BOOK I.
PREFACE.
THE remedies of acute diseases are connected with the form
of the symptoms, certain of which have been described by me
in the preceding works. Whatever, therefore, relates to the
cure of fevers, according to their differences, the form of the
diseases, and the varieties in them, the greater part of these will
be treated of in my discourses on fevers. But acute affections
which are accompanied with fevers, such as Phrenitis, or those
without fevers, as Apoplexy, of these alone will I now write;
and that I may not commit blunders, or become diffuse by
treating of the same matters in different places, the beginning and end correspond to the same in the work on the affections.
CHAPTER I. THE CURE OF PHRENITICS.
THE patient ought to be laid in a house of moderate size, and
mild temperature--in a warm situation, if winter, and in one
that is cool and humid, if summer; in spring and autumn, to
be regulated according to the season. Then the patient himself,
and all those in the house, are to be ordered to preserve quiet;
for persons in phrensy are sharp of hearing, are sensitive to
noise, and easily become delirious. The walls should be smooth,
level, without projections, not adorned with frieze
1 or paintings;
for painting on a wall is an excitant. And, moreover, they
catch at certain false appearances before their eyes, and grope
about things which are not projecting, as if they were so; and
any unreal occasion may be a cause sufficient to make them
raise their hands. Length and breadth of the couch moderate,
so that the patient may neither toss about in a broad one, nor
fall out of a narrow bed. In plain bed clothes, so that there
may be no inducement to pick at their nap. But on a soft
bed, for a hard one is offensive to the nerves; as in phrenitics,
above all others, the nerves especially suffer, for they are subject
to convulsions. Access of their dearest friends is to be permitted;
stories and conversation not of an exciting character;
for they ought to be gratified in everything, especially in cases
where the delirium tends to anger. Whether they are to be
laid in darkness or in light must be determined by the nature
of the attack; for if they are exasperated by the light, and
see things which exist not, and represent to themselves things
not present, or confound one thing with another, or if strange
images obtrude themselves upon them; and, in a word, if they
are frightened at the light, and the things in the light, darkness
must be chosen; but if not, the opposite state. It is a good
symptom, too, when they become of a sound mind, and their
delirium abates, on exposure to the light. Abstinence from
food should not be prolonged; food should be rather liquid,
scanty, and frequently administered, for food soothes the soul:
the proper time for giving it is during the remissions, both of
the fever and of the delirium. But if they have become
delirious from want of food, and if the fever do not remit, we
are to give food that does not do much harm in fever. It is a
favourable circumstance, when the fever and the delirium agree
both as to the paroxysms and intermissions.
If, therefore, the time for the administering of food be come,
in the first place, it must be enquired whether it be necessary
to abstract blood. If, then, the delirium have come on with
fever at the commencement, in the first or second day, it will
be proper to open a vein at the elbow, especially the middle.
But if the delirium supervene on the third or fourth day, we
are to open a vein up to the first period of critical days. But
if it was past the proper time for bleeding, on the sixth or
seventh day, it will be proper to evacuate considerably before
the crises in acute diseases, either by giving purgative medicines,
or by using other stimulants. But when opening a
vein you must not abstract much, even if you open the vein
at the commencement; for phrenitis is an ailment easily convertible
into syncope. But if the patient be plethoric and
youthful, and if the ailment be connected with fulness in
eating and drinking, those indications have nothing to do with
the phrenitis; for even without the delirium, it would be proper
to abstract much blood in such circumstances; but much less
is to be abstracted, if such persons labour under phrenitis.
But we may open a vein the more boldly in these cases, if the
disease proceed from the præcordia, and not from the head; for
there (in the præcordia) is the origin of life. But the head is
the seat of sensation, and of the origin of the nerves; and it
attracts more blood from the heart than it imparts to the
others. If it therefore suffer, it is not proper to open the vein
at the elbow; for these affections are such that it is no small
injury to evacuate in them. And if the strength be sufficient
to withstand the evacuation, we must abstract only once, lest
during the interval between the acts of evacuation, the proper
season for food be lost. The fevers, in cases of phrenitis, are
of a continual type, neither have they long intermissions,
but experience short and ill-marked remissions. But if the
patient give way before a sufficient quantity has been abstracted,
it must be put off until another remission, unless it
occur at a distant period; but, if not, having resuscitated the
patient by odours, stroking the face, and pricking the feet, we
are immediately to abstract blood. The measure of sufficiency
is the strength.
Liquid food is proper in all febrile diseases, but especially in
phrenitic cases, for these are more arid than mere fevers. The
mulse is to be given, unless they are bilious, for it is indigestible
in patients who are subject to bitter bile. Alica
2 washed
with water, or mulse, is a good thing; also it is good to give
pottages of a plain kind, such as decoctions of savory, of parsley,
or of dill, for these are beneficial to the respiration, and
are diuretic, and a free discharge of urine is beneficial in
phrenetics. All kinds of pot-herbs, especially melons, for their
gluten is good for lubricating the tongue, the trachea, and for
the alvine evacuations; but the best of all are beet, blite, cress,
gourd in season, and whatever else is best in its own season.
The juice of ptisan in a very liquid state, and containing little
nourishment, is most proper at first, being made always thicker
as the disease progresses. But the quantity of nourishment is
to be diminished at the crises, and a little before them. And,
if the disease be protracted, the customary food must not be
abstracted, but we must give nourishing articles from the
cereals, in order to support the patient; and when there is need,
of the flesh of the extremities of beasts and fowls, mostly dissolved
in the soups: these ought to be completely dissolved
during the process of boiling. The rock fishes are preferable
to all others;
3 but on the whole we must choose the best in
the country, for countries are believed to differ as to the kinds
of fish which are best in them. Fruit containing wine must
be given restrictedly, for it is apt to affect the head and præcordia;
but if required by the state of the strength and of
the stomach, we must give such articles as apples boiled in
mulse or roasted in suet. Of other things, each is to be diluted
with hot water, if you give it solely for the refreshment of the
stomach; but if it is wanted also for strength, you must not
dilute the vinous part much. In a word, the food must be
such as I have described.
For the sake of refrigeration, the head is to be damped with
the oil of the unripe olive pounded; for in phrenitics the head
is not fond of being kept warm. But if restlessness and false
visions be present, we must mix equal parts of rose-oil at first;
and the rose-oil is to be increased for the astringing and cooling
of the head. But if they become disordered in understanding,
and their voice change, the hair (
capillary leaves?) of
the wild thyme must be boiled in oils, or the juice of ivy or
of knot-grass is also to be infused. But if the delirium get
more violent, hog's-fennel and cow-parsnip are to be boiled in
the oils, and some vinegar poured in; for these things dissipate
the vapours and heat, and are solvents of the thick humours
which contribute to the delirium. But care must be taken
that the moist application do not extend to the neck and the
tendons, for it is prejudicial to tendons and nerves. Every
season is suitable for the damp application, except the commencement
of a paroxysm; it should be used more rarely
during the increase, but most frequently at the acme; and
whenever they are delirious, then, in particular, it will be
proper to use a cold application, made still more cold in the
season of summer, but in winter tepid. To soothe the delirium
it is well to foment the forehead with oxycrate, or the decoction
of fleabane, by means of a sponge, and then to anoint
with the oil of wild vine or of saffron, and also to anoint the
nose and ears with them.
These things, moreover, also induce sleep. For if they lay
awake all night, nor sleep during the day, and the eyes stand
quite fixed like horns, and the patients toss about and start up,
we must contrive to procure sleep and rest for them; first, by
fomentations to the head, with unmixed rose-oil, or oil of
marjoram with the juice of ivy, or the decoction of wild thyme
or of melilot. But poppy boiled in oil is particularly soporific
when applied to the fontenelle of the head, or with a sponge
to the forehead. But the poppies, if recently plucked and
green, may be applied whole under the pillows; for they
thicken and humectate the spirit (
pneuma), which is dry and
attenuated, and diffuse over the senses fumes which prove the
commencement of sleep. But if greater applications are needed,
we may rub in the meconium (
expressed juice of poppy) itself
on the forehead with water, and also anoint the nostrils with
the same, and pour it into the ears. Gentle rubbing of the
feet with oil, patting of the head, and particularly stroking of
the temples and ears is an effectual means; for by the stroking
of their ears and temples wild beasts are overcome, so as to
cease from their anger and fury.
4 But whatever is
familiar to any one is to him a provocative of sleep. Thus, to the sailor,
repose in a boat, and being carried about on the sea, the
sound of the beach, the murmur of the waves, the boom of
the winds, and the scent of the sea and of the ship. But to
the musician the accustomed notes of his flute in stillness; or
playing on the harp or lyre, or the exercise of musical children
with song. To a teacher, intercourse with the tattle of
children. Different persons are soothed to sleep by different
means.
To the hypochondria and region of the stomach, if distended
by inflammation, hardness, and flatulence, embrocations and
cataplasms are to be applied, with the addition of the oil of the
over-ripe olive, for it is thick, viscid, and calefacient; it therefore
is required in inflammation: let dill or flea-bane be boiled
in it, and it is a good thing to mix all together; but if flatulence
be present also, the fruits of cumin and parsley, and
whatever other things are diuretic and carminative, along
with sifted natron, are to be sprinkled on the application.
But if the liver experience suffering and pain, apply unwashed
wool just taken from the ewe, oil from the unripe olive, or
rose-oil; but we must mix also Hellenic or Cretan rob, and
boil in it melilot, and mixing all these things into one juice,
foment the liver therewith. To the spleen the oil must be
mixed with vinegar; or if it should appear to be enlarged in
bulk, oxycrate, and instead of the wool a soft sponge; for the
spleen delights in and is relieved by such things. But if the
hypochondria be collapsed and retracted upwards, and the
skin be stretched, it will be best instead of the oil, or along
with it, to use thick butter in equal quantity, and let fleabane
and rosemary be boiled in the decoction, and dill is not
unsuitable.
But if it be the proper time for cataplasms, we may use the
same oils to the same places, the ingredients of the cataplasms
being linseed, fenugreek, or fine barley-meal; beans and vetches,
also, are proper if the abdomen be swelled. Roasted millet,
also, in bags, makes a light and soft fomentation; when ground
it makes, along with honey, oil, and linseed, an excellent cataplasm
for the hypochondria. Also let the same flowers, herbs,
and seeds which I have described among the embrocations be
used for the cataplasms. Honey, also, is useful along with
these things, to give consistency to the dry things, and for the
mixing of the toasted things, and for the preservation of the
heat; it is a good thing, likewise, by itself; also a cataplasm
half-boiled, and an embrocation dissolved in some of the
liquids, is effectual as an emollient, calefacient, carminative,
and diuretic, and to moderate the inflammations. These
effects are produced also by mulse when drunk, and even
more and greater effects when conveyed internally to the
trachea, the lungs, the thorax, and the stomach.
The bowels, also, are to be frequently stimulated by suppositories
or liniments (for they are generally constipated), in
order to act as derivatives from the head, and also for the
evaporation of the vapours in the chest, and for the evacuation
of the matters in the belly; but, if the belly be confined for
several days, it must be opened by a clyster of mulse, oil, and
natron.
But if the distension of the inflammation do not properly
subside, we must apply a cupping-instrument with scarificators
where the inflammation points and is greatest, on the
first or second day, according as the inflamed parts may indicate,
and the strength direct; and from those the amount of
the evacuation of the blood must be determined, for excess
occasions syncope. During the first and second day the
fomentation should be the same; but, on the third, cerate with
some of the oils used in the embrocations is to be applied:
then, if they be still in a state of inflammation, epithemes,
consisting of hyssop, fenugreek boiled in mulse, the resin of
the turpentine plant, and wax; the oils the same for these
places. If by these means the delirium do not at all abate, it
will be necessary to have recourse to cropping of the head,
provided the hairs be very long, to the extent of one half;
but, if shorter, down to the skin: then, in the meantime
having recruited the strength, to apply a cupping-instrument
to the vertex, and abstract blood. But dry-cupping is first to
be applied to the back.
But since in all the acute diseases the chest must be remedied,
this part generally suffering with the heart and lungs,
more especially from the difficulty of the respiration, which is
sometimes hot, at other times cold; and, moreover, from ardent
fever, cough, badness of the humours, and sympathy of the
nerves, and complaint of the stomach, and illness of the pleura
and of the diaphragm (for the heart, if it suffer from any dreadful
illness, never recovers),--in cases of phrenitis these parts in
particular must be soothed. For, indeed, the delirium in certain
cases arises from some of the parts in the chest; respiration hot
and dry; thirst acrid; febrile heat not easily endured, as being
determined from all parts to the chest; and illness from the perversion
of its native heat, but greater and more intolerable the
communication of the same from the other parts to the chest:
for the extremities are cold--the head, the feet, and the
hands; but, above these last, the chest. It is to be remedied,
then, by humectation and refrigeration. For bathing, oil
boiled with camomile or nard; in summer, also, Hellenic rob.
But if it be necessary also to apply epithemes, dates moistened
with austere wine, then levigated and pounded into a mass with
nard, barley meal, and flower of the wild vine, form a soothing
cataplasm for the chest: a cooling one is formed of apples
bruised with mastich and melilot; all these things, however, are
to be mixed up with wax and nard. But if the stomach be
affected with torpor and loathing of food, the juice or hair of
worm-wood are mixed up with them; and the hypochondriac
region is to be fomented with this boiled up in oil. The
infusion or the juice of it may be drunk before food to the
amount of two cupfuls of the infusion, or one cupful of the
bitter juice with two cupfuls of water. But if the stomach
be affected with heartburn, not from the constitution of the
disease, but of itself from acrid and saltish humours, or from
being pinched with bile, or from being parched with thirst, we
must give in the food milk mixed with water to the amount
of half a hemina of milk in one cupful of water; the patient
should swallow the most of it, but he may take a small portion
of it with bread.
But if the patient be also affected with Causus, and there be
thirst, restlessness, mania, and a desire of cold water, we must
give less of it than in a case of Causus without phrenitis, for
we must take care lest we injure the nerves; we are to give
them as much as will prove a remedy for the stomach, and a
little is sufficient, for phrenitics are spare drinkers.
But if converted into syncope, and this also happens (the
powers of life being loosened, the patient being melted in
sweat, and all the humours being determined outwardly, the
strength and spirit (
pneuma) being also dissolved), we must disregard
the delirium, and be upon our guard lest the patient be
resolved into vapours and humidity. Then the only support
is wine, to nourish quickly by its substance, and to penetrate
everywhere, even to the extremities; to add tone to tone, to
rouse the torpid spirit (
pneuma), warm that which is cold,
brace what is relaxed, restrain those portions which are flowing
and running outwards, wine being sweet to the senses of smell
so as to impart pleasure; powerful to confirm the strength for
life; and most excellent to soothe the mind in delirium. Wine,
when drunk, accomplishes all these good purposes; for they
become composed by the soothing of their minds, are spontaneously
nourished to strength, and are inspired with
pleasure.
But when the fever has become protracted and feeble, and
the delirium is converted into fatuity, but the hypochondrium
is not much injured by swelling, flatulence, or hardness,
and the head is the part principally affected, we must
boldly wash the head, and practise copious affusions on it; for
thus will the habit of body be moistened, the respiration of the
head and exhalation over the whole body will be restored;
and thus will that which is dry become diluted, and the sense
purified of its mist, while the understanding remains sound
and firm. These, indeed, are the indications of the removal
of the disease.
CHAPTER II. THE CURE OF LETHARGICS.
LETHARGICS are to be laid in the light, and exposed to the
rays of the sun (for the disease is gloom); and in a rather
warm place, for the cause is a congelation of the innate heat.
A soft couch, paintings on the wall, bed-clothes of various
colours, and all things which will provoke the sense of sight;
conversation, friction along with squeezing of the feet, pulling,
tickling. If deep sleep prevail, shouting aloud, angry reproach,
threats regarding those matters which he is accustomed
to dread, announcement of those things which he
desires and expects. Everything to prevent sleep--the reverse
of that which is proper for phrenitics.
With regard to the depletion of lethargics this should be
known:--If the obliviousness be the sequela of another disease,
such as phrenitis, we must not open a vein, nor make a great
evacuation of blood in any way, but inject the belly, not
solely for the evacuation of its contents, but in order to produce
revulsion from above, and to determine from the head:
there should be a good deal of salts and natron in it, and it
answers very well if you add a sprinkling of castor to the
clyster; for in lethargics the lower intestine is cold, and dead,
as it were, to evacuation. But, if the lethargy is not the consequence
of another disease, but is the original affection, and
if the patient appear to be plethoric, provided it be with blood,
we must open a vein at the elbow; but, if with a watery
phlegm, or other humours, we must purge by means of cneoros
5
with the ptisan, or by black hellebore with honeyed-water, in
the beginning, if you wish to do so moderately; but if to a
greater extent, you must give to the patient when fasting of the
medicine called Hiera, to the extent of two drams with three
cupfuls of honeyed-water; and, having waited until it purges,
then give food, if it be the proper season; but otherwise
nourishment is to be given the next day. It will be seasonable
then to give in the evening a dram of the hiera, dissolved
either in two cupfuls of water or of honeyed-water.
Total abstinence from food is bad, as is also much food. It
is proper, then, to administer a little food every day, but not
to withdraw food altogether; for the stomach to be reminded
of its duties and fomented, as it were, during the whole day.
Also the food must be attenuant and laxative, rather in the
form of soups than roasted, such as hens or shell-fish; and the
herb mercury is to be boiled with it, and some vinegar added.
And we may add to the juices, if it be proper to use the juice
of ptisan, something to promote exhalation and the discharge
of urine, such as fennel, parsley--the pot-herbs themselves, or
their fruits. Horehound, also, by its acrid qualities, does good;
and likewise colewort with oil, and the brine of fish (
garum).
The sweet cumin is a most excellent medicine for the flatulence
and urine; for the stomach and bladder are to be stimulated
during the whole time of the disease.
The moist applications to the head the same as in the case
of phrenitics; for in both the senses are filled with vapours,
which must either be expelled by refrigerants and astringents,
such as the oil of roses or the juice of ivy, or dissipated into
exhalation by attenuants, such as wild thyme in vinegar, with
the rose-oil. But if there be pain of the nerves, and coldness of
the whole body, but more especially of the extremities, we
must besmear and bathe the head and neck with castor and
oil of dill, and anoint the spine with the same along with
Sicyonian oil, the oil of must, or old oil; at the same time, we
must rub both the arms from the shoulders and both the legs
from the groins. With these, moreover, the bladder is to be
soothed, which suffers, as being of a nervous nature, and is
stressed as being the passage for the urine; and also is irritated
by the acrimony of the humours, for the urine is bilious. But
if the trembling increase, and there be danger of a convulsion,
we must necessarily use Sicyonian oil to the head, but use it
in small quantity. But if there be inflammation of the hypochondria,
and fulness thereof, flatulence, and tension of the
skin, or if there be a hollow there from retraction inwards of
the hypochondria, we must apply the embrocations and cataplasms,
described by us under Phrenitics.
The cupping-instrument is by no means to be used if the
disease be the consequence of phrenitis, but this may be done
more boldly if it be the original disease. If the tongue be
black, and a swelling point in the hypochondria, the cupping-instrument
must necessarily be used. When in the course of
time the senses have been evacuated, and the patient is otherwise
more tolerant of the disease, we may apply the cupping-instrument
to the top of the head, since we can evacuate from
it without injury to the strength.
Flatulence is to be expelled both upwards and downwards;
for lethargy produces collections of flatus both in the cavities
and in the whole frame, from inactivity, torpor, and want of
spirit, which motion and watchfulness dissipate; wherefore,
having rubbed up green rue with honey and natron, we anoint
therewith; it will expel the wind more effectually if one part
of the resin of turpentine be added to these things. A fomentation
also will expel flatus, either with hot unwashed wool,
or with rough old rags, or a sponge with water in which hyssop,
marjoram, penny-royal, or rue, have been boiled. The
potions
6
also which are taken before food expel flatus, and these also
bring away phlegm and bile in the stomach and bowels; such
are hyssop, boiled mulse, Cretan dictamny, or marjoram:
maiden-hair and agrostis
7
are
acrid, but possessed of expulsive
qualities, for indeed they evacuate flatus and urine.
If there be trembling of the hands and head, he may take
a draught, consisting of castor with three cupfuls of honeyed-water,
for some days; or if he will not drink this, we may
melt down the castor in a sufficient quantity of oil, wherein
rue has been boiled, to the amount of three cupfuls; and a
double amount of this is to be injected into the lower bowel,
and is to be repeated for several days; and after the benefit
derived from it (for it brings off flatus upwards and downwards,
and, in certain cases, urine and fæces), if it should
be diffused over the whole system in any way, the nerves
recover from their tremblings and become strong, and it
changes the habit of body to the hot and dry, and alters the
constitutions of diseases. It is also a very excellent thing to
blow it into the nostrils, for in this way it expels flatulence by
sneezing; for as the bladder secretes urine, so does the nose
mucus. It effects these things by its gentle heat, in which respect
it is superior to the other sternutatories, pepper, hellebore,
soap-wort, and euphorbium; for these things, both at their first
and last impression are harsh, and disorder the head and the sense,
whereas castor gradually creates a gentle heat. To the head
it is also otherwise suitable, because the nerves everywhere
derive their origin from it; and castor is a remedy for the
diseases of the nerves; but to mix it with some one or more
of the medicines described will not be disagreeable, for if it
be mixed, it will not immediately disorder the head, even in
a moderate degree, but after a time it will stir up the heat.
The nose is to be moistened by tickling; by odours acrid
indeed to the sense, but possessed of heating powers, such as
the castor itself, or savory, or penny-royal, or thyme, either
in a green state, or in a dried, moistened well with vinegar.
Anointing with acrid medicines is proper to the feet and
knees. The
materiel thereof should be heating and pungent
by degrees; for there is need of both in cases of lethargy to
induce warmth and watchfulness. In the first place, it is
proper to whip the limbs with the nettles, for the down
thereof sticking to the skin does not endure long, but imparts
no disagreeable tingling and pain; it also moderately stimulates,
induces swelling, and provokes heat. But if you desire
to have these effects produced more powerfully, rub in equal
parts of lemnestis
8 and euphorbium, with oil of must. It is
also a very good thing to rub with raw squill pulverised; but
it is necessary to rub off the oily matter of the limb (for
everything acrid loses its stimulant properties with oil) --
unless it be medicinal -- either the oil of privet, or that
of must, or the Sicyonian. But if after these things a deep
coma prevail, it will be proper, having pounded the wild
cucumber with vinegar, and mixed it with an equal quantity
of a cake of mustard, to apply this as an acrid cataplasm,
and one which will speedily occasion redness, and will also
quickly produce swelling. But if there be danger of blistering
and of wounds, it will be proper to raise the cataplasm
frequently, and see that none of these effects be produced.
These things, therefore, are to be done to relieve the torpor
and insensibility of the parts at all seasons, except at the
commencement of the paroxysms.
But if the patient have already recovered his sensibility,
but there is still some heaviness of the head, noise, or ringing
thereof, it will be proper to evacuate phlegm by the mouth,
first by giving mastich to chew, so that he may constantly
spit, then again stavesacre, the granum cnidium,
9 but more
especially mustard, because it is a common article, and also
because it is more of a phlegmagogue than the others. And
if the patient drink it willingly, it will be sufficient to dissolve
the matters in the stomach, it will also be able to moisten the
stomach and expel flatulence; for this once fortunately happened
to myself in the case of a man who drank it by my
directions; for experience is a good teacher, one ought, then,
to try experiments, for too much caution is ignorance.
The head, then, after the hair has been clipped to the skin,
if much good is not thereby accomplished, is to be shaven to
procure insensible perspiration, and also to allow the anointing
with acrid medicines, such as that from lemnestis (or
adarce),
or thapsia,
10 or mustard moistened with water; these things,
with double the quantity of bread, are to be rubbed on an old
piece of skin, and applied to the head, taking good care at the
expiry of an hour to foment the parts with hot sponges.
It will also not be devoid of utility, when all, or most at
least, of the fatal symptoms of the disease are gone, but the
languor remains, to bathe; and then also gestation, friction,
and all gentle motion will be beneficial.
CHAPTER III. THE CURE OF MARASMUS. 11
IN these cases, indeed, if Marasmus prevail, we must remedy
it by quickly having recourse to the bath and to exercises.
And truly milk is a remedy of marasmus by nourishing,
warming, moistening the stomach, and soothing the bladder.
Moreover, the same means are beneficial in cases of
catochus,
for the form of these diseases is alike and the same. Castor,
then, is more particularly proper in these cases, and most
particularly soothing, whether to drink, to anoint with, or to
inject into the bowel. The affections similar to these which
happen to women from the uterus, will be treated of among
female diseases.
CHAPTER IV. THE CURE OF APOPLEXY.
. . . . . should indeed the apoplexy be severe, for by all
means the patients are, as it were, dead men whenever one is
old, to whom this affection is congenial, and they cannot
survive the greatness of the illness, combined with the misery
of advanced life. It has been formerly stated by me, how the
magnitude of the disease is to be estimated. If the patient be
young, and the attack of apoplexy weak, it is still no easy
matter to effect a cure; it must, however, be attempted. The
equivalent remedy, then, as being the great assistance in a
a great disease, is venesection, provided there be no mistake
as to quantity; but the amount is difficult to determine, since
if you take a little too much, you despatch the patient at
once; for to them a little blood is most potent, as being that
which imparts the vital heat to the frame itself, and to the
food. But, if the quantity be inferior to the cause, you do
little good with this the great remedy, for the cause still
remains. But it is better to err on the side of smallness; for,
if it should seem to have been deficient, and the appearance
of the eyes, as seen from below, be favourable, we can open a
vein again. We must open the vein at the hollow of the
elbow, for the blood flows readily from it in the left arm.
But in smaller attacks of apoplexy, it is necessary to consider
whether the paralytic seizure be on the left side or the right.
In a word, the abstraction is to be made from the healthy
parts, for there the blood flows more freely, and thither the
revulsion is made from the parts affected. When, therefore,
the patient is seized with apoplexy without any obvious cause,
we should decide thus concerning the abstraction of the blood.
But if the attack happen from a blow, a fall from a high place,
or compression, there must be no procrastination, for in certain
cases this alone is sufficient for the cure and to save life.
But if it is not thought expedient to open a vein, owing to
the patient's having been seized with much coldness, torpor,
and insensibility, an injection must be given for the evacuation
of the engorgement in the bowels (for very generally persons
are seized with apoplexy from the immoderate use of food and
wine), and for the revulsion of the humours seated in the head.
The clyster should be acrid; and an evacuant of phlegm and
bile, consisting not only of natron, but also of euphorbium, to
the amount of three oboli, added to the usual amount of a
clyster, also the medullary part of the wild cucumber,
or the decoction of the hair (
leaves) of centaury in oil or
water. The following is a very excellent clyster: To the
usual amount of honey add rue boiled with oil and the resin
of the turpentine tree, and some salts, instead of natron, and
the decoction of hyssop.
And if by these means the patient be somewhat aroused,
either from being moved by the supervention of fevers, or
having recovered from his insensibility, or the pulse has
become good, or if the general appearance of the face has
become favourable, one may entertain good hopes, and apply
the remedies more boldly. Wherefore, when the strength is
confirmed, the purgative hiera may be given to the patient
fasting, and particularly a full dose. But, if the strength be an
objection, it is to be given, to the amount of one-half, with
honeyed-water. And we are to move him about, after having
laid him stretched on a couch; and those who carry him must
do so gently, he being allowed to rest frequently, to avoid inducing
lassitude. And if there be a copious evacuation from
the bowels, we are to permit it; but if not, give water, or
honeyed-water, to the amount of two cupfuls, for drink. And
if nausea supervene upon the purging, we are not to interfere
with it; for the exertions of the body have some tendency to
resuscitate the patient, and the vomiting of the bile carries off
the cause of the disease. The medicine hiera is a purger of
the senses, of the head, and of the nerves. Enough, indeed,
has been said respecting evacuation of every kind at the
commencement.
But having wrapped the whole of his person in wool, we
are to soak it with some oil -- the Sicyonian, oil of musk
(
gleucinum), or old oil, either each of these separately, or all
mixed together; but it is best to melt into it a little wax, so
as to bring it to the thickness of ointments; and it is to be rendered
more powerful by adding some natron and pepper: these
are to be reduced to a powder, and strained in a sieve. But
castor has great efficacy in cases of palsy, both in the form of
a liniment with some of the fore-mentioned oils, and it is still
more potent when taken in a draught with honeyed-water, the
quantity being to the amount we have stated under lethargics;
but, at the same time, we must consider the age and disposition
of the patient, whether he be ready to take the drink for several
days. Inunctions are more powerful than fomentations, as
being more easily borne, and also more efficacious; for the
ointment does not run down so as to stain the bed-clothes (for
this is disagreeable to the patient), and adheres to the body
until, being melted by the heat thereof, it is drunk up. Moreover,
the persistence of their effects is beneficial, whereas liquid
applications run off. The ingredients of the ointments are
such as have been stated by me; but along with them castor,
the resin of the turpentine-tree, equal parts of euphorbium, of
lemnestis, and of pellitory; of pepper, and of galbanum one-half,
with triple the amount of Egyptian natron; and of wax,
so as to bring it to a liquid consistence. But a much more
complex mode of preparing these medicines has been described
by me on various occasions, and under a particular head.
Cataplasms are to be applied to the hardened and distended
parts; their ingredients are linseed, fenugreek, barley-meal, oil
in which rue or dill has been boiled, the root of mallows
pounded and boiled in honeyed-water, so as to become of the
consistence of wax. They should be of a soft and agreeable
consistence. These things are to be done if the patient still
remains free of fever, or if the fever be slight, in which case
no regard need be had to the heat.
But if the fevers be of an acute nature, and the remaining
disease appear to be of minor consequence, and if these induce
urgent danger, the diet and the rest of the treatment must be
accommodated to them. Wherefore, the patients must use
food altogether light and of easy digestion; and now, most
especially, attention ought to be paid to the proper season for
eating, and, during the paroxysms, the whole of the remedial
means must be reduced; and, altogether, we must attend to
the fevers.
But if the disease be protracted, and if the head be at fault,
we must apply the cupping-instrument to the back of the head,
and abstract blood unsparingly; for it is more efficacious than
phlebotomy, and does not reduce the strength. But, dry-cupping
is to be first applied between the shoulders, in order
to produce revulsion of the matters in the occiput.
Sometimes, also, the parts concerned in deglutition are
paralysed, which is the sole help and safety of persons in
apoplexy, both for the swallowing of food and for the transmission
of medicines. For not only is there danger of want
of nourishment and hunger, but also of cough, difficulty of
breathing, and suffocation; for if one pour any liquid food
into the mouth it passes into the trachea, neither the tonsils
coming together for the protrusion of the food, nor the epiglottis
occupying its proper seat where it is placed by nature,
as the cover of the windpipe; we must, therefore, pour
honeyed-water or the strained ptisan into a piece of bread resembling
a long spoon, and passing it over the trachea, pour
its contents into the stomach; for in this way deglutition is
still accomplished. But if the patient be in the extremity of
danger, and the neck with the respiration is compressed, we
must rub the neck and chin with heating things and foment.
They effect nothing, and are unskilful in the art, who apply
the cupping-instrument to the throat, in order to dilate the
gullet; for distension, in order to procure the admission of
food, is not what is wanted, but contraction of the parts for
the purposes of deglutition. But the cupping-instrument
distends further; and, if the patient wish to swallow, it prevents
him by its expansion and revulsion, whereas it is necessary
to pass into a state of collapse, in order to accomplish the
contraction of deglutition; and in addition to these, it stuffs
the trachea so as to endanger suffocation. And neither, if
you place it on either side of the windpipe, does it any good;
for muscles and nerves, and tendons and veins, are in front
of it.
The bladder and the loose portion of the rectum are sometimes
paralysed, in regard to their expulsive powers, when the
bowels are constantly filled with the excrements, and the
bladder is swelled to a great size. But sometimes they are
affected as to their retentive powers, for the discharges run
away as if from dead parts. In this case one must not boldly
use the instrument, the catheter, for there is danger of inducing
violent pain of the bladder, and of occasioning a convulsion
in the patient. It is better to inject with no great
amount of strained ptisan; and if the bowel be evacuated of
the fæces, it will be proper to inject castor with oil. But the
sole hope, both of general and partial attacks of paralysis,
consists in the
sitz bath of oil. The manner of it will be described under the chronic diseases.
CHAPTER V. CURE OF THE PAROXYSM OF EPILEPTICS.
EVEN the first fall in epilepsy is dangerous, if the disease
attack in an acute form; for it has sometimes proved fatal in
one day. The periodical paroxysms are also dangerous; and,
therefore, on these accounts, epilepsy has been described among
the acute diseases. But if the patient has become habituated
to the illness, and the disease has taken a firm hold of him, it
has become not only chronic, but, in certain cases, perpetual;
for if it pass the prime of life, it clings to him in old age and
in death.
Such remedies, then, as are applicable in the chronic state
will be described among the chronic diseases; but such things
as must be done for a sudden attack of the disease, of these
the greater number have been described under apoplectics,
namely, venesection, clysters, anointings, the cupping instrument;
these means being the most powerful for the purpose of
arousing. But I will now describe the peculiar remedies for
an attack of the falling sickness. In children, then, to whom,
owing to dyspepsia, or from excessive cold, the disease is
familiar, vomiting, either of food, or of phlegm, or of any
other humour, is beneficial. Feathers, then, dipped in the
ointment of iris, excite vomiting; and the unguentum irinum
is not inapplicable for smearing the tonsils with. But having
first laid the child on his belly (this is the easiest position for
vomiting), we must press gently on his lower belly. But if
the lower jaw be convulsed or distorted, or if the hands and
legs be tossed about, and if the whole face be fixed, the limbs
are to be soothed by gentle rubbing with oil, and the distortions
of the countenance rectified; the straight parts are to
be gently bound, so that they may not become distorted. The
cold parts are to be fomented with unscoured wool, or with
old rags. The anus is to be rubbed with honey along with
the oil of rue, or with natron and liquid resin along with these
things; and they are to be gently pushed within the anus, for
they expel flatus, and children pass flatus in this disease. But
if they can swallow, we may give them of this medicine: Of
cardamom, one part; of copper, one siliqua. These things
are to be drunk with honeyed-water; for either it is vomited
up along with the matter annoying the stomach, or the bowels
are opened. This is a very excellent linctus: Of cardamom, of
mustard, and of the hair of hyssop equal parts; of the root of
iris, one part, with a double quantity of natron; of pepper, to
the amount of one-third. Having mixed up all these things
together, and having separated the jaw, pour into the mouth,
and even beyond the tonsils, so that the things may be swallowed.
These things are proper for infants, and for young
persons the same are applicable. But the more powerful
emetics are to be taken: the bulbous root of narcissus; of
mustard and of hyssop, equal parts; of copper and pepper,
one-half the proportion of the former things. They are to be
mixed with honey and given. These things are proper, in
order to rouse from the paroxysm; but those calculated to
produce the resolution of the disease will be described under
the chronic diseases.
CHAPTER VI. THE CURE OF TETANUS.
NOW, indeed, a soft, comfortable, smooth, commodious, and
warm bed is required; for the nerves become unyielding, hard,
and distended by the disease; and also the skin, being dry
and rough, is stretched; and the eye-lids, formerly so mobile, can
scarcely wink; the eyes are fixed and turned inwards; and likewise
the joints are contracted, not yielding to extension. Let
the house also be in a tepid condition; but, if in the summer
season, not to the extent of inducing sweats or faintness; for
the disease has a tendency to syncope. We must also not
hesitate in having recourse to the other great remedies; for it
is not a time for procrastination. Whether, then, the tetanus
has come on from refrigeration, without any manifest cause,
or whether from a wound, or from abortion in a woman, we
must open the vein at the elbow, taking especial care with
respect to the binding of the arm, that it be rather loose; and
as to the incision, that it be performed in a gentle and expeditious
manner, as these things provoke spasms; and take away
a moderate quantity at first, yet not so as to induce fainting
and coldness. And the patient must not be kept in a state of
total abstinence from food, for famine is frigid and arid.
Wherefore we must administer thick honeyed-water without
dilution, and strained ptisan with honey. For these things do
not press upon the tonsils, so as to occasion pain; and, moreover,
they are soft to the gullet, and are easily swallowed, are
laxative of the belly, and very much calculated to support
the strength. But the whole body is to be wrapped in wool
soaked in oil of must or of saffron, in which either rosemary,
fleabane, or wormwood has been boiled. All the articles are
to be possessed of heating properties, and hot to the touch.
We must rub with a liniment composed of lemnestis, euphorbium,
natron, and pellitory, and to these a good deal of
castor is to be added. The tendons also are to be well wrapped
in wool, and the parts about the ears and chin rubbed with
liniments; for these parts, in particular, suffer dreadfully, and
are affected with tension. Warm fomentations, also, are to be
used for the tendons and bladder, these being applied in bags
containing toasted millet, or in the bladders of cattle half
filled with warm oil, so that they may lay broad on the
fomented parts. Necessity sometimes compels us to foment
the head, a practice not agreeable to the senses, but good for
the nerves; for, by raising vapours, it fills the senses with
fume, but relaxes the nervous parts. It is proper, then, to use
a mode of fomentation the safest possible, and materials not of
a very heavy smell; and the materials should consist of oil
devoid of smell, boiled in a double vessel,
12 and applied in
bladders; or of fine salts in a bag: for millet and linseed are
pleasant indeed to the touch, but gaseous, and of an offensive
smell. The patient having been laid on his back, the fomentations
are to be spread below the tendons, as far as the vertex;
but we must not advance further to the bregma, for it is the
common seat of all sensation, and of all remedial and noxious
means it is the starting-point. But if it be necessary to apply
cataplasms to the tendons, it must be done below the occiput;
for if placed higher, they will fill the head with the steam of
the linseed and fenugreek. After the cataplasms, it is a good
thing to apply the cupping-instrument to the occiput on both
sides of the spine; but one must be sparing in the use of heat,
for the pressure of the lips of the instrument is thus painful,
and excites contractions. It is better, then, to suck slowly
and softly, rather than suddenly in a short time; for thus the
part in which you wish to make the incision will be swelled
up without pain. Your rule in regard to the proper amount
of blood must be the strength. These are the remedies of
tetanus without wounds.
But if the spasm be connected with a wound, it is dangerous,
and little is to be hoped. We must try to remedy it,
however, for some persons have been saved even in such cases.
In addition to the other remedies, we must also treat the
wounds with the calefacient things formerly described by me,
by fomentations, cataplasms, and such other medicines as excite
gentle heat, and will create much pus: for in tetanus the
sores are dry. Let the application consist of the manna of
frankincense, and of the hair of poley, and of the resins of
turpentine and pine-trees, and of the root of marsh-mallow and
of rue, and of the herb fleabane. These things are to be
mixed up with the cataplasms, melting some of them, sprinkling
the others upon them, and levigating others beforehand
with oil; but the mallow, having been pounded, is to be boiled
beforehand in honeyed-water. We are to sprinkle, also, some
castor on the ulcer, for no little warmth is thereby communicated
to the whole body, because the rigors proceeding from
the sores are of a bad kind. Rub the nostrils with castor
along with oil of saffron; but also give it frequently, in the
form of a draught, to the amount of three oboli. But if the
stomach reject this, give intermediately of the root of silphium
an equal dose to the castor, or of myrrh the half of the silphium:
all these things are to be drunk with honeyed-water.
But if there be a good supply of the juice of the silphium
from Cyrene,
13 wrap it, to the amount of a tare, in boiled
honey,
and give to swallow. It is best given in this way, as it slips
unperceived through the palate; for it is acrid, and occasions
disagreeable eructations, being a substance which has a bad
smell. But if it cannot be swallowed thus, it must be given
dissolved in honeyed-water; for it is the most powerful of all
the medicines given to be swallowed, which are naturally
warming, diluent, and can relax distensions and soothe the
nerves. But if they can swallow nothing, we must inject it
into the anus with the oil of castor; and thus the anus is to be
anointed with oil or honey. With this, also, we must anoint
the fundament, along with oil or honey. But if they will
drink nothing, we must make an injection of some castor with
the oil. With this, also, we are to anoint the fundament,
along with fat or honey; and also foment the bladder; and
use it as an ointment, having melted it with a sufficiency of
wax to bring it to the proper consistence. But if it be the time
for evacuating flatulence and fæces, we are to inject two drams
of the purgative hiera along with honeyed-water and oil, since,
along with the expulsion of these, it warms the lower belly;
for hiera is both a compound and heating medicine.
CHAPTER VII. THE CURE OF QUINSEY.
THERE are two forms of quinsey. The one is attended with
heat, and great inflammation of the tonsils, and swelling outwardly;
moreover, the tongue, uvula, and all the parts there,
are raised up into a swelling. The other is a collapse of these
parts, and compression inwardly, with greater sense of suffocation,
so that the inflammation appears to be determined to the
heart. In it, then, particularly, we must make haste to apply
our remedies, for it quickly proves fatal.
If, then, it proceed from taking too much food and wine,
we must inject the bowels on the day of the attack, and that
with two clysters: the one a common clyster, so as to bring off
the feculent matters; and the other for the purpose of producing
revulsion of the humours from the tonsils and chest.
It will therefore be, but not undiluted . . . . . . . and the
decoctions of centaury and hyssop; for these medicines also
bring off phlegm. And if the patient has been on a restricted
diet, we open the vein at the elbow, and make a larger incision
than usual, that the blood may flow with impetuosity and in
large quantity; for such a flow is sufficient to mitigate the
heat most speedily, is able to relieve the strangulation, and
reduce all the bad symptoms. It is no bad practice, likewise,
to bring the patient almost to fainting, and yet not so as that
he should faint altogether, for some from the shock have died
of the fainting . . . . . . . . or binding them with ligatures
above the ankles and knees. It is a very good thing, likewise,
to apply ligatures to the forearms above the wrists, and
above the forearms to the arms. And if deglutition be easy, we
are to give elaterium with honeyed-water, and the whey of
milk, as much as will be sufficient to purge the patient. In
these cases, elaterium is preferable to all other cathartics; but
cneoros and mustard are also suitable, for both these purge the
bowels. If the inflammations do not yield to these means,
having bent the tongue back to the roof of the mouth, we
open the veins in it; and if the blood flow freely and copiously,
it proves more effectual than all other means. Liquid
applications to the inflamed parts, at first of an astringent
nature, so as to dispel the morbid matters: unwashed wool,
then, with hyssop, moistened in wine, and the ointment from
the unripe olive. But the cataplasms are similar to the liquid
applications,--dates
soaked in wine, and levigated with rose-leaves.
But in order that the cataplasm may be rendered glutinous
and soft, let flour or linseed, and honey and oil be added, to
produce the admixture of all the ingredients. But if it turn
to a suppuration, we are to use hot things, such as those used
in the other form of synanche. Let fenugreek be the powder,
and manna and resin the substances which are melted; and let
the hair of poley be sprinkled on it, and a hot fomentation
be made with sponges of the decoction of the fruit of the bay
and of hyssop. And the powdered dung of pigeons or of dogs,
sifted in a sieve, is most efficacious in producing suppuration,
when sprinkled on the cataplasm. As gargles, honeyed-water,
with the decoction of dried lentil, or of hyssop, or of
roses, or of dates, or of all together. We are also to smear the
whole mouth, as far as the internal fauces, either with Simples,
such as the juice of mulberries, or the water of pounded pomegranates,
or the decoction of dates; or with Compound preparations,
such as that from mulberries, or that from
besasa,
14 or
that from the juice of pomegranates, and that from swallows.
But if the ulcers proceed from eschars, these gargles, and
washes for the mouth, the decoction of hyssop in honeyed-water,
or of fat figs in water, and along with them starch dissolved
in honeyed-water, or the juice of ptisan, or of tragus
(
spelt?).
But in the species of synanche attended with collapse, we are
to make a general determination from within outwardly, of the
fluids, of the warmth, and of all the flesh, so that the whole may
swell out. Let the liquid applications then be of a hot nature,
with rue and dill, natron being sprinkled upon them; and along
with them the cataplasms formerly mentioned. It is a good thing
also to apply a cerate with natron and mustard for inducing heat;
for heat determined outwardly is the cure of such complaints; and
thus swelling takes place in the neck, and an external swelling
rescues from peripneumonia; but in cases of synanche, the evil
when inwardly is of a fatal nature. But those who, in order to
guard against suffocation in quinsey, make an incision in the
trachea for the breathing, do not appear to me to have proved
the practicability of the thing by actual experiment; for the
heat of the inflammation is increased by the wound, and thus
contributes to the suffocation and cough. And, moreover, if
by any means they should escape the danger, the lips of the
wound do not coalesce; for they are both cartilaginous, and
not of a nature to unite.
15 * * * * *
* * * * * * * *
* * * * * * * *
* * * * *
CHAPTER VIII. CURE OF THE AFFECTIONS ABOUT THE COLUMELLA (OR
UVULA).
OF the affections which form about the
columella, some
require
to be treated by excision; but the surgical treatment of such
cases does not come within the design of this work. Some
are to be treated as acute affections; for some of them readily
prove fatal by suffocation and dyspnœa. These are the diseases
which we call
uva and
columella; for both are attended
with inflammation and increase in thickness and length, so
that the parts hang down, and come into the
arteria aspera.
The
columna is of equal thickness from the base to the extremity
in the palate: the
uva is of unequal thickness; for its base
at the palate is slender, whereas at its extremity it is rounded
and thick, with redness and lividity, whence it gets the appellation
of
uva. These, then, must be speedily relieved; for the
death from suffocation is very speedy.
If, then, the patients be young, we must open the vein at the
elbow, and evacuate copiously by a larger incision than usual;
for such an abstraction frees one from suffocation, as it were,
from strangulation. It is necessary, also, to inject with a mild
clyster, but afterwards with an acrid one, again and again,
until one has drawn from the parts above by revulsion; and
let ligatures be applied to the extremities above the ankles
and knees, and above the wrists and forearms to the arms.
But if the suffocation be urgent, we must apply a cupping-instrument
to the occiput and to the thorax, with some scarifications,
and also do everything described by me under
synanche; for the mode of death is the same in both. We
must also use the same medicines to the mouth, both astringents
and emollients, with fomentation of the external parts,
cataplasms, and liniments to the mouth. For the forms named
columella and
uva, as an astringent medicine take the juice of
pomegranate, acacia dissolved in honey or water, hypocistis,
Samian, Lemnian, or Sinopic earth, and the inspissated juice
of sour grapes. But if the diseased part be ulcerated, gum
and starch moistened in the decoction of roses or of dates, and
the juice of ptisan or of spelt (
tragus). But in
columella let
there be more of the stronger medicines, from myrrh,
costus,
16
and cyperus;
17 for the
columella endures
these acrid substances.
But should the part suppurate, in certain cases even the bones
of the palate have become diseased, and the patients have
died, wasted by a protracted consumption. The remedies of
these will be described elsewhere.
CHAPTER IX. CURE OF THE PESTILENTIAL AFFECTIONS ABOUT THE
PHARYNX.
IN some respects, the treatment of these is the same as that of
the
other affections in the tonsils, and in some peculiar. In inflammation
and suffocation, the remedies are clysters, venesection,
liquid applications, cataplasms, fomentation, ligatures, cupping;
and all these are applicable here. But anointing with more potent
medicines is proper; for the ulcers do not stop, nor do eschars
form on the surface. But if a sanies from them run inwardly,
the parts, even if before in a healthy state, very soon become
ulcerated, and very soon the ulcers spread inwardly, and prove
fatal. It might be beneficial to burn the affection with fire,
but it is unsuitable owing to the isthmus. But we must use
medicines resembling fire to stop the spreading and also for
the falling off of the eschars: these are alum, gall, the flowers
of the wild pomegranate, either in a dried state or with
honeyed-water. And the same medicines may be blown in
by means of a reed, or quill, or a thick and long tube, so that
the medicines may touch the sores. The best of these medicines
is calcined chalcitis,
18 with cadmia
19 triturated in vinegar.
Let there be a double proportion of the cadmia, and of the
root of rhubarb, with some fluid. It is necessary, however, to
guard against their pressure, for the ulcers thus get moist and
spread farther. We must, therefore, sprinkle them in a dry
state with a quill. But the liquid medicines, having been
much diluted, are to be injected upon the columella. But if
the eschars be already loosened, and the ulcers become red,
there is then most danger of convulsion; for generally the
ulcers are dried up, and thereby tonic contractions of the
nerves are induced. It is necessary then to soften and moisten
by means of milk, with starch, and the juice of ptisan, or of
tragus, or linseed, or the seed of fenugreek. In certain cases
also the uvula has been eaten down to the bone of the
palate and the tonsils to their base and epiglottis; and in
consequence of the sore, the patient could neither swallow
anything solid nor liquid; but the drink regurgitating has cut him off by starvation.
CHAPTER X. CURE OF PLEURISY.
IN cases of Pleurisy there is no time for procrastination, nor
for putting off the great remedy. For the fever, being very
acute, hastens to a fatal termination; the pain also of the
succingens hurries on to the worse; and moreover coughs which
agitate the chest and head exhaust the powers. Wherefore
then, on the selfsame day we must by all means open a vein.
But if it be in connection with repletion of food and drink,
having kept the patient fasting for one day, we are to abstract
blood from the vein in the hollow of the elbow, in a line
with the opposite side, (for it is better to take it from a very
great distance); but not to the extent of deliquium animi,
for there is danger of Peripneumonia supervening if the body,
being congealed, should leave the soul; for the fluids rush inward
when deprived of their external heat and tension. For the
Lungs are of loose texture, hot, and possessed of strong powers
of attraction; the lungs also are the neighbours of the ribs,
and their associates in suffering; and this succession of disease
is not readily recovered from; whereas in Pleuritis from
Peripneumonia, recovery readily takes place, this combination
being milder. It is necessary, therefore, after a moderate
flow of blood, to recruit the patient for a time, and afterwards
abstract again; if matters go on well, the same day, provided
the remission be long; but if not, on the day following. But if
there is no remission of the fever (for generally the fever
prevails and increases for one day), we are to abstract blood
the third day during the second remission, when also food is
to be given--after having anointed the patient freely, having
also applied to the side soft oil with the heating ointment of
rue, or the decoction of dill. A very soothing fomentation
is also to be applied to the side. In certain cases, the pain
and inflammation are determined outwardly, so as to make it
appear an affection of the parts there; but it is merely an exacerbation
of the internal symptoms.
Let us now treat of regimen, in order that, respecting all
the system of treatment, there may be no mistake. "For in
food will consist the medicines, but also the medicines in
food." In kind, then, it is to be hot and humid, smooth and
consistent, detergent, solvent, having the power of dissolving
and attenuating phlegm. Of all kinds of food, therefore,
ptisan is to be preferred; at the commencement, then, strained
to its juice, so that the solid part of it may be separated; and
made with honey only; and let the usual articles added to it
for seasoning and variety be absent (for now the juice alone
is sufficient). It will be calculated to moisten and warm, and
able to dissolve and clear away phlegm, to evacuate upwards
without pain such matters as should be brought up, and also
readily evacuate the bowels downwards. For its lubricity
is agreeable and adapted to deglutition. Moreover, its glutinous
quality soothes heat, purges the membranes, concocts
coughs, and softens all the parts. These are the virtues of
barley. The next place to it is held by chondrus,
20 being
possessed of some of the good qualities of ptisan. For in
regard to its glutinous quality, its lubricity, and its appropriateness
for deglutition, it is equal to the other, but in other
respects inferior. They are to be made plain, with honey
alone. The tragus also is excellent.
21 But rice is worse than
these, inasmuch as it has the property of drying, roughening,
and of stopping the purgation of the sides, rather than of
making it more fluid. A very excellent thing is dry bread,
broken into pieces, passed through a sieve, gently warmed,
well concocted, which with honeyed-water is sufficient nourishment.
But if the disease have already progressed, and the
patient have given up his food, the ptisan of barley is to be
administered in a soft state, and well boiled. Dill and salts
are to be the condiments of the ptisan, and oil which is thin,
without quality, without viscidity, without asperity; it is
better, however, not to boil much of the oil with the ptisan;
for thus the draught becomes fatty, and the oil loses its
badness, and with much boiling is no longer perceptible, being
drunk up by the juice. And let leek with its capillary leaves,
and bitter almonds, be boiled with the juice of ptisan; for the
draught thus promotes perspiration, and becomes medicinal,
and the leeks eaten out of the juice are beneficial and very
delicious. Now also is the season for using wholesome eggs;
but if the expectoration be fluid and copious, sprinkle on them
some native sulphur and natron. But the best thing of all
is to give new-laid eggs which have never been subjected to
the fire; for the heat of the hen is more humid than fire, and
more congenial to the patient, as proceeding from one animal
to another. But if the phlegm be glutinous and viscid,
pour oil into the eggs, and sprinkle some of the dried resin
of pine--so that the sulphur may be more powerful; melting
also with them some of the resin of turpentine; pepper also
and all cognate substances are beneficial in eggs, and in all
kinds of food; the extremities of animals melted down in
soups, pigeons, boiled hens; the brains of swine roasted with
the cawl, but without it they are not savoury. If the patient
has no
râle, we must give him fish from the depth of the sea,
or rock fish, the best which the country produces. And that
the patient may not transgress in regimen, owing to his
appetite, nor become wasted by a spare diet, he is to be gratified
with some fruit; such as apples boiled in water, or
honeyed-water, or stewed in suet (but we must take off the
skin and rough parts within along with the seeds,); and in
season we may give some figs. We must give likewise of any
other kind of autumn fruit which is not only not hurtful but
also beneficial. So much with regard to diet.
Wool fumigated with sulphur and moistened with oil
in which dill and rue have been boiled, is to be laid on the
side. Foment the side constantly with these, and, before the
administration of food, apply cataplasms, in addition to the
usual ingredients containing melilot boiled with honeyed-water,
and mixing therewith some of the fleshy part of the
poppy in a boiled state, and sprinkling on it the meal of the
manna thuris.
22 But if the expectoration be more fluid and
copious, we are to mix the flour of darnel, or of hedge
mustard, and sprinkle natron on it. But if the disease be
prolonged, the pain having become fixed, and the purging
liquid, it is to be apprehended that pus is about to form;
wherefore mix with the cataplasms mustard and
cachrys;23
and if the patients have a feeling as if the internal parts were
cold, some vinegar may be poured into it. The heat of the
cataplasms should be of a strong kind, that it may last the
longer; for this is better than having the heat kept up by
renewal of the cataplasms. Let the fomentations consist of
salts and millet in bags, or of warm oil in bladders. Every
apparatus used for fomentation should be light, so that the
weight may not add to the pain. These things moreover are
to be used also after the food, if the pain be urgent.
And, in addition to these means, now also should be the
time of cupping; but it is best after the seventh day: before
this you should not be urgent with it, for the diseases are not
of a favourable character which require cupping before the
seventh day. Let the instrument be large, broad every way,
and sufficient to comprehend the place which is pained; for
the pain does not penetrate inwardly, but spreads in width.
There should be plenty of heat below the cupping-instrument,
so as not only to attract, but also to warm before the extinction
of the fire. And after the extinction, having scarified, we are
to abstract as much blood as the strength will permit; much
more than if you had to take away blood from the hypochondria
for any other cause. For the benefit from cupping is
most marked in cases of Pleurisy. But salts or natron are to
be sprinkled on the scarifications, a pungent and painful practice
indeed, but yet a healthful one. But we must estimate the
powers and habits of the patient. For if strong in mind and
robust in body, we must sprinkle some of the salts, not indeed so
as to come into immediate contact with the wounds themselves,
but they are to be sprinkled on a piece of linen-cloth damped
with oil, and it is to be spread over the place; for the brine
which runs from the melting of the salts is less stimulant than
the salts themselves. We must also pour in much of the oil, that
by its soothing properties it may obtund the pain occasioned by
the acrimony of the other. On the second day it will be a very
good rule to apply the cupping-instrument again, so as that a
thin sanies may be abstracted from the wounds. This, indeed,
is much more effectual than the previous cupping, and much
less calculated to impair the strength; for it is not blood, the
nutriment of the body, but sanies that runs off. This then
you are to do after having made a previous estimate of the
strength. On the third day we are to apply cerate with the
ointments of privet and of rue. But if the sputa still require
purging, we are to melt into the cerates some resin, or mix
some native sulphur therewith, and again the part is to have
a fomentation. With regard to the form of the cupping-instrument,
it should either be an earthen vessel, light, and adapted
to the side, and capacious; or, of bronze, flat at the lips, so as
to comprehend the parts affected with pain; and we are to
place below it much fire along with oil, so that it may keep
alive for a considerable time. But we must not apply the lips
close to the skin, but allow access to the air, so that the heat
may not be extinguished. And we must allow it to burn a
long while, for the heat within it, indeed, is a very good fomentation,
and a good provocative of perspirations.
And we must not overlook purging downwards, in men
injecting oil of rue into the gut, and, in women, also into the
womb. And let something be constantly drunk and swallowed;
for this purpose, honeyed-water, with rue and juice of ptisan,
if there is a constant cough, as being a medicine in the food.
But if it is not the season of administering food, let it be one
of the compound preparations, such as butter boiled with
honey to a proper consistence. Of this, round balls the size
of a bean are to be given to hold under the tongue, moving
them about hither and thither, so that they may not be
swallowed entire, but melted there. The medicine also from
poppies with honey and melilot is agreeable, being possessed
of soothing and hypnotic properties. This is to be given
before the administration of food, after it, and after sleep. To
the patient when fasting, the following medicinal substances are
to be given: of nettle, of linseed, of starch, and of pine fruit in
powder, of each, a cupful (
cyathus), and of bitter almonds twenty-five
in number, and as many seeds of pepper. These things
being toasted and triturated with honey, are to be mixed up
into a linctus; of these the dose is one spoonful (
cochleare).
But if he expectorate thin and unconcocted matters, two
drams of myrrh, one of saffron, and fifteen grains of pepper to
be mixed with one pound of honey. This medicine should be
given also before the administration of food to the amount of
half a spoonful. It is good also in chronic cases, when
oxymel likewise is to be given if the dyspnœa be urgent.
Such physicians as have given cold water to pleuritics, I
cannot comprehend upon what principle they did so, nor can
I approve the practice from experience; for if certain patients
have escaped the danger from having taken cold water, these
would appear to me not to have been pleuritic cases at all.
But by the older physicians, a sort of congestion was called
pleuritis, being a secretion of bile with pain of the side,
attended with either slight fever or no fever at all. This
affection, indeed, got the name of pleurisy, but it is not so in
reality. But sometimes a spirit (or
wind, pneuma) collecting
in the side, creates thirst and a bad sort of pain, and gentle
heat; and this ignorant persons have called pleurisy. In
them, then, cold water might prove a remedy through the
good luck of the person using it; for the thirst may have
been extinguished, and the bile and wind expelled downwards,
while the pain and heat have been dissipated. But in inflammation
of the side and swelling of the
succingeus, not only
cold water but also cold respiration is bad.
If, then, owing to the treatment formerly described persons
affected with pleurisy survive the attack, but have still a
short cough, and now and then are seized with heat, we must
hasten to dissipate these symptoms; for the residue of the
disease either produces a relapse, or it is converted into a suppuration.
