of three or four days, a fuller diet is to be given, and then the purgative hiera is to be taken in a draught; for it, in an especial manner, draws the pabulum of the disease from the head. The quantity of the medicine given is to be to the amount of four or five drams. And if well purged, we are to administer the bath, give wine, and improve the strength. Then again we are to open the straight vein (temporal?) on the forehead, for abstraction by it is most efficacious; the amount, about a hemina (half-pint?) or a little more. But we must not evacuate further, for we must avoid emptying the vessels. Then, having removed the hair with a razor, we are first to apply one cupping-instrument to the vertex, and another between the scapulæ, without drawing blood; but along with the instrument applied to the vertex, we are to scarify unsparingly, for the purpose of attracting the redundant fluid and of making an incision in the deep-seated parts. For remedial means applied even to the bones are beneficial in cephalæa. When the wounds are cicatrised, we are to excise a portion of the arteries;See Paulus Ægineta, b. vi. 5. (of these there are two, one behind the ears, at a little distance from them, being obvious from their pulsations; the others in front of the ear, and close to it, for they lie close to the antitragus; and these also are discovered by their pulsations); we are to incise the larger ones at the bones, for they afford relief. Adjacent to them are others, very slender, which there is no benefit from excising. The mode of operating has been described under operative surgery. This is the great remedy in cephalæa, epilepsy, vertigo, and, in fine, in all the diseases of the head.

+

In all cases we are to bring off phlegm, first evacuating the bowels, either by a purgative draught, or by a clyster; and sometimes from the nostrils by sternutatories; and sometimes from the mouth by sialogogues. Among the kinds of sternutatories are pepper, the root of soapwort, and the testicle of the beaver; these may all be used together; having levigated and sifted them, we are to blow the powder in, either with a reed or the thick stalk of a goose quill. Euphorbium is more active and stronger than these when mixed with any of them. It is also mixed up with the oils, such as gleucinum, the Sicyonian, or the ointment from storax. It is made into a liquid form as an injection, and it is injected by means of a nasal pipe; the instrument consists of two pipes united together by one outlet, so that we can inject by both at the same time. For to dilate each nostril separately is a thing which could not be borne, as the head gets quickly filled, and thus contracts a sharp pain. The medicines which evacuate phlegm from the mouth are, mustard, the granum cnidium, pepper, stavesacre, these either together or separately; and one may masticate these substances and spit out constantly; and give them mixed up with water or honeyed-water, rinse the mouth, and press them back to the tonsils with stretching of the neck, thus wash out along with the breath in expiration;This is rather an obscure description of the simple process of gargling. See the note of Petit. and when you have evacuated phlegm as much as you think proper, you must bathe and foment the head with a very large quantity of hot water to promote perspiration, for the obstructions become strong.

+

Supper should be spare; but wine also is to be given, to restore the tone of the stomach, for it also suffers in this complaint. When, in the meantime, you have re-established the strength, you will require to give a common clyster having sprinkled upon it much natron, or dissolving it in two drams of the resin of the turpentine tree. On the next day we are to abstract blood from the inside of the nostrils, and for this purpose push into them the long instrument named Katidion, or the one named Toryne, or, in want of these, we must take the thick quill of a goose, and having scooped the nervous part of it into teeth like a saw, we are to push it down the nostrils as far as the ethmoid cells, then shake it with both hands so that the part may be scarified by its teeth. Thus we shall have a ready and copious flow of blood; for slender veins terminate there, and the parts are soft and easily cut. The common people have many modes of scarification, by rough herbs, and the dried leaves of the bay, which they introduce with the fingers and move strongly.On this practice, see Paulus Ægineta, tom. i. p. 326, Syd. Soc. Edit. Having evacuated to a sufficient amount—say to the amount of half a hemina—we are to wipe the parts with sponges and oxycrate, or blow in some styptic powder, gall, fissil alum, or the flower of the wild pomegranate.

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Whether the pain remain, or cease after these things, we must go on to the conclusion of the system of treatment; for the mischief is apt to return, and frequently lurks in the seat of the disease. Wherefore, having removed the hair with a razor (and this also is beneficial to the head), we are to burn with heated cauteries, superficially, down to the muscles; or if you wish to carry the burning to the bone, you must avoid the muscles, for the muscles when burnt occasion convulsions. And if you burn superficially you must foment the part with plenty of fragrant sweet wine, along with rose-oil; a linen cloth wetted with this is to be spread over the eschars until the third day. But, if the eschars be deep, having pounded the hairy leaves of leeks with salt, and spread upon a linen rag, we are to apply it. On the third day, we are to put the cerate from rose-oil upon the superficial eschars, and lentil with honey upon the deeper. The medicinal applications to be made to the wound will be described in another place. Some have made an incision in the skin above the forehead, at the coronal suture, down to the bone, and having scraped it, or cut out a portion down to the diploe, have afterwards brought the part to incarnation. Some have perforated the bone, even to the meningx. These are bold remedies, but are to be used, if, after all, the cephalæa continue, and the patient be courageous, and the tone of the body good.On this heroic method of treating diseases of the head, see Paulus Ægineta, t.ii. pp. 248-250, and 258, Syd. Soc. Edit. Before making trial of it, I would recommend the reader to consult the part of De Haen’s works there referred to.

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But, if they progress gradually, they are to take exercises in the erect state of the body for the benefit of the chest and shoulders; the chironomy,See Oribasius, vi. 30, and p.663, ed. Bussemaker and Daremberg. the throwing of the halteres; leaping, and the well-regulated contortions of the body accompanying it; friction, first and last of the limbs, of the head in the middle of the process.

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The process of pitchingSee Paulus Ægineta, t.i. p. 82, Syd. Soc. Edit. is to be frequently applied to the head; and also rubefacients, sometimes rubbing in mustard with double quantity of bread, so that the heat may not be intolerable; and sometimes other medicines are to be so used, like the compound from lemnestis, euphorbium, and pellitory. The juice of thapsia, and the medicines made with it which produce swelling of the skin, and an eruption resembling vari, are beneficial both for allaying present pain and contributing to eradicate the evil.

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The diet in both kinds of the complaint should be light; little drink, water for drink, especially before giving any medicine; complete abstinence from acrid things, such as onions, garlic, the juice of silphium, but not altogether from mustard, for its acrimony, in addition to its being stomachic, is not unpleasant to the head, dissolving phlegm, and exhaling or discharging downwards. Of pulse, the worst is the common bean and its species, the common peas, and the species called ochrys,The pisum ochrys. and the common kidney-beans; next to them are the lentils, which have indeed certain good properties for promoting digestion and secretion, but induce fulness of the head and occasion pain; only when boiled with pepper they are not to be rejected. Granulated spelt (alica) when washed, is pleasant along with wine and honey, so as to sweeten, and, in like manner, their soups, and with plain broths. The seeds of carui, coriander, anise, and parsley, in the Lydian sauceSee Hesychius, under κηρυκεία and — κη, Athen. Deip. p. 516, Ed. Casaub. are excellent. But, of these articles, the best are the herbs mint and penny-royal, with the fragrant things which have some diuretic and carminative properties. Of fleshes, all such as are old are bad; of the recently killed, that of the hen is good; of birds, the wood pigeon, the common pigeon, and such others as are not very fat; the extremities of the swine; the roasted hare; that of the ox and of the sheep is incrassant and fills the head; the kid is not altogether bad. Milk and cheese occasion headache. Of fishes, those found among rocks, and those things that are best in each particular country. Of potherbs, such as promote the urinary and alvine discharges, the mallow, the blite, the beet, and asparagus; but the kale is also acrid. Among raw articles, the lettuce is the best of all. Roots are bad, even when boiled, such as radishes, navews, and parsnips, which are diuretic, but occasion repletion; the garden parsnip indeed is flatulent and swells up the stomach. Wine which is white, thin, and sweet, is to be admitted, if it have some astringency, so as not to bind the bowels. All articles of the dessert occasion headache, except dates of every species. In autumn the fig and grape are wholesome, and whatever other fruit is very good at any particular season. Repletion of all things, even of such as are proper, is bad; and so, also, indigestion is bad. Lassitude is less injurious than indigestion, but still it is hurtful. The morning walk after evacuation of the bowels, but so as not to affect the breathing nor induce weariness; and it is also very good after supper. Prolonged gestation, not exposed to wind or sun, is good for the head; but the dog-star is bad for it. Sexual intercourse is a self-inflicted evil to the head and nerves. A journey from a cold to a warmer climate, or from a humid to a drier, is proper; also a sea-voyage, and passing one’s life at sea; and if one lives by the sea-side it is a good thing to bathe in the sea-water, to tumble on the sands, and to reside close by the sea.

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The remedies for heterocrania are the same; for it is well to apply to a portion of the head the same remedies as are proper for the whole of it. In all cases in which the disease is not removed by these means, we are to use hellebore, as being the last and most potent of all methods of treatment.

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CHAPTER III. CURE OF VERTIGO. +

VERTIGO arises as the successor of cephalæa; but also springs up as a primary affection from certain causes, as the suppression of the hemorrhoidal flux; and if blood which used to flow from the nose has ceased to flow; or if the body has not perspired properly, either by sweating, or labour, when it had been used to labour. If then it arise as the consequence of cephalæa, we must do for its cure those things which have been described under cephalæa; and I will afterwards state certain other more powerful means which must be tried ultimately. But if the disease happen from the suppression of any of the humours, we must excite the customary secretion; for the recurrence of nature promotes recovery. If it be delayed, and the disease increases, in the other suppressions, those by the nose or sweats, we are to open the vein at the elbow; but in plethora of the liver, spleen, or any of the viscera in the middle of the body, cupping affords relief, but as much blood as is taken from a vein, so much is to be thus abstracted from them; for it is the nutriment of the exciting cause, in like manner as the belly. After this the remedies of the head are to be applied, opening the straight vein on the forehead, or those at the canthi on either side of the nose; a cupping-instrument is to be fastened to the vertex, the (temporal?) arteries are to be excised, the head shaven, rubefacients applied to it, phlegm evacuated from the nostrils by sternutatories, or from the mouth as I have stated—all these things are to be done in the order described under cephalæa, except that the juice of sow-bread or of pimpernel is to be used as an injection into the nose.

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But when you have exhausted all the remedies for cephalæa, the more violent means which are applicable for vertigo are to be used; we must use the emetics after supper, and those from radishes, which is also required as a preparation for the hellebore; for the stomach is to be trained beforehand to the more violent emetics. But the phlegm now becomes thinner, and fit for solution in the hellebore. There are several modes of giving the hellebore; to the stronger sort of patients it is to be given to the size of a sesame,The sesamum orientale, or oily-grain of the East. See Appendix to the Edinburgh Greek Lexicon. or a little larger; or, in slices, with washed chondrus or lentil, the dose, about two drams. In the case of feebler and more slender persons, the decoction with honey, to the amount of two or three spoonfuls, is to be given. The manner of preparing it will be described else-where. In the interval between each remedy, the patient is to be supported, in order that he may be able to endure what is to be given in the intermediate periods.

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The patient is to be assisted during the paroxysms thus:—The legs are to be bound above the ankles and knees; and the wrists, and the arms below the shoulders at the elbows. The head is to be bathed with rose-oil and vinegar; but in the oil we must boil wild-thyme, cow-parsnip, ivy, or something such. Friction of the extremities and face. Smelling to vinegar, penny-royal, and mint, and these things with vinegar. Separation of the jaws, for sometimes the jaws are locked together; the tonsils to be tickled to provoke vomiting; for by the discharge of phlegm they are sometimes roused from their gloom. These things, then, are to be done, in order to alleviate the paroxysm and dispel the gloomy condition.

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With regard to the regimen during the whole period of the treatment and afterwards, I hold as follows:—Much sleep is bad, and likewise insomnolency; for truly much sleep stupefies the senses of the head. From a redundance of vapours there is disinclination to every exertion; and these are also the cause of the weight in the head, the noises, and the flashes of light, which are the marks of the disease. Insomnolency induces dyspepsia, atrophy, and wearies out the body; the spirits flag, and the understanding is unsettled; and for these reasons such patients readily pass into mania and melancholy. Moderate sleep is suitable for the proper digestion of the food and refreshment from the labours of the day; care and perseverance in these respects; and particular attention is to be paid to the evacuation of the bowels, for the belly is the greater source of the bodily perspiration. Next, friction of the limbs, by means of rough towels, so as to produce rubefaction; then, of the back and sides; last, of the head. Afterwards, exercise in walking, gentle at first and in the end; carried to running in the middle; rest and tranquillity of the breathing (pneuma) after the walking. They are to practise vociferation, using grave tones, for sharp occasion distension of the head, palpitation of the temples, pulsatory movements of the brain, fulness of the eyes, and noises in the ears. Sounds of medium intensity are beneficial to the head. Then the season of gestation should be regulated so as to promote the expulsion of the weight in the head; it should be prolonged, yet not so as to induce fatigue; neither should gestation be made in tortuous places, nor where there are frequent bendings of the road, for these are provocative of vertigo. But let the walks be straight, long, and smooth. If then the patients have been in the habit of taking lunch, we must only allow of a little bread, so as to be no impediment to the exercises; for digestion should take place previously. The head and the hands, and the frictions thereof, are to be attended to; in the latter it is to be gently performed for the restoration of the heat, for plumpness, and strength. Then the head is to be rubbed while the patient stands erect below a person of higher stature than himself. Gymnastics skilfully performed which tend to distension of the neck, and strong exercise of the hands. It is proper, also, by raising the head, to exercise the eyes at chironomy, or at throwing the quoit, or contending at boxing. The exercise both with the large and the small ball is bad, for the rolling of the head and eyes, and the intense fixing of them, occasion vertigo. Leaping and running are very excellent; for everything that is keen is beneficial to the limbs, and gives tone to the general system.For an account of most of the ancient exercises mentioned by our author, see Paulus Ægineta, t. i. p. 22—27, Syd. Soc. Edit. The cold bath is better than no bath at all; no bath at all is better than the hot bath: the cold bath is very powerful as an astringent, incrassant, and desiccant of the head, which is the condition of health; while the warm bath is most powerful to humectate, relax, and create mistiness; for these are the causes of disease of the head, and such also are south winds, which occasion dulness of hearing. There should be rest after exercises, to allay the perturbation. Pinching of the head, even to the extent of producing excoriation of the skin.

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Whetters made of water, or of wine diluted with water, should be given before a meal. Lunch should be slight: laxatives from the capillary leaves of pot-herbs,—of mallow, of beet, and of blite. A condiment of a stomachic nature, which is pleasant to the mouth, laxative of the bowels, and not calculated to induce heaviness of the head, is made of thyme, or of savory, or of mustard. Eggs, hot in winter, and cold in summer, stripped of their shell, not roasted; olives, dates, pickled meat in season. Granulated spelt washed, with some of the sweet things, so as to give it a relish, is to be chosen; and, with these, salts. Solitude, rest as regards hearing and speaking. Promenades in a well-ventilated place, rendered agreeable by trees or herbs. But if it be come to supper-time, they are again especially to take the cold bath, having been slightly anointed with oil; or, otherwise, the limbs only. The supper should be of frumentaceous articles, such as pastry, or a soup from chondrus (granulated spelt), or a carminative ptisan, rendered easy of digestion by boiling. The medicines used for seasoning of the ptisan, pepper, penny-royal, mint, a small proportion of onions or of leeks, not so much as to float on the stomach; the acrid part of vinegar is suitable; of fleshes, the parts of fat animals which are not fat; of swine, the feet and head; all winged animals—you must select from the great variety of them what is suitable; the hare and the other kinds of venison are proper; the hen is easily procured, and suitable. All articles of the dessert create headaches, except the date, or figs in the summer season, or the grape if the patient be free from flatulence; and of sweetmeats, such as are well seasoned, without fat, and light. Walking, exhilaration; in solitude, resignation to sleep.

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CHAPTER IV. CURE OF EPILEPSY. +

OF remedies, whatever is great and most powerful is needed for epilepsy, so as to find an escape not only from a painful affection, and one dangerous at each attack, but from the disgust and opprobrium of this calamity. For it appears to me, that if the patients who endure such sufferings were to look at one another in the paroxysms, they would no longer submit to live. But the want of sensibility and of seeing conceals from every one what is dreadful and disgusting in his own case. It is best that the method of cure should follow the alleviation of nature, when, with the changes of age, she changes greatly the man. For if the diet akin to the ailment, and on which the disease subsisted, be changed, the disease no longer seizes the man, but takes its departure along with that in which it delighted.See Hippocrat. Aph. ii. 45.

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If, then, it seize on the head, it settles there; to it, therefore, we are to do those things which have been described by me under cephalæa, regarding the abstraction of blood (and also the purgings) from the veins at the elbow, the straight vein at the forehead, and by cupping; but the abstraction is not to be carried the length of deliquium animi; for deliquium has a tendency to induce the disease; we are to open all the ordinary arteries before and behind the ears, and we are also to practise purgings, which are more potent than all these things, by the purgative hiera and those medicines which draw off phlegm from the head; but the medicines should be particularly powerful, for the habit of such persons renders them tolerant of pains, and their goodness of spirits and good hopes render them strong in endurance. It is necessary, also, to apply heat to the head, for it is effectual. In the first place, we must perforate the bone as far as the diploe, and then use cerates and cataplasms until the meninx separate from the bone. The exposed bones are to be perforated with the trepan if still any small portion prevent its spontaneous removal, when the meninx there is found black and thickened; and when, having gone through the process of putrefaction and cleansing under the bold treatment of the physician, the wound comes to complete cicatrization, the patients escape from the disease. In all cases we are to use rubefacient applications to the head; namely, the common ones, as described by me formerly; and a still more powerful one is that from cantharides, but for three days before using it the patient must drink milk as a protection of the bladder, for cantharides are very injurious to the bladder. These are the remedies when the head is the part affected.

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But if the cause be seated in the middle parts, and if these induce the disease (this, however, very rarely happens, for, as in a mighty ailment, the middle parts of the body rather sympathise with the head, which is the origin of the disease), but however it may be, we must open the vein at the elbow in these cases also; for the flow by it is from the viscera. But such patients, more than the others, are to be purged with the hiera, cneoron,The rock-rose, or Daphne cneorum, L. and the granum cnidium,Seed of the Daphne cnidium. See Paulus Ægineta, t. iii. p. 179. for these are phlegmagogues. But the most suitable remedy in these cases is cupping. Of epithemes and cataplasms the components are well known, and it would be superfluous to describe them on all occasions, except in so far as to know the powers of them; namely, that by such means we must attenuate, promote exhalation, and render the secretions and perspirations healthy. We are also to use digestive, heating, desiccant, and diuretic articles, both in food and in medicine. But the best of all things is castor, taken frequently during the month in honeyed-water, and the compound medicines which possess the same powers, as the compound medicine from vipers, and the still more complex one of Mithridates, and also that of Vestinus; for these things promote digestion, form healthy juices, and are diuretic; for whatever simple medicines you could describe are contained in these powerful compositions — cinnamon. cassia, the leaves of melabathrum, pepper, and all the varieties of seseli; and which of the most potent medicines will you not find in them? It is told, that the brain of a vulture, and the heart of a raw cormorant, and the domestic weasel, when eaten, remove the disease; but I have never tried these things. However, I have seen persons holding a cup below the wound of a man recently slaughtered, and drinking a draught of the blood! O the present, the mighty necessity, which compels one to remedy the evil by such a wicked abomination! And whether even they recovered by this means no one could tell me for certain. There is another story of the liver of a man having been eaten. However, I leave these things to be described by those who would bear to try such means.

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It is necessary to regulate the diet, in respect to everything that is to be done either by others or by the patient himself. Now nothing must be omitted, nor anything unnecessarily done; and more especially we must administer everything which will do the slightest good, or even that will do no harm; for many unseemly sights, sounds, and tastes, and multitudes of smells, are tests of the disease. Everything, therefore, is to be particularly attended to. Much sleep induces fatness, torpor, and mistiness of the senses, but moderate sleep is good. An evacuation of the bowels, especially of flatulence and phlegm, is very good after sleep. Promenades long, straight, without tortuosities, in a well ventilated place, under trees of myrtle and laurel, or among acrid and fragrant herbs, such as calamint, penny-royal, thyme, and mint; so much the better if wild and indigenous, but if not, among cultivated; in these places, prolonged gestation, which also should be straight. It is a good thing to take journeys, but not by a river side, so that he may not gaze upon the stream (for the current of a river occasions vertigo), nor where he may see anything turned round, such as a rolling-top, for he is too weak to preserve the animal spirits (pneuma) steady, which are, therefore, whirled about in a circle, and this circular motion is provocative of vertigo and of epilepsy. After the gestation, a gentle walk, then rest so as to induce tranquillity of the agitation created by the gestation. After these, the exercises of the arms, their extremities being rubbed with a towel made of raw flax. Not much oil to be used in the inunction. The friction to be protracted, and harder than usual for condensation, since most of them are bloated and fat: the head to be rubbed in the middle of the process, while the patient stands erect. The exercises of the neck and shoulders, chironomy, and the others mentioned by me under the treatment of Vertigo, with sufficient fulness of detail; only the exercises should be sharper, so as to induce sweat and heat, for all these attenuate. During the whole of his life he should cultivate a keen temper without irascibility.

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All kinds of food derived from gross pulse are bad; but we are to give frumentaceous things, the drier sorts of bread, washed alica, and the drinks prepared from them. The medicines added for relish the same as before; but there should be more of acrid things, such as pepper, ginger, and lovage. Sauces of vinegar and cumin are both pleasant and useful. From fleshes in particular the patient is to be entirely restricted, or at least during the cure; for the restoration, those things are to be allowed which are naturally light, such as all sorts of winged animals, with the exception of the duck, and such as are light in digestion, such as hares, swines’ feet, and pickled fish, after which thirst is good. A white, thin, fragrant, and diuretic wine is to be drunk in small quantity. Of boiled pot-herbs, such as are possessed of acrid powers, attenuate and prove diuretic, as the cabbage, asparagus, and nettle; of raw, the lettuce in the season of summer. The cucumber and ripe melon are unsuitable to a strong man; but certain persons may have just a tasting of them. But being of a cold and humid nature, much of them is bad. The seasonable use may be granted of the green fig and the grape. Promenades; after these, recreation to dispel grief.

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Passion is bad, as also sexual enjoyment; for the act itself bears the symptoms of the disease. Certain physicians have fallen into a mistake respecting coition; for seeing that the physical change to manhood produces a beneficial effect, they have done violence to the nature of children by unseasonable coition, as if thus to bring them sooner to manhood. Such persons are ignorant of the spontaneous law of nature by which all cures are accomplished; for along with every age she produces that which is proper for it in due seasons. At a given time there is the maturity of semen, of the beard, of hoary hairs; for on the one hand what physician could alter Nature’s original change in regard to the semen, and, on the other, the appointed time for each? But they also offend against the nature of the disease; for being previously injured by the unseasonableness of the act, they are not possessed of seasonable powers at the proper commencement of the age for coition.

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The patients ought to reside in hot and dry places, for the disease is of a cold and humid nature.

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CHAPTER V. CURE OF MELANCHOLY. +

IN cases of melancholy, there is need of consideration in regard to the abstraction of blood, from which the disease arises, but it also springs from cacochymy in no small amount thereof. When, therefore, the disease seizes a person in early life, and during the season of spring we are to open the median vein at the right elbow, so that there may be a seasonable flow from the liver; for this viscus is the fountain of the blood, and the source of the formation of the bile, both which are the pabulum of melancholy. We must open a vein even if the patients be spare and have deficient blood, but abstract little, so that the strength may feel the evacuation but may not be shaken thereby; for even though the blood be thick, bilious, coagulated, and black as the lees of oil, yet still it is the seat and the pabulum of Nature. If, then, you abstract more than enough, Nature, by the loss of nourishment, is ejected from her seat. But if the patient has much blood, for the most part in such cases it is not much vitiated, but still we must open a vein, and not abstract all the blood required the same day, but after an interval, or, if the whole is taken the same day, the strength will indicate the amount. During the interval, the patient is to be allowed a fuller diet than usual, in order to prepare him for enduring the evacuation; for we must assist the stomach, it being in a state of disease, and distress from the black bile lodging there. Wherefore, having kept the patient on a restricted diet for one day previously, we must give black hellebore to the amount of two drams with honeyed-water, for it evacuates black bile. And likewise the capillary leaves of Attic thyme, for it also evacuates black bile. But it is best to mix them together, and give a part of each, to the amount of two drams altogether. After the purging we are to administer the bath, and give a little wine and any other seasoner in the food; for purging fatigues the powers of the stomach. We are, then, to come down to the middle parts, and having first relaxed by cataplasms and bathing, we are to apply a cupping-instrument over the liver and stomach, or the mouth of it; for this evacuation is much more seasonable than venesection. We are also to apply it to the back between the scapulæ, for to this place the stomach is adjacent. Then again we are to recruit; and if the strength be restored by the regimen, we are to shave the head, and afterwards apply the cupping-instrument to it, for the primary and greatest cause of the disease is in the nerves. But neither are the senses free from injury, for hence are their departure and commencement. Wherefore these also are changed, by participating in the affection. Some, likewise, from alienation of the senses have perverted feelings. It is necessary, then, especially to cure the stomach as being disordered of itself, and from black bile being lodged in it. Wherefore we must give to drink continuously of the juice of wormwood from a small amount to a cupful (cyathus), for it prevents the formation of bile. Aloe also is a good thing, for it brings down the bile into the lower gut. If, then, the disease be of recent origin, and the patient be not much changed, he will require no other treatment in these circumstances. There is a necessity, however, for the remaining part of the regimen to the restoration of the habits, and the complete purification of the affection, and the strengthening of the powers, so that the diseases may not relapse. I will explain afterwards the course of life during convalescence.

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But if the disease, having yielded a little to these means, should be seen relapsing, there will be need of greater remedies. Let there, then, be no procrastination of time, but if the disease appear after suppression of the catamenial discharge in women, or the hemorrhoidal flux in men, we must stimulate the parts to throw off their accustomed evacuation. But if it is delayed and does not come, the blood having taken another direction, and if the disease progress rapidly, we must make evacuations, beginning from the ankles. And if you cannot get away from this place so much blood as you require, you must also open the vein at the elbow. And after pursuing the restorative process for three or four days, we are to give the purgative medicine, the hiera. Then we are to apply the cupping-instrument to the middle parts of the body, bringing it near to the liver, and do those things which speedily prove effectual; for melancholy does not yield to small remedies, and, if long continued, it remains fixed in a spot. And if the disease lodge in all parts of the body,—in the senses, the understanding, the blood, and the bile,—and if it seize on the nerves, and turn to an incurable condition, it engenders in the system a progeny of other diseases,—spasms, mania, paralysis. And if they arise from melancholy, the newly-formed diseases are incurable. Wherefore we are to use hellebore for the cure of the ailment. But before the administration of the hellebore, we must train the stomach to vomiting, attenuate the humours, and render the whole system freely perspirable; emetics will accomplish these things sometimes those which are given with an empty stomach, and sometimes those which consist of radishes. I will describe the mode and materials of it; and I will also describe the species of hellebore and the modes of using it; and how we ought to judge of everything beforehand, and how to render assistance during the operation of the emetics. It cannot be doubted that by these means the disease has either been entirely removed or had intervals of several years. For generally melancholy is again engendered. But if it be firmly established, we are no longer to hesitate, but must have recourse to everything relating to the hellebore. It is impossible, indeed, to make all the sick well, for a physician would thus be superior to a god; but the physician can produce respite from pain, intervals in diseases, and render them latent. In such cases, the physician can either decline and deny his assistance, alleging as an excuse the incurable nature of the disease, or continue to the last to render his services. The hiera from aloe is to be given again and again; for this is the important medicine in melancholy, being the remedy for the stomach, the liver, and the purging of bile. But experience has proved, that the seed of mallow, to the amount of a dram, when taken in a drink with water answers excellently. But there are many other simple medicines which are useful, some in one case, and some in another.

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After these sufferings, the patient is to be recruited. For, in certain cases, during the time of this treatment, the disease has been removed; but if the patient come to a renewal of his flesh and of his strength, all traces of the disease become eradicated. For the strength of nature produces health, but her weakness, disease. Let the patient, then, proceed to the process of restoration by frequenting the natural hot baths; for the medicinal substances in them are beneficial, such as bitumen, or sulphur, or alum, and many others besides these which are possessed of remedial powers. For, after the parching heat of the disease, and the annoyance of the treatment, dilution is a good thing. Moreover, rare and soft flesh most readily throws off the disease; but in melancholy the flesh is dry and dense. An oily liniment, by gentle friction, with much oil containing . . . . . . . . . . . . washed bread, with something sweet, as the Cretan must, and the Scybelitic from Pamphylia, or wine and honey which have been mixed up together for some time. Eggs, both cold and hot, which have been stripped of their shells. Of fleshes, such as are not fatty, and are detergent. Of swine, the feet and the parts about the head. Of fowls, the wings, which are not fatty. Of wild animals, hares, goats, and deer. Of autumnal fruits, whatever is excellent in its kind. When the stomach rejects the food, we must consider beforehand that what is taken be not vomited up. Wherefore, before giving food, we are to administer honeyed-water to the amount of half a cyathus, which, being drunk, is vomited up again for cleansing the stomach. For, in this way, the food remains in the stomach. Medicines which are purgative of the necessary discharges are—the fruit of the pine, of the nettle, and seeds of the coccalus,Galen identifies the κόκκαλος of Hippocrates (de vict. Acut.) with κῶνος, or the fruit of the pinus pinea. Our author would seem to make them distinct substances. There being several species of the pine tribe, it is not always easy to distinguish them from one another. and pepper; bitter almonds; and let honey give it consistence. But if you wish to dry, the best thing is myrrh, or the root of iris, the medicine from vipers, and that of Vestinus, of Mithridates, and many others. For the epithemes, the materiel of cataplasms, melilot and poppies, and the tear (gum?) of turpentine, and hyssop, and the oil of roses, or of vine-flowers; wax should give consistence to all these. Liniments of oil; gestation, promenades, and whatever promotes the reproduction of flesh, and the strength of the powers, and the restoration of nature to its pristine state of * * * * * * * * * * * * * * * * * * * * * * * * * * *

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CHAPTER VIII. CURE OF PHTHISIS. +

. . . . . as in a ship and in a calm. And if the patient have it fortunately at his command, gestation and living on the sea will be beneficial. For the sea-water contributes something desiccant to the ulcers. After the gestation, having rested, the patient is now to be anointed with fat oil. After the frictions . . . . . . . . . . . from a small dose gradually up to five or six heminæ, or even much more; or if not, as much as one can, for often this alone sufficeth in place of all food. For milk is pleasant to take, is easy to drink, gives solid nourishment, and is more familiar than any other food to one from a child. In colour it is pleasant to see: as a medicine it seems to lubricate the windpipe, to clean, as if with a feather, the bronchi, and to bring off phlegm, improve the breathing, and facilitate the discharges downwards. To ulcers it is a sweet medicine, and milder than anything else. If one, then, will only drink plenty of this, he will not stand in need of anything else. For it is a good thing that, in a disease, milk should prove both food and medicine. And, indeed, the races of men called Galactophagi use no food from grain. But yet it is a very good thing to use porridge, pastry, washed groats of spelt (alica), and the other edibles prepared with milk. And if other food is required, let it be of the same nature, as the juice of ptisan, well-concocted and plain; but it is to be so seasoned as that it may become easy to swallow; or if anything be added as a seasoner, let it be something medicinal, as the hair (capillary leaves?) of lovage, penny-royal, mint, and a little of salts, vinegar, or honey. If the stomach suffer from dyspepsia, this is to be given; but if there be no such necessity, ptisan is of all things the best. One may also change the ptisan for alica, for this is less flatulent, and of easier digestion, and becomes detergent if, when used in the ptisan, the grain be bruised. When the sputa are unusually fluid, the bean cleanses the ulcers, but is flatulent. The pea and the pisum ochrys, in so far as they are less flatulent, are in the same degree inferior as cleansers of the ulcers. Forming a judgment, then, from present symptoms, select accordingly. Their condiments are to be such as described respecting the ptisan. Eggs from the fire, in a liquid state, but hot; they are best when newly laid, before the * * * * * * * * * * * * * * * * * * * * * *

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CHAPTER XIII. CURE OF THE LIVER. +

. . . in the liver the ulcer may be dangerous. But the most troublesome is a defluxion of pus on the stomach, when it makes the stomach its route in the course of being distributed upwards. For the food is the cause of life, but the stomach is the leader in the process of nutrition, and it also sometimes conveys medicines to the internal parts. If, then, in addition to all the other evils, a difficulty of deglutition come on, the patient must speedily die of disease and famine. But the indications by which it is discovered in what direction the pus will be diverted are diversified. If it pass by the intestines, there are tormina, watery discharges from the bowels, phlegm, and bile; then clots of blood floating in a fluid, or a thin discharge like the washings of raw flesh. But, if it pass by the bladder, there is a weight in the kidneys and loins; at first, therefore, the evacuations are copious, and tinged with bile; then turbid, which do not deposit their sediment, nor get settled. In all cases the sediment should become white. But if it be determined upwards to the stomach, nausea, loss of appetite, vomitings of phlegm or of bile, deliquium, and vertigo supervene, until it burst.

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This, then, is to be especially avoided, as being a bad course. But if the defluxion of pus be more violent, we must take every means, assisting the stomach by food, and medicines, and regimen, all in a mild way. We must administer the medicines for bursting the abscess; give to drink of the herb hyssop with honeyed-water, and the juice of the hair of horehound, and this with honeyed-water and the juice of the wormwood. These things must be given before food to dilute the fluids, to lubricate the parts, and facilitate the rupture of the abscesses. We are also to give the milk of an ass, which is soft, not bilious, nutritious, does not admit of being made into cheese, which is the perfection of milk. We should gratify the patient in regard to food and drink. And we are even to give things inferior to other more beneficial articles (for we thereby afford a passage to the fluid which occasions nausea and loathing of food, and many are hurt by the transit of the pus), lest they should come to loathe their food. And if they should take anything, they readily vomit. It is necessary, also, in the other defluxions, to have especial care of the stomach, for it is the passage to all sorts of medicine. It is necessary to keep in mind the liver, which is the root of the ulcerations.See the note on the text. The sense would be evidently much improved by reading blood-vessels in place of ulcerations. But if the defluxion be to the bladder, we are to promote it by diuretics, as the root of asarabacca, valerian, maiden-hair, spignel, in drinks; for these things are to be given to drink in honeyed-water. The compound medicine of Vestinus is also very good, and that from alkekengi, and such others as from trial have acquired reputation. But if you determine to draw off the discharge by the bowels, you can do this with milk, especially that of the ass, or otherwise of the goat or sheep. Give, also, juices of a lubricating nature and detergent, as the juice of ptisan; condiments, as pepper, ginger, and lovage. In a word, with regard to every method of diet in any case of abscess tending to rupture, the food should consist of things having wholesome juices, of savoury things, things of easy digestion, either juices, or the gruels with milk, starch, pastry with milk * * * * * * * * * * *

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CHAPTER XIV. CURE OF THE SPLEEN. +

RESOLUTION of scirrhus of the spleen is not easy to accomplish. But if the diseases engendered by it come on, as dropsy and cachexia, the ailment tends to an incurable condition . . . . . . . the physician to cure the scirrhus; we must try then to avert it when it is coming on, and to remove it when just commencing; and attend to the inflammations, and if the scirrhus be the substitute . . . . . . . . are brought by suppuration . . . . . the abscess. For these, if the inflammation . . . . . we are to use the remedies described by me among the acute diseases. But if, while you are doing everything, the scirrhus remain in an inflammatory state, you must use also the means resembling fire to soften the hardness; lotions of vinegar, oil, and honey; but, instead of wool, use compresses of linen; add to them, in powder, nut-ben sifted; and to the most emollient cataplasms * * * * * * * * * * * *

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OF ARETÆUS, THE CAPPADOCIAN, ON THE THERAPEUTICS OF CHRONIC DISEASE BOOK II. +

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CHAPTER II. CURE OF DIABETES. +

THE affection of diabetes is a species of dropsy, both in cause and in condition, differing only in the place by which the humour runs. For, indeed, in ascites the receptacle is the peritonæum, and it has no outlet, but remains there and accumulates. But in diabetes, the flow of the humour from the affected part and the melting are the same, but the defluxion is determined to the kidneys and bladder; and in dropsical cases this is the outlet when the disease takes a favourable turn; and it is good when it proves a solution of the cause, and not merely a lightening of the burden. In the latter disease the thirst is greater; for the fluid running off dries the body.

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But the remedies for the stoppage of the melting are the same as those for dropsy. For the thirst there is need of a powerful remedy, for in kind it is the greatest of all sufferings; and when a fluid is drunk, it stimulates the discharge of urine; and sometimes as it flows off it melts and carries away with it the particles of the body. Medicines, then, which cure thirst are required, for the thirst is great with an insatiable desire of drink, so that no amount of fluid would be sufficient to cure the thirst. We must, therefore, by all means strengthen the stomach, which is the fountain of the thirst. When, therefore, you have purged with the hiera, use as epithemes the nard, mastich, dates, and raw quinces; the juice of these with nard and rose-oil is very good for lotions; their pulp, with mastich and dates, form a cataplasm. And the mixture of these with wax and the nard ointment is good; or the juice of acacia and of hypocistis, both for lotions and cataplasms.

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But the water used as drink is to be boiled with autumn fruit. The food is to be milk, and with it the cereals, starch, groats of spelt (alica), gruels. Astringent wines to give tone to the stomach, and these but little diluted, in order to dissipate and clear away the other humours; for thirst is engendered by saltish things. But wine, which is at the same time astringent and cooling, proves beneficial by inducing a change and good temperament; for to impart strength, sweet wine is like blood, which also it forms. The compound medicines are the same, as that from vipers, the Mithridate, that from autumn fruit, and the others which are useful in dropsy. But the whole regimen and course of life is the same.

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CHAPTER III. CURE OF CALCULUS AND ULCERATION OF THE KIDNEYS. +

WHATEVER relates to inflammation, hemorrhage, and such other affections about the kidneys as quickly prove fatal, has been treated of under the Acute Diseases. But regarding ulceration thereof, and the formation of stones, and the many other affections which accompany old persons until death, I am now especially to treat, mostly in order to effect their cure; but, if not, to show how they may be alleviated.

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Wherefore, then, it is impossible to eradicate the disposition to form stones. It were easier to render the uterus unfruitful, than to destroy the tendency to engender stones in kidneys wherein it is already formed. We must strive, then, to facilitate the passage of them. If, therefore, the calculi be fixed in a place, I will tell what the remedies are which facilitate their passage; for they are attended with great pain, and sometimes patients die with tormina, volvulus of the colon, and retention of urine; for the kidneys and colon are adjacent to one another. Wherefore if there be a stoppage of the stones, and, along with it, retention of urine and tormina, we are to open the vein at the ankle, on the same side as the kidney affected; for the flow of blood from the kidneys relieves the constriction of the calculi, for inflammation detains them by binding all the parts; and an evacuation of the vessels produces resolution of the inflammation. We are also to bathe the loins where the region of the kidneys is placed. Let the oil which is used either be old, or if recent, let rue be boiled in it. The hair of dill is also diuretic, and rosemary, and marjoram. With these you are to bathe the parts as if with plain water; for mere inunction is a small affair. But you are also to foment with these things, by means of the bladders of cattle filled with the oil of camomile. The materials of the cataplasms along with meal are to be the same. Dry-cupping also has sometimes removed the stoppage of the stones; but in the case of inflammation, it is best to have recourse to scarifications. If, when you have done these things, the calculi still remain fixed, you must place the patient in a bath of oil: for this at once fulfils every indication, it relaxes by its heat, in so far lubricates; while its acrimony stimulates to a desire of making water. These are the means which contribute to the expulsion of calculi. The patient is to take drinks prepared from the roots of certain simple medicines, as valerian, spignel, and asarabacca; and herbs, the prionitis, parsley, and water-parsnip: and of compounds such ointments as contain nard, cassia, myrrh, cinnamon * * * * * * * * * for the cicatrization mustard, and eschars produced by fire, and epithemes as formerly described by me. A regulated diet, unction with oil, sailing and living on the sea,—all these things are remedies for affections of the kidneys. * * * * * * * *

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CHAPTER V. CURE OF GONORRHŒA. +

FROM the unseemly nature of the affection, and from the danger attending the colliquative wasting, and in consideration of the want of it for the propagation of the species, we must not be slow to stop a flow of semen, as being the cause of all sorts of evil. In the first place, therefore, we are to treat it like a common defluxion, by astringents applied to the parts about the bladder and the seat of the flux, and with refrigerants to the loins, groin, genital parts, and testicles, so that the semen may not flow copiously; and then again, apply calefacients to the whole system, so as to dry up the passages; this is to be done by styptics and lotions; wool then from the sheep with its sordes, and for oil, the rose ointment, or that from vine flowers, with a light-coloured and fragrant wine; but, gradually warming, by means of common oil, and melilot boiled with it, and marjoram, and rosemary or flea-bane; and a very excellent thing is the hair of dill, and still more, the rue. Use these for the cataplasms, with the meal of barley and vetches, and of hedge-mustard seed, and natron; but honey is to be added, so as to make all combine and mix together. Such also are the cataplasms which redden, and raise pustules, and thereby produce derivation of the flux, and warm the parts. Such is the Green plaster, and that from the fruit of the bay. Frequent draughts too are to be given, prepared from castor and winter cherry,Physalis alkekengi. See under στρύχνος, in Appendix to the Edinburgh Greek Lexicon. to the amount of one dram, and the decoction of mint; of compounds, that from the two peppers, that of Symphon, that of Philo, the liquid medicine from the wild creature the skink, that of Vestinus, that from the reptiles the vipers. Every attention is to be paid to diet, and he is to be permitted and encouraged to take gymnastics, promenades, and gestation; for these things impart warmth to the constitution, which is needed in this affection. And if the patient be temperate as to venereal matters, and take the cold bath, it may be hoped that he will quickly acquire his virility.

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CHAPTER VI. CURE OF STOMACHICS. +

IN the other affections, after the treatment, the diet contributes to the strength and force of the body, by good digestion; but in stomachics alone it is at fault.Although Ermerins thinks otherwise, I must say I agree with Wigan, that something is wanting near the beginning of this chapter. How it should be, I will now declare. For gestation, promenades, gymnastics, the exercise of the voice, and food of easy digestion, are sufficient to counteract the vitiated appetite of the stomach; but it is impossible that these things could remove protracted indigestion, and convert the emaciated condition of the body to embonpoint. But in these cases, much more than usual, the patients should be indulged, and everything done towards them liberally, the physician gratifying their appetites whenever the objects of them are not very prejudicial; for this is the best course, provided they have no desire of those things which would do them much good. Medicines are to be given in the liquid form—decoctions, as of wormwood; and nard ointment and the Theriac, and the fruit of stone-parsley, and of ginger, and of pepper, and of hartwort;Tordyllium officinale. these things are of a digestive nature. And an epitheme is to be applied to the breast for the purpose of astringency, containing nard, mastich, aloe, the acacias, and the juice of quinces, and the pulps of the apples bruised with dates, so as to form an astringent epitheme. Also such other things as have been enumerated by me under diabetes, for the cure of the thirst. For the same causes produce thirst in them, and yet in stomachics the tone of the stomach is not inclined to thirst.

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CHAPTER VII. CURE OF CŒLIACS. +

IF the stomach be irretentive of the food, and if it pass through undigested, unchanged and crude, so that nothing ascends into the body, we call such persons cœliacs; being connected with refrigeration of the innate heat which performs digestion, along with atony of the faculty of distribution.

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In the first place then, the stomach is to be relieved from its sufferings by rest and abstinence from food, for in this way the natural powers are restored. And if there also be a feeling of fulness in the stomach, we are to administer emetics, in the fasting state, with water or honeyed-water; and the abdomen is to be enveloped and bathed, for the purpose of astringency, with unwashed wool from the sheep, with oily things, as the unguentum rosaceum, œnanthemum, and melinum, or what is best, with that from the lentisk, with hypocistis and the unripe grape.For all these compositions, see Paulus Ægineta, t. iii. pp. 589-599, Syd. Soc. Edit. But, along with these, cataplasms, hot to the touch, but astringent in powers. And if there be distension or inflammation anywhere about the liver or mouth of the stomach, we are to apply the cupping-instrument, and scarify; and there are cases in which this alone is sufficient. But when, by means of cerates, the wounds have cicatrised and ended in hardness, we are to apply leeches to it, then digestive epithemes, such as that from seeds, if you possess the root of the chamæleon. The best thing here is the fruit of the bay, and the Malagma by name the Green, and mine—the Mystery. For these soften, irritate, rouse heat, discuss flatulence of the bowels, of which there is need for the sake of astringency. But likewise mustard, lemnestis, euphorbium, and all such prevent refrigeration indeed, and procure resuscitation of the heat. Such medicines also the patient must drink for astringency. In the first place, there is need . . . . . . . . . . the juice of plaintain with water made astringent by myrtles or quinces. The stone of an unripe grape is also a very good thing, and wines of a very astringent character. Then the medicines which warm the bowels, namely such potions as are made with ginger, and pepper, and the fruit of the wild parsley which is found among rocks, and the very digestive medicine made from the reptiles the vipers. But if it does not yield at all or slightly to these means, use emetics from radishes; and if you will put into them the root of the white hellebore, for a single night, the purging will thus become very strong, for purging away and removing the cold humours and for kindling up the heat.

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And likewise the diet and manner of life should be moderate. Sleep by night, by day walks, vociferation, gestation among myrtles, bays, or thyme; for the exhalation and respiration of such things prove a digestive remedy. Gymnastics, friction, chironomy, exercises of the chest and abdomen by throwing the halteres. Propomata; for bread alone contributes little towards strength. After these, rubefacients, walking * * * * * * * * * * * * * * * * * * * * * * * * *

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CHAPTER XII. CURE OF ARTHRITIS AND ISCHIATIC DISEASES. +

. . . . . . from food and radishes frequently. Then to have recourse to the hellebore. The diet after these the same as in the other affections, and after the diet, anointing with oil and the cold sea-bath. These in an especial manner are the common remedies in all arthritic diseases, for in gouty cases hellebore is the great remedy, yet only in the first attacks of the affection. But if it has subsisted for a long time already, and also if it appear to have been transmitted from the patient’s forefathers, the disease sticks to him until death. But for the paroxysms in the joints, we are to do this: let unscoured wool from the sheep be applied; bathe with rose-oil and wine; and in certain case sponging with oxycrate has done good. Then as a cataplasm, bread with the cooling parts of gourd and pompion, and simple cucumber, and the herb plantain and rose leaves. And the sideritisSideritis scordioides. mitigates pain, along with bread, also lichen, and the root of comfrey, and the herb cinque-foil, and the species of horehound having narrow leaves: of this the decoction makes a fomentation which allays pain, and it forms a cataplasm with crumbs of bread or barley-meal. And the part of citrons which is not fit for food, is excellent with toasted barley-meal. Dried figs and almonds with some of the flours. These form the materiel for refrigeration; and, indeed, this is sometimes beneficial to one, and sometimes to another. In certain cases calefacients are beneficial, and the same is sometimes useful to another. It is said that the following application is powerfully anodyne; let a goat feed on the herb iris, and when it is filled therewith, having waited until the food it has taken be digested in the stomach, let the goat be slaughtered, and bury the feet in fæces within the belly. The medicines for the disease are innumerable; for the calamity renders the patients themselves expert druggists. But the medicines of the physicians will be described in works devoted to these things.

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CHAPTER XIII. CURE OF ELEPHAS. +

THE remedies ought to be greater than the diseases, for the relief of them. But what method of cure could be able to overcome such a malady as elephas? For the illness does not attack one part or viscus, nor prevail only internally or externally, but inwardly it possesses the whole person, and outwardly, covers the whole surface—a spectacle unseemly and dreadful to behold! for it is the semblance of the wild animal. And, moreover, there is a danger in living or associating with it no less than with the plague, for the infection is thereby communicated by the respiration. Wherefore what sufficient remedy for it shall we find in medicine? But yet it is proper to apply every medicine and method of diet, — even iron and fire, — and these, indeed, if you apply to a recent disease there is hope of a cure. But if fully developed, and if it has firmly established itself in the inward parts, and, moreover, has attacked the face, the patient is in a hopeless condition.

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Wherefore we are to open the veins at the elbow, and on both sides; and also those at the ankles, but not the same day, for an interval is better both in order to procure a greater flow of blood, and for the resuscitation of the strength; for it is necessary to evacuate the blood frequently and copiously, as being the nutriment of the disease, but the good portion of it which is the natural nourishment is small. Wherefore while abstracting the vitiated portion, consisting of melted matters, we must form an estimate of the suitable part mixed up with it, until the disease has given way from want of pabulum; for the new part being incorporated with the body, in the course of a long time, obliterates the old. Then we are to give the hiera in a potion not once only, but let everything be done several times after recovery and recurrence. And let the other medicinal purgation by the food be practised; and let the treatment be that which I have described under Ischiatic disease, and let the patient drink undivided milk—and that in great quantity—for opening the bowels. Let it receive the fifth part of water, so that the whole of the milk may pass through. They are quickly to be treated with emetics, at first those given when fasting, next, those after food, then those by radishes. Let all things be done frequently and continuously; administering the hellebore at all seasons, but especially in spring and autumn, giving it every alternate day, and again next year. And if the disease has acquired strength, we must give whatever liquid medicines any one has had experience of; for it is a good thing to administer medicines frequently as a remedy. And I will now describe those with which I am acquainted. Mix one cyathus of cedriaProbably gum vernix. See Paulus Ægineta, t. iii. p. 452. and two of brassica, and give. Another: Of the juice of sideritis,Probably the sideritis scordioides L. See Appendix to Dunbar’s Lexicon in voce. of trefoil one cyathus, of wine and honey two cyathi. Another: Of the shavings of an elephant’s tooth one dram with wine, to the amount of two cyathi. But likewise the flesh of the wild reptiles, the vipers, formed into pastils,Or Troches. See Paulus Ægineta t. iii. p. 535. are taken in a draught. From their heads and tail we must cut off to the extent of four fingers’ breadth, and boil the remainder to the separation of the back-bones; and having formed the flesh into pastils, they are to be cooled in the shade; and these are to be given in a draught in like manner as the squill. The vipers, too, are to be used as a seasoner of food at supper, and are to be prepared as fishes. But if the compound medicine from vipers be at hand, it is to be drunk in preference to all others, for it contains together the virtues of all the others, so to cleanse the body and smooth down its asperities. There are many other medicines . . . . . . of the Celts, which are men called Gauls, those alkaline substances made into balls, with which they cleanse their clothes, called soap, with which it is a very excellent thing to cleanse the body in the bath. And purslain and houseleek with vinegar, and also the decoction of the roots of dock with the sulphur vivum proves an excellent detergent. The compound medicine from levigated alcyonium,A marine zoophyte. See Appendix to the Edinburgh Greek Lexicon, and Paulus Ægineta, tom. iii., Syd. Soc. Ed. natron, the burnt lees of wine, alum, sulphur vivum, costus, iris, and pepper, these things are all to be mixed together in each case according to the power, but in proportionate quantities, and this compound is to be sprinkled on the body and rubbed in. For the callous protuberances of the face, we are to rub in the ashes of vine branches, mixed up with the suet of some wild animal, as the lion, the panther, the bear; or if these are not at hand, of the barnacle goose;See Appendix to the Edinburgh Greek Lexicon in νῆσσα: also Aristot. H. N. viii. 5, and Ælian. N. A. v. 30. The remark which follows turns on this point, that the bird in question called the χηναλώπηχ, is to quadrupeds what the ape is to man. See the ingenious observations of Petit. for like in the unlike, as the ape to man, is most excellent. Also the ammoniac perfume with vinegar and the juice of plantain, or of knot-grass, and hypocistis and lycium.An electuary from the Berberis lycium. See Paulus Ægineta, in voce. It has been re-introduced lately from India in Ophthalmic practice. But if the flesh be in a livid state, scarifications are to be previously made for the evacuation of the humours. But if you wish to soothe the parts excoriated by the acrid defluxions, the decoction of fenugreek, or the juice of ptisan, will form an excellent detergent application; also the oil of roses or of lentisk. Continued baths are appropriate for humectating the body, and for dispelling the depraved humours.

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The food should be pure, wholesome, of easy digestion, and plain; and the regimen every way well adjusted, as regards sleeping, walking, and places of residence. As to exercises, running, tumbling, and the exercise with the leather-bag;See Oribasius Med. Collect., vi. 33, and Paulus Ægineta, t.i. p. 24. all these with well-regulated intensity, but not so as to induce lassitude. Let vociferation also be produced, as being a seasonable exercise of the breath (pneuma). The clothing should be clean, not only to gratify the sight, but because filthy things irritate the skin. While fasting, the patients are to drink the wine of wormwood. Barley-bread is a very excellent thing, and a sausage in due season, and a little of mallows or cabbage half-boiled, with soup of cumin. For supper, the root of parsnip and granulated spelt (alica), with wine and old honey adapted for the mixing; and such marine articles as loosen the bowels—the soups of limpets, oysters, sea-urchins, and such fishes as inhabit rocky places. And of land animals, such as are wild, as the hare and the boar. Of winged animals, all sorts of partridges, wood-pigeons, domestic-pigeons, and the best which every district produces. Of fruits, those of summer; sweet wines are preferable to such as are strong. The natural hot-baths of a sulphureous nature, a protracted residence in the waters, and a sea-voyage.

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Courses of Hellebore:—White hellebore is purgative of the upper intestines, but the black of the lower; and the white is not only emetic, but of all purgatives the most powerful, not from the quantity and variety of the excretion—for this cholera can accomplish—nor from the retching and violence attending the vomitings, for in this respect sea-sickness is preferable; but from a power and quality of no mean description, by which it restores the sick to health, even with little purging and small retching. But also of all chronic diseases when firmly rooted, if all other remedies fail, this is the only cure. For in power the white hellebore resembles fire; and whatever fire accomplishes by burning, still more does hellebore effect by penetrating internally—out of dyspnœa inducing freedom of breathing; out of paleness, good colour; and out of emaciation, plumpness of flesh.

 diff --git a/data/tlg0719/tlg004/tlg0719.tlg004.perseus-eng2.xml b/data/tlg0719/tlg004/tlg0719.tlg004.perseus-eng2.xml new file mode 100644 index 000000000..5f43100e2 --- /dev/null +++ b/data/tlg0719/tlg004/tlg0719.tlg004.perseus-eng2.xml @@ -0,0 +1,154 @@ + + + + + + + On the Cure of Chronic Diseases + Aretaeus of Cappadocia + Francis Adams + + Gregory Crane + + Prepared under the supervision of + Bridget Almas + Lisa Cerrato + Rashmi Singhal + + National Library of Medicine History of Medicine Division + + + Cultural Heritage Language Technologies + Kansas City Missouri + February 1, 2005 + + Trustees of Tufts University + Medford, MA + Perseus Digital Library Project + Perseus 4.0 + tlg0719.tlg004.perseus-eng2.xml + + Available under a Creative Commons Attribution-ShareAlike 4.0 International License + + + + + + The Extant Works of Aretaeus, The Cappadocian + Aretaeus of Cappadocia + Francis Adams + + London + Syndenham Society + 1856 + + + Boston + Milford House Inc. + 1972 + + + Internet Archive + + + + + + +

Data Entry

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This pointer pattern extracts book and chapter.

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This pointer pattern extracts book.

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BOOK I. +
CHAPTER I. THE PROŒMIUM. +

IN chronic diseases, the postponement of medical treatment is a bad thing; for, by procrastination, they pass into incurable affections, being of such a nature that they do not readily go off if they once attack; and if protracted by time, they will become strong, and end only in death. Small diseases also are succeeded by greater, so that although devoid of danger at first, their progeny proves deadly. Wherefore neither should the patient conceal his complaint, from the shame of exposure, nor shrink from fear of the treatment; nor should the physician be inactive, for thus both would conspire to render the disease incurable. Some patients, from ignorance of the present and what will come at last, are content to live on with the disease. For since in most cases they do not die, so neither do they fear death, nor, for this reason, do they entrust themselves to the physician. Cephalæa, of which I am about to treat in the first place, is a proof of these statements.

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CHAPTER II. CURE OF CEPHALÆA. +

THE head, inasmuch as it is necessary towards life, so is it also very dangerous in disease. And the onset of diseases about it is quite tolerable, being attended with slight pain, noises in the ears, and heaviness; but if they acquire increase, they become fatal at last. Wherefore even slight pains should not be overlooked, and, in certain cases, they have been cured by slight remedies. But if prolonged for a longer space, as greater sufferings supervene, we must open the vein at the elbow. But, for two days previous, the patient must get wine to drink, and the quantity of blood abstracted must be regulated by the strength; and it is best not to make the whole evacuation at once, so that the strength may bear the amount thereof; and the disease is rather removed by the repetition of the means. The same rule applies to all chronic diseases. During an interval of three or four days, a fuller diet is to be given, and then the purgative hiera is to be taken in a draught; for it, in an especial manner, draws the pabulum of the disease from the head. The quantity of the medicine given is to be to the amount of four or five drams. And if well purged, we are to administer the bath, give wine, and improve the strength. Then again we are to open the straight vein (temporal?) on the forehead, for abstraction by it is most efficacious; the amount, about a hemina (half-pint?) or a little more. But we must not evacuate further, for we must avoid emptying the vessels. Then, having removed the hair with a razor, we are first to apply one cupping-instrument to the vertex, and another between the scapulæ, without drawing blood; but along with the instrument applied to the vertex, we are to scarify unsparingly, for the purpose of attracting the redundant fluid and of making an incision in the deep-seated parts. For remedial means applied even to the bones are beneficial in cephalæa. When the wounds are cicatrised, we are to excise a portion of the arteries;See Paulus Ægineta, b. vi. 5. (of these there are two, one behind the ears, at a little distance from them, being obvious from their pulsations; the others in front of the ear, and close to it, for they lie close to the antitragus; and these also are discovered by their pulsations); we are to incise the larger ones at the bones, for they afford relief. Adjacent to them are others, very slender, which there is no benefit from excising. The mode of operating has been described under operative surgery. This is the great remedy in cephalæa, epilepsy, vertigo, and, in fine, in all the diseases of the head.

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In all cases we are to bring off phlegm, first evacuating the bowels, either by a purgative draught, or by a clyster; and sometimes from the nostrils by sternutatories; and sometimes from the mouth by sialogogues. Among the kinds of sternutatories are pepper, the root of soapwort, and the testicle of the beaver; these may all be used together; having levigated and sifted them, we are to blow the powder in, either with a reed or the thick stalk of a goose quill. Euphorbium is more active and stronger than these when mixed with any of them. It is also mixed up with the oils, such as gleucinum, the Sicyonian, or the ointment from storax. It is made into a liquid form as an injection, and it is injected by means of a nasal pipe; the instrument consists of two pipes united together by one outlet, so that we can inject by both at the same time. For to dilate each nostril separately is a thing which could not be borne, as the head gets quickly filled, and thus contracts a sharp pain. The medicines which evacuate phlegm from the mouth are, mustard, the granum cnidium, pepper, stavesacre, these either together or separately; and one may masticate these substances and spit out constantly; and give them mixed up with water or honeyed-water, rinse the mouth, and press them back to the tonsils with stretching of the neck, thus wash out along with the breath in expiration;This is rather an obscure description of the simple process of gargling. See the note of Petit. and when you have evacuated phlegm as much as you think proper, you must bathe and foment the head with a very large quantity of hot water to promote perspiration, for the obstructions become strong.

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Supper should be spare; but wine also is to be given, to restore the tone of the stomach, for it also suffers in this complaint. When, in the meantime, you have re-established the strength, you will require to give a common clyster having sprinkled upon it much natron, or dissolving it in two drams of the resin of the turpentine tree. On the next day we are to abstract blood from the inside of the nostrils, and for this purpose push into them the long instrument named Katidion, or the one named Toryne, or, in want of these, we must take the thick quill of a goose, and having scooped the nervous part of it into teeth like a saw, we are to push it down the nostrils as far as the ethmoid cells, then shake it with both hands so that the part may be scarified by its teeth. Thus we shall have a ready and copious flow of blood; for slender veins terminate there, and the parts are soft and easily cut. The common people have many modes of scarification, by rough herbs, and the dried leaves of the bay, which they introduce with the fingers and move strongly.On this practice, see Paulus Ægineta, tom. i. p. 326, Syd. Soc. Edit. Having evacuated to a sufficient amount—say to the amount of half a hemina—we are to wipe the parts with sponges and oxycrate, or blow in some styptic powder, gall, fissil alum, or the flower of the wild pomegranate.

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Whether the pain remain, or cease after these things, we must go on to the conclusion of the system of treatment; for the mischief is apt to return, and frequently lurks in the seat of the disease. Wherefore, having removed the hair with a razor (and this also is beneficial to the head), we are to burn with heated cauteries, superficially, down to the muscles; or if you wish to carry the burning to the bone, you must avoid the muscles, for the muscles when burnt occasion convulsions. And if you burn superficially you must foment the part with plenty of fragrant sweet wine, along with rose-oil; a linen cloth wetted with this is to be spread over the eschars until the third day. But, if the eschars be deep, having pounded the hairy leaves of leeks with salt, and spread upon a linen rag, we are to apply it. On the third day, we are to put the cerate from rose-oil upon the superficial eschars, and lentil with honey upon the deeper. The medicinal applications to be made to the wound will be described in another place. Some have made an incision in the skin above the forehead, at the coronal suture, down to the bone, and having scraped it, or cut out a portion down to the diploe, have afterwards brought the part to incarnation. Some have perforated the bone, even to the meningx. These are bold remedies, but are to be used, if, after all, the cephalæa continue, and the patient be courageous, and the tone of the body good.On this heroic method of treating diseases of the head, see Paulus Ægineta, t.ii. pp. 248-250, and 258, Syd. Soc. Edit. Before making trial of it, I would recommend the reader to consult the part of De Haen’s works there referred to.

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But, if they progress gradually, they are to take exercises in the erect state of the body for the benefit of the chest and shoulders; the chironomy,See Oribasius, vi. 30, and p.663, ed. Bussemaker and Daremberg. the throwing of the halteres; leaping, and the well-regulated contortions of the body accompanying it; friction, first and last of the limbs, of the head in the middle of the process.

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The process of pitchingSee Paulus Ægineta, t.i. p. 82, Syd. Soc. Edit. is to be frequently applied to the head; and also rubefacients, sometimes rubbing in mustard with double quantity of bread, so that the heat may not be intolerable; and sometimes other medicines are to be so used, like the compound from lemnestis, euphorbium, and pellitory. The juice of thapsia, and the medicines made with it which produce swelling of the skin, and an eruption resembling vari, are beneficial both for allaying present pain and contributing to eradicate the evil.

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The diet in both kinds of the complaint should be light; little drink, water for drink, especially before giving any medicine; complete abstinence from acrid things, such as onions, garlic, the juice of silphium, but not altogether from mustard, for its acrimony, in addition to its being stomachic, is not unpleasant to the head, dissolving phlegm, and exhaling or discharging downwards. Of pulse, the worst is the common bean and its species, the common peas, and the species called ochrys,The pisum ochrys. and the common kidney-beans; next to them are the lentils, which have indeed certain good properties for promoting digestion and secretion, but induce fulness of the head and occasion pain; only when boiled with pepper they are not to be rejected. Granulated spelt (alica) when washed, is pleasant along with wine and honey, so as to sweeten, and, in like manner, their soups, and with plain broths. The seeds of carui, coriander, anise, and parsley, in the Lydian sauceSee Hesychius, under κηρυκεία and — κη, Athen. Deip. p. 516, Ed. Casaub. are excellent. But, of these articles, the best are the herbs mint and penny-royal, with the fragrant things which have some diuretic and carminative properties. Of fleshes, all such as are old are bad; of the recently killed, that of the hen is good; of birds, the wood pigeon, the common pigeon, and such others as are not very fat; the extremities of the swine; the roasted hare; that of the ox and of the sheep is incrassant and fills the head; the kid is not altogether bad. Milk and cheese occasion headache. Of fishes, those found among rocks, and those things that are best in each particular country. Of potherbs, such as promote the urinary and alvine discharges, the mallow, the blite, the beet, and asparagus; but the kale is also acrid. Among raw articles, the lettuce is the best of all. Roots are bad, even when boiled, such as radishes, navews, and parsnips, which are diuretic, but occasion repletion; the garden parsnip indeed is flatulent and swells up the stomach. Wine which is white, thin, and sweet, is to be admitted, if it have some astringency, so as not to bind the bowels. All articles of the dessert occasion headache, except dates of every species. In autumn the fig and grape are wholesome, and whatever other fruit is very good at any particular season. Repletion of all things, even of such as are proper, is bad; and so, also, indigestion is bad. Lassitude is less injurious than indigestion, but still it is hurtful. The morning walk after evacuation of the bowels, but so as not to affect the breathing nor induce weariness; and it is also very good after supper. Prolonged gestation, not exposed to wind or sun, is good for the head; but the dog-star is bad for it. Sexual intercourse is a self-inflicted evil to the head and nerves. A journey from a cold to a warmer climate, or from a humid to a drier, is proper; also a sea-voyage, and passing one’s life at sea; and if one lives by the sea-side it is a good thing to bathe in the sea-water, to tumble on the sands, and to reside close by the sea.

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The remedies for heterocrania are the same; for it is well to apply to a portion of the head the same remedies as are proper for the whole of it. In all cases in which the disease is not removed by these means, we are to use hellebore, as being the last and most potent of all methods of treatment.

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CHAPTER III. CURE OF VERTIGO. +

VERTIGO arises as the successor of cephalæa; but also springs up as a primary affection from certain causes, as the suppression of the hemorrhoidal flux; and if blood which used to flow from the nose has ceased to flow; or if the body has not perspired properly, either by sweating, or labour, when it had been used to labour. If then it arise as the consequence of cephalæa, we must do for its cure those things which have been described under cephalæa; and I will afterwards state certain other more powerful means which must be tried ultimately. But if the disease happen from the suppression of any of the humours, we must excite the customary secretion; for the recurrence of nature promotes recovery. If it be delayed, and the disease increases, in the other suppressions, those by the nose or sweats, we are to open the vein at the elbow; but in plethora of the liver, spleen, or any of the viscera in the middle of the body, cupping affords relief, but as much blood as is taken from a vein, so much is to be thus abstracted from them; for it is the nutriment of the exciting cause, in like manner as the belly. After this the remedies of the head are to be applied, opening the straight vein on the forehead, or those at the canthi on either side of the nose; a cupping-instrument is to be fastened to the vertex, the (temporal?) arteries are to be excised, the head shaven, rubefacients applied to it, phlegm evacuated from the nostrils by sternutatories, or from the mouth as I have stated—all these things are to be done in the order described under cephalæa, except that the juice of sow-bread or of pimpernel is to be used as an injection into the nose.

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But when you have exhausted all the remedies for cephalæa, the more violent means which are applicable for vertigo are to be used; we must use the emetics after supper, and those from radishes, which is also required as a preparation for the hellebore; for the stomach is to be trained beforehand to the more violent emetics. But the phlegm now becomes thinner, and fit for solution in the hellebore. There are several modes of giving the hellebore; to the stronger sort of patients it is to be given to the size of a sesame,The sesamum orientale, or oily-grain of the East. See Appendix to the Edinburgh Greek Lexicon. or a little larger; or, in slices, with washed chondrus or lentil, the dose, about two drams. In the case of feebler and more slender persons, the decoction with honey, to the amount of two or three spoonfuls, is to be given. The manner of preparing it will be described else-where. In the interval between each remedy, the patient is to be supported, in order that he may be able to endure what is to be given in the intermediate periods.

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The patient is to be assisted during the paroxysms thus:—The legs are to be bound above the ankles and knees; and the wrists, and the arms below the shoulders at the elbows. The head is to be bathed with rose-oil and vinegar; but in the oil we must boil wild-thyme, cow-parsnip, ivy, or something such. Friction of the extremities and face. Smelling to vinegar, penny-royal, and mint, and these things with vinegar. Separation of the jaws, for sometimes the jaws are locked together; the tonsils to be tickled to provoke vomiting; for by the discharge of phlegm they are sometimes roused from their gloom. These things, then, are to be done, in order to alleviate the paroxysm and dispel the gloomy condition.

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With regard to the regimen during the whole period of the treatment and afterwards, I hold as follows:—Much sleep is bad, and likewise insomnolency; for truly much sleep stupefies the senses of the head. From a redundance of vapours there is disinclination to every exertion; and these are also the cause of the weight in the head, the noises, and the flashes of light, which are the marks of the disease. Insomnolency induces dyspepsia, atrophy, and wearies out the body; the spirits flag, and the understanding is unsettled; and for these reasons such patients readily pass into mania and melancholy. Moderate sleep is suitable for the proper digestion of the food and refreshment from the labours of the day; care and perseverance in these respects; and particular attention is to be paid to the evacuation of the bowels, for the belly is the greater source of the bodily perspiration. Next, friction of the limbs, by means of rough towels, so as to produce rubefaction; then, of the back and sides; last, of the head. Afterwards, exercise in walking, gentle at first and in the end; carried to running in the middle; rest and tranquillity of the breathing (pneuma) after the walking. They are to practise vociferation, using grave tones, for sharp occasion distension of the head, palpitation of the temples, pulsatory movements of the brain, fulness of the eyes, and noises in the ears. Sounds of medium intensity are beneficial to the head. Then the season of gestation should be regulated so as to promote the expulsion of the weight in the head; it should be prolonged, yet not so as to induce fatigue; neither should gestation be made in tortuous places, nor where there are frequent bendings of the road, for these are provocative of vertigo. But let the walks be straight, long, and smooth. If then the patients have been in the habit of taking lunch, we must only allow of a little bread, so as to be no impediment to the exercises; for digestion should take place previously. The head and the hands, and the frictions thereof, are to be attended to; in the latter it is to be gently performed for the restoration of the heat, for plumpness, and strength. Then the head is to be rubbed while the patient stands erect below a person of higher stature than himself. Gymnastics skilfully performed which tend to distension of the neck, and strong exercise of the hands. It is proper, also, by raising the head, to exercise the eyes at chironomy, or at throwing the quoit, or contending at boxing. The exercise both with the large and the small ball is bad, for the rolling of the head and eyes, and the intense fixing of them, occasion vertigo. Leaping and running are very excellent; for everything that is keen is beneficial to the limbs, and gives tone to the general system.For an account of most of the ancient exercises mentioned by our author, see Paulus Ægineta, t. i. p. 22—27, Syd. Soc. Edit. The cold bath is better than no bath at all; no bath at all is better than the hot bath: the cold bath is very powerful as an astringent, incrassant, and desiccant of the head, which is the condition of health; while the warm bath is most powerful to humectate, relax, and create mistiness; for these are the causes of disease of the head, and such also are south winds, which occasion dulness of hearing. There should be rest after exercises, to allay the perturbation. Pinching of the head, even to the extent of producing excoriation of the skin.

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Whetters made of water, or of wine diluted with water, should be given before a meal. Lunch should be slight: laxatives from the capillary leaves of pot-herbs,—of mallow, of beet, and of blite. A condiment of a stomachic nature, which is pleasant to the mouth, laxative of the bowels, and not calculated to induce heaviness of the head, is made of thyme, or of savory, or of mustard. Eggs, hot in winter, and cold in summer, stripped of their shell, not roasted; olives, dates, pickled meat in season. Granulated spelt washed, with some of the sweet things, so as to give it a relish, is to be chosen; and, with these, salts. Solitude, rest as regards hearing and speaking. Promenades in a well-ventilated place, rendered agreeable by trees or herbs. But if it be come to supper-time, they are again especially to take the cold bath, having been slightly anointed with oil; or, otherwise, the limbs only. The supper should be of frumentaceous articles, such as pastry, or a soup from chondrus (granulated spelt), or a carminative ptisan, rendered easy of digestion by boiling. The medicines used for seasoning of the ptisan, pepper, penny-royal, mint, a small proportion of onions or of leeks, not so much as to float on the stomach; the acrid part of vinegar is suitable; of fleshes, the parts of fat animals which are not fat; of swine, the feet and head; all winged animals—you must select from the great variety of them what is suitable; the hare and the other kinds of venison are proper; the hen is easily procured, and suitable. All articles of the dessert create headaches, except the date, or figs in the summer season, or the grape if the patient be free from flatulence; and of sweetmeats, such as are well seasoned, without fat, and light. Walking, exhilaration; in solitude, resignation to sleep.

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CHAPTER IV. CURE OF EPILEPSY. +

OF remedies, whatever is great and most powerful is needed for epilepsy, so as to find an escape not only from a painful affection, and one dangerous at each attack, but from the disgust and opprobrium of this calamity. For it appears to me, that if the patients who endure such sufferings were to look at one another in the paroxysms, they would no longer submit to live. But the want of sensibility and of seeing conceals from every one what is dreadful and disgusting in his own case. It is best that the method of cure should follow the alleviation of nature, when, with the changes of age, she changes greatly the man. For if the diet akin to the ailment, and on which the disease subsisted, be changed, the disease no longer seizes the man, but takes its departure along with that in which it delighted.See Hippocrat. Aph. ii. 45.

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If, then, it seize on the head, it settles there; to it, therefore, we are to do those things which have been described by me under cephalæa, regarding the abstraction of blood (and also the purgings) from the veins at the elbow, the straight vein at the forehead, and by cupping; but the abstraction is not to be carried the length of deliquium animi; for deliquium has a tendency to induce the disease; we are to open all the ordinary arteries before and behind the ears, and we are also to practise purgings, which are more potent than all these things, by the purgative hiera and those medicines which draw off phlegm from the head; but the medicines should be particularly powerful, for the habit of such persons renders them tolerant of pains, and their goodness of spirits and good hopes render them strong in endurance. It is necessary, also, to apply heat to the head, for it is effectual. In the first place, we must perforate the bone as far as the diploe, and then use cerates and cataplasms until the meninx separate from the bone. The exposed bones are to be perforated with the trepan if still any small portion prevent its spontaneous removal, when the meninx there is found black and thickened; and when, having gone through the process of putrefaction and cleansing under the bold treatment of the physician, the wound comes to complete cicatrization, the patients escape from the disease. In all cases we are to use rubefacient applications to the head; namely, the common ones, as described by me formerly; and a still more powerful one is that from cantharides, but for three days before using it the patient must drink milk as a protection of the bladder, for cantharides are very injurious to the bladder. These are the remedies when the head is the part affected.

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But if the cause be seated in the middle parts, and if these induce the disease (this, however, very rarely happens, for, as in a mighty ailment, the middle parts of the body rather sympathise with the head, which is the origin of the disease), but however it may be, we must open the vein at the elbow in these cases also; for the flow by it is from the viscera. But such patients, more than the others, are to be purged with the hiera, cneoron,The rock-rose, or Daphne cneorum, L. and the granum cnidium,Seed of the Daphne cnidium. See Paulus Ægineta, t. iii. p. 179. for these are phlegmagogues. But the most suitable remedy in these cases is cupping. Of epithemes and cataplasms the components are well known, and it would be superfluous to describe them on all occasions, except in so far as to know the powers of them; namely, that by such means we must attenuate, promote exhalation, and render the secretions and perspirations healthy. We are also to use digestive, heating, desiccant, and diuretic articles, both in food and in medicine. But the best of all things is castor, taken frequently during the month in honeyed-water, and the compound medicines which possess the same powers, as the compound medicine from vipers, and the still more complex one of Mithridates, and also that of Vestinus; for these things promote digestion, form healthy juices, and are diuretic; for whatever simple medicines you could describe are contained in these powerful compositions — cinnamon. cassia, the leaves of melabathrum, pepper, and all the varieties of seseli; and which of the most potent medicines will you not find in them? It is told, that the brain of a vulture, and the heart of a raw cormorant, and the domestic weasel, when eaten, remove the disease; but I have never tried these things. However, I have seen persons holding a cup below the wound of a man recently slaughtered, and drinking a draught of the blood! O the present, the mighty necessity, which compels one to remedy the evil by such a wicked abomination! And whether even they recovered by this means no one could tell me for certain. There is another story of the liver of a man having been eaten. However, I leave these things to be described by those who would bear to try such means.

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It is necessary to regulate the diet, in respect to everything that is to be done either by others or by the patient himself. Now nothing must be omitted, nor anything unnecessarily done; and more especially we must administer everything which will do the slightest good, or even that will do no harm; for many unseemly sights, sounds, and tastes, and multitudes of smells, are tests of the disease. Everything, therefore, is to be particularly attended to. Much sleep induces fatness, torpor, and mistiness of the senses, but moderate sleep is good. An evacuation of the bowels, especially of flatulence and phlegm, is very good after sleep. Promenades long, straight, without tortuosities, in a well ventilated place, under trees of myrtle and laurel, or among acrid and fragrant herbs, such as calamint, penny-royal, thyme, and mint; so much the better if wild and indigenous, but if not, among cultivated; in these places, prolonged gestation, which also should be straight. It is a good thing to take journeys, but not by a river side, so that he may not gaze upon the stream (for the current of a river occasions vertigo), nor where he may see anything turned round, such as a rolling-top, for he is too weak to preserve the animal spirits (pneuma) steady, which are, therefore, whirled about in a circle, and this circular motion is provocative of vertigo and of epilepsy. After the gestation, a gentle walk, then rest so as to induce tranquillity of the agitation created by the gestation. After these, the exercises of the arms, their extremities being rubbed with a towel made of raw flax. Not much oil to be used in the inunction. The friction to be protracted, and harder than usual for condensation, since most of them are bloated and fat: the head to be rubbed in the middle of the process, while the patient stands erect. The exercises of the neck and shoulders, chironomy, and the others mentioned by me under the treatment of Vertigo, with sufficient fulness of detail; only the exercises should be sharper, so as to induce sweat and heat, for all these attenuate. During the whole of his life he should cultivate a keen temper without irascibility.

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All kinds of food derived from gross pulse are bad; but we are to give frumentaceous things, the drier sorts of bread, washed alica, and the drinks prepared from them. The medicines added for relish the same as before; but there should be more of acrid things, such as pepper, ginger, and lovage. Sauces of vinegar and cumin are both pleasant and useful. From fleshes in particular the patient is to be entirely restricted, or at least during the cure; for the restoration, those things are to be allowed which are naturally light, such as all sorts of winged animals, with the exception of the duck, and such as are light in digestion, such as hares, swines’ feet, and pickled fish, after which thirst is good. A white, thin, fragrant, and diuretic wine is to be drunk in small quantity. Of boiled pot-herbs, such as are possessed of acrid powers, attenuate and prove diuretic, as the cabbage, asparagus, and nettle; of raw, the lettuce in the season of summer. The cucumber and ripe melon are unsuitable to a strong man; but certain persons may have just a tasting of them. But being of a cold and humid nature, much of them is bad. The seasonable use may be granted of the green fig and the grape. Promenades; after these, recreation to dispel grief.

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Passion is bad, as also sexual enjoyment; for the act itself bears the symptoms of the disease. Certain physicians have fallen into a mistake respecting coition; for seeing that the physical change to manhood produces a beneficial effect, they have done violence to the nature of children by unseasonable coition, as if thus to bring them sooner to manhood. Such persons are ignorant of the spontaneous law of nature by which all cures are accomplished; for along with every age she produces that which is proper for it in due seasons. At a given time there is the maturity of semen, of the beard, of hoary hairs; for on the one hand what physician could alter Nature’s original change in regard to the semen, and, on the other, the appointed time for each? But they also offend against the nature of the disease; for being previously injured by the unseasonableness of the act, they are not possessed of seasonable powers at the proper commencement of the age for coition.

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The patients ought to reside in hot and dry places, for the disease is of a cold and humid nature.

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CHAPTER V. CURE OF MELANCHOLY. +

IN cases of melancholy, there is need of consideration in regard to the abstraction of blood, from which the disease arises, but it also springs from cacochymy in no small amount thereof. When, therefore, the disease seizes a person in early life, and during the season of spring we are to open the median vein at the right elbow, so that there may be a seasonable flow from the liver; for this viscus is the fountain of the blood, and the source of the formation of the bile, both which are the pabulum of melancholy. We must open a vein even if the patients be spare and have deficient blood, but abstract little, so that the strength may feel the evacuation but may not be shaken thereby; for even though the blood be thick, bilious, coagulated, and black as the lees of oil, yet still it is the seat and the pabulum of Nature. If, then, you abstract more than enough, Nature, by the loss of nourishment, is ejected from her seat. But if the patient has much blood, for the most part in such cases it is not much vitiated, but still we must open a vein, and not abstract all the blood required the same day, but after an interval, or, if the whole is taken the same day, the strength will indicate the amount. During the interval, the patient is to be allowed a fuller diet than usual, in order to prepare him for enduring the evacuation; for we must assist the stomach, it being in a state of disease, and distress from the black bile lodging there. Wherefore, having kept the patient on a restricted diet for one day previously, we must give black hellebore to the amount of two drams with honeyed-water, for it evacuates black bile. And likewise the capillary leaves of Attic thyme, for it also evacuates black bile. But it is best to mix them together, and give a part of each, to the amount of two drams altogether. After the purging we are to administer the bath, and give a little wine and any other seasoner in the food; for purging fatigues the powers of the stomach. We are, then, to come down to the middle parts, and having first relaxed by cataplasms and bathing, we are to apply a cupping-instrument over the liver and stomach, or the mouth of it; for this evacuation is much more seasonable than venesection. We are also to apply it to the back between the scapulæ, for to this place the stomach is adjacent. Then again we are to recruit; and if the strength be restored by the regimen, we are to shave the head, and afterwards apply the cupping-instrument to it, for the primary and greatest cause of the disease is in the nerves. But neither are the senses free from injury, for hence are their departure and commencement. Wherefore these also are changed, by participating in the affection. Some, likewise, from alienation of the senses have perverted feelings. It is necessary, then, especially to cure the stomach as being disordered of itself, and from black bile being lodged in it. Wherefore we must give to drink continuously of the juice of wormwood from a small amount to a cupful (cyathus), for it prevents the formation of bile. Aloe also is a good thing, for it brings down the bile into the lower gut. If, then, the disease be of recent origin, and the patient be not much changed, he will require no other treatment in these circumstances. There is a necessity, however, for the remaining part of the regimen to the restoration of the habits, and the complete purification of the affection, and the strengthening of the powers, so that the diseases may not relapse. I will explain afterwards the course of life during convalescence.

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But if the disease, having yielded a little to these means, should be seen relapsing, there will be need of greater remedies. Let there, then, be no procrastination of time, but if the disease appear after suppression of the catamenial discharge in women, or the hemorrhoidal flux in men, we must stimulate the parts to throw off their accustomed evacuation. But if it is delayed and does not come, the blood having taken another direction, and if the disease progress rapidly, we must make evacuations, beginning from the ankles. And if you cannot get away from this place so much blood as you require, you must also open the vein at the elbow. And after pursuing the restorative process for three or four days, we are to give the purgative medicine, the hiera. Then we are to apply the cupping-instrument to the middle parts of the body, bringing it near to the liver, and do those things which speedily prove effectual; for melancholy does not yield to small remedies, and, if long continued, it remains fixed in a spot. And if the disease lodge in all parts of the body,—in the senses, the understanding, the blood, and the bile,—and if it seize on the nerves, and turn to an incurable condition, it engenders in the system a progeny of other diseases,—spasms, mania, paralysis. And if they arise from melancholy, the newly-formed diseases are incurable. Wherefore we are to use hellebore for the cure of the ailment. But before the administration of the hellebore, we must train the stomach to vomiting, attenuate the humours, and render the whole system freely perspirable; emetics will accomplish these things sometimes those which are given with an empty stomach, and sometimes those which consist of radishes. I will describe the mode and materials of it; and I will also describe the species of hellebore and the modes of using it; and how we ought to judge of everything beforehand, and how to render assistance during the operation of the emetics. It cannot be doubted that by these means the disease has either been entirely removed or had intervals of several years. For generally melancholy is again engendered. But if it be firmly established, we are no longer to hesitate, but must have recourse to everything relating to the hellebore. It is impossible, indeed, to make all the sick well, for a physician would thus be superior to a god; but the physician can produce respite from pain, intervals in diseases, and render them latent. In such cases, the physician can either decline and deny his assistance, alleging as an excuse the incurable nature of the disease, or continue to the last to render his services. The hiera from aloe is to be given again and again; for this is the important medicine in melancholy, being the remedy for the stomach, the liver, and the purging of bile. But experience has proved, that the seed of mallow, to the amount of a dram, when taken in a drink with water answers excellently. But there are many other simple medicines which are useful, some in one case, and some in another.

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After these sufferings, the patient is to be recruited. For, in certain cases, during the time of this treatment, the disease has been removed; but if the patient come to a renewal of his flesh and of his strength, all traces of the disease become eradicated. For the strength of nature produces health, but her weakness, disease. Let the patient, then, proceed to the process of restoration by frequenting the natural hot baths; for the medicinal substances in them are beneficial, such as bitumen, or sulphur, or alum, and many others besides these which are possessed of remedial powers. For, after the parching heat of the disease, and the annoyance of the treatment, dilution is a good thing. Moreover, rare and soft flesh most readily throws off the disease; but in melancholy the flesh is dry and dense. An oily liniment, by gentle friction, with much oil containing . . . . . . . . . . . . washed bread, with something sweet, as the Cretan must, and the Scybelitic from Pamphylia, or wine and honey which have been mixed up together for some time. Eggs, both cold and hot, which have been stripped of their shells. Of fleshes, such as are not fatty, and are detergent. Of swine, the feet and the parts about the head. Of fowls, the wings, which are not fatty. Of wild animals, hares, goats, and deer. Of autumnal fruits, whatever is excellent in its kind. When the stomach rejects the food, we must consider beforehand that what is taken be not vomited up. Wherefore, before giving food, we are to administer honeyed-water to the amount of half a cyathus, which, being drunk, is vomited up again for cleansing the stomach. For, in this way, the food remains in the stomach. Medicines which are purgative of the necessary discharges are—the fruit of the pine, of the nettle, and seeds of the coccalus,Galen identifies the κόκκαλος of Hippocrates (de vict. Acut.) with κῶνος, or the fruit of the pinus pinea. Our author would seem to make them distinct substances. There being several species of the pine tribe, it is not always easy to distinguish them from one another. and pepper; bitter almonds; and let honey give it consistence. But if you wish to dry, the best thing is myrrh, or the root of iris, the medicine from vipers, and that of Vestinus, of Mithridates, and many others. For the epithemes, the materiel of cataplasms, melilot and poppies, and the tear (gum?) of turpentine, and hyssop, and the oil of roses, or of vine-flowers; wax should give consistence to all these. Liniments of oil; gestation, promenades, and whatever promotes the reproduction of flesh, and the strength of the powers, and the restoration of nature to its pristine state of * * * * * * * * * * * * * * * * * * * * * * * * * * *

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CHAPTER VIII. CURE OF PHTHISIS. +

. . . . . as in a ship and in a calm. And if the patient have it fortunately at his command, gestation and living on the sea will be beneficial. For the sea-water contributes something desiccant to the ulcers. After the gestation, having rested, the patient is now to be anointed with fat oil. After the frictions . . . . . . . . . . . from a small dose gradually up to five or six heminæ, or even much more; or if not, as much as one can, for often this alone sufficeth in place of all food. For milk is pleasant to take, is easy to drink, gives solid nourishment, and is more familiar than any other food to one from a child. In colour it is pleasant to see: as a medicine it seems to lubricate the windpipe, to clean, as if with a feather, the bronchi, and to bring off phlegm, improve the breathing, and facilitate the discharges downwards. To ulcers it is a sweet medicine, and milder than anything else. If one, then, will only drink plenty of this, he will not stand in need of anything else. For it is a good thing that, in a disease, milk should prove both food and medicine. And, indeed, the races of men called Galactophagi use no food from grain. But yet it is a very good thing to use porridge, pastry, washed groats of spelt (alica), and the other edibles prepared with milk. And if other food is required, let it be of the same nature, as the juice of ptisan, well-concocted and plain; but it is to be so seasoned as that it may become easy to swallow; or if anything be added as a seasoner, let it be something medicinal, as the hair (capillary leaves?) of lovage, penny-royal, mint, and a little of salts, vinegar, or honey. If the stomach suffer from dyspepsia, this is to be given; but if there be no such necessity, ptisan is of all things the best. One may also change the ptisan for alica, for this is less flatulent, and of easier digestion, and becomes detergent if, when used in the ptisan, the grain be bruised. When the sputa are unusually fluid, the bean cleanses the ulcers, but is flatulent. The pea and the pisum ochrys, in so far as they are less flatulent, are in the same degree inferior as cleansers of the ulcers. Forming a judgment, then, from present symptoms, select accordingly. Their condiments are to be such as described respecting the ptisan. Eggs from the fire, in a liquid state, but hot; they are best when newly laid, before the * * * * * * * * * * * * * * * * * * * * * *

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CHAPTER XIII. CURE OF THE LIVER. +

. . . in the liver the ulcer may be dangerous. But the most troublesome is a defluxion of pus on the stomach, when it makes the stomach its route in the course of being distributed upwards. For the food is the cause of life, but the stomach is the leader in the process of nutrition, and it also sometimes conveys medicines to the internal parts. If, then, in addition to all the other evils, a difficulty of deglutition come on, the patient must speedily die of disease and famine. But the indications by which it is discovered in what direction the pus will be diverted are diversified. If it pass by the intestines, there are tormina, watery discharges from the bowels, phlegm, and bile; then clots of blood floating in a fluid, or a thin discharge like the washings of raw flesh. But, if it pass by the bladder, there is a weight in the kidneys and loins; at first, therefore, the evacuations are copious, and tinged with bile; then turbid, which do not deposit their sediment, nor get settled. In all cases the sediment should become white. But if it be determined upwards to the stomach, nausea, loss of appetite, vomitings of phlegm or of bile, deliquium, and vertigo supervene, until it burst.

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This, then, is to be especially avoided, as being a bad course. But if the defluxion of pus be more violent, we must take every means, assisting the stomach by food, and medicines, and regimen, all in a mild way. We must administer the medicines for bursting the abscess; give to drink of the herb hyssop with honeyed-water, and the juice of the hair of horehound, and this with honeyed-water and the juice of the wormwood. These things must be given before food to dilute the fluids, to lubricate the parts, and facilitate the rupture of the abscesses. We are also to give the milk of an ass, which is soft, not bilious, nutritious, does not admit of being made into cheese, which is the perfection of milk. We should gratify the patient in regard to food and drink. And we are even to give things inferior to other more beneficial articles (for we thereby afford a passage to the fluid which occasions nausea and loathing of food, and many are hurt by the transit of the pus), lest they should come to loathe their food. And if they should take anything, they readily vomit. It is necessary, also, in the other defluxions, to have especial care of the stomach, for it is the passage to all sorts of medicine. It is necessary to keep in mind the liver, which is the root of the ulcerations.See the note on the text. The sense would be evidently much improved by reading blood-vessels in place of ulcerations. But if the defluxion be to the bladder, we are to promote it by diuretics, as the root of asarabacca, valerian, maiden-hair, spignel, in drinks; for these things are to be given to drink in honeyed-water. The compound medicine of Vestinus is also very good, and that from alkekengi, and such others as from trial have acquired reputation. But if you determine to draw off the discharge by the bowels, you can do this with milk, especially that of the ass, or otherwise of the goat or sheep. Give, also, juices of a lubricating nature and detergent, as the juice of ptisan; condiments, as pepper, ginger, and lovage. In a word, with regard to every method of diet in any case of abscess tending to rupture, the food should consist of things having wholesome juices, of savoury things, things of easy digestion, either juices, or the gruels with milk, starch, pastry with milk * * * * * * * * * * *

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CHAPTER XIV. CURE OF THE SPLEEN. +

RESOLUTION of scirrhus of the spleen is not easy to accomplish. But if the diseases engendered by it come on, as dropsy and cachexia, the ailment tends to an incurable condition . . . . . . . the physician to cure the scirrhus; we must try then to avert it when it is coming on, and to remove it when just commencing; and attend to the inflammations, and if the scirrhus be the substitute . . . . . . . . are brought by suppuration . . . . . the abscess. For these, if the inflammation . . . . . we are to use the remedies described by me among the acute diseases. But if, while you are doing everything, the scirrhus remain in an inflammatory state, you must use also the means resembling fire to soften the hardness; lotions of vinegar, oil, and honey; but, instead of wool, use compresses of linen; add to them, in powder, nut-ben sifted; and to the most emollient cataplasms * * * * * * * * * * * *

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OF ARETÆUS, THE CAPPADOCIAN, ON THE THERAPEUTICS OF CHRONIC DISEASE BOOK II. +

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CHAPTER II. CURE OF DIABETES. +

THE affection of diabetes is a species of dropsy, both in cause and in condition, differing only in the place by which the humour runs. For, indeed, in ascites the receptacle is the peritonæum, and it has no outlet, but remains there and accumulates. But in diabetes, the flow of the humour from the affected part and the melting are the same, but the defluxion is determined to the kidneys and bladder; and in dropsical cases this is the outlet when the disease takes a favourable turn; and it is good when it proves a solution of the cause, and not merely a lightening of the burden. In the latter disease the thirst is greater; for the fluid running off dries the body.

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But the remedies for the stoppage of the melting are the same as those for dropsy. For the thirst there is need of a powerful remedy, for in kind it is the greatest of all sufferings; and when a fluid is drunk, it stimulates the discharge of urine; and sometimes as it flows off it melts and carries away with it the particles of the body. Medicines, then, which cure thirst are required, for the thirst is great with an insatiable desire of drink, so that no amount of fluid would be sufficient to cure the thirst. We must, therefore, by all means strengthen the stomach, which is the fountain of the thirst. When, therefore, you have purged with the hiera, use as epithemes the nard, mastich, dates, and raw quinces; the juice of these with nard and rose-oil is very good for lotions; their pulp, with mastich and dates, form a cataplasm. And the mixture of these with wax and the nard ointment is good; or the juice of acacia and of hypocistis, both for lotions and cataplasms.

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But the water used as drink is to be boiled with autumn fruit. The food is to be milk, and with it the cereals, starch, groats of spelt (alica), gruels. Astringent wines to give tone to the stomach, and these but little diluted, in order to dissipate and clear away the other humours; for thirst is engendered by saltish things. But wine, which is at the same time astringent and cooling, proves beneficial by inducing a change and good temperament; for to impart strength, sweet wine is like blood, which also it forms. The compound medicines are the same, as that from vipers, the Mithridate, that from autumn fruit, and the others which are useful in dropsy. But the whole regimen and course of life is the same.

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CHAPTER III. CURE OF CALCULUS AND ULCERATION OF THE KIDNEYS. +

WHATEVER relates to inflammation, hemorrhage, and such other affections about the kidneys as quickly prove fatal, has been treated of under the Acute Diseases. But regarding ulceration thereof, and the formation of stones, and the many other affections which accompany old persons until death, I am now especially to treat, mostly in order to effect their cure; but, if not, to show how they may be alleviated.

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Wherefore, then, it is impossible to eradicate the disposition to form stones. It were easier to render the uterus unfruitful, than to destroy the tendency to engender stones in kidneys wherein it is already formed. We must strive, then, to facilitate the passage of them. If, therefore, the calculi be fixed in a place, I will tell what the remedies are which facilitate their passage; for they are attended with great pain, and sometimes patients die with tormina, volvulus of the colon, and retention of urine; for the kidneys and colon are adjacent to one another. Wherefore if there be a stoppage of the stones, and, along with it, retention of urine and tormina, we are to open the vein at the ankle, on the same side as the kidney affected; for the flow of blood from the kidneys relieves the constriction of the calculi, for inflammation detains them by binding all the parts; and an evacuation of the vessels produces resolution of the inflammation. We are also to bathe the loins where the region of the kidneys is placed. Let the oil which is used either be old, or if recent, let rue be boiled in it. The hair of dill is also diuretic, and rosemary, and marjoram. With these you are to bathe the parts as if with plain water; for mere inunction is a small affair. But you are also to foment with these things, by means of the bladders of cattle filled with the oil of camomile. The materials of the cataplasms along with meal are to be the same. Dry-cupping also has sometimes removed the stoppage of the stones; but in the case of inflammation, it is best to have recourse to scarifications. If, when you have done these things, the calculi still remain fixed, you must place the patient in a bath of oil: for this at once fulfils every indication, it relaxes by its heat, in so far lubricates; while its acrimony stimulates to a desire of making water. These are the means which contribute to the expulsion of calculi. The patient is to take drinks prepared from the roots of certain simple medicines, as valerian, spignel, and asarabacca; and herbs, the prionitis, parsley, and water-parsnip: and of compounds such ointments as contain nard, cassia, myrrh, cinnamon * * * * * * * * * for the cicatrization mustard, and eschars produced by fire, and epithemes as formerly described by me. A regulated diet, unction with oil, sailing and living on the sea,—all these things are remedies for affections of the kidneys. * * * * * * * *

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CHAPTER V. CURE OF GONORRHŒA. +

FROM the unseemly nature of the affection, and from the danger attending the colliquative wasting, and in consideration of the want of it for the propagation of the species, we must not be slow to stop a flow of semen, as being the cause of all sorts of evil. In the first place, therefore, we are to treat it like a common defluxion, by astringents applied to the parts about the bladder and the seat of the flux, and with refrigerants to the loins, groin, genital parts, and testicles, so that the semen may not flow copiously; and then again, apply calefacients to the whole system, so as to dry up the passages; this is to be done by styptics and lotions; wool then from the sheep with its sordes, and for oil, the rose ointment, or that from vine flowers, with a light-coloured and fragrant wine; but, gradually warming, by means of common oil, and melilot boiled with it, and marjoram, and rosemary or flea-bane; and a very excellent thing is the hair of dill, and still more, the rue. Use these for the cataplasms, with the meal of barley and vetches, and of hedge-mustard seed, and natron; but honey is to be added, so as to make all combine and mix together. Such also are the cataplasms which redden, and raise pustules, and thereby produce derivation of the flux, and warm the parts. Such is the Green plaster, and that from the fruit of the bay. Frequent draughts too are to be given, prepared from castor and winter cherry,Physalis alkekengi. See under στρύχνος, in Appendix to the Edinburgh Greek Lexicon. to the amount of one dram, and the decoction of mint; of compounds, that from the two peppers, that of Symphon, that of Philo, the liquid medicine from the wild creature the skink, that of Vestinus, that from the reptiles the vipers. Every attention is to be paid to diet, and he is to be permitted and encouraged to take gymnastics, promenades, and gestation; for these things impart warmth to the constitution, which is needed in this affection. And if the patient be temperate as to venereal matters, and take the cold bath, it may be hoped that he will quickly acquire his virility.

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CHAPTER VI. CURE OF STOMACHICS. +

IN the other affections, after the treatment, the diet contributes to the strength and force of the body, by good digestion; but in stomachics alone it is at fault.Although Ermerins thinks otherwise, I must say I agree with Wigan, that something is wanting near the beginning of this chapter. How it should be, I will now declare. For gestation, promenades, gymnastics, the exercise of the voice, and food of easy digestion, are sufficient to counteract the vitiated appetite of the stomach; but it is impossible that these things could remove protracted indigestion, and convert the emaciated condition of the body to embonpoint. But in these cases, much more than usual, the patients should be indulged, and everything done towards them liberally, the physician gratifying their appetites whenever the objects of them are not very prejudicial; for this is the best course, provided they have no desire of those things which would do them much good. Medicines are to be given in the liquid form—decoctions, as of wormwood; and nard ointment and the Theriac, and the fruit of stone-parsley, and of ginger, and of pepper, and of hartwort;Tordyllium officinale. these things are of a digestive nature. And an epitheme is to be applied to the breast for the purpose of astringency, containing nard, mastich, aloe, the acacias, and the juice of quinces, and the pulps of the apples bruised with dates, so as to form an astringent epitheme. Also such other things as have been enumerated by me under diabetes, for the cure of the thirst. For the same causes produce thirst in them, and yet in stomachics the tone of the stomach is not inclined to thirst.

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CHAPTER VII. CURE OF CŒLIACS. +

IF the stomach be irretentive of the food, and if it pass through undigested, unchanged and crude, so that nothing ascends into the body, we call such persons cœliacs; being connected with refrigeration of the innate heat which performs digestion, along with atony of the faculty of distribution.

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In the first place then, the stomach is to be relieved from its sufferings by rest and abstinence from food, for in this way the natural powers are restored. And if there also be a feeling of fulness in the stomach, we are to administer emetics, in the fasting state, with water or honeyed-water; and the abdomen is to be enveloped and bathed, for the purpose of astringency, with unwashed wool from the sheep, with oily things, as the unguentum rosaceum, œnanthemum, and melinum, or what is best, with that from the lentisk, with hypocistis and the unripe grape.For all these compositions, see Paulus Ægineta, t. iii. pp. 589-599, Syd. Soc. Edit. But, along with these, cataplasms, hot to the touch, but astringent in powers. And if there be distension or inflammation anywhere about the liver or mouth of the stomach, we are to apply the cupping-instrument, and scarify; and there are cases in which this alone is sufficient. But when, by means of cerates, the wounds have cicatrised and ended in hardness, we are to apply leeches to it, then digestive epithemes, such as that from seeds, if you possess the root of the chamæleon. The best thing here is the fruit of the bay, and the Malagma by name the Green, and mine—the Mystery. For these soften, irritate, rouse heat, discuss flatulence of the bowels, of which there is need for the sake of astringency. But likewise mustard, lemnestis, euphorbium, and all such prevent refrigeration indeed, and procure resuscitation of the heat. Such medicines also the patient must drink for astringency. In the first place, there is need . . . . . . . . . . the juice of plaintain with water made astringent by myrtles or quinces. The stone of an unripe grape is also a very good thing, and wines of a very astringent character. Then the medicines which warm the bowels, namely such potions as are made with ginger, and pepper, and the fruit of the wild parsley which is found among rocks, and the very digestive medicine made from the reptiles the vipers. But if it does not yield at all or slightly to these means, use emetics from radishes; and if you will put into them the root of the white hellebore, for a single night, the purging will thus become very strong, for purging away and removing the cold humours and for kindling up the heat.

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And likewise the diet and manner of life should be moderate. Sleep by night, by day walks, vociferation, gestation among myrtles, bays, or thyme; for the exhalation and respiration of such things prove a digestive remedy. Gymnastics, friction, chironomy, exercises of the chest and abdomen by throwing the halteres. Propomata; for bread alone contributes little towards strength. After these, rubefacients, walking * * * * * * * * * * * * * * * * * * * * * * * * *

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CHAPTER XII. CURE OF ARTHRITIS AND ISCHIATIC DISEASES. +

. . . . . . from food and radishes frequently. Then to have recourse to the hellebore. The diet after these the same as in the other affections, and after the diet, anointing with oil and the cold sea-bath. These in an especial manner are the common remedies in all arthritic diseases, for in gouty cases hellebore is the great remedy, yet only in the first attacks of the affection. But if it has subsisted for a long time already, and also if it appear to have been transmitted from the patient’s forefathers, the disease sticks to him until death. But for the paroxysms in the joints, we are to do this: let unscoured wool from the sheep be applied; bathe with rose-oil and wine; and in certain case sponging with oxycrate has done good. Then as a cataplasm, bread with the cooling parts of gourd and pompion, and simple cucumber, and the herb plantain and rose leaves. And the sideritisSideritis scordioides. mitigates pain, along with bread, also lichen, and the root of comfrey, and the herb cinque-foil, and the species of horehound having narrow leaves: of this the decoction makes a fomentation which allays pain, and it forms a cataplasm with crumbs of bread or barley-meal. And the part of citrons which is not fit for food, is excellent with toasted barley-meal. Dried figs and almonds with some of the flours. These form the materiel for refrigeration; and, indeed, this is sometimes beneficial to one, and sometimes to another. In certain cases calefacients are beneficial, and the same is sometimes useful to another. It is said that the following application is powerfully anodyne; let a goat feed on the herb iris, and when it is filled therewith, having waited until the food it has taken be digested in the stomach, let the goat be slaughtered, and bury the feet in fæces within the belly. The medicines for the disease are innumerable; for the calamity renders the patients themselves expert druggists. But the medicines of the physicians will be described in works devoted to these things.

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CHAPTER XIII. CURE OF ELEPHAS. +

THE remedies ought to be greater than the diseases, for the relief of them. But what method of cure could be able to overcome such a malady as elephas? For the illness does not attack one part or viscus, nor prevail only internally or externally, but inwardly it possesses the whole person, and outwardly, covers the whole surface—a spectacle unseemly and dreadful to behold! for it is the semblance of the wild animal. And, moreover, there is a danger in living or associating with it no less than with the plague, for the infection is thereby communicated by the respiration. Wherefore what sufficient remedy for it shall we find in medicine? But yet it is proper to apply every medicine and method of diet, — even iron and fire, — and these, indeed, if you apply to a recent disease there is hope of a cure. But if fully developed, and if it has firmly established itself in the inward parts, and, moreover, has attacked the face, the patient is in a hopeless condition.

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Wherefore we are to open the veins at the elbow, and on both sides; and also those at the ankles, but not the same day, for an interval is better both in order to procure a greater flow of blood, and for the resuscitation of the strength; for it is necessary to evacuate the blood frequently and copiously, as being the nutriment of the disease, but the good portion of it which is the natural nourishment is small. Wherefore while abstracting the vitiated portion, consisting of melted matters, we must form an estimate of the suitable part mixed up with it, until the disease has given way from want of pabulum; for the new part being incorporated with the body, in the course of a long time, obliterates the old. Then we are to give the hiera in a potion not once only, but let everything be done several times after recovery and recurrence. And let the other medicinal purgation by the food be practised; and let the treatment be that which I have described under Ischiatic disease, and let the patient drink undivided milk—and that in great quantity—for opening the bowels. Let it receive the fifth part of water, so that the whole of the milk may pass through. They are quickly to be treated with emetics, at first those given when fasting, next, those after food, then those by radishes. Let all things be done frequently and continuously; administering the hellebore at all seasons, but especially in spring and autumn, giving it every alternate day, and again next year. And if the disease has acquired strength, we must give whatever liquid medicines any one has had experience of; for it is a good thing to administer medicines frequently as a remedy. And I will now describe those with which I am acquainted. Mix one cyathus of cedriaProbably gum vernix. See Paulus Ægineta, t. iii. p. 452. and two of brassica, and give. Another: Of the juice of sideritis,Probably the sideritis scordioides L. See Appendix to Dunbar’s Lexicon in voce. of trefoil one cyathus, of wine and honey two cyathi. Another: Of the shavings of an elephant’s tooth one dram with wine, to the amount of two cyathi. But likewise the flesh of the wild reptiles, the vipers, formed into pastils,Or Troches. See Paulus Ægineta t. iii. p. 535. are taken in a draught. From their heads and tail we must cut off to the extent of four fingers’ breadth, and boil the remainder to the separation of the back-bones; and having formed the flesh into pastils, they are to be cooled in the shade; and these are to be given in a draught in like manner as the squill. The vipers, too, are to be used as a seasoner of food at supper, and are to be prepared as fishes. But if the compound medicine from vipers be at hand, it is to be drunk in preference to all others, for it contains together the virtues of all the others, so to cleanse the body and smooth down its asperities. There are many other medicines . . . . . . of the Celts, which are men called Gauls, those alkaline substances made into balls, with which they cleanse their clothes, called soap, with which it is a very excellent thing to cleanse the body in the bath. And purslain and houseleek with vinegar, and also the decoction of the roots of dock with the sulphur vivum proves an excellent detergent. The compound medicine from levigated alcyonium,A marine zoophyte. See Appendix to the Edinburgh Greek Lexicon, and Paulus Ægineta, tom. iii., Syd. Soc. Ed. natron, the burnt lees of wine, alum, sulphur vivum, costus, iris, and pepper, these things are all to be mixed together in each case according to the power, but in proportionate quantities, and this compound is to be sprinkled on the body and rubbed in. For the callous protuberances of the face, we are to rub in the ashes of vine branches, mixed up with the suet of some wild animal, as the lion, the panther, the bear; or if these are not at hand, of the barnacle goose;See Appendix to the Edinburgh Greek Lexicon in νῆσσα: also Aristot. H. N. viii. 5, and Ælian. N. A. v. 30. The remark which follows turns on this point, that the bird in question called the χηναλώπηχ, is to quadrupeds what the ape is to man. See the ingenious observations of Petit. for like in the unlike, as the ape to man, is most excellent. Also the ammoniac perfume with vinegar and the juice of plantain, or of knot-grass, and hypocistis and lycium.An electuary from the Berberis lycium. See Paulus Ægineta, in voce. It has been re-introduced lately from India in Ophthalmic practice. But if the flesh be in a livid state, scarifications are to be previously made for the evacuation of the humours. But if you wish to soothe the parts excoriated by the acrid defluxions, the decoction of fenugreek, or the juice of ptisan, will form an excellent detergent application; also the oil of roses or of lentisk. Continued baths are appropriate for humectating the body, and for dispelling the depraved humours.

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The food should be pure, wholesome, of easy digestion, and plain; and the regimen every way well adjusted, as regards sleeping, walking, and places of residence. As to exercises, running, tumbling, and the exercise with the leather-bag;See Oribasius Med. Collect., vi. 33, and Paulus Ægineta, t.i. p. 24. all these with well-regulated intensity, but not so as to induce lassitude. Let vociferation also be produced, as being a seasonable exercise of the breath (pneuma). The clothing should be clean, not only to gratify the sight, but because filthy things irritate the skin. While fasting, the patients are to drink the wine of wormwood. Barley-bread is a very excellent thing, and a sausage in due season, and a little of mallows or cabbage half-boiled, with soup of cumin. For supper, the root of parsnip and granulated spelt (alica), with wine and old honey adapted for the mixing; and such marine articles as loosen the bowels—the soups of limpets, oysters, sea-urchins, and such fishes as inhabit rocky places. And of land animals, such as are wild, as the hare and the boar. Of winged animals, all sorts of partridges, wood-pigeons, domestic-pigeons, and the best which every district produces. Of fruits, those of summer; sweet wines are preferable to such as are strong. The natural hot-baths of a sulphureous nature, a protracted residence in the waters, and a sea-voyage.

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Courses of Hellebore:—White hellebore is purgative of the upper intestines, but the black of the lower; and the white is not only emetic, but of all purgatives the most powerful, not from the quantity and variety of the excretion—for this cholera can accomplish—nor from the retching and violence attending the vomitings, for in this respect sea-sickness is preferable; but from a power and quality of no mean description, by which it restores the sick to health, even with little purging and small retching. But also of all chronic diseases when firmly rooted, if all other remedies fail, this is the only cure. For in power the white hellebore resembles fire; and whatever fire accomplishes by burning, still more does hellebore effect by penetrating internally—out of dyspnœa inducing freedom of breathing; out of paleness, good colour; and out of emaciation, plumpness of flesh.

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