De Medicina

11 Now there are two kinds of cups, one made of bronze, the other of horn. The bronze cup is open at one end, closed at the other; the horn one, likewise

at one end open, has at the other a small hole. Into the bronze cup is put burning lint, and in this state the mouth is applied and pressed to the body until it adheres. The horn cup is applied as it is to the body, and when the air is withdrawn by the mouth through the small hole at the end, and after the hole has been closed by applying wax over it, the horn cup likewise adheres. Either form of cup may be made, not only of the above materials, but also of anything else suitable; when others are lacking, a small drinking-cup or porridge bowl with a narrowish mouth may be adapted conveniently for the purpose. If the skin upon which the cup is to be stuck is cut beforehand with a scalpel, the cup extracts blood; when the skin is intact, wind. Therefore when it is some matter inside which is doing the harm, the former method of cupping should be employed, when it is flatulency, then the latter. Now the use of a cup is the rule for a disease, not of the body as a whole, but of some part, the sucking out of which suffices for the re-establishment of health. And this same fact is a proof that with a scalpel, when a part is being relieved, blood must be let from that very part where the injury already exists; since unless it be to divert haemorrhage in that direction, nobody applies a cup to a part distant from the disease, but to that which is actually affected and has to be relieved. Further there may be need for cupping in chronic maladies, although already of somewhat long duration, if there is corrupted material or an unhealthy condition of wind; in certain acute cases also, if the body ought to be depleted and at the same time the patient's strength does not admit of cutting a vein; and cupping, as it is a less severe remedy, so it is a safer one; nor is it ever dangerous, even if adopted in the midst of the attack of a fever, or even with food undigested. Therefore, when blood-letting is needed, if cutting a vein is an instant danger, or if the mischief is still localised, recourse is to be had rather to cupping, not forgetting that whilst we recognize the absence of danger, its efficacy is thus the less, and it is impossible to remedy a severe malady unless by a remedy likewise severe.

12 Now purging was promoted by the ancients in almost all diseases by various medicaments, and by frequent clysters; they administered either black hellebore root, or polypody fern root, or the copper scales which the Greeks call lepida chalkou, or the milky juice of seaside spurge, of which one drop on bread purges freely, or milk, whether from an ass or cow, or goat, to which a little salt was added, which they boiled, and having removed the solidified skin, they obliged their patients to drink the whey-like remainder. But medicaments generally irritate the stomach; a motion when excessively liquid, or a clyster often repeated, weakens the patient. Never, therefore, in illness is a medicament which causes such a motion rightly given, unless when that malady is without fever, as when black hellebore root is given either to those with black bile and to those suffering from insanity with melancholy, or to those who have their sinews in some part paralysed. But in the presence of fevers, it suffices for the purpose of a purge to take such food and drink as both nourish and at the same time soften the belly; and there are sorts of illness in which purgation by milk is suitable.

Still, for the most part the bowel preferably is to be clystered; the practice was limited by Asclepiades

though still kept, but I see that in our time it is usually neglected. But the limitation which he seems to have adopted is most fitting: that this remedy should not be tried often, and yet we should not omit to use it once, or at most twice: if the head is heavy; if the eyes are dim; if the disease is in the larger intestine, which the Greeks call colon; if there are pains in the lower belly or in the hips; if bilious fluid collects in the stomach, or even phlegm or other water-like humor forms there; if wind is passed with undue difficulty; if there is no spontaneous motion, and especially if the faeces remain inside although close to the anus, or if the patient who fails to pass anything perceives a foul odour in his breath, or if the motions have become corrupted; or if abstinence does not at once get rid of the fever; or if the patient's strength does not allow of blood-letting when it is needed, or the time for that measure has passed; or if previous to the malady the patient has been drinking freely; or if a patient who has been purged repeatedly, whether that has been intentional or casual, has suddenly a suppression of motions. However, the following rules are to be observed: that the clyster is not to be administered before the third day, nor whilst there is any undigested food; nor in a case of weakness due to exhaustion by a long illness; nor to a patient who has daily a sufficient motion, nor to one whose stools are liquid; nor during the acme of the paroxysm of a fever, for what is then injected is retained in the bowel and mounting up into the head brings about a much graver danger. On the day too before the clyster the patient ought to fast, in order to fit himself for such a treatment, and on the actual day, some hours beforehand, he should drink warm water to moisten his upper parts; there should then be introduced into the bowel simply water when we are content with a gentle remedy, or hydromel as one a little stronger; or as a soothing enema a decoction of fenugreek, or of pearl barley, or of mallow, or as an astringent clyster a decoction of vervains, but a drastic one is sea-water or ordinary water with salt added; and the better in both instances for boiling. A clyster is made more drastic by the addition of olive oil, or soda, or honey: the more drastic the clyster, the more it extracts, but the less easily it is borne. The fluid injected should be neither cold nor hot, lest either way it should do harm. Following upon the injection the patient ought to keep in bed as long as he can, and not give way to his first desire to defaecate; then go to stool only when he must. In this way generally when the material is extracted, and the upper parts relieved, the disease itself is mollified. But when the patient has become exhausted owing to forced calls to stool, he ought for a while to keep quiet; and lest his strength fail, he should certainly take food that day, but whether it should be abundant or scanty, should be regulated according to the strength of the paroxysm anticipated, or the absence of such apprehension.