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
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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 The horn cup is applied as it is to the body, and when the air is withdrawn by the mouth through the small hole at the end, and after the hole has been closed by applying wax over it, the horn cup likewise adheres.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
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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
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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
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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.
13 Again, a vomit, as it is often quite a necessity for one who in health is bilious, so is it also in those diseases which bile has occasioned. It is the more necessary, therefore, for all who are troubled by shivering and trembling before fevers, for all suffering from cholera, even for all suffering from insanity accompanied by a kind of hilarity, and also for those afflicted by epilepsy. But if the disease is an acute one,
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as in the case of cholera, if there is fever, during the shivering fits, then the sharper medicaments are out of place, as mentioned above in relation to purgations, and for the purpose of a vomit it is sufficient to take the emetics which I have prescribed to be taken by those in health. But when there are chronic and violent diseases without fever, such as epilepsy and insanity, white hellebore root should also be used. But it is not right to give it either in winter or in summer; the spring is the best time, and autumn tolerably good. Whoever is going to administer it ought to take care beforehand that the body of the prospective recipient is rendered more humid. This should be recognized, that all such medicaments given as a drink do not always benefit the sick, and are always harmful to those in health.
14 Now concerning rubbing, Asclepiades as if he were the inventor of the practice has treated it in his volume, entitled "Common aids," at such great length, that, though making mention only of three such aids, namely, Rubbing, Water-drinking, and Rocking, yet he has taken up the greatest part with the first-named subject. Now on such matters recent writers ought to have credit where they have made discoveries, or where they have rightly followed others; yet we must not omit to attribute to their true authors teaching found among the more ancient writers. And it cannot be disputed that Asclepiades has taught when and how rubbing should be practised, with a wider application, and in a clearer way, although he has discovered nothing which had not been comprised in a few words by that most ancient writer Hippocrates, who said that rubbing, if strenuous, hardens the body, if gentle,
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relaxes; if much, it diminishes, if moderate, fills out. It follows, therefore, that in the following cases rubbing should be employed, when either a feeble body has to be toned up, or one indurated has to be softened, or a harmful superfluity is to be dispersed, or a thin and infirm body has to be nourished. Yet when examined with attention (although this no longer concerns the medical man) the various species of rubbing may be easily recognized as all dependent on causing one thing, depletion. For an object is toned up when that is removed, which, by its presence was the cause of the laxness; and is softened when that which has been producing induration is abstracted; and it is filled up, not by the rubbing itself, but by the nutriment, which subsequently penetrates by some sort of dispersal to the very skin itself after it has become relaxed. The cause of the different results lies in the degree.
Now there is a great difference between anointing and rubbing. For it is desirable that even in acute and recent diseases the body should be anointed and then gently stroked, but only during remissions and before food. But prolonged rubbing is unsuitable in acute and increasing troubles, unless it be in madness to procure sleep. Yet a prolonged illness and one declining from its primary vehemence loves this aid. I am quite aware that some say that the need for any aid is during the increase of diseases, not when diseases are tending to end of themselves. But this is not the case. For a disorder, even although it will end of itself, may be expelled yet more speedily by adopting the aid. An aid is necessary on two accounts, both that health may be regained at the earliest possible
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moment, and that what remains of the disease may not again become exacerbated from however slight a cause. Possibly the disease may have become less grave than it had been, yet is not completely got rid of, but some remnants of it persist, which the application of a remedy disperses. But while rubbing is rightly applied after a disorder has been lessened, yet it should never be applied whilst a fever is increasing: but if possible after the fever has entirely left the body, or if not, at least when it has remitted. Sometimes, moreover, rubbing should be applied to the body all over, as when a thin man ought to put on flesh; sometimes to a part only, either because weakness of the limb actually rubbed demands it, or that of some other part. For both prolonged headaches are relieved by rubbing of the head, although not at the height of the pain, and any partially paralysed limb is strengthened by itself being rubbed. Much more often, however, some other part is to be rubbed than that which is the seat of the pain; and especially when we want to withdraw material from the head or trunk, and therefore rub the arms and legs. Neither should we listen to those who would fix numerically how many times a patient is to be stroked; for that is to be regulated by his strength; and if he is very infirm fifty strokes may possibly be enough, if more robust possibly two hundred may be made; then an intermediate number according to his strength. Hence it is that the hand is to be passed even fewer times over a woman than over a man, fewer over a child or old man, than over a young adult. Finally, if particular limbs are rubbed, many strokes are re-
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quired and forcible rubbing; both because the body cannot be as a whole quickly rendered weak through a part, and it is necessary that as much as possible of the diseased matter should be dispersed, whether our aim is to relieve the limb actually rubbed, or through it another limb. When, however, general bodily weakness requires that the rubbing should be applied all over, it should be shorter and more gentle, just to the extent of softening the skin, so that the body may be more easily capable of forming new material from food recently consumed. As I have stated above (II.6.7), a patient is already in a bad way, when the exterior of the body is cold, whilst his interior is hot and there is thirst. But even then rubbing is the only remedy; if it draws the heat outwards into the skin, it makes possible an opportunity for other treatment.
15 Rocking also is very suitable for chronic maladies which are already abating; it is also of service both for those who are now entirely free from fever, but cannot as yet themselves take exercise, and also for those in whom persist sluggish remnants of maladies, not otherwise to be got rid of. Asclepiades has stated that use is to be made of rocking even for dispersal of a recent and severe fever, especially an ardent fever. But that gives rise to danger; an attack of that sort is better sustained by keeping quiet. If anyone, however, wants to give it a trial, let him try it when the tongue is not furred, when there is no swelling, no induration, no pain, either in the viscera or head or about the heart. And on the whole a body in pain should never be rocked, whether the pain be general or local, except, however, when sinews alone are in
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pain, and never during the rise of a fever, but only during its remission. But there are many sorts of rocking, and they are to be regulated both by the patient's strength and by his resources, lest either a weak patient undergo overmuch depletion, or a poor man come short. The gentlest rocking is that on board ship either in harbour or in a river, more severe is that aboard ship on the high seas, or in a litter, even severer still in a carriage: but each of these can either be intensified or mitigated. Failing any of the above, the bed should be so slung as to be swayed; if not even that, at any rate a rocker should be put under its foot so that the bed may be moved from side to side by hand.
And this sort of exercise of the lighter kinds suits the infirm, the stronger kinds again those who have already become free from fever for several days, or those who, whilst feeling the commencement of grave disorders, as yet are free from fever (which happens in the case both of phthisis and of stomach disease, and of dropsy, also, at times, of jaundice), or when certain diseases such as epilepsy and madness persist without fever, for however long. In which affections also those kinds of exercises are necessary, which we have included in the passage where we prescribed what healthy, yet not strong, men should carry out.
16 Now Abstinence is of two kinds, in one of which the patient takes nothing at all, in the other only what he must. The beginnings of diseases require at first hunger and thirst, the actual diseases then moderation, so that nothing but what is expedient, and not too much of that, may be consumed; for it is not at all proper to have surfeit at once after a fast.
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But if this be not good even in healthy bodies, when some necessity has imposed fasting, how much worse it is in a sick body! To a sufferer nothing is more advantageous than a timely abstinence. Among us intemperate men with regard to their food themselves . . . the times are left to the doctors; again others make a present of the times to their medical men, but reserve to themselves as to quantity. They think that they are generous, when they leave them to decide as to all else, and keep free as to the kind of food; as if it were a question of what may be yielded to the doctor, not what may be good for the patient, who suffers grievous harm, as often as he transgresses in what he consumes, whether as to the time of the meal, its quantity or its quality.
17 Sweating also is elicited in two ways, either by dry heat, or by the bath. The dry is the heat of hot sand, of the Laconian sweating-room, and of the dry oven, and of some natural sweating places, where hot vapour exhaling from the ground is confined within a building, as we have it in the myrtle groves above Baiae. Besides these it is also derived from the sun and through exercise. These treatments are useful whenever humor is doing harm inside, and has to be dispersed. And also some diseases of sinews are best treated thus. But the other treatments may suit the infirm: sun and exercise only the more robust, who must, however, be free from fever, whether only at the com-
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mencement of a disease, or when actually in the grasp of a grave malady. But care must be taken that none of the above are tried either during fever or with food undigested. Now the bath is of double service; for at one time after fevers have been dissipated, it forms for a convalescent the preliminary to a fuller diet and stronger wine; at another time it actually takes off the fever; and it is generally adopted, when it is expedient to relax the skin and draw out corrupt humor and change the bodily habit. The ancients used it rather timidly, Asclepiades more boldly. There is indeed nothing to be apprehended from its use, if it be timely; before the proper time it does harm. A patient who has become free from fever can safely be bathed, as soon as there has been no paroxysm for one whole day, on the next day after the time for a paroxysm. But where the fever has a regular periodicity so that it recurs every third or fourth day, when there has not been a recurrence, the bath is safe. Even whilst fevers are persisting, if they are slow and mild, and have lasted a long while, this treatment may properly be tried, so long as the parts below the ribs are neither indurated nor swollen, the tongue not furred, there is no pain in the trunk or head, and the fever is not then on the increase. And in those fevers which have a definite periodicity, there are two opportunities for the bath, one before the shivering, the other after the fever has ended: but in the case of those who have been the subjects for a long while of slow and slight fever, the time for the bath is when the paroxysm has wholly remitted, or if that does not occur, at any rate when it has mitigated, and the
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patient's body has already become as sound as it possibly can in this sort of complaint. A weakly patient who is about to go to the bath should avoid exposing himself to cold beforehand. On arriving at the bath, he should sit for a while to try whether his temples become tightened, and whether any sweat arises: if the former happens without the latter, for that day the bath is unsuitable, and he should be anointed lightly and carried home, and cold is to be avoided in every possible way and abstinence practised. But if the temples are unaffected, and sweating starts there first, and then elsewhere, his face is to be fomented with hot water; then he should go down into the hot bath, where it is to be noted whether there is shrivelling of the skin at the first touch of hot water, which can hardly happen when the indications noted above have been attended to properly: it is, however, a sure sign of the bath being injurious. Whether he should be anointed before entering, or after the hot bath, should be decided from the degree of his convalescence. Generally, however, unless it has been definitely prescribed that it is to be done afterwards, when the sweating begins the body should be slightly anointed, and then he is to get into the hot water. And whilst in it also regard should be had to his strength; he ought not to be kept in the bath until he faints from the heat, but be taken out earlier and carefully wrapped up so that no cold reaches him, and so that he may sweat there also before taking anything. There are hot foments: millet, salt, or sand, any of which is heated, and put into a linen cloth: when less heat is required the linen cloth may be used alone, but
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if greater heat, firebrands are extinguished, wrapped up in rags, and so put round him. Further, leathern bottles are to be filled with hot oil, or hot water is poured into earthenware vessels, called from their shape "lentils"; and salt is put into a linen bag, and dipped into very hot water, then laid upon the limb to be fomented. . . . and two broad-ended cautery irons are heated near the fire, and one of them is dipped into that salt, and water is lightly sprinkled upon the iron held over the part. When the iron begins to cool, it is put back into the fire, and the second iron made use of in the same way as the first, turn and turn about: during the procedure a hot brine drips down, which is beneficial for sinews contracted by disease of any kind. The common effect of all these measures is to disperse whatever is oppressing the parts over the heart, or strangling the throat, or harming some limb. It will be stated under particular maladies when use is to be made of each (III, IV).
18 After having spoken of those things which benefit by depleting, we come to those which nourish, namely food and drink. Now these are of general assistance not only in diseases of all kinds but in preserving health as well; and an acquaintance with the properties of all is of importance, in the first place that those in health may know how to make use of them, then, as we follow on to the treatment of diseases (III, IV), we can state the species of aliments to be consumed, without the necessity every time of naming them singly.
So then it should be known that all pulses, and all bread-stuffs made from grain, form the strongest
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kind of food (I call strongest that which has most nourishment). To the same class of further belong: all domesticated quadruped animals; all large game such as the wild she-goat, deer, wild boar, wild ass; all large birds, such as the goose and peacock and crane; all sea monsters, among which is the whale and such like; also honey and cheese. Hence it is not wonderful that pastry made of grain, lard, honey and cheese is very strong food.
Among food materials of the middle class ought to be reckoned: of pot-herbs, those of which the roots or bulbs are eaten; of quadrupeds, the hare; birds of all kinds from the smallest up to the flamingo; likewise all fish which do not bear salting or are salted whole.
The weakest of food materials are: all vegetable stalks and whatever forms on a stalk, such as the gourd and cucumber and caper, all orchard fruits, olives, snails, and likewise shellfish.
But although these are so divided, nevertheless even those of the same species admit of great differentiation, one thing being stronger or weaker than another: whilst there is more nutriment in bread than in anything else, wheat is a stronger food than millet, and that again than barley; and of wheat the strongest is siligo, next simila, then the meal from which nothing is extracted, which the Greeks call autopuros; weaker is bread made from pollen, weakest the common grey bread.
Among pulses, bean and lentils are stronger food than peas. Of vegetables the turnip and navew and all bulbs, among which I include the onion also and garlic, are stronger than the parsnip, or that which is specially called a root.
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Also cabbage and beet and leek are stronger than lettuce or gourd or asparagus. But of fruit growing on twigs, grapes, figs, nuts, dates are stronger than orchard fruit properly so‑called; and of these last, the juicy are stronger than the mealy.
Likewise of those birds, which belong to the middle class, those which rely more on their feet are stronger food than those which rely more on their wings; and of those birds which depend on flight, the larger birds yield stronger food than the smaller, such as the fig-eater and thrush. And those also which pass their time in the water yield a weaker food than those which have no knowledge of swimming.
Among food from domesticated quadrupeds pork is the weakest, beef the strongest. And so also of game, the larger the animal the stronger the food it yields.
The fish most in use belong to the middle class; the strongest are, however, those from which salted preparations can be made, such as the mackerel; next come those which, although more tender, are nevertheless firm, such as the gilthead, gurnard, sea bream, eyefish, then the flat fish, and after these still softer, the bass and mullets, and after these all rock fish.
Not only is there differentiation in the classes of nutriments, but also as much in the actual species of nutriment; which is due both to age and part of the animal and to soil and to climate and to habit. For every four-footed animal yields less nutriment while it is a suckling, likewise a chicken in a coop, the more tender it is; also a half-grown fish, which has not filled out to its full
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size. Then likewise in the same pig, trotters, chaps, ears or brain, in a lamb or kid the whole head, also the pettitoes, are somewhat less nutritious than other parts, and so can be placed in the middle class. In birds, the neck and wings are rightly counted as weak nutriment. As regards soil, grain is also more nutritious grown in hilly than in flat districts; fish living among rocks are less nutritious than those in sand, and these again less than those in mud. Hence it is that the same classes of fish from a pond or lake or river are heavier, and those which live in deep water are lighter food than those which live in shallows. Every wild animal is a lighter food than the same species domesticated, and the product of a damp climate is lighter than that of a dry one. Again, all kinds of fat meat have more nutriment than lean, fresh meat than salted, recently killed than stale. Then the same meat is more nourishing stewed than roasted, more so roasted than boiled. A hard-boiled egg is a very substantial material, a soft cooker or raw egg very light. And while all bread-stuffs are among the most solid, yet some kinds of grain after being soaked, such as spelt, rice, pearl barley, or the gruel or porridge made out of these, and also bread soaked in water, can be reckoned among the weakest of food.
Of drinks too the strongest class are: whatever can be made from grain, likewise milk, mead, must boiled down, raisin wine, wine either sweet or heady or still fermenting or of great age. But vinegar, and that wine which is a few years old, whether dry or rich, are intermediate in quality; and therefore to weak patients nothing of the other class
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should be given. Water is of all the weakest; and drink from grain is the more nutritious, according as the grain itself is nutritious; wine coming from a good soil is more nutritious than from a poor one, that from a temperate climate more nutritious than from an extreme one, whether too wet or too dry, whether excessively cold or hot. Mead, the more honey it contains, must the more it is boiled down, raisin wine the drier the grapes - are the stronger. Rain water is the lightest, then spring water, next water from a river, than from a well, after that from snow or ice; heavier still is water from a lake, the heaviest from a marsh. The recognition of water is as easy as it is necessary for those who want to know its nature. For by weighing, the lightness of water becomes evident, and of water of equal weight, that is the better, which most quickly heats or cools, also in which pulse is most quickly cooked. It is generally the case too that the more substantial the material, the less readily it is digested, but once digested it nourishes the more. Thus the quality of the food administered should be in accordance with the patient's strength, and the quantity in accordance with its quality. For weak patients, therefore, there is needed the lightest food; food of the middle class best sustains those moderately strong, and for the robust the strongest is the fittest. Finally, of the lightest foods more can be taken; it is rather with the strongest food that moderation should be observed.
19 The foregoing are not the only differentiations; but as well some materials have good juices,
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others bad, what the Greeks call euchylous and kakochylous; some are bland, others acrid; some render our phlegm thicker, others thinner; some agree with the stomach, others are alien; also some cause flatulence, others are free from that; some warm, others cool; some readily turn sour in the stomach, others do not readily decompose inside; some move the bowels, others check motions; some excite urination, others retard it; some promote sleep, others excite the senses. All these, then, should be known because one suits one body or constitution, one another.
20 Of good juice are: wheat, siligo, spelt, rice, starch, frumenty, pearl barley gruel, milk, soft cheese, all sorts of game, all birds of the middle class, also the larger birds named above; fish intermediate between the soft and hard, such as mullet and bass; spring lettuce, nettle-tops, mallow, gourd, raw egg, purslane, snails, dates; orchard fruit which is neither bitter nor sour; wine sweet or mild, raisin wine, must boiled down; olives preserved either in wine or must; sow's womb, pig's chaps and trotters, all fatty or glutinous meat, and the liver of all animals.
21 Of bad juice are: millet, panic, barley, pulse; very lean meat from domesticated animals and all salted meat; all pickled fish, fish sauce, old cheese; skirret, radish, turnip, navew, bulbs; cabbage and even more its sprouts, asparagus, beet, cucumber, leek, rocket, cress, thyme, catmint, savory, hyssop, rue, dill, fennel, cummin, anise, sorrel, mustard,
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garlic, onion; spleens, kidneys, chitterlings; orchard fruit when sour or bitter; vinegar, everything acrid, sour, bitter, oily; also rock fish, and all fish of the very soft kind, or on the other hand those which are very hard and strong-flavoured, mostly such as live in ponds, lakes and muddy rivers, and which have become excessively large.