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
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breathe, and, when we swallow food and drink, closes the windpipe. Now the actual windpipe is rigid and gristly; in the throat it is prominent, in the remaining parts it is depressed. It consists of certain little rings, arranged after the likeness of those vertebrae which are in the spine, but in such a way that whilst rough on the outer surface, the inside is smooth like the gullet; descending to the praecordia, it makes a junction with the lung.
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
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part. Now the foregoing are joined together. The kidneys on the other hand are different; they adhere to the loins above the hips, being concave on one surface, on the other convex; they are both vascular, have ventricles, and are covered by coats.
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
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towards the left, but not towards the right, which is therefore called the blind intestine.
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
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pregnant, it is not really much larger than a handful. Beginning over against the middle of the rectum by a straight narrow neck, which they call canalis, it is then turned a little towards the right hip joint; next, as it rises above the right intestine, its sides are fastened into the woman's ilia. Again, these ilia are situated between the hip joints and the pubes at the bottom of the abdomen. From them and from the pubes the abdominal wall extends upwards to the praecordia; it is covered visibly upon the outside by skin, inside by a smooth membrane which makes a junction with the omentum; and it is named by the Greeks peritoneal membrane.
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
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by wine or indigestion or cold or heat or the sun. And all these pains occur, sometimes with fever, sometimes without fever; sometimes they affect the whole head, sometimes a part only; at times so as to cause excruciating pain also in the adjacent part of the face. Besides the foregoing there is a class which may become chronic, in which a humour inflates the scalp, so that it swells up and yields to the pressure of the fingers. The Greeks call it hydrocephalus. Of these forms, that mentioned second, while it is slight, is to be treated by the regimen I have stated when I was describing what healthy men should do in the case of weakness of any part (I.4). For pain in the head accompanied by fever the remedies have been detailed when describing the treatment of fevers in general (III.3‑17). Now to speak of the rest.
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
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head a concave sponge now and again wrung out of cold water; to anoint the head with rose oil and vinegar, or better to put on unscoured wool saturated with the same, or else other refrigerant plasters. But if cold has done the harm, the head should be bathed with warm sea-water, or at any rate salt and water, or with a laurel-leaf decoction, after which the head should be rubbed smartly, have warm oil poured on it, and then be covered up. Some even bandage up the head, some load it with neck-wraps and mufflers, and so get relief; warm plasters give help in other cases. Hence, even when the cause is unknown, it should be observed whether cooling or heating methods afford the more relief, and to make use of those which experience has approved. But if the cause is not known, the head should be bathed, first in warm water as noted above, or in salt and water, or in the laurel decoction, next in cold vinegar and water. For all long-standing pain in the head, the following are the general measures: to provoke sneezing; to rub the legs smartly; to gargle things which provoke salivation; to apply cups to the temples and occiput; to draw blood from the nostrils; to pluck upon the skin of the temples frequently by the aid of pitch plasters; to apply mustard in order to cause ulcers over the site of the pain, after having put a layer of linen over the skin to prevent violent erosion; to excite ulcerations by cautery, applied over the seat of the pain; to take food in great moderation, with water; after the pain has been relieved, to go to the bath, and there to have much water poured over the head, first hot, then cold; if the pain has been quite dispersed, the patient may even return to wine, but should always before anything else drink some water.
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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
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unaffected parts mustard until it produces erosion. Food of the middle class is most suitable.
4 But if there is paralysis of the tongue, which sometimes occurs of itself, sometimes is produced by some disease, so that the man's speech is not distinct, he should gargle a decoction of thyme, hyssop or mint; drink only water; have the head, face, the parts under the chin and the neck smartly rubbed; the tongue itself smeared with laser; chew very acrid materials, mustard, onion, garlic, and strive with all his force to pronounce words; hold his breath at exercise; frequently pour cold water over his head; on occasion eat a quantity of radish and then vomit.
5 Again there is dripping from the head sometimes into the nose, which is a mild affair; sometimes into the throat, which is worse, sometimes into the lung, which is worst of all. When the drip is into the nostrils, a thin phlegm is discharged from them; there is slight pain, and a feeling of weight in the head, with frequent sneezing; if the drip is into the throat, it irritates and excites a slight cough; if the drip is into the lung, besides the sneezing, cough and even weight in the head, there is lassitude, thirst, a feeling of heat, and bilious urine.
Another although not very different affection is gravedo. This closes up the nostrils, renders the voice hoarse, excites a dry cough; in it the saliva is salt, there is ringing in the ears, the blood-vessels in the head throb, the urine is turbid. Hippocrates named all the above coryza; I note that now the Greeks reserve this term for gravedo, the dripping they call catastagmus. These affections are commonly of short duration, but if neglected may last a
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long while. None is fatal, except that which causes ulcers in the lung.
Whenever we feel anything of the sort, we should forthwith keep out of the sun, and abstain from the bath, wine and coition; but the use meanwhile of anointing and of customary food is allowable. The patient should walk, but only briskly and under cover; after that the head and face should be rubbed for more than fifty strokes. This complaint is generally relieved, provided that we take care of ourselves for a couple of days, or for three at the most. When the disease has been relieved so that the drip of phlegm becomes thick, or the gravedo so that the nostrils are more open, the bath may be resumed, much water, at first hot, then lukewarm, being used to foment the face and head; next, along with more food, wine may be taken. But if on the fourth day the phlegm is still thin, or the nostrils still stuffed up, the patient should take dry Aminaean wine, then for a couple of days water; after which he can return to the bath and his usual habits. Nevertheless, even during those days, when some things are to be avoided, it is not expedient to treat the patients as sick men, but they are to do everything as in health, unless these symptoms have been liable to cause more prolonged and severe trouble; for then a somewhat more careful attention is needed.
Therefore in such a case if there is a drip into the nose or into the throat, besides the treatment described above, the patient from the start should walk a good deal during the first days: have the lower limbs smartly rubbed, together with more gentle rubbing of the chest, face and head; his accustomed food should be reduced by one-half; he
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may take eggs, also starchy and such-like foods, which thicken phlegm; thirst should be resisted as far as he can bear it. When by these measures a patient has been prepared for the bath, and has used it, there may be added to the diet small fish or meat, provided that at first he should not take the full quantity of food; undiluted wine should be taken more freely.
But if the drip is into the lung also, there is even more need for walking and rubbing and the same regimen as to diet, and if that diet is not effective, more acrid food is to be employed; he should allow himself more sleep, and abstain from all business; but the bath should be tried at a somewhat later stage.
In the case of gravedo, he should lie in bed on the first day, neither eat nor drink, cover the head, and wrap wool around the throat; on the next day he should get up, and still abstain from drink, or, if he must have some, take not more than one tumbler-full of water; on the third day he may eat the crumb of bread, but not much, with some small fish, or light meat, and water for drink. Should the patient be unable to restrain himself from using a fuller diet, he is to provoke a vomit; when he gets to the bath, he should foment freely his head and face with hot water until he sweats, and then have recourse to wine. After the above measures it is scarcely possible for the same discomfort to persist; but if it does so, use cold, dry, light food with the least possible fluid, whilst continuing the rubbings and the exercises, such as are needed in all such sorts of illness.
6 From the head we pass to the neck, which is liable to harm from diseases of considerable
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gravity. There is, however, no disease more distressing, and more acute, than that which by a sort of rigor of the sinews, now draws down the head to the shoulder-blades, now the chin to the chest, now stretches out the neck straight and immobile. The Greeks call the first opisthotonus, the next emprosthotonus, and the last tetanus, although some with less exactitude use these terms indiscriminately. These diseases are often often fatal within four days. If the patients survive this period, they are no longer in danger. They are all treated by the same method and this is agreed upon, but Asclepiades in particular believed in blood-letting, which some said should be particularly avoided, because the body was then especially in need of that heat which was in the blood. But this is false; for it is not in the nature of the blood to be especially hot, but of all that composes man, the blood most quickly turns, now hot, now cold. Still, whether or no it ought to be let, can be learnt from the instructions concerning blood-letting (II.10, 11). But anyhow it is right to give castory, and with it pepper or laser; further, a warm and moist fomentation is needed. For this purpose most pour hot water freely at intervals over the neck. This affords temporary relief, but renders the sinews more susceptible to cold, a thing certainly
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to be avoided. It is, therefore, more beneficial, first to anoint the neck with a liquid wax-salve, then to apply ox-bladders or leathern bottles filled with hot oil, or else a hot meal plaster, or a pod of round pepper crushed up in a fig. The best thing, however, is to foment with moistened salt according to the method already described (II.17.9, 10; 33.1). Whatever meanwhile is being done, the patient should be brought near a fire, or into the sun in hot weather, and old oil in particular should be rubbed into his neck, shoulder-blades and spine; or if that is not at hand, Syriac oil, or if not even that, oldest lard. Rubbing applied to the whole length of the vertebrae is beneficial, but especially so to those of the neck. Therefore, with certain intervals however, this procedure should be carried out both by day and by night. During such intervals some kind of an emollient composed of heating substances should be put on. Cold is especially to be guarded against; and so there ought to be a fire kept burning constantly in the room in which the patient is lying, especially during the hours before dawn, when the cold is particularly intense. It is not unserviceable to keep the head closely clipped, moistened with hot iris or cyprus oil, and covered by putting on a cap; sometimes even to submerge the patient either in hot oil, or in hot water in which fenugreek has been boiled and a third part of oil added. If the bowels also have been moved by a clyster, this often relaxes the upper parts. Should the pain grow even still more severe, cups should be applied to the neck after the skin has been incised; or the same spot is to be burnt either with the cautery, or by mustard. When the pain has been relieved and the neck begins to be
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moved, it can be recognized that the disease is yielding to treatment. But for a long while food which has to be chewed should be avoided; sops and eggs, raw or soft boiled, are to be used; any kind of soup may be taken. But if the patient has done well, and the neck appears to be all right, then will be the time to begin with pulse porridge, or well-moistened crumbled bread. He is to chew bread, however, earlier than to drink wine, because the use of wine is particularly risky, and so ought to be deferred for a longer time.
7 Whilst this kind of disease involves the region of the neck as a whole, another equally fatal and acute has its seat in the throat. We call it angina; the Greeks have names according to its species. For sometimes no redness or swelling is apparent, but the skin is dry, the breath drawn with difficulty, the limbs relaxed; this they call synanche. Sometimes the tongue and throat are red and swollen, the voice becomes indistinct, the eyes are deviated, the face is pallid, there is hiccough; that they call cynanche: the signs in common are, that the patient cannot swallow food nor drink, and his breathing is obstructed. It is a slighter case when there is merely redness and swelling, not followed by the other symptoms; this they call parasynanche. Whichever form occurs blood must be let if strength permits; if there is no surplus strength, then move the bowels by a clyster. Cups also may be applied with benefit under the chin, also outside the throat, so as to draw out the matter which is suffocating.
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Next, moist foments are needed, for dry ones hinder the breath. Consequently sponges, dipped into hot oil at intervals, should be put on; that is better than hot water; but most efficacious here too is hot moistened salt. Moreover, it is useful: to make a decoction with hydromel of hyssop, catmint, thyme, wormwood, or even of bran, and dried figs, and to gargle with it; afterwards to smear the palate with ox-gall, or with the medicament made of mulberries. It is also appropriate for a cough to dust the palate with pounded pepper. If there is little effect from these remedies, the last resource is to make sufficiently deep incisions into the upper part of the neck under the lower jaw, or into the palate in front of the uvula, or into the veins under the tongue, in order that the disease may discharge through the incisions. If the patient is not benefited by all this, it must be recognized that he has been overcome by the disease. But if these measures have relieved the disease, and the throat again admits both food and breath, a return to health is easy. And sometimes nature also assists when the disease moves from a more restricted to a more widespread seat; so when redness and swelling have arisen over the praecordia, it may be recognized that the throat is becoming free. But whatever has relieved it, the patient should begin with fluids, especially with the hydromel decoction; next soft and unacrid food should be taken until the throat has returned to its original condition. I hear it commonly said that if a man eat a nestling swallow, for a whole year he is not in danger from angina; and that when the disease attacks anyone it is also beneficial to burn a nestling which has been preserved in salt and to crumble the powdered ash into
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hydromel which is administered as a draught. Since this remedy has considerable popular authority, and cannot possibly be a danger, although I have not read of it in medical authorities, yet I thought that it should be inserted here in my work.
8 There is also in the region of the throat a malady which amongst the Greeks has different names according to its intensity. It consists altogether in a difficulty of breathing; when moderate and without any choking, it is called dyspnoea; when most severe, so that the patient cannot breathe without making a noise and gasping, asthma; but when in addition the patient can hardly draw in his breath unless with the neck outstretched, orthopnoea. Of these, the first can last a long while, the two following are as a rule acute. The signs common to them are: on account of the narrow passage by which the breath escapes, it comes out with a whistle; there is pain in the chest and praecordia, at times even in the shoulder-blades, sometimes subsiding, then returning; to these there is added a slight cough. Blood-letting is the remedy unless anything prohibits it. Nor is that enough, but also the bowels are to be relaxed by milk, the stool being rendered liquid, at times even a clyster is given; as the body becomes depleted by these measures the patient begins to draw his breath more readily. Moreover, even in bed the head is to be kept raised; the chest movement assisted by hot foments and plasters, dry or even moist, and later either emollients are to be applied or at any rate a wax-salve made with cyprus, or iris ointment. Next, on an empty stomach the patient should take a draught of hydromel, in which either hyssop or crushed caper root has been boiled.
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It is also of use to suck either soda or white nasturtium seed, parched, crushed and then mixed with honey; and for the same purpose, galbanum and turpentine resin are boiled together to a coherent mass, and a bit of this, the size of a bean, is sucked every day, or unfused sulphur 1 gram and 0·66 gram of southernwood are pounded up in a cupful of wine and sipped lukewarm. It is also not a foolish idea that the liver of a fox should be dried, pounded and the mash sprinkled into the above, or that the lung of that animal, as fresh as possible, roasted without touching iron in the cooking, should be eaten. In addition to the above, gruels and light food are to be used, at intervals also a light dry wine, occasionally an emetic. Some kind of diuretic is also beneficial, but there is nothing better than a walk until almost fatigued, also frequent rubbings, especially of the lower extremities, either in the sun, or before a fire, done by the patient himself or others, until he sweats.
9 But in the interior parts of the throat there is sometimes ulceration. For this most employ plasters and hot foments externally; they also order hot steam to be inhaled by the mouth. Others say that by these measures the parts are rendered more soft and more liable to the complaint already existing there. But these applications are salutary if cold can be completely avoided; if cold is to be apprehended, they are useless. But anyhow to rub the throat is dangerous; for it provokes ulceration. Nor are diuretics useful, because in the course of being swallowed they can also make thin the phlegm there, which is better suppressed. Asclepiades, who wisely advises many things, which we
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also ourselves practise, said that very sour vinegar should be sipped; for by this the ulcers are constricted without doing harm. But whilst vinegar can suppress bleeding, it cannot heal the actual ulcerations. For that purpose lycium is better, and Asclepiades approved equally of it, or leek or horehound juice, or almonds pounded up with tragacanth and mixed with raisin wine, or linseed pounded and mixed with sweet wine. Exercise also by walking and by running is necessary, and smart rubbing from the chest downwards should be applied to the whole of the lower part of the body. The food too should be neither very acrid nor rough, honey, lentils, wheat porridge, milk, pearl barley gruel, fat meat and especially a leek decoction and anything mixed with it. Of drink the least possible is proper; water can be given either by itself, or when quince or dates have been boiled in it. Bland gargles are of service also, or when ineffectual then repressants. This sort of affection is not acute, and cannot last long; nevertheless, it requires timely treatment, lest it should become a severe and chronic complaint.
10 Cough again is generally owing to ulceration of the throat. This is incurred in many ways: and so when the throat has healed the cough is ended. Nevertheless, at times cough is a trouble by itself, and when it has become chronic, is difficult to get rid of. Sometimes the cough is dry, sometimes it excites phlegm. Hyssop should be taken every other day; the patient should run whilst holding the breath, but not where there is dust; he should practise reading loudly, which may at first be impeded by the cough, but later overcomes it; next walking; then manual exercises also, and the chest should
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be rubbed for a long while. After such exercises he should eat three ounces of very juicy figs, cooked over charcoal. Besides the above, when the cough is moist, smart rubbings with some kind of heating substance are good, provided that the head too is briskly rubbed when dry; in addition, cups are applied to the chest; mustard put on outside over the throat until there is slight excoriation; and a draught taken, composed of mint, almonds, and starch; first of all dry bread should be eaten, then any kind of bland food. But if the cough is dry and very troublesome, it is relieved by taking a cup of dry wine, provided that this is done only three or four times at rather long intervals; further, there is need to swallow a little of the best laser, to take juice of leeks or horehound; to suck a squill, to sip vinegar of squills, or at any rate sharp vinegar; or two cupfuls of wine with a bruised clove of garlic. In every case of cough it is of use to travel, take a long sea voyage, live at the seaside, swim, sometimes to take bland food, such as mallows, or nettle-tops, sometimes acrid; milk cooked with garlic; gruels to which laser has been added, or in which leeks have been boiled to pieces; a raw egg to which sulphur has been added; at first warm water to drink, than, in turn, one day water, the next day wine.
11 When blood is spat up there is more cause for alarm, although that presents at one time less, at another more of danger. Blood sometimes comes from the gums, sometimes from the mouth, and that at times copiously, yet without cough, without ulceration, without any disease of the gums, so that there is no expectoration. But just as there is on occasion bleeding from the nostrils, so also does it
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burst out from the mouth. And sometimes it is blood which flows, sometimes something resembling water in which fresh meat has been washed. On the other hand, blood may come from the uppermost part of the throat, at one time when there is ulceration in that part, at another without ulceration, but either the mouth of some blood-vessel has opened, or the blood breaks out of certain tubercles which have originated there. When this happens, neither food nor drink does harm, nor is there any expectoration as from an ulcer. When, however, the throat and air tubes are ulcerated, the frequent cough also forces out blood; at times it is even brought up out of the lung or out of the chest or out of the sides or out of the liver. Often women, in whom the blood is not being given out through the menses, expectorate blood.
According to medical authorities blood gains exit either from some part eroded, or ruptured, or from the opened mouth of some blood-vessel; the first they call diabrosis, the second rhexis, the third anastomosis. The last is the least harmful, the first, the worst. And often indeed it happens that pus follows the blood. Now at times to stop the bleeding suffices to promote recovery; but if there follow ulcerations, or pus, or a cough, according to the situation there arise various and dangerous classes of diseases. But if only blood flows out, both the remedy and the ending are the quicker. Nor ought we to ignore that in those who are in the habit of bleeding or in whom the back or hips ache whether after hard running or walking, a limited flow of blood is not disadvantageous as long as fever is absent, and when blood is passed by the
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urine it even relieves this very lassitude; nor indeed, in the case of a fall from a height, is there anything alarming if blood comes with the urine, so long as there is nothing else unusual in the urine; nor does vomiting of blood bring about danger, even when repeated, if before it recurs the body is allowed to regain strength and fill up; and it does no harm at all in a robust man, if not excessive, and when it excites neither cough nor fever.
The foregoing are general remarks: now I come to the particular points mentioned above. If blood escapes from the gums, it suffices to chew purslane; if from the mouth, undiluted wine should be held in it; if this does no good, then vinegar. If in spite of these remedies there is a severe outburst, since this may be the death of the patient, its attack is best diverted by applying a cup to the occipital region, after first incising the skin; when this happens in a woman whose menses are not forthcoming, a cup is applied to each groin, likewise after making incisions. But if the bleeding comes from the throat, or from more internal parts, there is more to fear, and a more active treatment is to be adopted. Blood should be let, and if the flow from the mouth is not lessened, the venesection should be repeated a second or a third time, and every day a little. From the first also the patient should sip either vinegar or plantain or leek juice with frankincense, and outside over the seat of pain there is to be applied unscoured wool soaked in vinegar, cooled at intervals by means of a sponge. Erasistratus used also to bind up the legs and thighs and the forearms of such patients in several places. This constricting Asclepiades declared far from being beneficial, to be even harmful. But that it often
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answers well experience bears witness. Yet there is no necessity to bind the patient in many places; it is enough to do it below the groins and above the ankles and at the upper part of the arms, also the forearms. Further, if fever is troublesome, gruel must be given, and for drink water in which has been boiled any one of the intestinal astringents. But if fever is absent, there may be given: either washed spelt or bread soaked in cold water and also soft eggs, and for drink either that mentioned above, or sweet wine or cold water; but drink must be given with the knowledge that in this disease thirst is an advantage. Besides these, there are needed rest, freedom from care, and silence. The head also of the patient whilst in bed should be kept raised, and well shaved; the face is often to be bathed with cold water. On the other hand, there is danger in wine, the bath, coition, oil in the food, all acrid food; the same applies to hot foments, a hot close room, much bedclothes piled on the patient. Rubbings also are useful after the bleeding has quite stopped. Then indeed a beginning can be made on the arms and legs, avoiding the chest. A patient in this case should live through the winter by the sea, during the summer inland.
12 Below the throat is placed the stomach, in which there tend to occur many chronic complaints. For sometimes great heat affects it, sometimes flatulence, sometimes inflammation, sometimes ulceration; at times phlegm collects, at times bile; but the most frequent malady is that in which it undergoes paralysis, nor does anything else so affect it, or,
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through it, the whole body. As diverse as are its complaints, so are the remedies.
When heated, it should be bathed externally at intervals with vinegar and rose oil, and road dust applied with oil, and those plasters which simultaneously repress and soothe. For drink, unless there is anything against it, lukewarm water is the best.
If there is flatulence, it is beneficial to apply cups, but there is no need to incise the skin; dry and hot foments do good, but not the strongest kind. At intervals there should be enjoyed abstinence from food; a draught of wormwood or hyssop or of rue on an empty stomach is useful. Exercise at first should be light, then more is to be taken, especially such as moves the upper limbs; the kind most appropriate in all complaints of the stomach. After exercise there is need of anointing, rubbing, occasionally also the bath, yet less often than usual; now and then a clyster; later, food which is hot but not flatulent, and similarly hot drinks, first water and after the flatulence has subsided, dry wine. In all complaints of the stomach this also is to be prescribed, that each should adopt in health that regimen which has cured him; for his weakness will recur unless his health is protected by the same measures as those by which it was restored.
But if there is inflammation of any kind, which is generally followed by swelling and pain, the primary remedies are rest, abstinence, a belt of sulphurated wool, and the wormwood draught upon an empty stomach. If a burning heat troubles the stomach, it should be fomented at intervals with vinegar and
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rose oil; next food should be given in moderation, external applications are also to be made which simultaneously both repress and soothe; next after that, when these are taken off, hot meal plasters are put on to disperse the remnants of the disease: now and again a clyster must be given, exercise must be taken, and a fuller diet.
But if ulcers attack the stomach, generally the same treatment should be applied as has been prescribed in the case of an ulcerated throat (IV.9). Exercise, also rubbing of the lower extremities, is to be practised; bland and glutinous foods taken short of satiety; and all pungent and sharp food withdrawn. Sweet wine is to be used if there is no fever, or if that causes flatulence at any rate light wine, but neither very cold nor too hot.
If the stomach becomes filled with phlegm an emetic is needed, sometimes on an empty stomach, sometimes after food: there is benefit in exercise, rocking, a sea-voyage, rubbing. Nothing should be eaten or drunk unless hot, whilst such things must be avoided as have tended to collect phlegm.
There is worse trouble when the stomach is vitiated by bile. Patients who are troubled with this, vomit up bile at intervals of some days, and worst of all, vomit black bile. For such a clyster is appropriate, and draughts of wormwood should be given; rocking and a sea-voyage are necessary; vomiting when possible is induced by sea-sickness; indigestion must be avoided, the food should be such as is readily swallowed, and not repugnant to the stomach, the wine must be dry.
But the commonest and worst complaint of the stomach is paralysis, when it does not retain food,
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and the nutrition of the body is wont to cease, and so it is consumed by wasting. In this sort of disease the bath is most harmful; reading aloud and exercise of the upper limbs are needed, as also anointing and rubbings; it is good for the patient to have cold water poured over him, and to swim in cold water, also to submit his stomach to jets of it, especially at the back of the stomach from the shoulder-blades downwards, to bathe in cold medicinal springs, such as those at Cutilia and Simbruvium. Food should be also taken cold, rather that which is digested with difficulty than that which readily decomposes. Hence many who can digest nothing else, digest beef, and therefore it may be inferred that neither poultry no venison, nor fish except the harder kinds, should be given. The most suitable drink is wine cold, or else undiluted and well heated, particularly Rhaetic or Allobrogic wine, or any other which is both dry and seasoned with resin; if there is none of the above at hand, then the harshest possible, especially Signine wine. If food is not retained, water must be given and a more copious vomit elicited, after which food is to be given again, and then cups are to be applied two fingers' breadth below the stomach, and they are to be kept on two or three hours. If simultaneously there is both vomiting and pain, there should be placed over the stomach unscoured wool or sponge soaked in vinegar, or a refrigerant plaster. The arms and legs too are to be rubbed sharply, but not for long, and to be kept warm. If pain is more severe, a cup is to be put on four fingers' breadth below the praecordia, and following that bread in cold vinegar and water is to be given; should this not be retained, after the vomiting,
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anything light or not unsuitable for the stomach can be given; if even that is not retained, give a cupful of wine every hour until the stomach settles down. Radish juice also is an active remedy; more active still is a mixture of the juice of sour and sweet pomegranates in equal parts, with the addition of endive and mint juice, the least quantity of the last; the whole of the above may be mixed thoroughly well with an equal quantity of cold water, which is better than wine for tightening up the stomach. Now, vomiting when spontaneous should be arrested; but if there is nausea, or if food turns acid inside, or decomposes, both of which are manifested by eructations, the food should be evacuated, and the stomach forthwith replenished by the taking of food of the kind just noted (§ 9). When immediate apprehension has been removed a return should be made to the prescriptions given above (§ 7).
13 The stomach is girt about by the ribs, and in these also severe pains occur. And the commencement either is from a chill, or from a blow, or from excessive running, or from disease. But at times pain is all there is the matter, and this is recovered from be it slowly or quickly; at times it goes on until it is dangerous, and the acute disease arises which the Greeks call pleurisy. To the aforesaid pain in the side is added fever and cough; and by means of the cough, phlegm is expectorated when the disease is less serious, but blood when it is grave. At times also there is a dry cough without expectoration, which is worse than the former condition, and better than the latter. The aparo remedy for severe and recent pain is blood-letting; but if the case is either of a slighter or of a more chronic kind,
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then this remedy becomes either unnecessary or belated; and recourse is to be had to cupping after incising the skin. It is also appropriate to apply vinegar and mustard upon the chest until this raises ulcerations and pustulations, and then a medicament to draw out the humour that way. Besides the above the side should be first surrounded with a sheet of sulphurated wool; next, after the inflammation has subsided somewhat, have dry and hot foments applied to it. From these transition is made to emollients. If the pain persists for a longer time, it may finally be dispersed by resin plaster. Food and drink should be taken hot, avoiding cold. Along with the above treatment, however, it is not unfitting to rub the lower limbs with oil and sulphur. If the cough has been relieved, the patient should read a little out loud, and now take both sharp food and undiluted wine. Though such are what medical practitioners prescribe, yet our country people, lacking these remedies, find help enough in a draught of germander. The foregoing are the remedies common to all cases of pain in the side: there is more to do if this affection has also become acute. In such cases, besides what has been described above, attention must be given to the following: that the food be as thin and bland as possible, and gruel is most suitable, especially that made with pearl barley, or soup made by boiling a chicken with leeks, and this may be given, but only every third day, if the patient's strength permits of this; the drink should be hydromel in which hyssop or rue has been boiled. The times at which these should be given will become apparent from the way the fever increases or diminishes, so that it should be given when there is least fever, not forgetting,
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however, that a dry throat must not be combined with that kind of cough; for often when there is no expectoration, the cough is incessant and chokes the patient. On this account I stated above that a cough which brings up nothing is of a worse kind than that causing phlegm to be expectorated. But here the disease does not allow of wine being sipped as prescribed above (10.3); pearl barley gruel is to be taken instead. As these have to sustain the patient during the hot stage of the disease, as soon as there is a little remission, the diet can be increased and also some wine given, as long as nothing is given that will either chill the body or irritate the throat. If the cough persists in convalescence, it will be well on one day to omit the wine, and on the next to take a little extra wine with the food. And also at the beginning of a cough, as stated above, it is not amiss to sip cupfuls of wine; but sweet or at any rate light wine, is the more suitable in this kind of illness. If the malady has become inveterate the body must be strengthened by food fit for an athlete.
14 Passing from the framework of the body to the viscera, we come first to the lung, where a grave and acute disease arises, which the Greeks name peripleumoniacon. The conditions are these: the lung is attacked as a whole; this is followed by a cough which draws up bile or pus; there is a feeling of weight over the praecordia and all the chest; there is difficult breathing, high fever, persistent insomnia, loss of appetite, wasting. This sort of disease has in it more of danger than of pain. Blood should be let if there is strength enough; if not, dry cups should be applied over the praecordia. Then if the patient is strong enough he should be rocked to disperse the
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disease; if not, he should yet be moved about in the house: his drink should then be a decoction of hyssop with a dried fig, or hydromel in which hyssop or rue has been boiled; he should be rubbed twice daily, longest between the shoulder-blades, then the arms, feet and legs, but lightly over the lung. As regards food too, in this instance it should be neither salted nor acrid nor bitter nor constipating, but of the rather blander kinds. Therefore on the first days pearl barley or spelt or rice gruel in which fresh lard has been boiled are to be given; with this raw eggs, pine kernels in honey, bread or washed groats of spelt in hydromel; then he may drink not only water by itself but also lukewarm hydromel, or even this cold in summer, unless there is some objection. But whilst the disease is on the increase, it is enough to give these every other day. When the increase has come to a stand, he should abstain, so far as is practicable, from everything except lukewarm water. If the strength begins to fail, hydromel is to be added. For the relief of pain it is helpful to apply foments hot, or those which both repress and soothe. The application to the chest of salt, well rubbed up and mixed with wax-salve, is beneficial because it slightly erodes the skin, and thereby draws out that flood of the matter by which the lung is being oppressed. Useful also is any one of the emollients which draw out the matter. During the pressure of the disease it is not wrong to keep the patient with the windows shut: when he is somewhat better, some windows should be opened three or four times a day to let in a little air. Next during recovery he should for several days abstain from wine, use rocking, rubbing and gruels; to the previous foods add: of vegetables,
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leeks, of meat, trotters and tit-bits, also small fish, so long as for a while nothing but what is soft and bland is consumed.
15 Further a disease of another of the viscera, the liver, is also sometimes chronic, sometimes acute: the Greeks call it hepaticon. There is severe pain in the right part under the praecordia, which spreads to the right side, to the clavicle and arm of that side; at times there is also pain in the right hand, there is hot shivering. In a grave case there is vomiting of bile; sometimes the patient is nearly choked by hiccough. Such are the signs when acute; but in a more chronic case, where there is suppuration within the liver, the praecordia on the right side become hard and swollen; after a meal there is greater difficulty in breathing; then supervenes a sort of paralysis of the lower jaws. When the disease has become inveterate, the abdomen and legs and feet swell; there is wasting of the chest and arms and about the clavicle on both sides. It is best to begin by letting blood; then the bowel is to be moved, if nothing else takes effect, by black hellebore. Externally plasters are to be applied, first repressants, then hot ones to disperse; appropriate additions are iris or wormwood unguents; after these emollients. Gruels, moreover are to be given, all food hot and not too nourishing, generally that kind which is also suitable to pleurisy (IV.13, 4), and in addition such food and drink as promote urination. Beneficial in this disease are: thyme, savory, hyssop, catmint, starch, sesamum
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seeds, laurel berries, young pine-cone tips, knotgrass, mint, quince pulp, the fresh raw liver of a pigeon. Some of the above may be eaten alone, some can be added to the gruel or draughts, so long as they are taken sparingly. There is no objection to wormwood rubbed up in honey and pepper, of which a dose is taken daily. All cold things must be especially avoided; for nothing is more harmful to the liver. Rubbings of the extremities should be employed; all manual work should be avoided, and all more active movement; the patient should never even hold his breath for long together. Anger, hurry, weight-lifting, boxing, running are harmful. A copious affusion of the body with water, hot in winter, tepid in summer, is beneficial, also free anointing and sweating at the bath. But if the liver suffers from an abscess, the same is to be done as in other internal suppurations. Some even with a scalpel make an incision over the liver, and burn through into the actual abscess with the cautery.
16 Now the spleen when affected swells, and with it simultaneously the left side; and this becomes hard and resists pressure. The abdomen is tense: there is even some swelling of the legs. Ulcerations either do not heal at all, or at any rate form a scar with difficulty: there is also pain and some difficulty in walking fast or running. Rest increases this complaint, and so there is need for exercise and work; nevertheless, care must be taken lest if carried too far fever be excited. Anointings and rubbings and
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sweatings are necessary. All sweet things are hurtful, also milk and cheese; but sour things are the most suitable. Therefore sharp vinegar may be sipped by itself, vinegar of squills is even better. Such patients should eat salt fish or olives preserved in strong brine, lettuce dipped in vinegar, also endive in the same, beet with mustard, asparagus, horse-radish, parsnip, trotters, chaps, poultry not fatted, and similar game. The drink too, when taken on an empty stomach, should be wormwood decoction; after food, water in which a blacksmith has from time to time dipped his red-hot irons; since this water especially reduces the spleen. For it has been observed that animals reared by our blacksmiths, have small spleens. Dry thin wine can also be given: and everything, whether food or drink, which causes urination. Of particular value in this respect are: trefoil seeds or cummin or celery or creeping thyme or broom tops or purslane or catmint or thyme or hyssop or savory: for these seem best adapted to draw out humour from the spleen. Ox-spleen may be usefully given to eat; rocket and nasturtium in particular render the spleen smaller. Palliatives must also be applied externally: there is one made of ointment and dates which the Greeks call myrobalanon, or that made of linseed and nasturtium seeds, to which wine and oil have been added; or that made of green cypress and a dried fig; or that made with mustard to which is added a fourth part by weight of he-goat's kidney fat, and which is rubbed up in the sun and applied forthwith. Moreover, capers may be employed in several ways; for they may be both
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taken with the food, and the brine and vinegar in which they have been soaked may be sipped. They may be even applied externally, the root or bark having been rubbed up with bran or the capers themselves with honey. There are also emollients suitable for this affection.
17 As regards the kidneys, these when they have become affected, continue diseased for a long while. It is worse if bilious vomiting is added. The patient should rest, sleep on a soft bed, keep the bowels loose even using a clyster when they do not act otherwise; he should sit frequently in a hot bath; take neither food nor drink cold, abstain from everything salted, acid, acrid, and from orchard fruit; drink freely; add whether to the food or to the drink pepper, leeks, fennel, white poppy; which are the most active in causing a discharge of urine. As an additional remedy when there is ulceration of the kidneys, if the ulcerations are still in need of being cleaned, sixty cucumber seeds stript of the husk, twelve pine kernels, of aniseed as much as can be taken up by three fingers, and a little crocus, are rubbed up together, and divided between two draughts of honey wine: but if it is merely pain was has to be relieved, thirty of the cucumber seeds, twenty pine kernels, five almonds, and a little crocus are rubbed up together and given in milk. And besides it is right to apply certain emollients, and especially such as extract humour.
18 From the viscera we proceed to the intestines, which are subject to diseases, both acute and chronic.
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And in the first place mention is to be made of cholera, because it appears to be a complaint common to the stomach and intestines: for there occur simultaneously diarrhoea and vomiting, and in addition flatulence. The intestines are griped, bile bursts upwards and downwards; first it is watery, then like water in which fresh meat has been washed; at times it is white in colour, at other times black or variously coloured. Hence the Greeks term this affection by the name of cholera. Besides those symptoms which are mentioned above, often the legs and arms are also contracted, there is urgent thirst, and fainting; when such things occur together, it is not to be wondered at if the patient dies suddenly, and yet in no other disease is there less time for affording relief. Therefore immediately upon the commencement of the above signs, the patient should drink as much as he can of tepid water, and vomit. Vomiting hardly ever fails to follow; but even if it does not occur, nevertheless it is advantageous to have mixed fresh material with that which is decomposed; the cessation of vomiting is a step towards recovery. If this happens, the patient should abstain forthwith from all drink; if there are still gripings, the stomach should be treated with cold and moist foments, or if there is pain in the belly, these should be lukewarm, so that the belly itself is relieved by moderately warm applications. But if vomiting, diarrhoea and thirst give rise to severe distress, and the vomit still contains undigested food, it is not yet a fitting time for wine: water should be given, not cold but rather lukewarm: pennyroyal
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in vinegar should be applied to the nostrils, or wine sprinkled with polenta, or mint in its natural state. But when the indigestion has been relieved, there is then greater apprehension of fainting. Recourse therefore should then be had to wine. The wine taken should be thin, aromatic, mixed with cold water, adding either polenta or crumbled bread, and bread by itself ought also to be taken, and as often as either the stomach or intestines discharge their contents, so often should the patient recruit his strength by these means. Erasistratus said that a draught should have mixed with it at first three or five drops of wine, subsequently gradual additions of undiluted wine. If Erasistratus both gave wine at the beginning and was influenced by fear of causing indigestion, he acted not without reason; if he thought that severe weakness could be relieved by three drops of wine, he erred. But if the patient is empty and his legs are contracted, a draught of wormwood should be given at intervals. If the extremities become cold, they should be anointed with hot oil to which a little wax has been added, and stimulated by hot foments. If there is no relief even from the above remedies, outside over the actual stomach cups should be applied, or mustard laid upon it. When he has settled down, he should go to sleep. On the next day he should be sure to abstain from drinking, on the third day he should go to the bath, gradually recruit himself with food. Whoever easily gets to sleep is quickly restored; the trouble is brought back by indigestion and also by fatigue and cold. If, after the suppression of the cholera, slight fever persists, there is need for a clyster, and then to take food and wine.
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19 Now the disorder just described is both acute and has its seat between the intestines and stomach, so that it is not easy to say to which part it most belongs. That which the Greeks term coeliacus has its seat at the gateway of the stomach and is usually both acute and chronic. Under this affection the belly becomes hard and painful; the bowels void nothing, not even wind; the extremities become cold; the breath is passed with difficulty. To begin with it is best to apply hot foments and plasters all over the belly to relieve pain, after food to induce a vomit and thus to empty the belly; next on the following days to apply dry cups to the abdomen and hips; to loosen the bowels, by giving milk and cold salted wine; also if in season green figs, provided that neither drink nor food is given all at once but a little at a time. It is enough, therefore, to take two or three cupfuls at intervals, and food in the same proportion; a cup of milk, mixed with one of water, and so administered, is suitable; flatulent and pungent foods are more useful, hence it is well to add pounded garlic to the milk. And as time goes on there is need for: rocking, especially a sea-voyage; rubbing three or four times a day, soda being added to the oil; hot-water affusions after food; then mustard should be put upon all the extremities, omitting the head, until there is irritation and redness, especially if the body is robust and virile. Gradual transition should next be made to remedies which confine the bowels. Roast meat, such as is nutritious and does not readily decompose, is to be given; and for drink,
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boiled rainwater, of which two or three cupfuls should be drunk at a time. If the disorder is of longer standing the proper thing is to swallow a bit of the best laser the size of a peppercorn, to drink wine and water on alternate days, between meals at times to sip a cupful of wine; to administer a clyster of tepid rain-water, especially if pain persists in the lower bowel.
20 In the intestines proper two diseases have their seat, one in the small, the other in the large. The mr is acute, the latter may become chronic. Diocles of Carystus named the disease of the small intestines chordapsos, of the large eileos. I note that by many the former is now termed eileos, the latter colicos. The former excites pain, at times above, at times below the navel. At one or the other of these places there is inflammation; neither motion nor wind is passed downwards. If the upper part is affected, food, if the lower, faeces is returned by the mouth; if either happens the disease is chronic. Additional signs of danger are if the vomit is bilious, malodorous, either varying in colour of black. The remedy is blood-letting or cupping in several places, the skin not being incised at all; for it is sufficient to do so in two or three places; in the others it is quite enough to extract wind. Next attention should be turned to the seat of disease: for there is commonly a swelling over it. And if this is situated above the navel, there is no
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use in the clyster; if below, to clyster the bowels as Erasistratus advised is the best remedy and often that is all the treatment required. Now the clyster should consist of strained pearl barley gruel, together with oil and honey, nothing else being added. If there is no swelling, the two hands should be placed upon the upper part of the belly, and little by little drawn downwards; for the seat of the trouble may be thus discovered, owing to its being necessarily resistent; and from this one can form an opinion whether the bowels should be clystered or not. The treatments common to both forms are: the application of hot plasters, put on from the breasts to the groins, and back to the spine, and often changed; rubbing of the arms and legs; immersing the patient all over in hot oil. If the pain is not relieved, there is injected into the bowels from below three or four cupfuls of hot oil. When we have brought it about by these measures that wind is now passed down and out, tepid honeyed wine, not much, is given to drink; for before that every care should be taken that nothing at all is drunk. If the honeyed wine is kept down, then give gruel. When pain and feverishness have subsided, then at length a fuller diet is adopted, but nothing flatulent nor solid nor rich, lest the intestines, whilst still weak, take harm; but for drink nothing is better than plain water, for in this disease vinous and acid drinks are objectionable. Subsequently the patient should avoid the bath, walking, rocking and other bodily movements; for this disorder is very liable to recur, and, unless the intestines have already returned to a sound state, either cold or shaking of any kind may cause a return of the trouble.