De Medicina

28 From those lesions which are due to something from without we come to those which originate from within, when some bodily part has become corrupted. Of these none are worse than carbuncles, the signs of which are: redness, with a few pustules projecting

A carcinoma does not give rise to the same danger unless it is irritated by imprudent treatment. This disease occurs mostly in the upper parts of the body, in the region of the face, nose, ears, lips, and in the breasts of women, but it may also arise in an ulceration, or in the spleen. Around the spot is felt a sort of pricking; there is a fixed, irregular swelling, sometimes there is also numbness. Around it are dilated tortuous veins, pallid or livid in hue; sometimes in certain cases they are even hidden from view; and in some the part is painful to the touch, in others there is no feeling. And at times the part becomes harder or softer than natural, yet without ulcerating; and sometimes ulceration supervenes on all the above signs. The ulceration at times has no special characteristic; at times it resembles what the Greeks call condylomata, both in a sort of roughness and in size; its colour is either red or like that of lentils. It is not safe to give it a blow; for either paralysis or spasm of the sinews follows at once. Often from a blow on it a man loses speech and faints; in some also, if the place is pressed, the parts around become tense and swollen. Then it is the worst kind. And generally the first stage is what the Greeks call cacoethes;

There is also an ulceration which the Greeks call therioma. This may arise spontaneously, and at times it may supervene upon ulceration from another cause. It has either a livid or black colour, a foul odour, and an abundant mucus-like discharge. The ulcer itself is insensitive to touch and applications; there is just disturbance by itching. But around there is pain and inflammation; sometimes even fever is set up, occasionally blood is discharged from the ulceration. This also is a spreading disease. And all these signs often extend, and there results from them an ulcer which the Greeks call phagedaena, because it spreads rapidly and penetrates down to the bones and so devours the flesh. This ulceration is uneven, bog-like; there is a large amount of glutinous discharge; the stench is intolerable, and the inflammation is greater than accords with the extent of the ulceration. Both therioma and phagedaena, like all canker, occur for the most part in the aged or those of a bad habit of body. Both are treated in the same way, but treatment is more necessary in the severer form. Firstly, a regimen must be enforced, so that the patient rests in bed, abstains from food for the first days, drinks very freely of water; also has the bowels moved by a clyster; then, on the subsidence of the inflammation, takes digestible food, avoiding everything acrid; drinks as much as he likes, but for the time being contents himself with water, except that at dinner he may drink a little dry wine. But fasting is not to be used for patients with phagedaena

Ignis sacer should be counted also among the bad ulcerations. Of this there are two kinds; one is reddish or partly red, partly pale and roughened by a chronic pustulation, the pustules all of about equal size, but mostly very small: in them there is nearly always pus and often there is redness with heat. And sometimes the disease spreads while the first part attacked is healing; sometimes even after this is ulcerated, when the pustules have ruptured and the ulcer continues and a humour is discharged which appears to be continuing between sanies and pus. It attacks chiefly the chest or flanks or

Again, the ulcer called chironean is large and has hard, callous, swollen margins. A sanies exudes, which is not copious, but thin. There is no bad odour, either in the ulcer or in its discharge; no inflammation; pain is moderate; it does not spread, so it brings no design, but it does not heal rapidly. At times a thin scab is produced, then in turn it is broken down and the ulceration is renewed. It occurs chiefly on the feet and legs. On it should be applied something which is at once soothing, and active and repressant, such as the following: copper scales, washed lead calcined, 16 grams each, cadmia and wax, 32 grams each, along enough rose-oil to give the wax together with the other materials a soft consistence.

Ulcers are also produced in winter by the cold, mostly in children, and particularly on their feet and toes, sometimes also on the hands. There is redness with moderate inflammation; some pustules arise followed by ulceration; the pain is

Struma, again, is a swelling, in which there occur underneath certain concretions of pus and blood like little glands; they are specially embarrassing to medical men, for they set up fever and yet do not quickly come to a head; and whether they are treated by incision or by medicaments, they are generally prone to recur in the neighbourhood of their scars, and this happens much more often after the application of medicaments; and in addition to all this, they are of long duration. These swellings arise particularly in the neck, but also in the armpits and groins and in the flanks. The surgeon Meges stated that he had met with them also in the breasts of women.

For these white hellebore is an appropriate remedy, and this must be taken frequently until they are dispersed; and also the medicaments which have been mentioned above are applied in order to draw out or disperse the humour. Some also use caustics

The boil, again, is a pointed swelling attended by inflammation and pain, and especially so when it is being converted into pus. When it has opened and the pus gone out, it is seen that part of the flesh has been turned into pus, part into a greyish-reddish core which some call the sac of the boil. There is no danger in it, even although no treatment is adopted; for it ripens of itself, and bursts; but the pain renders treatment preferable in order to afford earlier relief. The special medicine for this is galbanum; but there are others also which have been mentioned above. If none of these are available a plaster that is not greasy should first be applied to disperse it; next, if this is not effective, something adapted to promote suppuration; if even that is not to be had, either raisin wine or yeast. When the pus has been squeezed out, no further treatment is needed.

A phyma is a swelling which resembles a boil, but is rounder and flatter, often also larger. For a boil rarely reaches the size of half an egg, and never exceeds it; a phyma commonly extends even over a wider area, but the pain and the inflammation in it are less. When it has been opened, pus appears in the same way; no core is found as in a

Phygetron, again, is a wide swelling, not much raised up, in which there is a certain resemblance to a pustule. The pain and tension is severe, and more than would be expected from the size of the swelling; at times there is also feverishness. The ripening takes place slowly, and not much pus is formed. It occurs particularly on the top of the head, or in the armpits or groins. Our people call it panus, from its spindle-shape. And I have pointed out above by what medicament this should be relieved.

But although all these diseases are really only minute abscesses, that name implies in general a more extensive lesion, tending to suppuration; and it occurs usually either after fevers or after pains in some part, and particularly after those which have attacked the abdomen. And generally it is visible, since there is some rather widespread swelling, like that which I have previously described as called phyma, and it grows red and hot and shortly afterwards hard as well, and becomes more painful as it increases and occasions both thirst and insomnia: sometimes, however, there may be none of these signs to note in the skin, and especially when pus is forming more deeply; but along with the thirst and insomnia some stabbing pains are felt internally.

Now a swelling is immature when the blood-vessels throb more as if they were bubbling and there is weight and heat and tension and pain and redness and hardening and, if the abscess is larger, shivering or even persistent feverishness; and a

Sometimes, again, fistulae arise, both from abscesses of this kind and from other sorts of ulceration. A fistula occurs in almost any part of the body, but in each place it has some peculiarities. I shall speak first of its general characteristics. There are many kinds of fistulae, then, and whilst some are short, others penetrate deeper; some run straight

There is besides a class of ulceration which the Greeks call κηρίον from its resemblance to honeycomb, and of this there are two kinds. One is greyish, like a boil, but larger and more painful. As it is maturing, holes appear through which is discharged a glutinous and purulent humour; yet it does not properly mature. If it is cut into, there appears much more corruption than in a boil, and it penetrates deeper. It is rare except in the scapular region. The other kind is found only in the head; it projects less above the surface, is hard, broad, greenish or greyish-green in colour, more ulcerated; there are holes at the root of each hair, through which is discharged a glutinous greenish-white humour, in consistency like honey or mistletoe-juice, or at times like olive-oil. If it is cut into, the flesh within appears green. The pain also and inflammation are so severe that they generally cause acute fever. On a case which is only irritated by a few openings, suitable applications are a dry fig and linseed boiled in honey wine or plasters or emollients which draw out diseased matter, or the medicaments noted above for such purposes. For the other form of this, the same medicaments are good, also flour boiled in honey wine mixed with half its quantity of turpentine-resin;

Of these the acrochordon and thymion often end of themselves, and the more so the smaller they are. The myrmecia and corns scarcely ever subside without treatment. The acrochordon, if cut off, leaves no trace of a root behind, and so does not sprout again. When the thymion and clavus have been cut off, a small rounded root is formed underneath, which penetrates right down into the flesh, and if this is left behind it sprouts up again. The myrmecia are held by very broad roots, and so cannot be excised without causing a large wound. A corn is best scraped down from time to time; for thus, without any violence, it softens, and if also a little blood is let out, it often dies away. It is also removed if we clean the part round it and then put on resin mixed with a little powdered millstone. All the other varieties are to be burnt away by medicaments: for some the ash of wine-lees is best; for myrmecia the application made of alum and sandarach. But the skin all round should be covered with leaves that it also may not become ulcerated; afterwards lentil meal is put on. Even a fig in boiled water removes a thymium.

Pustules arise chiefly in the spring; there are many kinds. For at times a sort of roughness comes all over the body, or a part of it, resembling the pustules which are set up by nettles or by sweating; exanthemata the Greeks call them. At times

But scabies is harder: the skin is ruddy, from which the pustules grow up, some moist, some dry. From some of these sanies escapes; and from them comes a persistent itching ulceration, which in some cases rapidly spreads. And whilst in some persons it vanishes completely, in others it returns at a definite time of the year. The rougher the skin, and the more the itching, the more difficult is its relief. Hence the Greeks call such scabies, agria that is, savage. In this case also the same regimen as that given above is necessary; at the beginning a suitable application is that composed of sublimed zinc oxide, saffron, verdigris 1· 16 grams each; white pepper and omphacium 4 grams; zinc oxide ore 9· 3 grams. But when ulceration already exists that com-

Impetigo, again, has four species. The least bad is that which presents a semblance to scabies; for there is redness and some hardness and ulceration and erosion. But it is distinguished from scabies because there is more ulceration and there are pustules like pimples, and in it is seen an appearance as of small bubbles from which after a time little scales are detached; and this recurs at fixed seasons. The second kind is worse, almost like a pimple, but rougher and redder; it has various shapes; small scales are detached from the skin surface; there is more erosion; it spreads more rapidly and widely, and both comes and goes at fixed seasons even more markedly than the previous sort; it is called rubrica. The third kind is worse still; for it is thicker, harder and there is more swelling; there are cracks in the skin and more active erosion. This form also is scaly,

Of papules again there are two kinds. There is one in which the skin is roughened by very small pustules, and is reddened and slightly erodes; in the middle it is a little smoother; it spreads slowly. This disease generally has a round shape at its beginning, and in the same fashion it spreads in a circle. But the other variety is that which the Greeks call agria that is, savage; and in this there is a similar but greater roughness of the skin with ulceration, more severe erosion, and redness; sometimes it even loosens the hair. It is less round in shape, heals with more difficulty, and unless it is got rid of, turns into an impetigo. But in fact a slight papule heals if it is rubbed daily with spittle before eating; a more severe one is got rid of best by an application of pounded pellitory. But turning to compound medicaments, that same one of Protarchus is efficacious in these cases, when the disorder is less severe. An alterna-

Vitiligo also, though not dangerous in itself, is still ugly and is due to a bad habit of body. There are three species. It is called alphos when it is white in colour, generally rather rough, and not continuous, so that it looks as if drops of some sort had been sprinkled about. Sometimes also it spreads still more widely with certain gaps. That called melas differs from it in being of a black colour and like a shadow; otherwise it is similar. Leuce is somewhat like alphos, but is whiter and extends deeper; there are hairs on it, white, and like down. All these spread, but more quickly in some people than in others. The alphos and melas come and go at various seasons; the leuce, once established, is not easily got rid of. The two former are not difficult to treat, the latter is scarcely ever cured, for even if the discoloration is mitigated, the colour of health does not right altogether. But whether any one of these is curable or not is easily learnt by this test. The skin should be cut into or pricked with a needle: if blood escapes, which it usually does in the first two species, there is place for a remedy; if a whitish humour, cure is impossible, and then we should even refrain from treating it. But to the species which admits of treatment we should apply lentil meal, mixed with sulphur and frankincense, pounded

1 I have spoken of those lesions which affect the whole body and require the aid of medicaments; now I come to those which customarily occur only in particular parts, beginning with the head.

In the head, then, when the hair falls out, the principal remedy is frequent shaving. Ladanum mixed with oil, however, is some help in preserving it. I am now referring to the falling out of hair after illness; for no kind of remedy can be given to stop the head of some people from becoming bald through age.

2 But the condition is called porrigo, when between the hairs something like small scales rise up and become detached from the scalp: and at times they are moist, much more often dry. Sometimes this happens without ulceration, sometimes there is a localized ulceration, and from this comes sometimes a foul odour, sometimes none. This generally occurs on the scalp, more seldom on the beard, occasionally even on the eyebrow. It does not arise only there is some general bodily lesion, so that it is not entirely without its use; for it does not exude from a thoroughly sound head. When there is present some lesion in the head, it is not disadvantageous for the surface of the scalp to become here

3 There is also an ulceration, called sycosis by the Greeks from is resemblance to a fig; a sprouting up of flesh occurs. That is the general description: but there are two subordinate species; in one the ulceration is indurated and circular, in the other moist and irregular in outline. From the hard species there is a somewhat scanty and glutinous discharge; from the moist the discharge is abundant and malodorous. Both occur in those parts which are covered by hair; but the callous and circular ulceration mostly on the beard, the moist form, on the other hand, chiefly on the scalp. In both it is good to apply elaterium, or pounded linseed worked up in water, or a fig boiled in water, or the plaster tetrapharmacum moistened with vinegar; also Eretrian earth dissolved in vinegar is suitable for smearing on.

4 Bald spots also are of two kinds. In both,

5 To treat pimples and spots and freckles is almost a waste of time, yet women cannot be torn away from caring from their looks. But of these just mentioned, pimples and spots are commonly known, although that species of spot is more rare which is called by the Greeks semion, since it is

6 Now the foregoing are subjects of minor importance. But there are grave and varied mishaps to which our eyes are exposed; and as these have so large a part both in the service and the amenity of life, they are to be looked after with the greatest care. Now directly ophthalmia sets in, there are certain signs by which it is possible to foretell the course of the disease. For if lacrima-

Now for this disease there are many salves devised by many inventors, and these can be blended even now in novel mixtures, for mild medicaments and moderate repressants may be readily and variously mingled. I will mention the most famous.

There is then the salve of Philo, which contains: washed cerussa, spode and gum 4 grams each; poppy-tears toasted 8 grams. It is important to know that each of these ingredients should be pounded separately, than mixed together, gradually adding water, or some other fluid. Gum, amongst other properties, has this particular advantage, that when salves made of it have become dry, they stick together and do not break up.

The salve of Dionysius consists of: poppy-tears toasted until they soften 4.66 grams, toasted frankincense and gum 2 grams each, and zinc oxide 16 grams.

The salve of Cleon is quite famous: poppy-tears toasted 4 grams, saffron 0.66 grams, gum 4 grams, to which after being pounded is added rose juice. The same man prescribed another more active salve: scales of the copper which is called stomoma 4 grams; saffron 8 grams; zinc oxide 16 grams; lead washed and roasted 24 grams; with a like quantity of gum. There is also for the same complaint the salve of Attalus especially when the rheum is profuse: castoreum 0.33 grams; lign-aloes 0.66 grams; saffron 4 grams; myrrh 8 grams; lycium 12 grams; prepared zinc oxide 32 grams; a like quantity of antimony sulphide and acacia juice 48 grams. And when no gum is added it is preserved liquid in a small receptacle. Theodotus added to the above mixture: poppy-tears toasted 0.33 grams; copper scales roasted and washed 8 grams; toasted date kernels 40 grams; gum 48 grams.

The salve of Theodotus himself, which by some is called achariston, is composed of: castoreum and Indian nard 4 grams each; lycium 0.66 gram; an equal amount of poppy-tears; myrrh 8 grams; saffron,

Besides the above, among the most commonly used salves is that which some call cycnon, others from its ashen colour tephron, which contains: starch, tragacanth, acacia juice, gum 4 grams each; poppy-tears 8 grams; washed cerussa 16 grams; washed litharge 32 grams. These ingredients likewise are compounded with rain-water.

Euelpides, the most famous oculist of our time, used a salve of his own composition called trygodes: castoreum 1.33 grams; lycium, nard and poppy-tears 4 grams each; saffron, myrrh and lign-aloes 16 grams each; roasted copper scales 36 grams; oxide of zinc and antimony sulphide 48 grams; acacia juice 144 grams; the same amount of gum.

The more severe the inflammation, the milder should the application be made, by adding to it white of egg or woman's milk. But if neither doctor nor medicine is at hand, either of the above, dropped into the eye with a little screw of lint prepared for the purpose, often relieves the trouble. But when the patient has been relieved and the discharge of rheum is already checked, any slight symptoms which remain may be got rid of by making use of the bath and of wine. Therefore when at the bath the patient should be first rubbed over gently with oil, especially over the legs and thighs, and he should bathe his eyes freely with hot water, next hot water should be poured over his head, followed

This salves consists of Indian nard and poppy-tears 0.33 gram each; gum 4 grams; saffron 8 grams; fresh rose leaves 16 grams, which are mixed up in rain-water or in a rather mild wine. And it is not out of place to boil pomegranate rind or melilot in wine and then pound it; or to mix black myrrh with rose leaves,

It is also customary for inflammation to give rise to carbuncles, sometimes upon the actual eyeballs, sometimes upon the eyelids, either on the inner or on the outer surface of these. When this occurs, the

Pustules are also an occasional consequence of inflammation. If this happens early during the first stage, the blood-letting and rest prescribed above should be even more strictly enforced; if later than the stage when blood-letting is possible, the bowels, nevertheless, should be clystered; and if anything should prevent this also, at any rate the regimen as to diet should be followed. For this condition also soothing medicaments are necessary, such as those of Nileus and Cleon.

Also the salve named after Philalethus is suitable, consisting of: myrrh and poppy-tears 4 grams each; washed lead, Samian earth called aster, and tragacanth 16 grams each; boiled antimony sulphide and starch 24 grams each; washed oxide of zinc and washed cerussa 32 grams each. These are made up with rain-water. The salve is used either with white of egg or milk.

From pustules ulcerations sometimes arise. These when recent are likewise to be treated by mild applications, generally by the same as I have prescribed above for pustules. That which is called 'dia libanu' is specially prepared for the above condition. It is composed of roasted and washed copper, and parched poppy-tears 4 grams

It happens too that the eyeballs, either both or one, become smaller than naturally they ought to be. An acrid discharge of rheum in the course of ophthalmia causes this, also continuous weeping, and an injury improperly treated. In these cases the same mild applications mixed with woman's milk should also be used, and for food, that which is most nourishing and body-building. In every way any cause which may excite tears must be avoided, and anxiety about home affairs also, knowledge of which, if anything of that sort has arisen, must be kept from the patient. And acrid medicaments and sour food do harm in these cases, chiefly because of the tears which they excite.

There is also a kind of disorder in which lice are born between the eyelashes; the Greeks call it phthiriasis. Since this comes from a bad state of health it seldom fails to get worse; but usually in time a very acrid discharge of rheum follows, and if the eyeballs become severely ulcerated, it even destroys their vision. In these cases the bowel should be clystered, the head shaved to the scalp, and rubbed for a good while daily whilst the patient fasts; walking and other exercises should be diligently practised; he should gargle honey wine in which mint and ripe figs have been boiled; at the bath the head should often be freely fomented with hot water, acrid food avoided, milk and sweet wine should be taken, with more drink than food. Medicaments administered internally should be bland lest they stimulate the acridity of the rheum;

The preceding diseases of the eyes are treated with bland applications. Next come other classes which require a different treatment, and they usually originate from inflammation, but also persist after the inflammation has subsided. And first in some cases there is a thin discharge of rheum which persists; in these the bowel is to be clystered, and the amount of food somewhat reduced. And it is not inappropriate to smear the forehead with the composition of Andrias; this consists of gum 4 grams, cerussa and antimony sulphide 8 grams each, litharge heated and washed 16 grams. But the litharge must be boiled in rain-water, and the dry ingredients pounded up in myrtle juice. When the forehead has been smeared with this, a poultice is put on of flour mad eio a paste with cold water, to which is added acacia juice or cypress oil. It is also useful to apply a cup to the top of the head after making an incision, or blood may be let from the temples. The following ointment should be used: copper scales and poppy-tears 4 grams each; stag's horn calcined and washed, washed lead, and gum, 16 grams each; frankincense, 48 grams. This slave, because it contains horn, is called dia tu keratos. Whenever

For the same purpose there is the salve of Euelpides, which he called memigmenon, containing poppy-tears and white peppercorns 28 grams each; gum 336 grams; roasted copper 6 grams. However, in the course of the treatment, after a subsidence of the disease, the bath and wine are of some service. In all cases of ophthalmia food that makes thin should be avoided, but especially in those who have had for long a discharge of thin humour. But if food which renders the rheum thicker comes to be disliked, which very readily happens with this kind of diet, recourse should be had to those foods which, in bracing up the bowels, do the same to the body in general.

Again, ulcerations which do not heal after inflammation has ended, tend to become fungous or foul or excavated, or at any rate chronic. Such as are fungous are best repressed by the salve called menigmenon; those which are foul are cleaned both by the same and by that called zmilion. This contains: verdigris 16 grams; gum the same; ammoniacum and Sinopic minium 64 grams; some pound up these with water, others with vinegar, in order to make it more active.

The salve of Euelpides also which he called pyrron is of use for this: saffron 4 grams; poppy-tears and gum 8 grams; roasted and washed copper and myrrh 16 grams each; white pepper 24 grams. But the eyes are first smeared with a mild ointment, then with the above.

That salve of his which he named sphaerion has the same effect: washed haematite stone 4.66 grams; 6 peppercorns; washed zinc oxide, myrrh and poppy-tears 8 grams; saffron 16 grams; gum 32 grams; these are pounded up in Aminean wine.

For the same purpose he prepared a liquid salve, containing verdigris 0.66 gram; roasted antimony sulphide, shoemakers-blacking, and cinnamon 4 grams each; saffron, nard and poppy-tears 4.66 grams each; myrrh 8 grams; roast copper 12 grams; ash of aromatic herbs 16 grams; 15 peppercorns. These are pounded up in dry wine, then boiled in 750 cc. of raisin wine until of uniform consistency. This is rendered more efficacious by age.

Excavated ulcerations, too, are most readily replenished with flesh by the compositions mentioned above, sphaerion, and that called Philalethus. Sphaerion is the best remedy for old-standing ulcerations, and those that are difficult to heal.

There is also a salve, which whilst efficacious in many ways seems to be specially so in the case of ulcerations. It is said to have been invented by Hermon. It contains: long pepper 4.66 grams; white pepper 0.33 gram; cinnamon and costmary 4 grams each; shoemaker's blacking, nard, casia and castoreum 8 grams each; gall 20 grams; myrrh, saffron, frankincense, lycium and cerussa, 32 grams each; poppy-tears 48 grams; lign-aloes, roasted copper and oxide of zinc 64 grams each; acacia, antimony sulphide and gum 100 grams each.

Scars resulting from ulcerations are liable to two defects, they are either depressed or thick. If

There is also a class of inflammation in which, if the eyes swell and become tense with pain, it is necessary to let blood from the forehead, and to foment the head and eyes frequently with hot water; also to gargle, using a decoction of lentils, or the cream of figs; to apply as an ointment acrid medicaments, such as have been noted above, especially that named sphaerion, and that containing haematite stone. There are also other salves of use for softening trachoma of which I am just going to speak.

Now this condition generally follows inflammation

That called after Hierax is also efficacious for trachoma. It contains: myrrh 4 grams; ammoniacum used for incense 8 grams; copper filings 16 grams. For the same purpose there are also those called respectively Canopite, smilion, pyxinum, and sphaerion. But when none of these made up medicaments is at hand, then goat's bile or honey of the best is suitable enough for the treatment of trachoma.

There is a kind of dry inflammation of the eyes called by the Greeks xerophthalmia. The eyes neither swell nor run, but are none the less red

Again, a most suitable salve is that called rhinion. It contains: myrrh 0.66 gram; poppy-tears, acacia juice, pepper and gum 4 grams each; haematite stone, Phrygian and Lycian stone, and split stone, 8 grams each; roasted copper 16 grams. The salve pyxinum is also fitting for this same purpose.

When the eyes are scabrous, which mostly occurs at their angles, the rhinion slave noted above may do good; that one may also serve which contains: copper filings, long pepper and poppy-tears 8 grams each; white pepper and gum 16 grams each; washed oxide of zinc and cerussa 64 grams each. Nothing, however, is better than that named by Euelpides basilicon. It contains: poppy-tears cerussa and Assos stone, 8 grams each; gum 12 grams; white pepper 16 grams; saffron 24 grams; psoricum 42 grams. Now there is no drug called psoricum, but some copper ore and a little more than half as much oxide of zinc are pounded up together in vinegar,

Again the eyes tend at times to become dim from ophthalmia, but also apart from that, on account of old age, or other weakness. If the disorder is owing to the remnants of an ophthalmia, the salve called Asclepios is of service and that which is composed of saffron dregs.

Also there is a special preparation for this purpose called dia crocu. It contains pepper 4 grams; Cilician saffron, poppy-tears and cerussa 8 grams each; psoricum and gum 16 grams each.

But if the eyes are dim from old age or other weakness, it is good to anoint with best honey, cyprus oil, and old olive oil. The most suitable unguent, however, is made of balsam one part, and old olive or cyprus oil two parts, and three parts of the sharpest honey. Here too those applications are suitable which were noted just above

Cataract also, which the Greeks call hypochysis, sometimes interferes with the vision of the eye. When it has become long established it is to be treated surgically. In its earliest stages it may be dispersed occasionally by certain measures: it is useful to let blood from the forehead or nostrils, to cauterize the temporal blood vessels, to bring out phlegm by gargling, to inhale smoke, to anoint the eyes with acrid medicaments. That regimen is best which makes phlegm thin.

Again, even the relaxation of the eyes which the Greeks call paralysis is not to be treated by any different regimen or by any different medicaments. It is sufficient to explain just the kind of lesion it is. It happens then sometimes in the case of one eye, sometimes of both, from some blow, or from epilepsy, or from a spasm, by which the eyeball itself is violently shaken, that it cannot be directed at any object, or be held at all steady, but with no reason it turns now this way, now that, and so does not even afford a view of objects.

The malady the Greeks call mydriasis is not very different from the above. The pupil spreads out and is dilated, and its vision becomes dimmed and almost lost. This kind of weakness is most difficult to relieve. Both of these paralysis and mydriasis are to be countered by all the same prescriptions as mistiness of the eyes, but with a few alterations such as the addition sometimes of vinegar, sometimes of soda, to the iris unguent for the head; while honey is sufficient for the eye inunctions. In the case of mydriasis, some patients have been relieved by the use of hot water, some without any obvious cause have suddenly become blind. Some of these after seeing nothing for some time have suddenly regained vision following a profuse stool. Hence it seems not inappropriate, whether in a recent case or in one of some standing, by the use of medicaments to force stools in order to drive downwards all noxious matter.

There is besides a weakness of the eyes, owing to which people see well enough indeed in the daytime but not at all at night; in women whose menstruation is regular this does not happen. But success sufferers should anoint their eyeballs with the stuff dripping from a liver whilst roasting, preferably of a he-goat, or failing that of a she-goat; and as well they should eat some of the liver itself. But, we may also use with advantage the same remedies which dry up scars and trachoma. Some add honey to pounded purslane seed until the mixture no longer drops from the end of a probe, and with it anoint the

All the foregoing disorders arise within the body; but a blow from without at times so inures the eye that it is suffused with blood. Nothing is then better than to anoint the eyeball with the blood of a pigeon, dove, or swallow. There is some reason for this, because the vision of these birds, when indicate from without, returns after an interval to its original state, most speedily in the case of the swallow. This also has given rise to the fable that the old birds restore the vision by a herb, when it really returns spontaneously. Hence the blood of these birds most properly protects our eyes too after an external injury, and in the following order: swallows' blood is best, next that of the pigeon, and the dove's is the least efficacious, both as regards the birds themselves and us. In order to relieve inflammation, it is not unfitting to apply a poultice over the injured eye. The best salt from Ammon, or some other salt, is pounded, and oil gradually added until it is of the consistency of strigil scrapings. Then this is mixed with barley-meal which has been boiled in honey wine. But it is easy, after looking through all that medical practitioners have written, for anyone to see that there is scarcely any one of the eye disorders among those included above which it may not be possible to clear up by simple and readily procured remedies.

7 So much, then, for those classes of eye disease, for which medicaments are most successful; and now we pass to the ears, the use of which comes next to eye-

If again the ears have pus in them as well, it is proper to pour in boxthorn juice by itself, or iris unguent or leek juice or the juice of a sweet pomegranate warmed in its rind, to which a little myrrh is added. It is useful to mix together myrrh of the sort called

A general remedy for all ear cases, and one approved by experience, was composed by Asclepiades. This contains: cinnamon and casia 4 grams each; flowers of round cyperus, castoreum, white pepper, long pepper, cardamomum and bennut, 8 grams each; male frankincense, Syrian nard, fatty myrrh, saffron, soda-scum, 12 grams each. These are pounded separately, then mixed with vinegar and again pounded, and so preserved; when for use they are diluted with vinegar. In the same way a general remedy for all ear disorders is the tablet of Polyidus, dissolved in sweet wine, the prescription for which is given in the last book. But if there is both a discharge of matter and a swelling, it is not unfitting to ash out the ear with diluted wine through an ear syringe, and then pour in dry wine mixed with rose oil, to which a little oxide of zinc has been added, or boxthorn juice with milk, or polygonum juice with rose oil, or pomegranate juice with a very little myrrh.

If there is also foul ulceration, it is better to wash out with honey wine, and then pour in some one of the compositions described above which contain honey. If there is a great discharge of pus the head is to be shaved, and hot water poured freely over it, also the patient should gargle with the same, walk until tired, and take food sparingly. If there is bleeding from the ulcerations, boxthorn

When maggots have appeared, if they are near the surface, they must be extracted by an ear scoop; if further in they must be killed by medicaments, and afterwards care taken that they do not breed. White veratrum pounded up in vinegar serves for both these purposes. The ear should also be washed out with a decoction of horehound in wine. By this procedure dead maggots will be driven forwards into the outer part of the ear, whence they can be readily withdrawn.

But if the ear-passage has been narrowed and thick matter collects within, honey of the best ought to be introduced. If this does not help, there must be added to 65 cc. of honey 8 grams of verdigris scrapings; they must be boiled together and so used. Iris root with honey has the same efficacy. So also has galbanum 8 grams, myrrh and ox bile 1.33 grams each, and of wine a sufficient quantity to dissolve the myrrh.

When a man is becoming dull of hearing, which happens most often after prolonged headaches, in the first place, the ear itself should be inspected: for there will be found either a crust such as comes upon the surface of ulcerations, or concretions of wax.

Another class of lesion is that in which the ears produce a ringing noise within themselves: and this also prevents them from perceiving sounds from without. This is least serious when due to cold in the head; worse when occasioned by diseases or prolonged pains of the head; worst of all when it precedes the onset of serious maladies, and especially epilepsy.

If it is due to a cold, the ear should be cleaned

If the noise begins without these reasons and so causes dread of some new danger, there should be inserted into the ear castoreum in vinegar or with either iris oil or laurel oil; or castoreum is mixed with this together with the juice of bitter almonds; or myrrh and soda with rose oil and vinegar But in this case also, there is more benefit from regulation of the diet, and the same is to be done as was prescribed above, with even greater care. And, besides, until the noise has ceased the patient must abstain from wine. But if there is at the same time both ringing and inflammation, laurel oil should be freely inserted, or the oil expressed from bitter almonds with which some mix myrrh or castoreum.

It happens also occasionally that something slips into the ear, such as a small stone, or some living thing. If a flea has got in, a little wool is introduced in which it becomes engaged and so is extracted. If it does not come out, or if it is some other creature, a probe is wrapped round with a little wool, soaked in very sticky resin, especially turpentine resin, which after being passed in the ear is there twisted

8 Now ulcerated nostrils should be fomented with steam from hot water; that is done either by applying a sponge after squeezing it ou, or by holding the nose over a narrow-mouthed vessel filled with hot water. After this fomentation the ulcerations should be smeared with lead slag, white lad or litharge; with any of these a kind of poultice is compounded, and to this, while it is being pounded up, wine and myrtle oil are added alternately, until it becomes of the consistency of honey. But if these ulcerations involve bone, and have numerous crusts with a foul odour, which kind the Greeks call ozaena, it ought to be understood that it is scarcely possible to afford relief in that disease. The following measures, none the less, can be tried: the head may be shaved to the scalp, rubbed frequently and vigorously, and sluiced with quantities of hot water; then the patient is to take a great deal of

Again, inside the nostrils there are sometimes formed little lumps like women's nipples, and these are fixed by their deepest and most fleshy parts. These should be treated by caustics, under which they are completely eaten away. A polypus, in fact, is a lump of this sort, sometimes white, sometimes reddish, which is attached to the bone of the nose, and fills the nostril, being directed

9 Now in the case of pain in the teeth, which by itself also can be counted among the greatest of torments, wine must be entirely cut off. At first the patient must fast, then take sparingly of soft food, so as not to irritate the teeth when masticating; then externally steam from hot water is to be applied by a sponge, and an ointment put on made from cyprus or iris oil, with a woollen bandage over it, and the head must be wrapped up. For more severe pain a clyster is useful, with a hot poultice upon the cheeks, and hot water containing certain medicaments held in the mouth and frequently changed. For this purpose cinquefoil root may be boiled in diluted wine, and hyoscyamus root either in vinegar and water, or in wine, with the addition of a little salt, also poppy-head skins not too dry and mandragora root in the same condition. But with these three remedies, the patient should carefully avoid swallowing the fluid in the mouth. The bark of white poplar roots boiled in diluted wine may be

10 Again, if the tonsils owing to the inflammation

11 Now ulcerations of the mouth if accompanied by inflammation, and if they are foul and reddish, are best treated by the medicaments made from pomegranates mentioned above. And, as a repressant, pearl barley gruel to which a little honey has been added is to be often held in the mouth; the patient must walk and not take acrid food. As soon as the ulcerations begin to clean, a bland liquid, at times even the purest water, is held in the mouth. It is then beneficial to eat a pear of the softer sort, and more food along with sharp vinegar; then the ulcers should be dusted over with split alum, to which about half as much again of unripe oak-galls has been added. If the ulcers are alar encrusted, as happens after cauterization, those compositions are to be applied which the Greeks call antherae: equal portions of galingale, myrrh, sandarach, and alum. Or saffron and myrrh 4 grams each; iris, split alum and sandarach 16 grams each; galingale 32 grams. Or oak-galls and myrrh 4 grams each; split alum 8 grams; rose leaves 16 grams. But some mix saffron 0.66 gram; split alum and myrrh 4 grams each; sandarach 8 grams; galingale 16 grams.

But by far the most dangerous are those ulcers which the Greeks call aphtae, certainly in children; in them they often cause death, but there is not the same danger for men and women. These ulcers begin from the gums: next they invade the palate and the whole mouth; then they pass downwards to the uvula and throat, and if these are involved, it is not easy for the child to recover. But the disease is even worse in a suckling, for there is then less possibility of its conquest by any remedy. But it is most important that the nurse should be made to take exercise both by walking and by doing work which moves her arms; she should be sent to the bath, and ordered when there to have hot water poured over her breasts; moreover, she should have bland, easily digestible food; and for drink, if the infant is feverish, water; if free from fever, diluted wine. And if the nurse is constipated, her bowels are to be moved by a clyster. If there is clotted phlegm in her mouth, she must vomit. Then the child's ulcers are to be anointed with honey, to which is added sumach, which they call Syrian, or bitter almonds; or a mixture of dried rose leaves, pinecone seeds, mint, young stalks, and honey, or that medicament which is made of mulberries, the juice of which is concentrated in the same way as pomegranate juice to the consistency of honey; similarly too there is mixed with it saffron, myrrh, alum, wine and honey; nothing should be given which can provoke spittle. If it is an older child he should

12 Ulcerations of the tongue need no other treatment than that noted in the first part of the previous chapter. But those which arise at the side of the tongue last the longest; and it should be looked to, whether some tooth opposite the ulcer is too pointed, which often keeps an ulceration in that position from healing, in which case the tooth must be smoothed down.

13 There often occur on the gums adjacent to the teeth certain painful swellings: the Greeks call them parulides. These at first should be gently rubbed over with powdered slat; or with a mixture of powdered rock-salt, cyprus oil and catmint; then the mouth is washed out with lentil gruel, and the mouth is held open at intervals until there has been a sufficient flow of phlegm.

When there is still more severe inflammation, the same medicaments are to be used as noted above for ulcerations of the mouth: and between the tooth and gum should be inserted a little roll of soft lint soaked in one of the compositions which I said are called antherae. If the hardness of the gum prevents this, then hot steam by means of a sponge

14 Inflammation of the uvula should also cause anxiety when severe. In this case, as before, abstinence is necessary, and it is right to let blood; and if anything prevents this, it is useful to clyster the bowel; and also the head must be kept covered and raised; and the patient must gargle with a decoction of blackberries and lentils. But the uvula its is to be smeared either with omphacium or oak-galls or split alum to any one of which honey has been added; it is also good to smear the uvula with chelidonium juice by means of a spoon, and especially with honey. For this purpose also the composition called Andronium is suitable; it consists of: split alum, red copper scales, blacking, oak-galls, myrrh and antimony sulphide; these are pounded separately and again pounded when mixed together, a dry wine being gradually added till the ingredients have the consistency of honey. After the uvula has been smeared with one of these compounds there is, as a rule, a free flow of phlegm; when this has subsided, hot wine should be gargled. But if there is less severe inflammation, it is sufficient to pound up assafoetida and add cold water to it, and to put the fluid into a spoon and apply it under the uvula itself. When there is only moderate swelling, even cold water held in the same way under the uvula subdues it. Also the same cold water is to be used as a gargle which, with or without the addition of assafoetida, has been applied in this manner to the uvula.

15 If at any time gangrene has attacked ulcers of the mouth, the first thing to consider is whether the general health is bad, and if so to obviate it; next the actual ulcers are to be treated. But if the

Also vinegar of squills held sufficiently long in the mouth is beneficial for such ulceration, so too the salt after evaporation as described above dissolved again in vinegar. But whilst the affection continues to be severe it is necessary both to hold one or other of the remedies in the mouth for some time and to use them two or three times a day, If it is a child who is attacked, a probe wrapped round with wool is dipped in the medicament and held to the ulcer, lest by accident he should swallow the caustic. If it is the gums which are involved, and some teeth are loose, they should be extracted, for they greatly hinder treatment. If these medicaments do no good, the ulcers are to be cauterized. But this procedure is not necessary for any ulcer on

16 Such are the disorders in the head which generally require medicaments. But just below the ears parotid swellings are inclined to occur, sometimes during health when inflammation occurs there, some after prolonged fevers when the force of the disease has been turned in that direction. It is of the nature of an abscession; and so no novel treatment is called for, only what follows must be attended to: if there is swelling without previous disease, repressants are to be tried first; if there has been illness, repressives are objectionable, and it is more convenient that the abscess should mature and be opened as soon as may be.

17 For prominent navels, in order that surgical measures need not be used, abstinence should first be tried, a clyster to induce a motion, and the following applications to the umbilicus: hemlock and soot 4 grams each; washed white lead 24 grams; washed lead 32 grams; 2 eggs; to these nightshade juice also is added. This ought to be kept on for a long time, the patient meanwhile lying up, and taking food in such moderation that all flatulence

18 Next come subjects relating to the privy parts, for which the terms employed by the Greeks are the most tolerable, and are now accepted for use, since they are met with in almost every medical book and discourse. Not even the common use has commended our coarser words for those who would speak with modesty. Hence it is more difficult to set forth these matters and at the same time to observe both propriety and the precepts of the art. Nevertheless, this ought not to deter me from writing, firstly in order that I may include everything which I have heard of as salutary, secondly because their treatment ought above all things to be generally understood, since every one is most unwilling to show such a complaint to another person.

So then when the penis swells up owing to inflammation, and the foreskin cannot be drawn back, or conversely drawn forwards, the place should be fomented freely with hot water. But when the glans is covered up, hot water should be injected, between it and the foreskin, by means of an ear syringe. If the foreskin is thus softened and rendered thinner, and yields when drawn upon, the rest of the treatment is more speedy. If the swelling goes on, either lentil meal or horehound or olive leaves, boiled in wine, is to be laid on, to each of which, whilst being pounded up, a little honey is to be added; and the penis is to be bandaged upwards to the belly. That is required in the treatment of all its disorders; and the patient ought to keep quiet and abstain from food, and drink water just so much as is justified by thirst. On the next day fomentations with water must again be applied in the same way, and even force should be tried as to

The foregoing ulcerations stop short of canker, which in other parts, but here the more especially, attacks ulcerations. It begins in a black patch. If it invades the foreskin, at once a probe should be passed underneath, upon which the foreskin is to be incised and the margins seized with forceps; then

Occasionally on this part there arises that kind of canker which the Greeks call phagedaena. In such a case there must be no delay whatever: the treatment is immediate cauterization, whether with medicaments as above, or, if these have little effect, with the cautery. There is also a sort of blackness, which is insensitive, but spreads and, if we leave it

Again, now and then a callosity forms in the penis; and it is almost entirely without feeling; this also should be excised. But if a carbuncle occurs here, it is first to be irrigated with water through an ear syringe; next the growth is to be cauterized with medicaments, especially copper ore with honey or verdigris with boiled honey, or fried sheep's dung pounded up similarly with honey. When the carbuncle falls off, use the fluid medicaments prepared for ulcers of the mouth.

But if any inflammation occurs in the testicles, not due to injury, blood is to be let from the ankle; there must be abstinence from food and bean meal boiled in honey wine must be applied, always cumin rubbed up in boiled honey; of pounded cumin with the rose oil cerate; or parched linseed, pounded up and boiled in honey wine; or wheat flour in honey wine boiled with cyprus shoots; or pounded lily root. If the testicles have become indurated, apply linseed or fenugreek seed boiled in honey wine; or the cyprus oil cerate; or fine wheat flour pounded up in wine to which a little saffron has been added. If the induration is already of long standing, the most efficacious something is wild cucumber root boiled in honey wine, then pounded up. If the testicles swell as the result of an injury, it is necessary

The anus also is subject to many most tedious maladies, which do not require much variation in their treatment. In the first place, the skin of the anus is often fissured at several places; the Greeks call these ragadia. If this is recent, the patient should keep quiet and sit in hot water. Further, pigeon's eggs are to be boiled until hard, shelled, and then one should be covered completely in very hot water, the other is applied hot to the place, the eggs being used thus turn and turn about. Then the tetrapharmacum or the rhypodes is to be diluted for use with rose oil; or fresh wool-grease is mixed with the liquid cerate made up with rose oil; or washed lead with the same cerate; or a little myrrh to turpentine resin; or old oil to litharge; with any one of which the anus is smeared. If the lesion is external, not hidden inside, lint may be soaked in the same medicament and applied; whatever is put on is to be covered by a cerate. In such a case also neither acrid nor coarse food is to be taken nor such as constipates; dry food is not satisfactory

A condyloma is a small tumour due to inflammation of some kind. When it appears the same prescriptions apply regarding rest, food and drink as have just been set out. Also the tumour itself may be properly treated by fomenting similarly with eggs. But the patient should first sit in a repressant decoction of vervains. Then we may properly apply lentil meal with a little honey, also mellilot boiled in wine, bramble leaves pounded up with the rose oil cerate or a quince, or the inner rind of a pomegranate boiled in wine, pounded up in the same cerate; or copper ore boiled and pounded, then taken up in wool-grease and rose oil; and the composition containing: frankincense 4 grams, split alum 8 grams, white lead 12 grams, litharge 20 grams, into which whilst it is being pounded up rose oil and wine are dropped by turns. But the binder for this part is a square of linen or woollen cloth, which has a loop at each of two adjacent angles and a tape at each of the two opposite ones. The square having been applied underneath with the two loops upon the abdominal wall, the pes are brought round from behind and passed through the loop on its corresponding side. Each tape being drawn tight, that on the right side is carried round the back to the left, and the left tape back and round to the right side. Finally, the ends of the tapes are tied together in front of the abdomen. But if a long-standing condyloma is already indurated and does not yield to the foregoing measures, it can be burnt with a caustic consisting of: verdigris 4

There is also a third lesion, in which vein mouths rise up as from little heads, which at frequent intervals pour out blood: the Greeks call them haemorrhoids. In women they may even appear at the vulvar orifice. There are some in whom it is hardly safe to suppress such a flux of blood, those who are not the weaker for it; for to these it is a purgation, not a disease. Hence some, after being cured, since the blood had no way out, and diseased matter was diverted towards the praecordia and viscera, have been carried off by sudden diseases of the gravest kind. But if the bleeding is doing harm to anyone, he should sit in a decoction of vervains, and the best thing to apply is pomegranate rind pounded up with dried rose leaves, or anything else that stops bleeding. But inflammation especially tends to occur when first a rather violent evacuation of the bowels has ruptured the epidermis, and later a hard stool has injured this spot. Then the patient should sit in soft water and foment with eggs; yolk of egg which has been stirred up with rose leaves and boiled in raisin wine is to be applied; if the haemorrhoids are internal, by the finger, if external, spread upon linen. The medicaments described above for recent fissures are suitable here also. In this case the diet

If the anus itself, or, as sometimes happens, the mouth of the womb, prolapses, examination should be made to see whether what is protruding is clean, or is covered with a mucous humour. If it is clean, the patient should sit in water; either in salt water or in water boiled with vervains or pomegranate rind. If it is moist, it should be bathed with dry wine and smeared with roasted wine lees. After being treated in one of these ways, it is to be replaced, and pounded plantain or willow leaves boiled in vinegar applied, next lint, and wool over it: and these must be bandaged on, whilst the legs are kept tied together.

In the same place an ulceration like a fungus may arise, which must be bathed with lukewarm water in winter, at other seasons in cold water; then copper scales are dusted on, and over that is applied a cerate made with myrtle oil to which has been

19 Old-standing ulcerations of the fingers are most suitably treated by buckthorn juice, or by boiled olive lees, in either case with the addition of wine. In the same parts a small piece of flesh sometimes grows out from the nail, causing great pain; the Greeks call it pterygium. Round alum from Melos should be dissolved in water to the consistency of honey; the same quantity of honey as there was of dry alum is then poured in, and the mixture is stirred with a rod until it is of a saffron colour, and then smeared on. Some prefer to boil up the same ingredients together for the same purpose after mixing equal quantities of dry alum and honey. If the whitlow is not removed by this treatment, it should be cut away; next the finger is bathed in a decoction of vervains, and over it is then put the following composition: copper ore, pomegranate rind, and copper scales, mixed with ripe figs, lightly boiled in honey; or burnt papyrus, orpiment, and crude sulphur in equal parts may be mixed with a cerate containing myrtle oil; or scraped verdigris 4 grams, copper scales 8 grams, mixed together in 42 cc. of honey; or equal parts of limestone, copper ore and orpiment are mixed together. Whichever of these is applied, it is covered over by linen wetted with water. On the third day the finger is dressed again, any dried part is

And when nails are scabrous, they must be loosened all round, where they are in contact with the flesh; next some of the following composition is put on them: sandarach and sulphur 8 grams each; soda and orpiment 16 grams each; liquid resin 32 grams. The finger is dressed again on the third day. Under this medicament, diseased nails fall off and in their stead better ones grow.