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.