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.
21 The disease which is in the larger intestine is situated chiefly in that part which I have described as a blind alley (IV.1, 8). There is extreme flatulence, violent pains especially on the right side; the intestine which appears to undergo torsion, . . . almost forces out wind. In most cases it comes on after chills and
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fits of indigestion, then subsides, and in course of time often recurs so as to be a cause of suffering but without shortening the length of life. At the commencement of the pain, dry, hot foments should be applied, at first mild, then stronger ones, at the same time rubbing is used to draw off the matter to the extremities, into the legs and arms; if the pain be not so dispersed, dry cups should be applied. There is even a medicament compounded for this very purpose called colicos: Cassius used to boast that he had invented it. It is of more benefit when given as a draught, but when applied externally too it relieves pain by dispersing the wind. Until griping has quite ceased it is not right to take properly either food or drink. I have already stated what kind of food should be used in this kind of disorder (1, 7). The composition of the medicament termed colicos is as follows: costmary, anise, castor, of each 12 grams, of parsley 12 grams, of long and round peppers, a.a. 8 grams, of poppy tears, round rush, myrrh, nard, a.a. 24 grams, all mixed together with honey. This may be either swallowed by itself of the taken in hot water.
22 The most akin to the above among intestinal maladies are gripings, called by the Greeks dysenteria. The insides of the intestines ulcerate; from these blood trickles and at times is excreted with some faeces which are always liquid, at times with a sort of mucus, sometimes at the same time something fleshlike comes down; there is frequent desire to stool and pain in the anus. Along with this
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pain a scanty motion is discharged, and by this too the griping pain is intensified: and after a while there is some relief and a short interval of ease; sleep is broken, feverishness comes; when the disorder has continued for a long while, it either carries off the patient, or even, although it come to an end, puts him to torture. Rest must be adopted from the first, since any shaking sets up ulceration; next on an empty stomach he is to sip a cupful of wine to which has been added powdered cinquefoil root; then repressant plasters are put upon the abdomen, which in the case of disorders of the upper abdomen is not expedient; whenever the patient goes to stool, he should bathe the anus with hot water in which vervains have been boiled; purslane should be eaten, whether cooked or pickled in strong brine; also such foods and drink as are astringent to the bowel. If the distemper is of longer standing, there should be injected into the rectum either a tepid cream of pearl barley, or milk, or melted fat, or deer marrow, or olive oil, or rose oil with butter or with raw white of egg, or a decoction of linseed, or if sleep does not occur, yolk of eggs in a decoction no rose-leaves: for such remedies relieve pain and mitigate ulceration, and are of special utility if loss of appetite has ensued. Themison has stated in writing that the strongest brine should be used in these cases. Food too should be of the kind which will act as mild astringents. But diuretics if they take effect are beneficial by directing humour to another part: if they do not take effect, they increase the trouble; so unless for those on whom they act promptly, they should not be used. If there is feverishness, the drink should be hot water, either plain or with some astrin
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gent in it; if none, then light dry wine. If for several days other remedies have done no good, and the disease is now of long standing, drinking of very cold water acts as an astringent upon the ulcerations and starts recovery. But as soon as the movement of the bowels is under control, there should forthwith be a return to warm drinks. Sometimes also there is discharged a putrid sanies having a foul odour, sometimes unmixed blood escapes. If the former occurs, a hydromel clyster should be given, and then the other things mentioned above injected. An effective remedy even for intestinal canker is a lump of minium rubbed up with 250 grams of salt, dissolved in water, and administered as a clyster. But if there is a flux of blood, food and drink should be astringent.
23 From dysentery there proceeds sometimes leienteria, when the intestines cannot retain anything, and whatever is swallowed is straightway excreted imperfectly digested. Sometimes in the patients this drags on, sometimes it hurries them off. In this affection especially astringents should be put on the chest, and when the skin becomes ulcerated, then an emollient to draw out humour; and the patient should sit in a decoction of vervains; take both food and drink which control the bowel: and have cold water poured over him. Nevertheless, care should be taken lest with all these remedies there be an opposite trouble
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set up by excessive flatulence. Consequently, little by little, the intestines should be strengthened by some additions daily. As in the case of any abdominal flux, so in this, it is particularly necessary that the patient should go to stool, not as often as inclined, but as often as compelled, so that by such delay the intestines may be got into the habit of holding up their contents. There is another thing which, whilst applicable equally to all similar affections, is to be specially observed in this, that as many beneficial medicaments are disagreeable to the taste, such as the mixture containing plantain and blackberries and any mixture containing pomegranate rind, that shall be chosen which the patient likes most. Moreover, if he loathes all of them, something to excite his appetite should be interposed, less useful, perhaps, but most pleasant. Exercise and rubbing are needed in this disease also, as well as heat, whether of the sun, or a fire, and baths; and according to Hippocrates, a vomit even by white hellebore, when other measures prove of little avail.
24 Again, worms also occasionally take possession of the bowel, and these are discharged at one time from the lower bowel, at another more nastily from the mouth: and we observe them sometimes to be flattened, which are the worse, at times to be rounded. For the flat worms there should be given as draughts, a decoction of lupins, of or of mulberry bark, to which may be added, after pounding, either hyssop or a vinegar cupful of pepper, or a little scammony. Alternatively on one day let him eat a quantity of garlic and vomit, then on the next day take a handful of fine pomegranate roots, crush them and boil them in a litre and a half of water down to one-
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third, to this add a little soda, and drink it on an empty stomach. At three hours' interval, let him take two further draughts; but with the addition of half a pint of sea water or strong brine; then on going to stool, sit over a basin of hot water. Again, for the round worms which especially trouble children, both the same remedies may be given and some milder ones, such as pounded-up seeds of nettles or of cabbage or of cummin in water, or mint in the same or a decoction of wormwood or hyssop in hydromel or cress seeds pounded up in vinegar. It is also of service either to eat lupin or garlic, or administer into the lower bowel a clyster of olive oil.
25 There is, again, another affection which the Greeks call tenesmos, slighter than all those last spoken of. It should be counted neither with acute nor with chronic diseases, since it is readily relieved, and never by itself fatal. As in the case of dysentery, there is equally the frequent desire for stool, and equally the pain when anything is passed. There is a discharge resembling phlegm and mucus; sometimes it is even slightly bloodstained; but mingled with properly formed faeces derived from food. The patient should sit in hot water, and make application frequently to his anus. For this there are several suitable medicaments; butter in rose oil, gum acacia dissolved in vinegar; that wax-salve which the Greeks call tetrapharmacon, made liquid with rose oil; alum wrapped up in wool and so applied; the same clysters as are beneficial in dysentery; the same decoction of vervains to foment the lower parts. He should drink on alternate days water and a thin dry wine
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lukewarm or better cold. The diet should be the same as prescribed above 922) for dysentery.
26 Even slighter, while recent, is diarrhoea, in which the stool is liquid and more frequent than ordinary; and sometimes the pain is bearable, at times very severe, when it is a worse affair. But a flux from the bowel for one day is often salutary, and even for several days, provided that fever is absent and it subsides within seven days. For the body is purged, and whatever is about to cause a complaint inside is evacuated with advantage. But persistence is the danger; for it excites at times dysentery and feverishness and exhausts strength. It is sufficient on the first day to rest, and not to check the movement of the bowels. If it stops of itself, the patient should make use of the bath, and take a little food; if it persists, he should abstain, not only from for, but even from drink. If on the day following, in spite of all, the stool is still liquid, he should rest as before and take a little astringent food. On the third day he should go to the bath; be rubbed all over vigorously except the abdomen, sit with his loins and shoulder-blades before a fire; take food of an astringent kind, and a little undiluted wine. If on the fourth day the flux persists, he should eat more but provoke a vomit afterwards, and counter in a general way the diarrhoea by thirst, hunger and vomiting, until it subsides for it is scarcely possible that after so attending to it, the bowel will not be controlled. Another method to suppress the diarrhoea is to dine and then vomit; the next day to rest in bed, in the evening to be anointed, but lightly, then to eat about half a pound of bread soaked in undiluted Aminaean wine; after that something roasted, poultry in par=
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ticular, and lastly to drink the same wine mixed with rain-water; and to do so until the fifth day, then vomit again. Now Asclepiades, against the opinion of previous writers, affirmed that the drink should be kept constantly cold, indeed as cold as possible. I myself hold that each should trust in his own experiences, whether hot than cold drink should be made us of. It sometimes happens also that this disorder, having been neglected for several days, is more difficult to relieve. Such a patient should commence with an emetic; then the following day at evening be anointed in a warm room; take food in moderation, and the sourest wine undiluted; a wax-salve with rue should be applied to the abdomen. In this affection neither walking nor rubbing is of benefit; sitting in a carriage and even more riding on horseback is advantageous; for nothing strengthens the intestines more. But if use is to be made of medicaments as well, the most suitable is that made from orchard fruit. At the time of the vintage, pears and crab apples are thrown into a large vessel; and if the latter are not to be had, green Tarentine or Signine pears, Scaudian, or Amerian apples, sweet-scented. To these are added quinces and pomegranates with their rind, service fruit, and those that are called torminalia, which we use by preference, so that these occupy one-third of the jar; then this is next to be fille up with must, and boiled until all the ingredients have become resolved into a uniform mass. It is not unpleasant to the taste, and taken as needed, it controls the bowel gently, without any harm to the stomach. It is enough to take in one day two or three
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spoonfuls. Another composition is stronger: myrtle berries are gathered, and wine expressed from them is boiled down to one-tenth, of which a cup is sipped. A third can be prepared at any time by scooping out the inside of a pomegranate, removing all the seeds, and returning the pulp into the cavity, than raw eggs are pounded in, and stirred round with a small rod; next the fruit itself is heated over charcoal, for it does not burn so long as the inside is liquid; when the inside begins to dry the pomegranate is taken off the brazier and with a spoon the inside is scooped out and eaten. By certain acrid additions this remedy can be made more active; thus also it may be stirred up in peppered wine and mixed with salt and pepper, and so eaten. Pease porridge, with which a little of an old honeycomb has been boiled, also lentil porridge boiled with pomegranate rind, also a decoction of bramble tops eaten with oil and vinegar, are efficacious, as also draughts of a decoction of dates or quinces or dried service fruits or brambles. Such are the kind I refer to whenever I say an astringent draught should be administered. Also a half-pint of wheat is boiled in dry Aminaean wine, and first the wheat is eaten on a stomach empty both of food and drink, afterwards the wine itself is drunk and can be justly counted amongst the most active remedies. Also there can be given to drink Signian wine, or dry and resinated wine, or any other dry wine. And a pomegranate may be pounded up along with its rind and seeds, and mixed with wine of the above sort; the
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patient either sips it undiluted, or drinks it mixed with water. But it is superfluous except in bad cases to make use of medicaments.
27 From the womb of a woman, also, there arises a violent malady; and next to the stomach this organ is affected the most by the body, and has the most influence upon it. At times it makes the woman so insensible that it prostrates her as if by epilepsy. The case, however, differs from epilepsy, in that the eyes are not turned nor is there foaming at the mouth nor spasm of sinews; there is merely stupor. In some women this attack recurs at frequent intervals and lasts throughout life. When this happens, if there is sufficient strength, blood-letting is beneficial; if too little, yet cups should be applied to the groins. If she lies prostrate for a long while, or if she has done so at other times, hold to her nostrils an extinguished lamp wick, or some other of these materials which I have referred to as having a specially foetid odour (III.20, 1), to arouse the woman. For the same end, affusion with cold water is also effectual. And there is benefit from rue pounded up with honey, or from a wax-salve made up with cyprus oil or from hot moist plasters of some sort applied to the external genitals as far as the pubes. At the same time also the hips and the backs of the knees should be rubbed. Then when she has come to herself, she should be cut off from wine for a whole year, even if a similar attack does not recur. Friction should be applied daily to the whole body, but particularly to the abdomen and behind the knees. Food of the middle class should be given: every third or fourth day mustard is to be applied over the hypogastrium until the skin is reddened. If induration
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persists, a convenient emollient appears to be bitter sweet steeped in milk, then pounded and mixed with white wax and deer marrow in iris oil, or suet of beef or goat mixed with rose oil. Also there should be given in draught either castory, or git, or dill. If the womb is not healthy, it is cleaned with square rushes; but if it is actually ulcerated a wax-salve is made with rose oil, with pounded rose-leaves added to give it consistence. When painful the womb should be fumigated from below with sulphur. But if excessive menstruation is doing harm to the woman, the remedy is to scarify and cup the groins, or even to apply cups under the breasts. If the menstrual discharge is bad, the following medicaments are to be applied to evoke blood: costmary, pennyroyal, white violet, parsley, catmint and savory and hyssop. Let her include what is suitable in her diet: leeks, rue, cummin, onion, mustard, or any other acrid vegetable. If blood bursts out from the nose at a time when it should do so from the genitals, the groins are to be scarified and cupped, repeating this every thirtieth day for three or four months, then you may be sure that this affection has been cured. But if there is no show of blood, you may be sure that there are pains coming in the head. Then blood is to be let from the arms, and you have given relief at once.
. . . constricting remedies. White olives also produce the same effect, also black poppy seeds, taken
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with honey, and liquid gum, mixed with pounded celery seeds, and given in a cupful of raisin wine. Besides the above, draughts suited for all bladder pains are made from aromatics, such as spikenard, saffron, cinnamon, cassia, and such like, also decoction of mastic does good. If in spite of these pain becomes intolerable and there is blood in the urine, venesection is proper, or at any rate wet cupping over the hips.
But when the urine exceeds in quantity the fluid taken, even if it is passed without pain, it gives rise to wasting and danger of consumption; if it is thin, there is need for exercise and rubbing, particularly in the sun and before a fire. The baths should be taken but seldom, and the patient should not stay in it for long; the food should be astringent, the wine dry and undiluted, cold in summer, lukewarm in winter, and in quantity the monument required to allay thirst. The bowels also are to be moved by a clyster or by taking milk. If the urine is thick, exercise and rubbing should be more though, and the patient should stay longer in the bath; food and wine should be of the lighter kind. In both affections, everything that promotes urine should be avoided.
28 There is also a complaint about the genitals, an excessive outflow of semen; which is produced without coition, without nocturnal apparitions, so that in course of time the man is consumed by wasting. Salutary remedies in this affection are: vigorous rubbings, affusions, swimming in quite cold water; no food and drink taken unless cold. He should, moreover, avoid everything
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indigestible, everything flatulent; nothing should be taken of those things which appear to collect the semen, such things are siligo, simila, eggs, spelt, starch, all glutinous flesh, pepper, colewort, bulbs, pine kernels. It is not inexpedient to bathe the lower extremities in a decoction of astringent vervains, to cover the hypogastrium and groins with plasters prepared from the same decoction, and in particular from rue preserved in vinegar: also the patient should avoid sleeping on his back.
29 It remains for me to come to the extremities of the body which are interconnected by joints. I begin with the hips. In these severe pain is wont to occur, and this often weakens the patient, and some it never leaves: and on this account it is a difficult class to treat, for it is generally after chronic diseases that a pestiferous force directs itself to the hip; which, as it releases other parts, seizes upon this, which now becomes the seat of the disease. The hip is to be first fomented with hot water, after which hot plasters are applied. Those which appear to be especially beneficial are these: caper bark chopped up and mixed either with barley meal or with fig decoction, or darnel meal boiled in diluted wine and mixed with sour wine lees: since these are apt to grow cold, by night it is better to put on emollients. Inula root also pounded and afterwards boiled in dry wine and applied widely of the hip is among the most efficacious of remedies. If these do not resolve the trouble, then hot moist salt is to be employed. If even these measures do not end the pain, and a swelling supervenes, the skin is incised and cups are to be applied; diuretics are given; and the bowels if costive are to be clystered.
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The ultimate measure and the most efficacious in cases of old standing, is to set up issues in three or four places over the hip by burning the skin with cauteries. But rubbing is also to be employed, particularly in the sun and often each day, in order that the materials of the disease, which have been doing harm by collecting, may be the more readily dispersed; and the rubbing is applied actually over the hips in the absence of ulceration; if there is any, then to other parts. Since now some issue often has to be set up by the hot cautery, in order that matter may be extracted, it is the general rule not to let ulcerations of this kind heal offhand, but to let them drag on until the complaint which we aim to relieve has quieted down.
30 Next to the hips come the knees, in which pain now and again occurs, and these same plasters and cuppings are a safeguard, as also when any pain arises in the shoulder or other joints. Riding on horseback is of all things the most injurious to anyone with painful knees. All such pains, when of long standing, are hardly ever ended except by cauterization.
31 Joint troubles in the hands and feet are very frequent and persistent, such as occur in cases of podagra and cheiragra. these seldom attack eunuchs or boys before coition with a woman, or women except those in whom the menses have become suppressed. Upon the commencement of pain blood should be let; for when this is carried out at once in the first stages it ensures health, often for a year, sometimes for always. Some also, when they have washed themselves out by drinking asses' milk, evade this disease in perpetuity; some have obtained lifelong
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security by refraining from wine, mead and venery for a whole year; indeed this course should be adopted especially after the primary attack, even although it has subsided. But if the malady has already become established, it may be possible to act with more freedom in those seasons in which the pain tends to remit; but he should adopt more careful treatment at those times in which it recurs, which is generally in spring or autumn. Now when the pain requires it, in the morning the patient should be rocked; then carried to a promenade; there he should move about, and in the case of podagra he should take short turns at sitting down and walking about: next before taking food and without entering the bath itself, but in a hot room, he should be gently rubbed, sweated, and then douched with lukewarm water: the food following should be of the middle class; diuretics are given with it, and an emetic whenever he is of a fuller habit. When the pain is very severe, it makes a difference whether there is an absence of swelling, or a swelling with heat, or swellings which already hardened. For if there is no swelling, hot foments are needed. Either sea-water, or strong brine should be heated, then poured into a vessel; and as soon as he can bear it, the man puts his feet in, over the vessel is spread a cloak, and over him a blanket; after that hot water is poured over the lip of the vessel, a little at a time, to prevent the contents from losing heat: and then at night heating plasters are applied, especially mallow root boiled in wine. But if there is swelling and heat, refrigerants are more useful, and the joints may be rightly held in very cold water, but not every day, nor for long, lest the sinews become hardened. There is to be applied
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also a cooling plaster; this, however, is not to be kept on for long, but a change made to those which soothe as well as repress. If pain is greater, rind of poppy-heads is to be boiled in wine, and mixed with wax-salve made up with rose oil; or wax and lard, equal parts, are melted together, and then the wine mixed with these; and as soon as this application becomes hot, it is to be removed and another immediately put on. But if the swellings have grown hard and are painful, the application of a sponge frequently squeezed out of oil and vinegar, or out of cold water, or the application of pitch, wax and alum, equal parts mixed, gives relief. There are also several emollients suitable alike for the hands and feet. But if the pain does not allow of anything being put on, when there is no swelling, the joint should be fomented with a sponge which has been dipped in a warm decoction of poppy-head rind, or of wild cucumber root, next the joints are smeared with saffron, poppy-juice and ewe's milk. But if there is a swelling, this ought to be bathed with a tepid decoction of mastic or some other repressant vervain, and then covered with a medicament composed of bitter almonds pounded up in vinegar, or of white lead, to which has been added the juice of pounded pellitory. The stone, too, which corrodes flesh, which the Greeks call sarcophagos, is carved out so as to admit the feet; when these are painful, they are inserted and held there, and are usually relieved. In Asia Minor Assian limestone is held in esteem for this purpose. When pain and inflammation have subsided, which should happen within forty days, unless the patient is in fault, gentle exercise, spare diet, soothing anoint-
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ings, are to be employed, provided that also then the joints may be rubbed with an anodyne salve or with a liquid wax-salve of cyprus oil. But riding on horseback is harmful for those with podagra. Those, too, in whom joint-pains tend to recur at certain seasons ought both to take precautions beforehand as to their diet, lest there should be a surfeit of harmful material in the body, and to use an emetic the most frequently; and those in any anxiety as to their body should make use of clystering, or of purgation by milk. This treatment for those with podagra was rejected by Erasistratus, lest a flux directed downwards might fill up the feet, though it is evident that any purgation extracts, not only from the upper parts, but also from the lower as well.
32 Now from whatever disease he is recovering, if his convalescence is slow, the patient ought to keep awake from dawn, but nevertheless stay at rest in bed: about nine o'clock he should be gently stroked over with anointed hands, after that by way of amusement, and as long as he pleases, walk, all business being omitted: then he should use conveyances for a good while, be rubbed much, often change his residence, climate and diet. Having taken wine for three or four days, he should for one or two days drink water only. For thus he will ensure that he does not lapse into a complaint which causes wasting, but soon gets back his full strength. When he has, in fact, completely recovered, it will be dangerous for him suddenly to change his way of life and to act without restraint. Therefore he should only little by little leave off what has been prescribed, and pass to a way of life of his own choosing.