De Medicina

26 We also see occasionally some who have been stunned, in whom the body and the mind are stupefied. This is produced sometimes by lightning stroke, sometimes by disease; the Greeks call this latter apoplexia. In these cases, blood is to be let, and either white hellebore (II.13.2) or a clyster administered; then rubbings are applied, and food of the middle class given, and that the least fatty; also some which is acrid; there is to be abstinence from wine.

27 Relaxing of the sinews, on the other hand, is a frequent disease everywhere. It attacks at times the whole body, at times part of it. Ancient writers named the former apoplexy, the latter paralysis: I see that now both are called paralysis. Those who are gravely paralyzed in all their limbs are as a rule quickly carried off, but if not so carried off, some may live a long while, yet rarely however regain health. Mostly they drag out a miserable existence, their memory lost also. The disease, when partial only, is never acute, often prolonged, generally remediable. If all the limbs are gravely paralyzed withdrawal of blood either kills or cures. Any other kind of treatment scarcely ever restores health, it often merely postpones death, and meanwhile makes life a burden. If after blood-letting, neither movement nor the mind is recovered, there is no hope left; if they do return, health also is in prospect. But when a particular part is paralyzed, in accordance with the force of the disease, and the strength of the body, either blood is to be let, or the bowel

At times also there occurs pain in the sinews. In that case it is not expedient to excite vomiting nor urination as some prescribe, nor indeed sweating

Tremor of sinews again is like with made worse by an emetic, and by medicaments causing urination. Inimical also are baths and dry sweatings. Water is to be drunk; the patient should there are a smart walk and be anointed and rubbed as well, especially by himself; the upper limbs are to be exercised by ball games and the like; he may think what food he likes provided that he studies his digestion. He should avoid worry after meals; make the rarest use of venery. If at any time he has given way to it, then

Now suppurations which arise in some interior part, when they become noticeable, first should be acted upon by those poultices which repress, less there is produced a harmful collection of the material of disease; next if these remedies are unsuccessful, the suppurations may be dissipated by dispersive poultices. If we are not successful in that, it follows that the suppuration should be drawn outwards, next that it should mature. The ending of every abscess is to rupture; the indication is pus discharged either from the bowels or mouth. But nothing ought to be done to diminish the discharge of the pus. Broth and hot water are chiefly to be given. When pus ceases to be discharged, then there should be a transition to digestible yet nutritious food consumed cold, also cold water for drink, commencing, however, with lukewarm. To begin with, things such as pine kernels, or almonds, or hazel nuts, may be eaten along with honey; afterwards these make way for whatever can make the scar form earlier. At this stage as a medicament for the ulceration there is to be taken either leek or horehound juice, and whatever the food, leeks should be added. Rubbing is required also for parts unaffected, so also gentle walks; to be avoided are wrestling and running and other things tending to irritate healing ulcerations, for in this malady the vomiting of blood is most pernicious and to be guarded against in every way.

1 Thus far I have dealt with those classes of diseases which so affect bodies as a whole, that fixed situations cannot be assigned to them: I will now speak of diseases in particular parts. Diseases of all the internal parts and their treatment, however, will come under view more readily if I first describe briefly their institutions.

The head, then, and the structures within the mouth are not only bounded by the tongue and palate, but also by whatever is visible to our eyes. On the right and left sides around the throat, great blood-vessels named sphagatides, also arteries called carotids, run upwards in their course beyond the ears. But actually within the neck are placed glands, which at times become painfully swollen.

From that point two passages begin: one named the windpipe, the more superficial, leads to the lung; the deeper, the gullet, to the sm; the former takes in the breath, the latter food. Though their courses diverge, where they are joined, there is a little tongue in the windpipe, just below the fauces, which is raised when we

The lung is spongy, and so can take in the breath, and at the back it is joined to the spine itself, and it is divided like the hoof of an ox into two lobes. To the lung is attached the heart, which, muscular in nature, is placed under the left breast, and has two small stomach-like pockets. Now, under the heart and lung is a transverse partition of strong membrane, which separates the belly from the praecordia; it is sinewy, and many blood-vessels also take their course through it; it separates from the parts above not only the intestines but also the liver and the spleen. These organs are placed against it but under it, on the right and left sides respectively.

The liver, which starts from the actual partition under the praecordia on the right side, is concave within, convex without; its projecting part rest lightly on the stomach, and it is divided into four lobes. Outside its lower part the gall-bladder adheres to it: but the spleen to the left is not connected to the same partition, but to the intestine; in texture it is soft and loose, moderately long and thick; and it hardly projects at all from beneath the ribs into the belly, but is hidden under them for the most

These then are the situations of the viscera. Now the gullet, which is the commencement of the intestines, is sinewy; beginning at the seventh spinal vertebra, it makes a junction in the region of the praecordia with the stomach. And the stomach, which is the receptacle of the food, consists of two coats; and it is placed between the spleen and the liver, both overlapping it a little. There are also fine membranes by which these three are interconnected, and they are joined to that partition, which I have described above as transverse.

Thence the lowest part of the stomach, after being directed a little to the right, is narrowed into the top of the intestine. This juncture the Greeks call pylorus, because, like a gateway, it lets thru into the parts below whatever we are to excrete.

From this point begins the fasting intestine, not so much infolded; it has this name because it does not hold what it has received, but forthwith passes it on into the parts below.

Beyond is the thinner intestine, infolded into many loops, its several coils being connected with the more internal parts by fine membranes; these coils are directed rather to the right side, to end in the region of the right hip; however, they occupy mostly the upper parts.

After that spot this intestine makes a junction crosswise with another, the thicker intestine; which, beginning on the right side, is long and pervious

But that one which is pervious being widespread and winding, and less sinewy than the upper intestines, has a flexure on both sides, right and left, especially on the left side and in the lower parts and touches the liver and stomach, next it is joined to some fine membranes coming from the left kidney, and thence bending backwards and to the right, it is directed straight downwards to the place where it excretes; and so it is there named the straight intestine.

The omentum too, which overlies all these, is at its lower part smooth and compact, softer at its upper part; fat also is produced in it, which like the brain and marrow is without feeling.

Again from the kidneys, two veins, white in colour, lead to the bladder; the Greeks call them ureters, because they believe that through them the urine descending drops into the bladder.

Now the bladder, sinewy and in two layers at its bag, is at its neck bulky and fleshy; it is connected by blood-vessels with the intestine, and with that bone which underlies the pubes. The bladder itself is loose and rather free, and situated differently in men and women: for in men it is close to the straight intestine, being inclined rather to the left side; in women it is situated over the genitals, and whilst free above, is supported actually by the womb.

Again, in males, a longer and narrower urinary passage descends from the neck of the bladder into the penis; in women, a shorter and wider one presents itself over the neck of the womb. Now the womb in virgins is indeed quite small; in women, unless they are

2 Having made a sort of survey as it were of these organs, so far as it is necessary for a practitioner to know them, I shall follow out the remedies for the several parts when diseased, starting with the head; under that term I now mean that part which is covered with hair; for pain in the eyes, ears and teeth and the like will be elsewhere explained (VI.6‑9, VII.7‑12).

In the head, then, there is at times an acute and dangerous disease, which the Greeks call cephalaia; the signs of which are hot shivering, paralysis of sinews, blurred vision, alienation of the mind, vomiting, so that the voice is suppressed, or bleeding from the nose, so that the body becomes cold, vitality fails. In addition there is intolerable pain, especially in the region of the temples and back of the head. Again, there is sometimes a chronic weakness in the head, which, although neither severe nor dangerous, lasts through life; sometimes there is more severe pain, but of short duration, and not fatal, which is brought about

Of these the case that is acute, also that which surpasses ordinary limits, and that which is of sudden causation and although not deadly, is yet violent, has its primary remedy in blood-letting. But this measure is unnecessary, unless the pain is intolerable, and it is better to abstain from food; also from drink, when possible; if not possible, then to drink water. If, on the day following, pain persists, the bowels should be clystered, sneezing provoked, and nothing but water taken. For often, in this way, all the pain is dispersed within one or two days, especially if it has originated from wine of indigestion. But if there is little benefit from the above, the head should be shaved down to the scalp; then it should be considered what cause excited the pain. If the cause was hot weather, it is well to pour cold water freely over the head, to put on the

The class in which humour collects upon the head is different. In that case it is necessary to shave the head to the scalp; then to apply mustard until it causes ulcers; if this is of little avail, recourse must be had to the scalpel. The following measures are the same as for dropsical patients: exercise, sweating, smart rubbing, and such food and drink as will specially promote urination.

3 Again, about the face there originates an affection which the Greeks call "dog spasm." And it begins along with acute fever; the mouth is drawn to one side by a peculiar movement, and so it is nothing else than a distortion of the mouth. In addition there is frequent change of colour in the face as well as over all the body, also an inclination to sleep. In this case blood-letting is the best thing; if that does not end the disorder, the bowels are moved with a clyster; when not even thus dispersed, vomiting is provoked by white hellebore. It is necessary besides to avoid the sun, fatigue and wine. If it is not dispersed by these measures, use running, rubbing of the affected part gently and repeatedly, also rub other parts for less time, but smartly. It is also useful to provoke sneezing; to shave the head, to pour over it hot sea water, or at any rate salt and water, provided that sulphur is also added; after this affusion the patient should again be rubbed; should chew mustard, applying at the same time to the parts of the mouth affected a wax salve, likewise to the