De Medicina

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.

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 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.

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.