Of Medicine, in Eight Books

by Aulus Cornelius Celsus

PREFACE.

Of the approach of a disorder there are many signs. In the explication of which, I shall, without hesitation, make use of the authority of the ancients, and more especially that of Hippocrates; as even the more modern physicians, although they have made alterations in the method of curing, nevertheless confess, that he has delivered the best prognostics from these signs. But before I speak of those antecedents, which give cause to apprehend distempers ensuing; it seems not improper to explain, what seasons of the year, what kinds of weather, what times of life, what constitutions are most safe from, or most obnoxious to dangers, and what kinds of disorders are most to be feared in each of these. Not but in any weather[(1)], men of all ages and all habits, fall into all kinds of distempers, and die of them too; but because some events are more frequent than others. And therefore it is useful for every person to know, against what, and when, he should be most upon his guard.

CHAP. I. OF THE DIFFERENT SEASONS, WEATHER, AGES, CONSTITUTIONS, AND THE DISEASES PECULIAR TO EACH.

The most healthful season then is the spring, next to that the winter, the summer is more dangerous than either, the autumn by far the most dangerous of all. With regard to the weather, that is best, which is equal, whether it be cold or hot: that, which varies most, is the worst. For this reason it is, that the autumn destroys the greatest number. For generally in the middle of the day it is hot, the nights, mornings, and evenings too, are cold: thus the body relaxed by the preceding summer, and by the frequent meridian heats of autumn, is exposed to sudden cold. But as this is most common in this season, so it is hurtful, whenever it happens. When the weather is equal, serene days are most healthful: rainy are better than those that are only misty or cloudy: and in winter those days are best, that have no wind at all; in summer, that have the westerly breezes. If the winds blow from any of the other quarters, the northerly are more salutary than the easterly or southerly. Nevertheless these sometimes differ according to the situation of countries. For generally in every place a wind, that comes from the inland parts, is healthful; one from the sea is sickly. And not only health is more certain in a good temperature of the weather, but even the more malignant distempers, which happen to come on then, are more mild and sooner removed. That air is the worst for a sick person, which has occasioned his distemper; insomuch that in such a case, a change for weather in it’s own nature worse is favourable.

The middle age is safest, because it is neither endangered by the heat of youth, nor the coldness of old age. Old age is more liable to chronical diseases, and youth to acute ones. The body most promising for health is the square, neither over slender, nor over fat. For a tall stature, as it is comely in youth, so it quickly wears out by age. A slender body is weak, a corpulent heavy.

Whatever disorders arise from the motion of the humours, are generally to be most apprehended in the spring[(2)]; so that, at this season, lippitudes, pimples, hæmorrhages, abscesses of the body, which the Greeks call apostemata[ AF ], atrabilis, which they name melancholia[ AG ], madness, epilepsy, angina, gravedoes, and catarrhs, usually occur. Also those distempers in the joints and nerves, which sometimes are troublesome, and sometimes easy, at this time of the year are the most apt both to begin and return. Neither is the summer altogether free from most of the above-mentioned distempers; but adds moreover fevers, either ardent, or tertian, vomitings, purgings, ear-achs, ulcers of the mouth, gangrenes, both in the other parts of the body, and chiefly in the private parts; and all these disorders that waste a man by sweat. There is hardly any of these, that is not found in the autumn; but there arise then, besides irregular fevers, pain of the spleen, dropsical disorders[(3)], consumption, which the Greeks call phthisis[ AH ]; difficulty of urine, which they term stranguria[ AI ]; the distemper of the smaller intestine which they name ileos[ AJ ], there happens also what the Greeks call lienteria[ AK ]; pains of the hips, epileptic disorders. And the same season is mortal to those that are worn out with long diseases, and such, as have been oppressed by the preceding summer; and it dispatches some by new distempers, and involves others in very tedious ones, especially quartan agues, which may even continue through the winter. Nor is any season more liable to the plague, of whatever kind it be, however various in its manner of hurting. The winter provokes pains of the head, the cough, and whatever disorder is contracted in the fauces, sides, or bowels.

With regard to the varieties of weather, the north wind raises a cough, exasperates the fauces, binds the belly, suppresses urine, excites shudderings, also pain of the side and breast; yet it braces a sound body[(4)], and renders it more mobile and brisk. The south wind causes dulness of hearing, blunts the senses, raises a pain of the head, opens the belly, and renders the whole body heavy, moist, and languid. The other winds, by how much they approach more nearly to either of these, produce effects the more similar to each of them. All heat inflames the liver and spleen, enervates the mind, and occasions faintings, and hæmorrhages. Cold causes sometimes convulsions, and sometimes a tetanus, the Greek name for the first is spasmos[ AL ], and for the other tetanos[ AM ]: it produces blackness in ulcers, and a shuddering in fevers. In dry weather we meet with acute fevers, lippitudes, dysenteries, stranguries, pains of the joints; in rainy, tedious fevers, diarrhœas, angina, gangrenes, epilepsies, palsy, which the Greeks call paralysis[ AN ]. Nor is the present weather only to be considered, but also what has been its course for some time. If a dry winter has been attended with northerly winds, and the spring with southerly, and rains, there most commonly ensue lippitudes, dysenteries, fevers, and these chiefly in more delicate bodies, particularly women. But if southerly winds and rains have prevailed in the winter, and the spring be cold and dry, then indeed pregnant women, whose time is near, are in danger of a miscarriage; and those, that go their full time, bring forth weakly children, not likely to live. Other people are attacked with dry lippitudes, and if they are old, with bad gravedoes and catarrhs. But if the southerly winds have continued from the beginning of winter to the end of spring, people are very quickly taken off by pleurisies, and fevers attended with a delirium, which is called phrenitis[ AO ]. But when the heat begins with the spring, and continues through the summer, profuse sweating in fevers necessarily follows. But if a dry summer has been attended with northerly winds, and the autumn with rains, and southerly, all the following winter we find coughs, catarrhs, hoarseness, and in some a consumption. But if the autumn too is equally dry, and the same northerly winds blow, all the more delicate bodies, amongst which I placed women, enjoy a good state of health: and for the more robust, they may possibly be attacked with dry lippitudes, and fevers either acute, or tedious, and atrabiliary disorders.

As to the different ages, children, and those a little more advanced, have their health best in the spring, and are most safe in the beginning of summer; old men in the summer, and beginning of autumn; young and middle aged men in the winter. The winter is more hurtful to old men, and the summer to youths. For the peculiar weaknesses, that appear at different times of life, first of all infants and young children will be troubled with spreading ulcers of the mouth, which the Greeks call aphthæ[ AP ], vomitings, nightly watching, humour in the ears, and inflammations about the navel. The peculiar complaints of such as are teething, are exulcerations in the gums, convulsions, slight fevers, purgings, and these are chiefly troublesome about the cutting of the canine teeth. Infants of the fullest habit, and whose bellies are very much bound, are most liable to these dangers. But when they have grown up a little, there appear disorders of the glands, and different inclinations of the vertebræ, which compose the spine, scrophulous swellings, some painful kinds of warts, by the Greeks called acrochordones[ AQ ], and many other tubercles. In the beginning of puberty, many of the above-named, and long fevers, and hæmorrhages from the nose. And generally all children are most in danger first about the fortieth day, then the seventh month, then the seventh year, after these at the time of puberty. Moreover any distempers, which commence in infancy, and are terminated neither by puberty, nor in men by their first commerce with women, nor in women by the appearance of their menses, commonly continue long: yet more frequently these puerile disorders of long standing are removed by these means. Youth is most subject to acute disorders, and epileptic, and to a consumption: and they are commonly young men, who spit blood. After this age, come on pleurisies and peripneumonies, lethargy, cholera, madness, and discharges of blood from certain mouths, as it were, of the veins, by the Greeks called hæmorrhoides[ AR ]. In old age, difficulty of breathing, and making urine, gravedo, pains of the joints and kidneys, palsies, bad habit of body, which the Greeks call cachexia[ AS ], nightly watchings, tedious disorders of the ears, of the eyes, and nose, and especially a loose belly, and its consequences a dysentery, or lientery, and other indispositions incident to that habit. Besides these the slender are distressed with consumptions, purgings, catarrhs, and pains of the bowels, and sides. The corpulent generally are oppressed with acute diseases, and difficulty of breathing, and often die suddenly, which seldom happens in a more slender body.

CHAP. II. OF THE SIGNS OF AN APPROACHING ILLNESS.

Before an illness, as I mentioned above, there appear some signs of its approach. All of them have this in common, that the body alters from its ordinary state; and not only for the worse, but even for the better. For this reason, if one has become more plump, and looks better, and of a more florid complexion than usual, he ought to hold these advantages suspected. For because these things can neither continue at a stay, nor admit further improvement, they generally run backward very fast, like some heavy body tumbling down. But it is a worse sign, when one is emaciated contrary to his natural habit, and has lost his colour and comeliness: because bodies redundant can allow something to be carried off by a distemper; the deficient have not wherewithal to bear the force of the distemper itself. Besides there is cause to be presently alarmed, if the limbs are heavy; if frequent ulcers break out; if the body has grown hotter than common; if sleep be too heavy; if the dreams are tumultuous; if one awakes oftner than usual, and then falls asleep again; if the body of a person asleep sweats in some parts contrary to custom, especially if that be about the breast, or neck, or legs, or knees, or hips; also if the mind is languid; if there is a reluctance to speaking and motion; if the body be indisposed to action; if the præcordia are pained, or the whole breast, or which happens in most people, the head; if the mouth is filled with saliva; if the eyes feel pain in turning; if the temples be strait bound[(5)]: if the limbs have shudderings; if the breathing is difficult; if the arteries in the forehead are dilated and beat strong; if there be frequent yawnings; if the knees feel tired, or the whole body be afflicted with a lassitude. Several of these things often, some of them always, precede a fever. This, however, ought to be first considered, whether any of these happen frequently to a person without any consequent uneasiness. For there are some peculiarities in the constitutions of particular persons, without the knowledge of which, it is not easy to prognosticate what is to happen. With reason therefore a man is free from apprehensions about those things, which he has often escaped without danger: he only is justly uneasy, to whom these appearances are new, or who has never been secured from their bad effects without proper precautions.

CHAP. III. GOOD SYMPTOMS IN SICK PEOPLE.

When any person is seized with a fever, it is certain he is not in danger, if he lies either upon his right or left side, as may have been usual with him, with his legs a little drawn up, which by the way is commonly the lying posture of a person in health; if he turns himself with ease; if he sleeps in the night-time, and keeps awake in the day; if he breathes easily; if he does not struggle; if the skin about the navel and pubes be full[(6)]; if his præcordia be equally soft on both sides, without any sense of pain; or although they are a little swelled, yet yield to the impression of the fingers, and are not pained. This illness, though it will continue some time, yet will be safe. The body also, which is every where soft, and in the same degree of heat, and which sweats all over equally, and whose fever is removed by that sweat, is in a fair way of doing well. When the body is recovering its health, sneezing also is amongst the good signs, and an appetite, either continued from the beginning, or even coming after a nausea. Nor should that fever alarm, which terminates in one day; nor indeed that, which though it has prevailed for a longer time, yet has totally intermitted betwixt paroxysms, so as the body became free from all complaint, which the Greeks call eilicrines[ AT ]. If any thing happens to be discharged by vomiting, it ought to be a mixture of bile and phlegm: and the sediment of the urine white, smooth, equal; so that, if there is any thing like small clouds swimming in it, that subsides to the bottom. And the stools in one, who is safe from danger, are soft, figured, and evacuated at nearly the same intervals, as was usual in health, and in quantity duly proportioned to the nourishment, that is taken. A loose belly is worse: but even this should not immediately be esteemed dangerous, if the discharge be of a harder consistence in the morning, or gradually turn less liquid, and the excrements be reddish, and their offensive smell don’t exceed that of the like discharge of a healthy man. And there is nothing bad in voiding some worms at the end of the distemper[(7)]. If a flatulency has occasioned a pain and swelling in the upper parts without an inflammation, a rumbling of the belly from thence to the lower parts is a good sign; and more so, if it has found an easy passage with the excrements.

CHAP. IV. BAD SYMPTOMS IN SICK PEOPLE.

On the other hand there is hazard of a dangerous distemper, when the patient lies supine, with his arms and legs extended: when he inclines to sit up during the greatest violence of an acute distemper, especially in a peripneumony: when he is distressed with wakefulness in the night, even although he sleep in the day time. Now sleep, which happens betwixt the fourth hour[(8)] and night, is worse than that, which is betwixt morning and the same hour. But it is worst of all, if he neither sleep in the night, nor the day time: for that cannot well happen without a constant delirium. Neither is it a good sign to be oppressed with sleep beyond measure: and the worse, the nearer the sleep comes to being continued day and night. It is also a sign of a dangerous distemper to breathe quickly, and with vehemence; for shudderings to have come on after the sixth day; to spit matter; to expectorate with difficulty; to have constant pain; to be much distressed with the distemper; to toss the arms and legs about; to weep involuntarily; to have a glutinous humour sticking to the teeth; for the skin about the navel and pubes to be emaciated; for the praecordia to be inflamed, painful, hard, swelled, tense: the case is worse, if these appearances be more on the right side than on the left: but the danger is still greatly increased, if at the same time the pulsation of the arteries there be violent. Again, it indicates a bad distemper to be too quickly emaciated; to have the head, feet, and hands cold, with the belly and sides hot; or for the extremities to be cold during the violence of an acute distemper; or to shudder after sweating; or after vomiting to have the hiccough, or the eyes to be red; or after having an appetite for food, or at the end of long fevers, to loath it; to sweat much, and especially a cold sweat; or to have sweats not equally diffused over the whole body, and such as do not terminate the fever. They are also bad fevers, which return every day at the same time; or those, that always have paroxysms equally violent, and which do not remit every third day; or those, that continue so as to increase in their paroxysms, and only remit in their intervals, but never leave the body quite free from disorder. It is worst of all, if the fever does not at all remit, but continues with equal violence. It is dangerous too for a fever to come after a jaundice, especially if the praecordia have continued hard on the right side; or on the left, if attended with pain there. Every acute fever ought to give us no small apprehensions: and always in such a fever, or after sleep, convulsions are terrible. It is also a sign of a bad distemper to wake with a fright, and likewise in the beginning of a fever for the mind to be presently disordered, or any limb to become paralytic. In that case, though the patient escape with life, yet for the most part that limb is debilitated. A vomiting also of pure phlegm or bile is dangerous; and if it be green, or black, it is worse. Urine is bad, where the sediment is reddish or livid; and worse, in which there is a kind of small and white threads: and worst of all, that, which bears the resemblance of small clouds, composed as it were of particles of bran. Thin and white urine is bad, but especially in phrenitic patients. It is bad to have the belly entirely bound. And a purging too in fevers is dangerous, where it will not allow a man to rest in his bed; especially if the discharge be very liquid, or whitish, or pale, or frothy. Besides these it portends danger, if the excretion be small in quantity, glutinous, smooth, white, and at the same time of a palish colour; or if it is either livid, or bilious, or bloody, or of a more offensive smell than common. An unmixed discharge also, which comes after long fevers, is bad.

CHAP. V. SIGNS OF LONG SICKNESS.

After the foregoing symptoms have appeared, ’tis known, that a distemper will become tedious: for it must necessarily be so, unless it be mortal. And there is no other hope in violent diseases, than that the patient may escape by eluding the first shock of the distemper, that there may be room for the application of proper methods of cure. But some signs appear in the beginning of a distemper, from which we may gather, that although it does not prove mortal, yet it will last for a considerable time. In fevers not violent, when a cold sweat comes on only about the head or neck; or when the body sweats without the fever intermitting; or when the body is sometimes cold, and sometimes hot, and the colour changes; or when in fevers an abscess, which has been formed in some part, does not prove salutary; or when the patient, considering the time of his illness, is but little emaciated. Also, if the urine at some times is thin and limpid, and at other times has some sediment; and if what subsides be smooth, and white, or red; or if it have the appearance of motes; or if it send up air bubbles.

CHAP. VI. THE SYMPTOMS OF DEATH.

But though in such circumstances there is reason to fear, yet there remains some hope. But we are sure a person is come to the last stage, when the nose is sharp, the temples shrivelled, the eyes hollow, the ears cold, and languid, and slightly inverted at their extremities, the skin about the forehead hard and tense, the colour either black or very pale; and much more so, if these things happen without any preceding wakefulness, or purging, or fasting: from which causes this appearance sometimes arises, but then it vanishes in one day. So that if it continues longer, it is a forerunner of death. And if it remains the same for three days in a tedious distemper, death is very near: and more especially if besides the eyes can’t bear the light and shed tears; and the white part of them grows red; and their small vessels are pale; and humour floating in them at last sticks to the angles; and one eye is less than the other; and they are either very much sunk, or much swelled; and when the eye-lids in sleep are not closed, but betwixt them there appears some part of the white of the eye; provided it be not occasioned by a flux; when the eye-lids also are pale, and the same paleness discolours the lips and nose; and also when the lips, and nose, and eyes, and eye-lids, and eye-brows, or some of these, are distorted, and the patient from pure weakness loses his hearing, or sight.

Death is also to be expected, when the patient lies supine, and his knees are contracted; when he slides downward now and then towards his feet; when he lays bare his arms and legs, and tosses them about irregularly, and there is no heat in them; when he gapes with his mouth; when he sleeps constantly; when being insensible, he grinds his teeth, and had not that custom in health; when an ulcer, which broke out either before, or in the time of his sickness, has grown dry, and turned either pale or livid, The following symptoms are also deadly; pale-coloured nails, and fingers; a cold breath; or if one in a fever, and acute disease, or madness, or peripneumony, or pain of the head, gathers the wool off the cloaths with his hands, or draws out and smooths their edges, or catches at any small prominences in an adjoining wall. Pains also, that have begun in the hips and lower parts, if they have been translated to the bowels, and suddenly ceased, are sure prognostics of approaching death; and more so, if any of the other symptoms have also concurred. And it is impossible to save that person, who labouring under a fever without any tumour, is suddenly, as it were, strangled, or cannot swallow his spittle; or one, whose neck, while the fever and habit of body remain the same, is turned aside, so that it is equally impossible for him to swallow any thing; or him, who at the same time has a continued fever, and extreme weakness of body; or when, without an abatement of the fever, the external surface of his body is cold, and the internal parts so hot as to produce thirst; or one, who, the fever continuing as in the former case, is distressed at once with a delirium and difficulty of breathing; or one, who, after drinking hellebore, has been seized with convulsions; or one, that has lost his speech after being intoxicated with liquor, for he is commonly carried off by convulsions, unless either a fever has supervened, or he has begun to speak at the time, when the effects of the liquor shall be over. A pregnant woman is also easily destroyed by an acute distemper. And likewise any person, whose disorder is increased by sleep; and one, who in the beginning of a recent disorder, vomits, or voids by stool, atrabilis; and the event is the same, where this has been discharged in either of these ways, when the body has been already extenuated, and wasted by a long illness. A bilious spitting, and purulent, whether they come up separately, or mixed, shew that there is danger of death. And if this appearance has commenced about the seventh day of a disease, the consequence is, that the patient will die about the fourteenth, unless some other symptoms more benign, or malignant, come on: and these after symptoms, the more gentle or violent they are, signify that death will happen so much the later, or sooner. A cold sweat likewise in an acute fever is mortal; and in every disease, a vomiting variegated with different colours; and especially if it be fetid. And it is also extremely bad to vomit blood in a fever. The urine is commonly of a bright yellow colour and thin in great crudity; and often before it has time to concoct, kills the patient. Upon this account, if it continue so for any time, it prognosticates danger of death. But the worst of all and most deadly is the black, thick, and fetid. And such as this is the worst in men and women; but in children that, which is thin and watery. A variegated discharge also by the belly is very bad; and such as contains strigments[(9)], blood, bile, and something green, and these either at different times, or all together in a kind of mixture, but so as each of them appear distinctly. Yet ’tis possible for one to endure this somewhat longer. But a speedy death is denoted, when the discharge is liquid, and withal either black, or pale, or fat; especially if besides it have an intolerable stench.

I am sensible I may be asked, how it happens, if the signs of future death are infallible, that some, who are entirely given over by physicians, should recover, and that some are reported to have come to life again, even when they were carried out to be buried? Nay, the justly famed Democritus maintained, that even the marks that life was gone, which physicians had trusted, were not certain: so far was he from allowing, that there could be any certain prognostics of death. In answer to which I shall not insist, that some marks, which bear a great resemblance to each other, often deceive not the able, but the unskilful physicians, (which Asclepiades knowing, when he met a funeral, cried out, that the person, whom they were about to bury, was alive) and that the art is not to be charged with the faults of any of its professors. But I will answer with more moderation; that medicine is a conjectural art, and that the nature of conjecture is such, that although it answers for the most part, yet sometimes it fails. And if a prognostic may deceive a person, perhaps in one of a thousand instances, it must not therefore be denied credit, since it answers in innumerable others. And this I say not only with regard to the mortal, but also to the salutary symptoms. For hope too is sometimes disappointed, and one dies, whom at first the physician thought in no danger. And those things, which have been contrived for curing, sometimes occasion a change for the worse. Nor is it possible for human weakness to avoid this, in so great a variety of constitutions. But medicine however deserves credit, which most frequently, and in the greatest number of sick people by far, is of service. Nevertheless we ought not to be ignorant, that the prognostics both of recovery and death are more fallacious in acute distempers.

CHAP. VII. OF THE SIGNS IN PARTICULAR DISEASES.

Having then mentioned those signs, which belong to diseases in general, I shall now proceed to point out those marks, which may attend the particular kinds of them. Now there are some of these, which happen before, and others in the time of fevers, which discover either the state of the internal parts, or what is likely to follow. Before fevers, if the head be heavy, or there be a dimness in the eyes after sleep, or there be frequent sneezings, some disorder from phlegm about the head may be feared. If a person abound with blood, or be very hot, the consequence is, that there may be an hæmorrhage from some part. If any person is emaciated without an evident cause, he is in danger of falling into a bad habit of body. If the præcordia are pained, or there is a troublesome flatulency, or if the urine is discharged the whole day unconcocted, ’tis plain there is a crudity. Such as have a bad colour for a long time without a jaundice, are either distressed with pains of the head, or labour under a malacia. Those, whose faces long continue pale and swelled, have disorders either of the head, or bowels, or belly. If a boy in a continued fever has no passage in his belly, and his colour is changed and he is deprived of sleep, and is constantly bemoaning, himself, convulsions are to be apprehended. A frequent catarrh in a slender body and tall, gives ground to fear a consumption. When for several days there is no stool, it portends either a sudden purging, or a slight fever. When the feet swell, and there is a long continued purging, or pain in the bottom of the belly and hips, a dropsical disorder is impending: but this kind of distemper commonly arises from the ilia. Those also are exposed to the same danger, whose belly, discharges nothing, when they have a stimulus, unless with difficulty, and the excrements hard. When there is a swelling in the feet, and when the like tumour, sometimes in the right, sometimes in the left side of the belly alternately rises and falls, that disorder seems to arise from the liver. It is a mark of the same distemper, when the intestines about the navel are pained, which the Greeks call strophos[ AU ], and pains of the hip continue without being relieved either by time or remedies. If a pain of the joints, for instance in the feet or hands, or in any other part, be attended with a contraction of the nerves there; or if any limb fatigued by slight exercise, is equally distressed by heat and cold, we may expect the gout either in the feet or hands, or that there will be a disease in that joint, where the pain is felt. Such as have had hæmorrhages from the nose, while they were children, which afterwards ceased, must either be afflicted with pains of the head, or have some troublesome exulcerations in their joints, or fall into some languishing distemper. Women, whose menses are suppressed, will be subject to excruciating pains of the head, or a disorder in some other part. And those are liable to the same dangers, who have complaints in their joints, such as pains and swellings coming and going, without the gout, and such-like distempers. Particularly if their temples are often pained, and their body sweats in the night-time, and their forehead itches, there is fear of a lippitude. If a woman after delivery has violent pains, with no other bad symptoms, about the twentieth day there will either be an eruption of blood from the nose, or some abscess in the lower parts. And in general in any person, a violent pain about the temples and forehead, will be removed in one of these two ways: more probably by an hæmorrhage, if the person be young; if somewhat more advanced, by a suppuration. A fever, which goes off suddenly without any apparent reason, without good signs, commonly returns. A person, whose fauces are filled with blood, both in the day-time, and in the night, will be found to have an ulcer there, if neither pains of the head, nor of the præcordia, nor a cough, nor vomiting, nor slight fever have preceded. If a woman is attacked with a slight fever from a disorder in the groin, and the cause does not appear, there is an ulcer in the womb. Thick urine, in which there is a white sediment, implies that there is a pain about the joints, or the bowels, and fear of some impending distemper. When it is green, it shows, that the bowels will be pained, or that there will be a swelling attended with some danger; or at least, that the body is not sound. But if there is blood or pus in the urine, either the bladder or kidneys are ulcerated. If it be thick, and contain in it some small caruncles, or something like hairs; or if it be frothy, or fetid; or sometimes bring off something like sand, and sometimes like blood; and the hips be pained, and those parts, which lie between them, and above the pubes; and besides these if there be frequent eructations, sometimes a bilious vomiting, and the extremities be cold, and there is a frequent inclination to make water, but great difficulty in it, and what comes away be limpid, or reddish, or pale, and gives some small relief, and the belly be discharged with much wind; in such circumstances the distemper lies in the kidneys. But if the urine drops away slowly, or if blood is discharged with it, and in that some bloody concretions, and it is made with difficulty, and the internal parts about the pubes are pained, the fault is in the bladder. Those, that have calculous concretions, are known by these symptoms. The urine is made with difficulty, and comes away slowly, and by drops, and sometimes involuntarily, is sandy; sometimes blood, or bloody concretions, or something purulent is discharged with it. Some make it more readily standing upright, others lying upon their back: especially those, that have large stones; some even in an inclined posture, and these by drawing out the penis, alleviate their pain. There is also a sensation of weight in that part, which is increased by running, and every kind of motion. Some also in the paroxysm of the pain, cross their feet over one another, often changing them. But women are often obliged to rub the external orifice of their pudenda with their hands: sometimes applying their finger to that part, when it presses upon the neck of the bladder, they feel the stone. But where any expectorate frothy blood, their disorder is in the lungs. A pregnant woman, whose belly is very loose, may possibly miscarry. If the milk flows from her breast, the fœtus is weak. Hard breasts shew the child to be sound. A frequent hiccough, and of longer continuance than ordinary, is a sign of an inflammation of the liver. If tumours upon ulcers have suddenly disappeared, and this has happened in the back, we may be apprehensive either of convulsions, or a tetanus: but if in the fore part of the body, either a pleurisy or madness is to be expected. Sometimes also a purging, which is the safest of them all, follows such an accident. If the hæmorrhoidal veins, in one used to a discharge of blood from them, suddenly stop, either a dropsical disorder or a consumption ensues. A consumption also comes on, if suppurated matter derived from a pleurisy cannot be carried off within forty days. But where there is a long continued grief attended with long fear and watching, the atrabiliary distemper is the consequence. Those, who have frequent hæmorrhages from the nose, labour under a swelling of the spleen, or pains of the head: and they commonly see imaginary objects floating before their eyes. But those, whose spleens are large, have their gums diseased and a stinking mouth, or an hæmorrhage in some part. If none of these happen, bad ulcers will be formed in their legs, and black cicatrices from them. Where there is a cause of pain and no sense of it, the mind is disordered. If blood has been collected in the abdomen, it is there converted into pus. If a pain removes from the hips and the lower parts into the breast, and no bad symptom has supervened, there is danger of a suppuration in that place. Those, that without a fever have a pain, or itching, with redness and heat, in any part, will have a suppuration there. Limpid urine also in a valetudinary person portends some suppuration about the ears.

Now as these appearances, even without a fever, contain indications of what is latent or future, they are much more certain when accompanied with a fever; and then symptoms of other disorders also shew themselves. Wherefore when a person speaks more quickly than he used to do in health, and of a sudden talks much, and that with greater confidence than ordinary; or when one breathes slow, and with great force, and the pulse beats high, with hard and swelled præcordia, then there is a fear of approaching madness. Frequent motion of the eyes also, and a darkness arising before them, together with head-ach; or loss of sleep without any pain, and a continual watching day and night; or lying upon the belly contrary to custom, if that is not occasioned by a pain of the belly itself; also an unusual grinding of the teeth, while the body continues strong, are signs of madness. If an abscess has been formed, and subsides before a discharge by spitting comes on, the usual fever still continuing, there will be danger first of madness, and then of death. An acute pain also of the ear, with a continued and strong fever, often disorders the mind: and of this malady younger people sometimes die in seven days; those that are older hold out something longer: because their fevers are not equally violent, nor their distraction so great; so that they last till the distemper is resolved into pus. A suffusion of blood in the breasts of a woman betokens approaching madness. Those, that have long fevers, will either have an abscess formed somewhere, or pains of the joints. Those, whose breath is greatly straitened in passing through the fauces in fevers, will soon fall into convulsions. If an angina suddenly disappears, the distemper is removing into the lungs; and that is often fatal before the seventh day: and if that does not happen, the consequence is a suppuration in some part. Lastly, after long purgings come dysenteries; after these a lientery; after violent catarrhs a consumption; after pleurisies diseases of the lungs; after which madness; after great heats of the body a tetanus or convulsion; after a wound of the head a delirium; after great torment for want of sleep, convulsions; when the blood vessels above ulcers are in strong motion, there will be an hæmorrhage.

A suppuration is produced many ways[(10)]; for if fevers unattended with pain continue long without any manifest cause, the disorder is transferred upon some particular part: but this happens only in younger people; for in the elderly, a quartan ague is the common consequence of such a disease. A suppuration also happens, if the præcordia being hard and pained have neither carried off the patient before the twentieth day, nor an hæmorrhage from the nose has ensued; and this holds chiefly in youths, especially if in the beginning of the distemper they had dimness of the eyes, or pains of the head: but then the abscess forms in the lower parts of the body. But if there be a soft tumour in the præcordia, and it has not ceased within sixty days, and the fever continues all that time, then the abscess forms in the superior parts: and if there is not a discharge of blood from the nose[(11)] in the beginning, it breaks out about the ears. And as every tumour of long standing generally tends to suppuration, so one, that is seated in the præcordia is more likely to have that issue, than one that is in the belly: and one, that is above the navel, than one, that is below it. Also if there is a sense of lassitude in a fever, an abscess is formed either in the jaws, or the joints. Sometimes too the urine continues long and thin, and crude, and the other symptoms are good: in this case for the most part an abscess is formed below the transverse septum (which the Greeks call diaphragma). If a peripneumony is removed neither by expectoration, nor by cupping, nor bleeding, nor a proper regimen, it sometimes gives rise to some vomicæ, either about the twentieth day, or thirtieth, or fortieth, and even sometimes about the sixtieth. Now we must date our reckoning from that day, in which the person was first taken with the fever, or seized with a horror, or felt a weight in the part. But these vomicæ are generated sometimes in the lungs, sometimes about the ribs. Where the suppuration is seated, it raises a pain and inflammation, and there is a greater heat there: and if one has lain down upon the sound side, he imagines it loaded with some weight. And every suppuration, that is not yet visible, may be known by the following signs: the fever does not wholly intermit, but is more mild in the day-time, and increases at night, there is plentiful sweating, an inclination to cough, and hardly any thing brought up by it, the eyes are hollow, cheeks red, the veins under the tongue white, the nails of the hands crooked, the fingers, especially their extremities, hot; there are swellings in the feet, difficulty in breathing, loathing of food, pimples breaking out over the whole body. But if the pain, cough, and difficulty of breathing have come on immediately at the beginning, the vomica will break before, or about the twentieth day. If these have begun later, they must of course increase; but the less quickly they have appeared, the more slowly will they be removed. It is common also in a severe distemper for the feet, hands, and nails to turn black: and if death has not followed, and the other parts of the body are restored, yet the feet fall off.

CHAP. VIII. WHAT SYMPTOMS ARE DANGEROUS, OR HOPEFUL IN PARTICULAR DISEASES.

Our next business is to explain the particular marks in every kind of distemper, which either afford hope, or indicate danger. If the bladder be pained, and there be a discharge of purulent urine, and also a smooth and white sediment in it, there is no danger. In a peripneumony, if the pain is mitigated by the spitting, although that be purulent, yet if the patient breathes easily, expectorates freely, and is not much distressed with the distemper, he may possibly recover his health. Nor need we immediately give way to fears, if the spittle is mixed with some reddish blood, provided that presently ceases. Pleurisies, that suppurate, when the matter is carried off within forty days, are thereby terminated. If there is a vomica in the liver, and the matter discharged from it be unmixed and white, the patient easily recovers, for that disorder is seated in the membrane. Now these kinds of suppurated tumours are tolerable, which are directed towards the external parts, and rise to a point. But of those, which point inward, the more mild are such, as while close, don’t affect the skin, and suffer it to remain without pain, and of the same colour with the other parts. Also pus from whatever part it is discharged, if it be smooth, white, and uniform, is not at all dangerous; and if after the evacuation of it the fever has presently abated, and the nausea and thirst have ceased to be troublesome. If at any time also a suppuration falls into the legs, and the patient’s discharge by spitting becomes purulent instead of reddish, the danger is less. But in a consumption, he that is to recover, will have his spitting white, uniform, and of the same colour, with out phlegm: and whatever falls down from the head by the nostrils, should be of a like nature. ’Tis far best to be altogether free from a fever: next to this, that it be so gentle, as neither to prevent the taking of food, nor occasion a frequent thirst. In this distemper that state of the belly is safe, in which every day consistent excrements are evacuated, in quantity proportioned to the food; and so is that body, which is least slender, and has the broadest and most hairy chest, and whose cartilage is small and fleshy. In a consumption too, if a woman has had her menses suppressed, and while the pain still remains about her breast, and shoulders, and the blood has of a sudden made its way, the distemper is commonly mitigated: for both the cough is lessened, and the thirst and febricula cease. But in the same patients, if their menses do not return, for the most part the vomica breaks: and the more bloody the discharge from it is, so much the better. A dropsical disorder is the least to be feared, which has begun without any preceding distemper. Of the next favourable sort is that, which succeeds a long distemper, if at the same time the bowels be firm; if the breathing be easy; if there is no pain; if the body is not hot; and is equally lean in its extremities; if the belly is soft; if there be no cough, no thirst; if the tongue even in sleep does grow dry; if there is an appetite for meat; if the belly yields to purging medicines; if spontaneously it discharges excrements soft and figured; if it grows less[(12)]; if the urine is altered by the change of wine, and by drinking certain medicinal potions; if the body is free from lassitude, and easily bears motion: for where one has all these symptoms, he is altogether safe; where most of them appear, the patient is in a hopeful way. Diseases of the joints, as the gout in the feet or hands, if they have attacked the patients young, and have not brought on a callus, may be removed; and they are most of all allayed by a dysentery, and when by any means the belly becomes loose. Also an epilepsy, that begins before puberty, is easily removed; and where a person sensibly feels the approaching fit first affecting some part of the body. It is best, that it begin at the hands or feet; next to them, at the sides; but worst of all, when it begins at the head. And in these patients also, excretions by the belly are of the greatest service. Now a purging is not in the least hurtful, which is without a fever, if it quickly, ceases; if upon feeling the belly, there is no motion perceived; if wind is discharged at the end of a stool. Nay even a dysentery is not dangerous, if blood and strigments are discharged, provided the patient is without a fever, and the other concomitants of this distemper: insomuch, that a pregnant woman may not only be cured, but her fœtus also preserved. And it is an advantage in this disorder, if the patient has come to some age. On the contrary, a lientery is more easily cured in tender age: especially if the urine begins to be excreted, and the body to be nourished with food. The same age is most favourable in pains of the hip, and arms, and in every paralytic disorder. Amongst these, the hip, if it be without numbness, if its coldness be slight, although it be greatly pained, yet it is easily and quickly cured; and a paralytic limb, if it continue to be nourished, may be recovered. A palsy of the mouth also is cured by a loose belly. And all purging does good to one labouring under a lippitude. Madness is removed by the appearance of a varicous swelling, or sudden eruption of blood from the hæmorrhoidal veins, or a dysentery. Pains of the arms, which are propagated either to the shoulders, or hands, are cured by vomiting of atrabilis. And whatever pain moves downward, is more easily cured. A hiccough is cured by sneezing. A vomiting stops long purgings. A woman, that vomits blood, is relieved by the flux of her menses. She, whose menses are deficient, if there has been an hæmorrhage from the nose, is free from all danger. And one, that is hysteric[(13)] or has a difficult labour, is relieved by sneezing. To one, that has a heat and tremour, a delirium is salutary. Dysenteries are of service to splenetic people. Lastly, a fever itself, which may seem very wonderful, is often a remedy for other distempers. For it both cures pains of the præcordia, that are not attended with inflammation, and relieves in a pain of the liver; and entirely removes convulsions, and a tetanus, if it comes after them; and where the distemper of the smaller intestine has been occasioned by a difficulty in making urine, if by the heat it promotes urine, it gives ease. Pains of the head attended with dimness of the eyes and redness with an itching in the forehead, are removed by a discharge of blood, either spontaneous or procured. If pains of the head and forehead arise from being exposed to the wind, or cold, or heat, they are cured by a gravedo, and sneezing. A sudden shuddering puts an end to an ardent fever, which the Greeks call causodes[ AV ]. When in a fever, there is a deafness, if blood is discharged from the nose, or the belly turns loose, that disorder is entirely removed. Nothing is more prevalent against deafness, than bilious stools. Those, that have small abscesses, which the Greeks call phymata[ AW ], formed in the urethra, are cured, when pus is discharged from thence. Now as most of these favourable turns happen of themselves, we may conclude, that nature has very great power in these very helps, which are applied by art.

On the contrary, when there is a pain in the head in a continued fever, and it does not at all remit, it is a bad and mortal symptom: and boys from the seventh to the fourteenth year are most liable to this danger. In a peripneumony, if the spitting did not come on in the beginning, but after the seventh day, and has continued above other seven days, it is dangerous: and the more mixed and less distinct the colours are, so much the worse. And yet nothing is worse, than for it to be excreted entirely homogeneous, whether it be reddish, or bloody, or white, or glutinous, or pale, or frothy: but the worst of all colours is black. A cough and catarrh are dangerous in the same disease; also a sneezing, which in other cases is reckoned salutary; and there is the greatest danger of all, if these things have been followed by a sudden purging. Now generally the symptoms, which are either good or bad in peripneumonies, are so in pleurisies too. A discharge of bloody pus from the liver is mortal. These are the worst kinds of suppurations, which tend inward, and discolour the external skin at the same time. Of that kind, that breaks outward[(14)], the worst are those, that are largest and flattest. But if the fever has not gone off, when the vomica is broke, or the pus evacuated, or after its ceasing returns again; also if there be a thirst, or a nausea, or a loose belly, or livid and pale pus, if the patient expectorates nothing but frothy phlegm; then there is certain danger. And of these kinds of suppurations, which have been produced by diseases of the lungs, old men commonly die: but those; those that are younger, by the other kinds. But in a consumption, a mixed and purulent spitting, a continued fever, which also destroys the appetite, and torments with thirst, in a slender body are sure prognosticks of immediate danger. If one has lasted under this distemper even for a considerable time, when the hairs first fall off, when the urine has something floating upon it like cobwebs, and the spittle has a fetid smell, and particularly when after these a purging has appeared, he will die soon: and more especially if it be autumn: in which season commonly those, that have got over the other part of the year, come to the close of their life. It is also mortal in this distemper to have expectorated pus, and afterwards for that to have entirely disappeared. It is likewise common for this disease in young people to arise from a vomica or fistula; and they do not readily recover, unless many salutary symptoms have ensued. With regard to others, virgins are the hardest to cure, or those women, that fall into a consumption from a suppression of the menses. A healthy person who has been taken with a sudden pain of his head, and then fallen into a deep sleep, so as to snore, and does not awake, will die before seven days are expired: and more especially if, when a looseness has not preceded, his eyelids are not closed in sleep, but the white of his eyes appears. Death however is not the certain consequence, if a fever comes on, which may remove the distemper. A dropsical disorder occasioned by an acute distemper, is seldom cured: especially if followed by the opposite symptoms to those above-mentioned. A cough likewise is equally destructive of hope in this distemper: also an hæmorrhage either upward or downward, and a collection of water in the middle of the body[(15)]. Some people too in this disease have swellings, which afterwards subside, and then appear again. Such indeed are more safe than those mentioned before, if they take the proper care: but they commonly perish from a persuasion of their being well. Some people with good reason will wonder, how any thing can at once both be hurtful to our bodies, and in part conduce to their preservation. For whether a dropsy has filled one with water, or a great quantity of pus has been collected in a large abscess, for the whole to be discharged at once is equally mortal, as for a sound person to lose all his blood by a wound. If the joints of any person are pained, so that some tubercles from a callus grow upon them, they are never cured: and the disorders of those parts, which have either begun in old age, or have continued from youth to that time of life, though they may be sometimes mitigated, yet are never entirely removed. An epilepsy also, that begins after the twenty-fifth year, is difficult to cure: and much more so that, which has begun after the fortieth; so that, although there may be some hope from nature, scarce any thing is to be expected from medicine at that age. In the same disease if the whole body is affected at once, and the patient is not sensible of the fit beginning in any part, but falls down suddenly, whatever his age be, he rarely gets free of the distemper: but if his intellects be injured, or a palsy has come on, there is no room for medicine. In purgings too, if attended with a fever; if with an inflammation of the liver, or præcordia, or belly; if with an intolerable thirst; if the disease has continued long; if the discharge of the belly is variegated; if it is expelled with pain, there is danger even of death: and more especially if with these symptoms a dysentery has grown inveterate. And this distemper sweeps off children chiefly to their tenth year: at other times of life, it is more easily endured. A pregnant woman also may be carried off by such a case: and although she herself recovers, yet she loses her child. Moreover a dysentery occasioned by atrabilis is mortal: or a sudden and black discharge from the belly, when the body is already wasted by that distemper. But a lientery is more dangerous, if the purging be frequent; if the belly is discharged at all hours, both with a rumbling, and without it; if it continues with equal violence both night and day; if what is excreted, is either crude, or black, and besides smooth and fetid; if thirst is troublesome; if urine is not made after drinking (the cause of which is, that all the liquor at that time descends, not into the bladder, but into the intestines) if the mouth is ulcerated; if the face is red, and marked with certain spots of all colours; if the belly is puffed up as it were by fermentation[(16)], fat and full of wrinkles; and if there is no appetite for food. And as in these circumstances death is the plain consequence; it is much more evidently so, if the disease is already of long standing; especially if withal the patient be old. In the distemper of the smaller intestine, a vomiting, hiccough, convulsion, and delirium, are bad symptoms. In the jaundice it is the most pernicious symptom for the liver to be indurated. Those, that have disorders in the spleen, if they be seized with a dysentery, which afterwards turns to a dropsy or a lientery, it is scarce in the power of medicine to save. The distemper of the smaller intestine arising from a difficulty of urine, unless it be removed by a fever, kills within seven days. If a woman after delivery is seized with a fever, and violent and constant pains of the head, she is in danger of dying. If there is a pain and inflammation in those parts, which contain the bowels, it is a bad sign to fetch the breath often. If a pain of the head continues long without a perceptible cause, and removes into the neck and shoulders, and again returns into the head; or comes from the head to the neck and shoulders, it is dangerous: unless it produce some vomica, so that the pus may be expectorated; or unless there is an hæmorrhage from some part; or scurf break out plentifully in the head, or pustules over the whole body. It is an equally formidable distemper when a numbness and itching wander about; sometimes over the whole head, sometimes in a part of it; or when there is something like a sensation of cold in the part, and these reach even to the end of the tongue. And though in these cases abscesses are beneficial, yet there is less hope of a recovery by their means, as they are seldom formed after such disorders begin. In pains of the hip, if there is a great numbness, and the leg and hip are cold, and the belly has no passage, but when assisted, and the excrements are slimy, and the age of the person exceed forty, the distemper will be very tedious, and at least of a year’s continuance; neither will it be possible to remove it, unless it be either in the spring or autumn. At the same time of life, the cure is equally difficult, when a pain of the arms removes into the hands, or reaches to the shoulders, and produces a torpor and pain, and is not relieved by a bilious vomiting. A paralytic limb in any part of the body, if it has no motion, and pines away, will not recover its former state; and the more inveterate the distemper, and the more advanced in years the patient is, so much the less probable is the cure. And in every paralytic disorder, the winter and autumn are improper seasons for medicine: some benefit may possibly be hoped for in the spring and summer. And this distemper, when moderate, is cured with difficulty; when violent, it cannot be cured at all. Every pain also, which moves upward, yields less to medicine. If the breasts of a pregnant woman have shrunk suddenly, there is danger of a miscarriage. In a woman that has milk, and has neither had a child, nor is pregnant, the menses are suppressed. A quartan ague in the summer is short, but in the autumn commonly long; especially that, which has come on, when the winter was approaching. If there has been an hæmorrhage followed with madness and convulsions, there is danger of death. Also if a convulsion has seized a person purged by medicines and still empty; or if the extremities are cold in the time of great pain. Nor does a person return to life, who has been hanged, and taken down with a frothing mouth. A black and sudden discharge of the belly, like black blood, whether it be attended with a fever or not, is pernicious.

CHAP. IX. OF THE CURE OF DISEASES.

Having considered those signs, which may give us hope or fear, we must proceed to the methods of curing diseases. Now these are divided into the general and particular: the general, which relieve several distempers, the particular, which are confined to single disorders. I shall first treat of the general. But there are some of those, that not only support the sick, but conduce to the preservation of the healthy, others are made use of in sickness only.

Now every thing that assists the body, either evacuates somewhat, or adds, or draws, or restrains, or cools, or heats, and at the same time either hardens, or mollifies. Some things also are useful not in one way only, but even in two, that are not contrary to each other. An evacuation is made by bleeding, cupping, purging, vomiting, friction, gestation, and all exercise of the body, abstinence and sweat. Of these I shall now treat.

CHAP. X. OF BLEEDING.

To let blood by the incision of a vein is not new: but to practise this in almost every distemper is new. Again, to bleed younger people, and women, that are not pregnant, is of ancient use. But to attempt the same in children and old people, and in pregnant women, is not an old practice. For indeed the ancients judged, that the first and last stages of life were not able to bear this kind of remedy; and they were persuaded, that a pregnant woman, who had been thus treated, would miscarry. But afterwards experience proved, that none of these rules were universal, and that some other circumstances were rather to be regarded, by which the intention of the physician was to be directed. For the material point is not, what the age may be, or what is contained within the body, but what degree of strength there is. Upon this account if a young man is valetudinary, or a woman not with child be weak, bleeding is bad: for the remaining strength, is by this evacuation destroyed. Whereas to a stout boy, and a robust old man, and a strong pregnant woman, it may be used with safety. ’Tis true an unskilful physician may be greatly deceived in such patients: because there is commonly less strength at these times of life. And a pregnant woman stands in need of strength after her cure, to support not only herself, but her fœtus also. But whatever requires either attention of mind, or prudence, is not to be immediately rejected: since the excellency of the art here consists, not in numbering the years, nor in regarding conception alone, but in considering the strength, and collecting from thence, whether there will be left sufficient to support either a boy, or an old man, or two bodies at once in one woman. There is a difference also between bodies strong, and corpulent: and those, that are slender, and infirm. In the slender, blood more abounds, but in those of a fuller habit, flesh. Wherefore the first bear this evacuation more easily: and he, that is over fat, is soonest distressed by it. For this reason the strength of the body is to be estimated rather by the state of the vessels, than from its appearance.

Nor are these the only particulars to be considered, but also what kind of distemper it is: whether a redundancy, or deficiency of matter has been hurtful; whether the body be corrupted or sound. For if there be a deficiency, or the humours be sound, this method is prejudicial. But if either the quantity of matter is hurtful, or it is corrupted, no other remedy is more successful; for this reason a violent fever, when the skin is red, and the veins are full and turgid, requires bleeding: likewise diseases of the bowels, and palsies, and the tetanus, and convulsions; in fine, whatever strangulates the fauces, so as to cause a difficulty in breathing; whatever suddenly stops the speech; any pain, that is intolerable; and any internal rupture, or bruise, from whatever cause; also a bad habit of body; and all acute distempers; provided, as I observed above, they hurt not by weakness, but by redundancy.

But it may possibly happen, that a distemper may indeed require this method, and at the same time the body may seem hardly able to bear it: but yet if there appears no other remedy, and the patient must perish, unless he shall be relieved even by a rash attempt; in this case, it is the part of a good physician to shew, that there is no hope without bleeding; and to confess what bad consequences may be apprehended even from that remedy; and after that, to bleed if desired. It is by no means proper to hesitate about it in such a situation as this: for it is better to try a doubtful remedy, than none at all. And this ought especially to be practised, when there is a palsy; when one has lost his speech suddenly; when an angina suffocates; when the preceding paroxysm of a fever has almost killed a person, and another equally severe is likely to follow, and the strength of the patient seems unable to bear it.

Though bleeding ought not to be performed in a state of crudity, yet even that does not hold always. For the circumstances will not at all times wait for concoction. So that if any person has fallen front a height, or has received a contusion, or vomits blood from some sudden accident, although he has taken food a little before, yet that evacuation is proper, lest if the matter settle, it distress the body. The same rule will hold in other sudden cases too, where there is a danger of suffocation. But if the nature of the distemper will allow a delay, it must not be done, till all remaining suspicion of crudity is removed. Upon this account, the second or third day of an illness seems most proper for this operation. But as sometimes it is necessary to bleed even on the first day, so it is never good after the fourth, when by time alone, the matter is either dissipated, or has corrupted the body; so that the evacuation may weaken, but cannot make it sound. But when a vehement fever prevails, to bleed in the time of its violence is killing the patient. Therefore an intermission[(17)] is to be awaited for: if it does not intermit, when it has ceased to increase: if there be no hopes even of a remission, in that case the only opportunity offered, though less favourable, is not to be neglected.

Further this remedy, where it is necessary, generally were best to be divided into two days; for it is better at the first to lighten the patient, and after that to cleanse him thoroughly, than to run any risk of his life by dissipating all his strength at once. And if this method be found to answer in the cure of a dropsy, how much more must it of necessity answer with regard to the blood?

If the disorder be in the whole body, the evacuation ought to be made from the arm: if in any particular place, from the part affected, or at least as near to it as may be; because it cannot be performed every where, but only in the temples, and in the arms, and near the ancles. I am not ignorant, that it is the opinion of some, that blood should be let at the greatest distance from the part where it does harm; for that thus the course of the matter is diverted; but in the other way it is drawn into that very place, which is distressed. But this is altogether false. For it first empties the part nearest: and the blood flows from the more remote, as long as the evacuation is continued: when this is stopt, because there is no more attraction, it then ceases to come. Yet experience itself seems to have shewn, that in a fracture of the skull blood is to be let rather from the arm: and if the disorder is in one arm, it must be performed in the other: I suppose for this reason, because if any miscarriage should happen, those parts, which are already hurt[(18)], are more exposed to injuries. Sometimes also an hæmorrhage breaking out in one part, is stopt by bleeding in another. For it ceases to flow, where we would not have it, when we apply what will stop its course there, and open another passage for it.

Altho’ bleeding is very easy to one, who has experience; yet it is very difficult to one, that is ignorant. For the vein lies close to the arteries; and to these the nerves. So that if the lancet has touched a nerve, a convulsion will follow, which destroys a man miserably. And then a wounded artery neither unites again, nor heals; and sometimes it occasions a violent hæmorrhage. If also the vein itself happens to be cut quite through, the two ends are compressed, and discharge no blood. Again, if the lancet is entered with fear, it lacerates the surface of the skin, and does not open the vein. Sometimes too the vein lies concealed, and is not easily found. Thus many circumstances make that difficult to an ignorant person, which is very easy to the skilful.

The vein is to be cut at the middle. And when the blood flows from it, its colour and consistence ought to be observed. For if it be thick and black, it is bad; and therefore the discharge is useful: if red and pellucid, it is sound; and that evacuation is so far from being beneficial, that it may even hurt, and is immediately to be stopt. But such an accident cannot happen to the physician, who knows in what case bleeding is to be used. It more commonly happens, that it flows on the first day equally black thro’ the operation. And altho’ it be so, yet if the discharge is sufficient, it must be stopt: and an end must always be put to it, before the person faints.

Then the arm is to be bound up, putting upon it a penecillum[(19)] dipt in cold water, and squeezed; and on the following day, the vein must be rubbed with the middle finger, that its recent union may be resolved, and it may again discharge blood. Whether it happens on the first or second day, that the blood, which at first flowed thick, and black, has begun to appear red and pellucid, there is then a sufficient quantity taken away, and what remains is pure: so that the arm is to be immediately bound up, and kept so, till the cicatrice is firm; which firmness it very soon acquires in a vein.

CHAP. XI. OF CUPPING.

There are two sorts of cucurbitals: the one of copper, the other of horn. That of copper is open at the one end, and close at the other; that of horn is likewise open at one end, and at the other has a small hole. Into the copper one burning linen is put, and its mouth is clapt close to the body, and is prest down, till it adhere to it. The horn kind is only applied to the body, and after that, when a person has sucked out the air by the small hole, and that is closed with wax, it sticks, as well as the other. Both of these are made not only of these two materials, but of any thing else. Where no better can be got, a small cup with a narrow mouth is fit enough for the purpose. When it adheres, if the skin has been cut before with a scalpel, it will bring out blood: if the skin is whole, air. Wherefore when the offence is from matter contained within, the first method is to be pursued: when it is only a flatulency, the other is commonly used.

Now the principal use of a cucurbital is, when a disorder is not in the whole body, but only in a part, the emptying of which is sufficient to render it sound. And this very thing is a proof, that in the cure of any member, bleeding by a lancet too is to be performed rather in the part which is already hurt: because no body puts the cucurbital upon a different part, unless to divert the flux of blood thither, but on that, which is diseased, and which is to be relieved.

There may possibly be a necessity for using the cucurbital in chronic distempers (although they be already of some standing) if there be either corrupted matter, or a flatulency. Likewise in some acute distempers, if at the same time the body requires to be lightened, and the strength will not admit of bleeding from a vein. And this remedy, as it is less violent, so it is more safe; and is never dangerous, though it be made use of in the greatest violence of a fever, or even in the time of crudity. For this reason, when there is a necessity for bleeding, if the opening of a vein is very dangerous, or the disorder is fix’d in a noble part of the body, we must also have recourse to this instrument. We must be sensible however, that as it is attended with no danger, so it gives a feebler aid; and that is not possible to relieve a violent distemper, but by an equally violent remedy.

CHAP. XII. OF PURGING.

In almost every distemper the ancients endeavoured to purge by various medicines and frequent clysters: and they gave either black hellebore, or polypody of the oak, or scales of copper[(20)], or the milk of sea-spurge[(21)], a drop of which taken upon bread purges plentifully; or asses, or cow’s, or goat’s milk, with the addition of a little salt; and this they boiled, and taking away what had been curdled, they obliged the patient to drink what remained like whey.

But generally purging medicines injure the stomach. Wherefore aloes is to be mixed with all cathartics. If the purging be severe, or frequent clysters be administered, it weakens a man. For that reason it is never proper in an illness to give medicines with that view, unless there be no fever concomitant: as when black hellebore is given to those that labour under atrabilis, or a melancholy madness, or any paralytic disorder. But where there are fevers, it is better to take such food and drink for that purpose, as may at once both nourish, and prove laxative. And there are some kinds of disorders, with which purging by milk agrees.

Of clysters.

But for the most part the belly is to be opened by clysters. Which method, somewhat censured, though not entirely laid aside by Asclepiades, I observe to be generally neglected in our own age. That moderation, which he seems to have followed, is most proper, that neither this remedy should be often tried, nor be entirely omitted, but used once, or at most twice, if the head is heavy, or the eyes dim; if there is a disorder of the large intestine, which the Greeks call colon; if there are pains of the lower belly, or in the hips; if any thing bilious be accumulated in the stomach, or even any flux of phlegm or a humour like water thither; if the breathing is difficult; if there is no natural discharge from the belly; especially if the excrements are near the anus, and still remain within; or if the patient, while he has no passage, nevertheless perceives the smell of excrements in his breath; or if the stools appear corrupted; or if an early abstinence has not removed a fever; or when a case may require bleeding, and the strength will not allow of it, and the time for that operation is past; or if one has drank much before an illness; or if a person, who was frequently loose, either naturally or by some accident, is suddenly bound in the belly. But the following rules are to be observed, that it be not used before the third day; nor while any crudity remains; nor in a body weak and exhausted by long sickness; nor to a person, whose belly discharges sufficiently every day, or one that is loose; nor during the paroxysm of a fever; because what is injected at this time, is retained within the belly, and being thrown upon the head, greatly increases the danger. On the day before, the patient ought to fast, that he may be prepared for this remedy. On the day of the operation to drink, some hours before, hot water, that his superior parts may be moistened; then the injection is to be performed with pure water, if we be content with a gentle medicine; if somewhat more powerful is required, hydromel[(22)]; if a lenient, a decoction of fœnugreek, or ptisan[(23)], or mallows, in water: if it be intended to restringe, a decoction of vervains[(24)]. Sea-water, or any other water with the addition of salt, is acrid: but both of these are better boiled. A greater degree of acrimony is given by adding either oil, or nitre, or honey also. The more acrid it is, it evacuates the more; but it is not so easy to bear. The injection ought neither to be cold, nor hot; lest it hurt either way. When it is injected, the patient ought to confine himself as much as possible in bed, and not yield immediately to the first stimulus he finds to go to stool; and not till necessity obliges him. And commonly this evacuation by lightning the superior parts mitigates the distemper itself. When a person has fatigued himself by going to stool, as often as he was obliged, he ought to take rest for a little time; and lest he grow faint, even on the same day to take food. The quantity of which ought to be determined by considering the nature of the paroxysm that is expected; or whether there is no danger of any.

CHAP. XIII. OF VOMITING.

As a vomit even in health is often necessary to persons of a bilious habit; it is likewise so in those distempers, which are occasioned by bile. Upon this account it is necessary to those, that before fevers are distressed with horrors and tremors; to all those, that labour under a cholera; and all, that are attacked with madness, and a concomitant mirth; and those also, who are oppressed with an epilepsy. But if the distemper be acute, as the cholera; if it be a fever, while there are tetani, the rougher medicines are improper, as has been observed above in the article of purging; and it is sufficient to take such a vomit, as I prescribed for people in health. But when distempers are of long standing, and stubborn, without any fever, as an epilepsy or madness, we must use even white hellebore. Which it is not proper to administer in the winter, or summer; it is best in the spring: in the autumn it does tolerably well. Whoever prescribes it, ought first to take care, that the body of his patient be moist. It is necessary to know, that every medicine of this kind, which is given by way of potion, is not always beneficial to sick people, to healthy always hurtful.

CHAP. XIV. OF FRICTION.

Concerning friction[(25)], Asclepiades looking upon himself as the inventor of it, has said so much in that book, which he entitled ‘of general remedies,’ that tho’ he mentions only three things, that, and wine, and gestation, yet he has taken up the greatest part of his treatise upon the first. Now as it is not fit to defraud the moderns of the merit either of their new discoveries or judicious imitations, so it is but just at the same time to assign those things, which were practised among some of the ancients, to their true authors. It cannot indeed be doubted, that Asclepiades has been both fuller and clearer in his directions, when and how friction ought to be used; but he has discovered nothing, which was not comprized in a few words by the most ancient author Hippocrates; who said, that friction, if violent, hardens the body; if gentle, softens it; if plentiful, extenuates; if moderate, increases its bulk: from whence it follows, that it is to be made use of, when a lax body requires to be braced; or to soften one, that is indurated; or to dissipate where the fulness is hurtful; or to nourish that, which is slender and infirm.

Nevertheless, if a person examine more curiously into these different species (which is not here the province of a physician) he will easily understand that the effects of them all proceed from one cause; that is, the carrying off of something. For a part will be bound, when that thing is taken away, the intervention of which had caused it to be lax; and another is softened by removing that, which occasioned the hardness; and the body is filled, not by the friction itself, but by that food, which afterwards makes its way to the skin, relaxed by a kind of digestion[(26)]. And the degree of it is the cause of these effects so widely different.

But there is a great deal of difference betwixt unction, and friction. For it is necessary for the body to be anointed, and gently rubbed even in acute and recent distempers; but this must be done in the time of their remission, and before taking food. But to make use of long friction is not proper, either in acute or increasing disorders; except when the intention of it is to procure sleep in phrenitic patients. This remedy is very agreeable to inveterate distempers, and where they have abated somewhat of their first violence. I am not ignorant that some maintain, that every remedy is necessary for distempers, while they are increasing, not when they are going off spontaneously. But this is not just; for a distemper, though it would come to a period of itself, may notwithstanding be sooner terminated by the application of remedies. The use of which is necessary upon a double account, both that the health may be restored as soon as possible; and that the disorder, which remains, be not irritated again by any slight cause: for a distemper may be less violent, than it has been, and yet not entirely removed; but there may be some remains of it, which the use of remedies may dissipate.

But though friction may be used in the decline of an illness, yet it is never to be practised in the increase of a fever; but if possible, when the body is entirely free of it; if that can’t be done, at least when there is a remission. It ought also to be performed sometimes over the whole body, as when we would have an infirm person take on flesh; sometimes in particular parts, either because the weakness of that part itself, or of some other, requires it. For both inveterate pains of the head are mitigated by the friction of it (yet not during their violence) and any paralytic limb is strengthened by rubbing it: but much more commonly, when one part is pained, a different one is to be rubbed; and particularly, when we want to make a derivation from the upper or middle parts of the body; and with this intention we rub the extremities. And these people are not to be regarded, who prescribe to a certain number, how often a person is to be rubbed: for that is to be estimated from his strength. Thus if one is very weak, fifty times may be sufficient: if of a more robust habit, it may be done two hundred times. And then in different proportions betwixt these two according to the strength. Whence it also happens, that the motion of the hands in friction must be less frequent in a woman than a man; less frequent in a boy or an old man, than a young man. Lastly, if particular parts are rubbed, they require much and strong friction. For the whole body cannot be quickly weakened by a part, and there is a necessity for dissipating as much of the matter as we can, whether the intention be to relieve the part we brush, or another by means of it. But where a weakness of the whole body requires this treatment all over, it ought to be shorter and more mild; so as only to soften the surface of the skin, to render it more apt to receive new matter from fresh nourishment. A patient is known to be in a bad situation, when the surface of his body is cold, and the internal part is hot with a concomitant thirst, as I observed above. But even in this case friction is the only remedy, which, if it have brought out the heat, may make way for the use of some medicine.

CHAP. XV. OF GESTATION.

Gestation is most proper for chronic distempers, and those that are already upon the decline. And it is useful both to those, who are quite free of a fever, but yet are not able to exercise themselves; and those, that have the slow relicks of distempers, which are not otherwise expelled. Asclepiades said, that gestation was to be used even in a recent and violent, and especially an ardent fever, in order to discuss it. But that is dangerous; and the violence of such a distemper is sustained better by remaining quiet. Yet if any person will make trial of it, he may do it under these circumstances, if his tongue is not rough, if there be no tumour, no hardness, no pain in his bowels, nor head, nor præcordia. And gestation ought never to be used at all in a body that is pained, whether in the whole, or in any part, unless the pain be in the nerves alone; and never in the increase of a fever, but upon its remission.

There are many kinds of gestation: in the use of which the strength and circumstances of the patient are to be considered; that they may neither dissipate too much a weak man, nor be out of the reach of one of small fortune. The most mild kind of gestation is in a ship, either in a port, or a river; or in a litter, or a chair; more brisk in a chariot; more violent in a ship on the ocean. And each of them may be rendered both more sharp, and more mild. If none of them can be done, the bed must be suspended and moved to and fro. If even that can’t be accomplished, at least a prop is to be put under one foot[(27)] of the bed, and thus the bed moved back and forward by the hand. And indeed the mild kinds of exercise agree with the weakest; the stronger with those, who have been for several days free from the fever; or those, who feel the beginnings of severe distempers, but are yet without a fever (which is the case in a consumption, and indispositions of the stomach, and a dropsical disorder, and sometimes in a jaundice) or when some distempers, such as an epilepsy or madness, continue, though for a considerable time, without any concomitant fever. In which disorders, these kinds of exercises also are necessary, which were mentioned in that place, where we prescribed rules for the conduct of sound, but weakly men.

CHAP. XVI. OF ABSTINENCE.

There are two kinds of abstinence. One, when the patient takes no food at all: the other, when he takes only what is proper. The beginnings of diseases call for fasting and thirst: after that in the distempers themselves moderation is required, so that nothing but what is proper be taken, and not too much of that; for it is not fit after fasting, to enter immediately upon a full diet. And if this be hurtful even to sound bodies, that have been under the necessity of wanting food for some time, how much more is it so to a weak, not to say a diseased one? And there is nothing which more relieves an indisposed person, than a seasonable abstinence. Intemperate men amongst us chuse for themselves the seasons of eating, and leave the quantity of their food to the physicians. Others again compliment the physicians with the times, but reserve the quantity to their own determination. Those fancy themselves to behave very genteelly, who leave every thing else to the judgment of the physicians, but insist upon the liberty of chusing the kind of their food; as if the question was, what the physician has a right to do, not what may be salutary to the patient; who is greatly hurt as often as he transgresses either in the time, measure, or quality of his food.

CHAP. XVII. OF SWEATING.

A sweat is procured in two ways; either by a dry heat, or a bath. A dry heat is raised by hot sand, the laconicum, and clibanum[(28)], and some natural sweating places, where a hot vapour exhaling out of the earth is inclosed by a building, as there is at Baiæ amongst the myrtle groves. Besides these, it is solicited by the sun and exercise. These kinds are useful, wherever an internal humour offends, and is to be dissipated. Also some diseases of the nerves are best cured by this method. And the others may be proper for weak people: the heat of the sun and exercise agree only with the more robust; when they are falling into a disorder, or even during the time of distempers not violent, provided they be free of a fever. But care must be taken, that none of these be attempted either in a fever[(29)], or in the time of crudity.

But the use of the bath is twofold. For sometimes after the removal of fevers, it is a proper introduction to a fuller diet and stronger wine for the recovery of health: sometimes it removes the fever itself. And it is generally used, when it is expedient to relax the surface of the skin, and solicit the evacuation of the corrupted humour, and to change the habit of the body. The ancients used it with greater caution: Asclepiades more boldly. And there is no reason to be afraid of it, if it be seasonable: before the proper time, it does harm. Whoever has been freed of a fever, as soon as he has escaped the fit for one day, on the day following, after the usual time of its coming on, may safely bathe. And if the fever used to be periodical, so as to return upon the third or fourth day, whenever it has missed, the bath is safe. And even during the continuance of fevers, if they be of the slow kind, and the patients have splenetic disorders of long standing, it is proper to make trial of this remedy: on this condition however, that the præcordia be not hard nor swelled, nor the tongue rough, and there be no pain either in the trunk of the body or in the head, and the fever be not then increasing. And in these fevers indeed, which have a certain period, there are two opportunities for bathing; the one, before the shuddering; the other, after the fit is ended. In those again, who are long distressed with slow febriculas, either when the fit is entirely off; or if that does not happen, at least when it has remitted, and the body is as sound, as it generally is in that kind of illness.

A valetudinary man, that is going into the bath, ought to be careful not to expose himself to any cold before. When he has come to the bagnio, he is to stand still a little, and try whether his temples are bound, and if any sweat breaks out: if the first has happened, and the other not followed, the bath will be improper that day: he must be anointed slightly, and carried back, and by all means avoid cold, and be abstemious. But if his temples are not affected, and a sweat begins, first there, and then elsewhere, he must wash his mouth with plenty of warm water, then go into the bath; and there he must observe, whether at the first touch of the warm water he feels a shuddering upon the surface of his skin; which can scarcely happen, if the circumstances above-mentioned were as they should be: however, this is a certain sign of the bath’s being hurtful.

One from the state of his health may know, before he go into the warm water, whether it be proper to anoint himself after it. However for the most part (except in cases where it shall be expressly ordered to be done after) upon the beginning of a sweat the body is to be anointed gently, and then to be dipped in the warm water. And in this case also regard must be had to his strength; and he must not be allowed to faint by the heat, but must be speedily removed, and carefully wrapped up in cloaths, lest any cold get to him; and there also he must sweat, before he take any food.

Warm fomentations are millet-seed, salt, sand: any of these heated, and put into a linen cloth: even linen alone, if there be less heat required; but if greater, extinguished coals, wrapt up in cloths, and applied round a person. Moreover bottles[(30)] are filled with hot oil: and water is poured into earthen vessels, which from their resemblance in shape are called lenticulæ[(31)]: and salt is put into a linen bag, and dipt into water well heated, then set upon the limb that is to be fomented. And at the fire are placed two ignited pieces of iron, with pretty broad heads: one of these is put into dry salt, and water is sprinkled lightly upon it; when it begins to grow cold, it is carried back to the fire: the other is made use of in the same manner; so each of them alternately: and in the mean time, the hot and salt liquor drops down through the cloth, which relieves the nerves contracted by any disease. All of them have this property in common of dissipating that, which either loads the præcordia, or suffocates the fauces, or is hurtful in any limb. When each of these sorts of fomentations is to be used, shall be directed under the particular kinds of distempers.

CHAP. XVIII. OF THE DIFFERENT KINDS OF FOOD AND DRINK.

Since we have treated of those things, which relieve by evacuation, we must now proceed to those, which nourish us, that is, our food and drink. Now these are not only the common supports in all distempers, but even of health too. And it is of importance to be acquainted with the properties of them all: first, that the healthy may know, in what manner they are to make use of them: secondly, that in treating of the method of curing diseases, it may suffice to mention in general the species of what is to be taken, without being under the necessity of naming each particular upon every occasion.

It is fit to know then, that all leguminous vegetables, and those grains, which are made into bread, are of the strongest kind of food (I call that the strongest, in which there is the most nourishment) also every quadruped, that is tame, all large wild beasts, such as the wild goat, deer, wild boar, wild ass; every great bird, such as the goose, peacock, and crane; all large fishes, the cetus[(32)], and others of a like size; also honey, and cheese. So that it is no wonder that particular kind of bread[(33)] should be very strong, which is made of corn, fat, honey, and cheese. Of a middle nature ought to be reckoned those pot-herbs, whose roots or bulbusses we use for food; amongst quadrupeds the hare; all birds, from the least upwards to the phœnicopter[(34)]; also all fish, that will not bear salt, or such, as are salted whole. Of the weakest kind are all potherbs, and whatever grows on a stalk, such as the gourd, and cucumber, and caper, and all the apple kind, olives, snails[(35)], and also conchylia[(36)].

But although these are thus distinguished, yet there are great differences between things even of the same class; and one is either more substantial, or weaker than another. For instance, there is more nourishment in bread, than in any thing else. Wheat is more firm than millet: and that again than barley: and the strongest kind of wheat is the siligo[(37)]; after that the finest flour; next, that which has nothing taken from it, which the Greeks call autopyron[ AX ]: still weaker than these is the second flour: the weakest is grey bread. Amongst the leguminous vegetables the bean or lentil is more substantial than pease. Amongst the potherbs, turnep and navew gentle, and all the bulbous kind (in which I rank the onion also, and garlick) are more substantial than the parsnip, or that which is particularly called radicula (garden radish.) Also cabbage, and betes, and leeks, are stronger than lettuce, or gourd, or asparagus. But amongst the fruits of the surculous tribe, grapes, figs, nuts, dates, apples properly so called, are of the firmer kind. And amongst these the juicy are stronger than the mealy[(38)] fruits. Also of these birds, which are of the middle kind, those are stronger, which make more use of their feet, than their wings: and of those, that trust more to flying, the larger birds are stronger than the small ones, as the beccaficos, and thrush[(39)]. And those also, which live in the water, afford a lighter food than those, which cannot swim. Amongst the tame animals pork is lightest; beef heaviest. Also of the wild, the larger any animal is, so much the stronger food it is. And of those fishes also, which are of the middle kind, the heaviest, though we make most use of them, are first all those, that are made salsamenta[(40)], such as the lacertus[(41)]; next such, as though more tender than the other, yet are in themselves hard, as the aurata, corvus, sparus, oculata; in the next rank are the plani fish, after which lighter still are lupi and mulli: and then all rock fish.

And there is not only a difference in the classes of things, but also in the things themselves; which arises from their age, the different parts of their body, the soil, air, and the case they are in. For every four footed animal[(42)], that is sucking, affords less nourishment; also a dunghill fowl, the younger it is. In fish too, the middle age, before they have reached their greatest bulk. For the parts, the heels, cheeks, ears, and brain of a hog; of a lamb or kid, the whole head with the petty toes, are a good deal lighter than the other parts; so that they may be ranked in the middle class. In birds, the necks or wings are properly numbered with the weakest. As to the soil, the corn, that grows upon hilly parts, is stronger than what grows upon a plain. Fish got in the midst of rocks, is lighter than those in the sand; those in the sand, than those in the mud. Whence it happens, that the same kinds either from a pond, or lake, or river, are heavier: and that, which lives in the deep, is lighter than one in shoal water. Every wild animal also is lighter than a tame one: and whatever is produced in a moist air, than another in a dry. In the next place, all the same foods afford more nourishment, fat than lean; fresh more than salt; new than stale. Again, the same thing nourishes more, when it is stewed into broth, than roasted, more roasted than fried. A hard egg is of the strongest kind; soft, or sorbile[(43)] of the weakest. And though all grains, made into bread, are most firm, yet some kinds washed, as alica[(44)], rice, ptisan, or gruel made of the same, or pulse[(45)], and bread moistened with water, may be reckoned with the weakest.

With regard to drinks, whatever is prepared from grain, also milk, mulse, defrutum, passum[(46)], wine either sweet or strong, or must, or very old wine, are of the strongest kind. But vinegar, and wine a few years old, or austere, or oily, is of the middle kind. And therefore none of these should be given to weak people. Water is weakest of all. And the drink, that is made of grain, is stronger in proportion to the hardness of the grain itself: and that wine, which is produced in a good soil, more so than in a poor soil; or in a temperate air, than one, which is either over moist or too dry, and either over cold or too hot. Mulse, the more honey it contains, defrutum, the more it is evaporated in boiling, and passum, the drier the grape is from which it is prepared, are so much the stronger. Rain water is lightest; next spring water, then river water, then that of a well; after these snow, or ice; water of lakes is heavier than these; and that of fens heaviest of all. The trial is both easy and necessary to those, that want to know its nature. For the lightness appears from weighing it; and amongst those, that are of equal weight, the sooner any of them grows hot or cold, and the more quickly herbs are boiled in it, the better it is.

It is a general rule, that the stronger each kind is, so much the less easily it is concocted; but when once concocted, it nourishes more. Wherefore the nature of the food must be determined by the degree of one’s strength; and the quantity proportioned to the kind. Upon this account weak men must make use of the weakest things; a middle kind best supports those, that are moderately strong; and the most substantial is fittest for the robust. Lastly, A person may take a greater quantity of what is lighter: but in what is most substantial, he ought to moderate his appetite.

CHAP. XIX. GENERAL PROPERTIES OF DIFFERENT FOODS.

And these above-mentioned are not the only distinctions; but some things afford good juices, others bad, which two kinds the Greeks term euchyma and cacochyma[ AY ]; some are mild, others acrid; some generate in us a thicker phlegm, others a more fluid; some agree with the stomach, others not; likewise some produce flatulencies, others have not that property; some heat, others cool; some readily turn sour in the stomach, others are not easily corrupted there; some open the belly, others bind it; some promote urine, others retard it; some are soporiferous, others excite the senses. Now all these must be known for this reason, that different things are proper in different constitutions or states of health.

CHAP. XX. OF THINGS CONTAINING GOOD JUICES.

Good juices are afforded by wheat, siligo, alica, rice, starch[(47)], tragum[(48)], milk, soft cheese, all venison, all birds of the middle class; of the larger kind also, those that we mentioned above; the middle kind betwixt tender and hard fishes, as the mullus, and lupus; pot-herbs, lettuce, nettle, mallows, cucumber, gourd, purslane, snails, dates; any of the apple kind, that are neither bitter, nor acid; wine sweet or mild, passum, defrutum, olives, or any of this fruit preserved in either of the two last mentioned liquors; the wombs[(49)], cheeks, and legs of hogs, all fat flesh, and glutinous, all livers, and a sorbile egg.

CHAP. XXI. OF FOODS CONTAINING BAD JUICES.

Of bad juices are millet, panick, barley, leguminous vegetables, the flesh of tame animals very lean, and all salt meat, all salt fish and garum[(50)], old cheese, skirret, radish, turneps, navew gentle, bulbusses[(51)], cabbage, and more especially its sprouts, asparagus, betes, cucumber, leek, rocket, cresses, thyme, catmint, savory, hyssop, rue, dill, fennel, cumin, anise, dock, mustard, garlick, onion, spleens, kidneys, intestines, every kind of apple, that is acid or bitter, vinegar, every thing, that is acrid, acid, or bitter, oil, also rock-fish, and those, that are of the tenderest kind, or those again, which are either too hard and strong tasted, as those found in ponds, lakes, or muddy rivers generally are, or those, that have grown to an excessive bulk.

CHAP. XXII. OF MILD AND ACRID THINGS.

The following are mild; gruel, pulse, pancake[(52)], starch, ptisan, fat flesh, and all glutinous flesh, such as we have in all tame animals, but especially in the heels, and legs of swine, the petty-toes, and heads of kids, calves, and lambs, and the brains of them all. Also milk, and what are properly called sweets, defrutum, passum, pine-nuts.

Things acrid are, whatever is too austere, all acids, all salt provisions; and even honey, which is the more so, the better it is: likewise garlick, onion, rocket, rue, cresses, cucumber, bete, cabbage, asparagus, mustard, radish, endive, basil, lettuce, and the greatest part of pot-herbs.

CHAP. XXIII. OF THOSE THINGS WHICH GENERATE A THICK AND A FLUID PHLEGM.

A thick phlegm is generated by sorbile eggs, alica, rice, starch, ptisan, milk, bulbous roots, and almost every thing that is glutinous.

The contrary effect is produced by all salted, and acrid, and acid substances.

CHAP. XXIV. OF WHAT AGREES WITH THE STOMACH.

Whatever is austere or acid, or whatever is moderately sprinkled with salt, is agreeable to the stomach: also un-leavened bread, and washed alica, or rice, or ptisan; and all birds, and all venison; and both of these either roasted or boiled: amongst the tame animals, beef; if any of the rest is made use of, rather lean than fat; in a swine the heels, cheeks, ears, and barren wombs; amongst pot-herbs endive, lettuce, parsnip, boiled gourd, skirret; of the apple kind, the cherry, mulberry, service fruit, mealy pears, such as are either those called crustumina[(53)] or næviana, also those called tarentina, or signina; the round apples, or scandiana, or amerina, or quinces, or pomegranates, wormwood[(54)], jar raisins, soft eggs, dates, pine-nuts, white olives preserved in strong brine or tinctured with vinegar, or the black kind, which have grown thoroughly ripe upon the tree, or been kept in passum or defrutum; austere wine, although it be grown rough, also resinated[(55)]; hard fish of the middle class, oysters, pectines[(56)], murex and purpura[(57)], periwinkles; food and drink either cold or hot.

CHAP. XXV. OF THINGS HURTFUL TO THE STOMACH.

The stomach is offended by every thing tepid, all salt provisions, all meat stewed into broth, every thing too sweet, all fat substances, gruel, leavened bread, and the same made either from millet or barley, oil, roots of pot-herbs, and whatever greens are eaten with oil or garum, honey, mulse, defrutum, passum, milk, all cheese, fresh grapes, figs both green and dry, all leguminous vegetables, and things, that usually prove flatulent; also thyme, catmint, savory, hyssop, cresses, dock, nipplewort, and walnuts. From this account it may be inferred, that it is no rule that what affords a good juice, agrees with the stomach; nor that what agrees with the stomach, is for that reason of good juice.

CHAP. XXVI. OF THOSE THINGS, WHICH OCCASION FLATULENCIES, AND THE CONTRARY.

Flatulencies are generated by almost all the leguminous vegetables, every thing fat, or over sweet, all stewed meat; must, and even any wine, that has not got age: amongst pot-herbs, garlick, onion, cabbage, and all roots (except skirret and parsnip) bulbusses, dry figs too, but more especially the green, fresh grapes, all nuts, except pine-nuts, milk, and all cheese, and lastly, whatever is too crude.

Little or no flatulency is occasioned by venison, wild fowl, fish, apples, olives, conchylia, eggs either soft or sorbile, old wine. But fennel and dill even relieve flatulencies.

CHAP. XXVII. OF THOSE THINGS WHICH HEAT AND COOL.

Heat is excited by pepper, salt, all flesh stewed into soup, garlick, onion, dry figs, salt fish, wine which is the more heating, the stronger it is.

Those greens are cooling, whose stalks are eaten without boiling, as endive, and lettuce: likewise coriander, cucumber, boiled gourd, bete, mulberries, cherries, austere apples, mealy pears, boiled flesh, and especially vinegar mixed either with meat or drink.

CHAP. XXVIII. OF WHAT IS EASILY CORRUPTED IN THE STOMACH, AND THE CONTRARY.

The following kinds easily corrupt in the stomach, leavened bread, and such as is made of any other grain than wheat, and all kinds of the sweet bread mentioned before[(58)], milk, honey, also sucking animals, and tender fish, oysters, greens, cheese both new and old, coarse or tender flesh, sweet wine, mulse, defrutum passum; lastly, whatever is either juicy, or too sweet, or over thin.

But unleavened bread, birds, especially the harder, hard fish, and not only the aurata for instance, or scarus[(59)], but even the lolligo, locusta, polypus, do not easily corrupt; also beef and all hard flesh: the same is preferable if it be lean, and salted; and all salt fish; periwinkles, the murex and purpura, austere wine, or resinated.

CHAP. XXIX. OF WHAT OPENS THE BELLY.

The belly is opened by leavened bread, and the more so if it be coarse, or made of barley; cabbage if it be not well boiled, lettuce, dill, cresses, basil, nettle, purslane, radishes, capers, garlick, onion, mallows, dock, bete, asparagus, gourd, cherries, mulberries, all mild apples, figs even dry, but more especially green, fresh grapes, fat small birds, periwinkles, salt fish and garum, oysters, pelorides[(60)], sea-urchins, muscles, and almost all shell fish, and chiefly the liquor of them, rock fish, and all tender fish, blood of the cuttle fish; and any fat meat, and the same stewed, or boiled; birds that swim; crude honey, milk, all sucking animals, mulse, sweet or salt wine, soft water[(61)], every thing tepid, sweet, fat, boiled, stewed, salt, or diluted.

CHAP. XXX. OF WHAT BINDS THE BELLY.

On the contrary the belly is bound by bread made of the siligo, or flour of wheat; especially if it be unleavened; and more so if it be also toasted: and this virtue is even increased, if it be twice baked: pulse made either from alica, or panick, or millet; also gruel prepared from the same; and more so, if these have been toasted first. Lentils with the addition of betes, or endive, or cichory, or plantain, and more so, if these have been toasted before: endive also by itself or cichory toasted, with plantain; small greens, cabbage twice boiled; hard eggs, and more so if roasted; small birds, black bird, ring-dove, especially boiled in vinegar and water, crane and all birds that run, more than they fly; hare, wild goat; the liver of those animals, that have suet, especially that of beef, and the suet itself; cheese, which is grown strong by age, or by that change, which we observe in the foreign kind; or if it be new, boiled with honey or mulse; also boiled honey, unripe pears, fruit of the service-tree, more especially those that they call torminalia[(62)], quinces and pomegranates, olives either white or early ripe, myrtle-berries, dates, the purpura and murex, wine either resinated or rough, and wine undiluted, vinegar, mulse, that has been boiled, also rough defrutum, passum, water either tepid or very cold, and hard, that is, such as keeps long without stinking, therefore particularly rain water, every thing hard, lean, austere, rough, and scorched, and the same flesh rather roasted, than boiled.

CHAP. XXXI. OF DIURETIC MEATS AND DRINKS.

The urine is promoted by whatever grows in the garden of a good smell, as smallage, rue, dill, basil, mint, hyssop, anise, coriander, cresses, rocket, fennel. Besides these, asparagus, caper, catmint, thyme, savory, nipplewort, parsnip, especially the wild kind, radish, skirret, onion; of venison principally the hare; small wine, pepper both round and long, mustard, wormwood, pine-nuts.

CHAP. XXXII. OF SOPORIFEROUS AND EXCITING THINGS.

Sleep is procured by the poppy, lettuce, especially the summer kind, when its stalk is replete with milk, mulberries, and leeks.

The senses are excited by catmint, thyme, savory, hyssop, particularly pennyroyal, rue and onion.

CHAP. XXXIII. OF THOSE THINGS, WHICH DRAW, REPEL, OR COOL, OR HEAT, OR HARDEN, OR SOFTEN.

Many things are powerful in drawing out matter: but as these consist principally of foreign medicines, and not so much adapted to the cases of those who are to be relieved by diet, I shall postpone the mention of them for the present: and shall only name those things, which are commonly at hand, and are fit for corroding, and thus extracting whatever is hurtful in those distempers, concerning which I am presently to treat. This virtue resides in the seeds of rocket, cresses, radish; but most of all mustard. The same power is also found in salt, and figs.

Sordid wool[(63)] dipt either in vinegar, or wine, with an addition of oil; bruised dates, bran boiled in salt water or vinegar, are all at the same time both restringent and emollient.

But the following things both restringe and cool, the wall herb (which they call parthenium or perdicium, feverfew) serpyllum, pennyroyal, basil, the blood herb (which the Greeks call polygonon[ AZ ],) purslane, poppy-leaves, and clippings of vines, coriander-leaves, henbane, moss, skirret, smallage, nightshade (which the Greeks call struchnos)[ BA ], cabbage-leaves, endive, plantain, fenel-seed, mashed pears or apples, chiefly quinces, lentils; cold water, especially rain water, wine, vinegar; and bread, or meal, or sponge, or pieces of cloth, or sordid wool, or even linen, moistened in any of these liquors; Cimolian chalk[(64)], tarras[(65)], oil of quinces[(66)], or myrtles[(67)], or of roses[(68)], bitter oil[(69)], leaves of vervains bruised with their tender stalks; of this kind are olive, cypress, myrtle, mastich-tree, tamarisk, privet, rose, bramble, laurel, ivy, pomegranate.

Boiled quinces, pomegranate bark, a hot decoction of vervains, which I mentioned before, powder from the lees of wine, or myrtle-leaves, bitter almonds, all restringe without cooling.

A cataplasm made from any meal is heating, whether it be of wheat, or of far[(70)], or barley, or bitter vetch, or darnel, or millet, or panick, or lentil, or beans, or lupines, or lint, or fenugreek; the meal after being boiled is laid on hot. But every kind of meal boiled in mulse is more effectual for this purpose, than the same prepared with water. Besides these, Cyprine oil[(71)], or iris[(72)], marrow, fat of a cat, mixed with oil, especially if it be old, salt, nitre[(73)], git, pepper, cinquefoil.

And we may observe in general, that those things, which both restringe violently and cool, are hardening: and those which heat and dissipate, are softening: but the most powerful cataplasm for softening is made from the seeds of lint or fenugreek.

Now physicians make use of all these things variously, both by themselves, and mixed; so that we rather see what each of them was strongly persuaded of, than what upon certain trial he found to be useful.

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A. CORNELIUS CELSUS

OF

MEDICINE.

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BOOK III.

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CHAP. I. GENERAL DIVISION OF DISTEMPERS.

Having already considered all that relates to distempers in general, I come to treat of the cure of each distinctly. Now the Greeks divided them into two kinds, the one they called acute, the other chronic. And because their process was not always the same, for this reason some ranged the same distempers among the acute, which others reckoned in the number of the chronic. From whence it is plain, that there are more kinds of them. For some are short and acute, which either carry off a person quickly, or are themselves soon terminated. Others are of long continuance, from which there is neither a speedy recovery, nor speedy death. And the third kind are those, which are sometimes acute, and sometimes chronic; and this happens not only in fevers, where it is most frequent; but also in other diseases. And besides these, there is a fourth kind; which can neither be called acute, because they are not mortal; nor yet chronic, because if remedies are used, they are easily cured. When I come to treat of each, I shall point out to what kind they belong.

Now I shall divide all of them into those, that seem to affect the whole body, and those, which occur in particular parts. After a few general observations upon them all, I shall begin with the first. Though there is no distemper in which fortune can pretend to more power than art, or art than nature; since medicine can do nothing in opposition to nature: yet a physician is more excusable for want of success in acute, than in chronic disorders. For in the first, there is but a small space, within which, if the remedies do not succeed, the patient dies: in the other case, there is time both for deliberation, and a change of medicines; so that very seldom, where a physician is called at its beginning, an obedient patient is lost without his fault. Nevertheless, a chronic distemper, when it is firmly rooted, becomes equally difficult with an acute one. And indeed the older an acute distemper is, so much the more easily it is cured; but a chronic one, the more recent it is.

There is another thing we ought not to be ignorant of; that the same remedies don’t agree with all patients. Whence it happens, that the greatest authors extol some one remedy, some another, each recommending his own as the only one, according as they had succeeded with themselves. It is fit therefore, when any thing does not answer, not to pay so much regard to the author of it, as to the patient, and to make trial of one thing after another. Remembering however, that in acute distempers, what does not relieve, must be quickly changed: in the chronic, which time both causes, and removes, whatever has not immediately done service, is not to be hastily condemned; much less must that be discontinued, which does but give a small relief, because its good effects are completed by time.

CHAP. II. GENERAL DIAGNOSTICS OF ACUTE AND CHRONIC, INCREASING AND DECLINING DISEASES; THE DIFFERENCE OF REGIMEN IN EACH; AND PRECAUTIONS NECESSARY UPON THE APPREHENSION OF AN APPROACHING ILLNESS.

It is easy to know in the beginning, whether a distemper be acute, or chronic: not in those only, that are always the same; but in those also, that vary. For when the paroxysms and violent pains without intermissions distress, the disease is acute. When the pains are gentle, or the fever slow, and there are considerable intervals betwixt the fits, and those symptoms accede, which have been explained in the preceding book, it is plain, that the distemper will be of long continuance.

It is necessary also to observe, whether the distemper increases, or is at a stand, or abates: because some remedies are proper for disorders increasing, more for those, that are upon the decline. And those, which are suitable to increasing disorders, when an acute distemper is gaining ground, ought rather to be tried in the remissions. Now a distemper increases, while the pains and paroxysms grow more severe; when the paroxysms return after a shorter interval, and last longer than the preceding did. And even in chronic disorders, that have not such marks, we may know them to be increasing, if sleep is uncertain, if concoction grows worse, if the intestinal excretion is more fetid, if the senses are more heavy, the understanding more slow, if cold or heat runs over the body, if the skin grows more pale. But the contrary symptoms to these are marks of its decrease.

Besides in acute distempers, the patient must not be allowed nourishment so soon, not till they be upon the decline; that fasting by a diminution of matter may break its violence; in chronic disorders, sooner, that he may be able to endure the continuance of the disease. But if the distemper happens not to be in the whole body, but only in a particular part, yet it is more necessary to support the strength of the whole body, than of the part; since by means of that strength the diseased parts may be cured. It also makes a great difference, whether a person has been properly or wrong treated from the beginning: because a method of cure is less successful, where it has been often applied unsuccessfully. If one has been injudiciously treated, but still possesses his natural strength, he is quickly restored by a proper management.

But since I began with those symptoms, which afford marks of an approaching illness, I shall commence the methods of cure from the same period. Wherefore if any of those things[(1)], which have been mentioned, happen, rest and abstinence are best of all: if any thing is drunk, it should be water; and sometimes it is sufficient to do that for one day; sometimes for two days, if the alarming symptoms continue; and immediately after fasting, very little food must be taken, water must be drunk; the day after, wine; then every other day by turns water and wine, till all cause of fear be removed. For by these means often a dangerous distemper impending is averted. And a great many are deceived, while they hope upon the first day immediately to remove a langour either by exercise, or bathing, or a gentle purge, or vomiting, or sweating, or drinking wine. Not but this may sometimes happen, or answer their expectations, but that it more frequently fails; and abstinence alone may cure without any danger. Especially as that may be regulated according to the degree of one’s apprehensions: and if the symptoms are slight, it is sufficient only to abstain from wine; a diminution of which assists more than lessening the quantity of food: if they are somewhat more dangerous, it may serve the turn not only to drink water (as in the first case), but to forbear flesh too: and sometimes to take less bread than ordinary, and confine one’s self to moist food, especially greens. And it may be sufficient then only to abstain entirely from food, wine and all motion, when violent symptoms give the alarm. And without doubt scarce any body will fall into a distemper, who does not neglect it, but takes care by these means to oppose its beginning in due time.

CHAP. III. OF THE SEVERAL KINDS OF FEVERS.

These are the rules to be observed by such as are in health, that are only apprehensive of the cause. We next proceed to the cure of fevers, which is a kind of disease, that affects the whole body, and is the most common of all. Of these one is a quotidian, another a tertian, and a third a quartan. Sometimes some fevers also return after a longer period, but that seldom occurs. With regard to the former, they are both diseases in themselves, and a cure for others.

But quartan fevers are more simple. They begin commonly with a shuddering; then a heat breaks out; after the paroxysm is over, the patient is well for two days. So that it returns upon the fourth day.

Of tertians again there are two kinds. One of them both beginning and ending like the quartan; with this difference only, that there is one day’s intermission, and it returns upon the third. The other kind is much more fatal, which indeed returns upon the third day, but of forty-eight hours, thirty-six are occupied by the fit (and sometimes either less or more,) nor does it entirely cease in the remission; but is only mitigated. This kind most physicians call semitertian[ BB ].

But quotidians are various, and different in their appearances. For some of them begin with a heat, others with a coldness, others with a shuddering. I call that a coldness, when the extremities of the limbs are chilled; a shuddering, when the whole body trembles. Again, some end, so as to be followed by an interval quite free from indisposition; others so, as that though the fever somewhat abates, yet some relicks remain, till another paroxysm comes on; and others often remit little or nothing, but continue as they began. Some again are attended with a very vehement heat, others more tolerable; some are equal every day, others unequal, and alternately milder one day and more severe another: some return at the same time the following day, others either later or sooner: some by the fit and the intermission take up a day and a night, some less, others more: some, when they go off, cause a sweat, others do not; and in some a sweat leaves the patient well, in others it only renders the body weaker: sometimes also one fit comes on each day, sometimes two or more. Whence it frequently happens, that every day there are several both paroxysms and remissions; yet so as that each of them answers to some preceding one. Sometimes too the fits are so irregular, that neither their durations nor intermissions can be observed. Nor is it true, which is alledged by some, that no fever is irregular, unless it arise from a vomica, or an inflammation, or an ulcer. For the cure would always be easier, if this were fact. For what is occasioned by the evident causes, may also proceed from the occult. Nor do those dispute about things, but words, who alledge, that when feverish paroxysms come on in different manners in the same distemper, these are not irregular returns of the fever, but new and different fevers successively arising. Which however would have no relation to the method of cure, though it were true. The intervals also are sometimes pretty long, at other times scarce perceptible.

CHAP. IV. OF THE DIFFERENT METHODS OF CURE.

This then is the general nature of fevers. But the methods of cure differ, according to their different authors. Asclepiades says, that it is the duty of a physician to effect the cure safely, speedily, and with ease to the patient. This is to be desired: but generally too great haste and too great indulgence both prove dangerous. What moderation must be used in order to obtain all these ends as far as possible, the principal regard being always had to the safety of the patient, will come into consideration, when we treat of the particulars of the cure.

And the first inquiry is, how the patient is to be treated in the beginning of the distemper. The ancients by the use of some medicines endeavoured to promote concoction; for this reason, that they were extremely afraid of crudity: next they discharged by frequent clysters that matter, which seemed to hurt. Asclepiades laying aside the use of medicines, ordered clysters not so frequently as they, but in almost every distemper. And he professed his principal cure for a fever was the disease itself. He thought also, that the strength of the patient was to be worn out by light, watching, and great thirst: insomuch that he would not even allow the mouth to be washed in the first days. So much are those mistaken, who imagine the whole of his regimen to be agreeable. For indeed in the advance of the distemper he even administered to the luxury of the patient; but at the beginning he acted the part of a tormentor.

Now I grant that medicinal potions and clysters, ought to be used but sparingly. And yet I do not think these are to be administered with a view to destroy the patient’s strength: because the greatest danger arises from weakness. Wherefore it is proper only to diminish the redundant matter; which is naturally dissipated, when there is no new accession to it. For this reason the patient must abstain from food in the beginning, and in the day-time be kept in the light, unless he be weak, because even that contributes to the discharge. And he ought to lye in a very large room.

As to thirst and sleep, the best mean is, that he be awake in the day-time, and rest in the night, if possible; and neither drink plentifully, nor be too much tormented with thirst. His mouth also may be washed, when it is both dry, and has a fetid taste; although such time is not seasonable for drinking. And Erasistratus very justly observed, that often the mouth and fauces require moisture, when there is no want of it in the internal parts; and that it is of no consequence, that the patient is uneasy. Such then ought to be the treatment at first.

Now the best medicine is food seasonably administered: when that must be given first, is a question. Most of the ancients were slow in giving it; often on the fifth or sixth day: and that perhaps the nature of the climate in Asia or in Egypt admits of. Asclepiades, after he had for three days fatigued the patient in every way, appointed the fourth for food. But Themison of late considered, not when the fever had begun, but when it had gone off, or at least was abated; and waiting for the third day from that time, if the fever had not returned, he gave food immediately; if it did come on, when it had ceased; or if it continued constantly, when at least it was mitigated.

Now none of these rules is always to be followed. For it may be proper to give food on the first day, it may on the second, it may on the third, it may not before the fourth or fifth; it may after one fit, it may after two, it may after several. For the qualities of the distemper, constitution, air, age, and season of the year make some difference. And no time can be universally fixed in things so widely different from each other. In a distemper that weakens more, food must be sooner allowed; also in an air that is more dissipating. Upon this account in Africa for no day it seems proper to prescribe fasting. It should be given also sooner to a boy, than a young man; more quickly in summer, than winter. This one thing must be practised always and every where, that a physician sitting by should now and then observe the strength of the patient, and as long as that continues, encounter the disease by abstinence; if he begins to apprehend weakness, support him by food. For it is his business to be careful neither to load the patient by superfluous matter, nor when he is weaker, to kill him by fasting. And this I find in Erasistratus, who though he did not direct, when the belly, when the body itself was to be evacuated, yet by saying that these were to be regarded, and that food was to be given, when the body stood in need of it, has plainly enough shewn, that it ought not to be given, while there w as a sufficient quantity of strength, and that care should be taken, that it was not too much exhausted.

From these things it may be inferred, that many people cannot be attended by one physician; and that the man to be trusted is he, that knows his profession, and is not much absent from the patient. But they, that practise only from views of gain, because their profits arise in proportion to the number of patients, readily fall in with such rules, as do not require close attendance; as in this very case. For it is easy even for such, as seldom see the patient, to count the days and the fits: but it is necessary for him to sit by his patient, who would form a true judgment what is alone fit to be done; when he will be too weak unless he get food. In most people however the fourth day is usually the most proper for beginning to give food.

But there is still another doubt about the days themselves, because the ancients chiefly regarded the odd days, and called them critical[ BC ], as if on these a judgment was to be formed concerning the patients. These days were the third, fifth, seventh, ninth, eleventh, fourteenth, and twenty-first; so that the greatest influence was attributed to the seventh, next to the fourteenth, and then to the twenty-first. And therefore with regard to the nourishment of the sick, they waited for the fits of the odd days: then afterwards they gave food, expecting the approaching fits to be easier; insomuch that Hippocrates, if the fever had ceased on any other day, used to be apprehensive of a relapse.

This Asclepiades justly rejected as idle, and said that no day was more or less dangerous to the patients, by its being either even or odd. For sometimes the even days are worse; and food is given more properly after the paroxysm of the fevers: sometimes also in the same distemper the quality of the days is changed: and that becomes more severe, which had used to be more mild: and the fourteenth day itself is even, upon which the ancients laid a great stress. And when they maintained, that the eighth was of the same nature with the first, because the second number of seven began from it, they were inconsistent with themselves in not taking the eighth, or tenth, or twelfth day, as the more important: for they attributed more to the ninth and eleventh. When they had done this without any plausible reason, they passed on from the eleventh, not to the thirteenth, but to the fourteenth. It is a remark of Hippocrates too, that the fourth day is worst to him, that is to be relieved on the seventh. So that even by his own account, upon an even day both the fever may be more violent, and a sure indication given of what is to follow. And the same author elsewhere takes every fourth day to have the strongest influence with regard to both events; that is the fourth, seventh, eleventh, fourteenth, seventeenth: in which he passes from the odd to the even reckoning. Neither in this indeed has he kept to his point: since the eleventh is not the fourth, but the fifth day after the seventh. Whence it appears, in whatever light we consider the number, no true reasoning can be found in his doctrine. But with regard to these the ancients were misled by the Pythagoric numbers at that time in great vogue: whereas here as well as in other cases a physician ought not to count the days, but to consider the paroxysms themselves; and upon them to found his conjecture when food is to be given.

But this is of more importance, to know whether the proper time for giving food be, when the tumultuous motion of the vessels has pretty much subsided, or while some relicks of the fever still remain. For the ancients prescribed nourishment, when the body was in the soundest state: Asclepiades, upon the decline of the fit, but before it was over; his reason for which was weak; not but that food is to be given sometimes more quickly, if another paroxysm is apprehended soon; but because certainly it ought not to be given, but when the body is in its best condition: for what is received by a body free from disorder is less liable to corruption. Neither is it true, which Themison imagined, if a patient was to be well for two hours, that it would be better to give it then, that it might be digested[(2)], while the body was in health. Indeed if it could be so speedily digested, that would be best. But as so short a time is not sufficient, it is better that the beginning of food should be upon the end of one paroxysm, than that any of it should lie in the stomach, when another begins. Thus if a pretty long interval is to follow, it is to be given, when the person is freest of all indisposition; if but a short one, before the patient be quite well. What has been said of the sound state during an intermission, holds likewise with respect to the greatest remission we find in a continued fever. But it is also a question, whether it is necessary to wait so many hours, as use to be taken up by the fit; or whether it is sufficient to pass over the first part of them, that those patients may be more easy, who sometimes have not a perfect intermission. But it is most safe to suffer the whole time of the fit to be over first: although when the paroxysm has been long, the patient may be indulged sooner; nevertheless so that at least the one half be suffered to elapse first. And this is not only to be observed in the kind last mentioned, but in all fevers.

CHAP. V. PARTICULAR DIRECTIONS FOR THE GIVING OF FOOD IN THE DIFFERENT SPECIES OF FEVERS.

These observations are of a more general nature belonging to all kinds of fevers: I shall now descend to the particular species of them. Wherefore if there has been only one fit, which has gone off, and that arose either from the inguen[(3)], or from fatigue, or from heat, or from some such accident, so that there is no reason to apprehend danger from any internal cause, the following day, when the time of the fit has passed without any disorder, food may be given. But if the heat come from within; and a heaviness of the head or præcordia has followed; and there is no apparent cause for the disturbance of the body; although health has followed one fit, yet because a tertian may be apprehended, the third day is to be expected; and when the time for the fit is over, food is to be given, but very little of it; because a quartan may also be feared. But upon the fourth day, if the body is well, it may be freely used. If indeed the paroxysm has followed upon the second, third, or fourth day, then we may conclude it to be a disease. But the method of cure in tertians and quartans (whose periods are certain, whose fits leave no indisposition, and the intervals are in a good measure calm) is easier: of which I shall speak in their proper place.

At present I shall treat of those, which distress every day. Wherefore it is most convenient to give food to the patient every third day; that the abstinence of one day may lessen the fever, on the other nourishment may recruit the strength. But when the fever is quotidian, and goes entirely off, it ought to be given as soon as the body becomes well. But if though there are not distinct fits immediately succeeding each other, yet there are feverish heats without intermission, and these daily increase without going entirely off, then it is to be allowed at that point of time, when a greater remission is not to be expected: if on one day the fit is more severe, and on another milder, after the most severe. Now commonly a more severe fit is followed by an easier night: whence it happens also, that a more troublesome night precedes a severer fit.

But if the fever is continued, and is never mitigated, and there is a necessity for giving food, the proper time for doing this is much disputed. Some, because patients are commonly easier in the morning, think that the opportunity. Which if it be so, is a proper time, not because it is the morning, but because the patients then have a remission. If even at that time the patient has no ease, since upon this very account that time is worse, that whereas from its own nature it ought to be better, from the force of the distemper it is not so; and likewise because the middle of the day follows, after which as almost every patient grows worse, there is room to fear, lest he be then more distressed, than he used to be: therefore, some give food to such a patient in the evening. But since at that time sick people are commonly worst, there is cause to be afraid, lest if we raise any commotion then, the disorder may be increased. For these reasons others defer it[(4)] till midnight, when the severest is just over, and while the same is at the greatest distance. It is more safely given before day-light, when most sick people get the quietest sleep; next to that in the morning, the time which is naturally the easiest of all.

But if the fits are irregular, because in such a case there is room to fear, that they may follow immediately after food; whenever a patient is relieved from the paroxysms he ought to eat. But if several paroxysms come on the same day, it is necessary to consider, whether these be in all respects equal (which can scarcely happen) or unequal. If they be in every point equal, food ought rather to be given after that fit, the end of which does not fall betwixt mid-day and the evening. If they are unequal, it must be considered what the difference is. For if one is more severe, and the other more mild, it ought to be given after the more severe fit: if the one is longer, and the other shorter, after the longer: if one is more severe, and the other of longer continuance, it must be examined, which of the two distresses most, the one by its violence, or the other by its continuance; and it must be given after the most weakening. But it is plainly the most important point of all, how great the remissions are, and of what nature, which happen between the fits. For if an uneasiness remains after one paroxysm, and the body feels no indisposition after the other; when the body is well, it is the fitter time for food.

If a feverishness always continues, but yet one remission is longer than the other, that is rather to be chosen: so that when the fits are continued, food may be administered immediately upon the decline of the first. For this is an universal rule, and may serve for directing all our measures in this article, to give food at the greatest distance always from a future fit; and with this caution to give it in the best state of the body. Which must be observed not only between two fits, but also amongst several. But whereas it is most generally proper to give food every third day, yet if the body is weak it must be given every day: and much more so, if the fevers are continued without any remission: and it is the more needful, the more they weaken the body; or if two or more fits attack on the same day. Which occurrence also requires the giving of food every day immediately from the first, if the pulse has presently sunk; and oftener on the same day, if in the midst of several fits the strength of the body now and then fails. Yet in these this observation must be regarded; that after such fits less food be given, where if the strength of the body would admit, none would be given at all. Now as a paroxysm must either be instantly expected, or beginning, or increasing, or at its height, or abating; and again in its abatement either at a stand, or entirely gone off; it is certain the best season for food is, when the fever is ended; next to that, when in its abatement it stops; thirdly, if there be a necessity, whenever it begins to abate: all other times are dangerous. But if upon account of weakness there is an absolute necessity for it, it is better to give somewhat, when its increase is at a stand, than while it still increases; better when it is instantly expected, than when it is beginning. Nevertheless no time is improper for supporting one, who faints for want.

Nor indeed is it sufficient for a physician to regard only the fevers, but also the state of the whole body, and direct his cure by that; whether the patient has a sufficient measure of strength or not, whether some troublesome passions affect the mind. And as the sick should always be in a state of tranquillity, that they be distressed in body only, and not in mind at the same time; so it is more especially necessary immediately after food; so that if there be any thing, which would render them uneasy, it is the best way, while they are sick, to conceal it from them; if that cannot be done, at least to forbear after food; and after their time of sleep, and when they have awaked, then to communicate it.

CHAP. VI. THE PROPER TIMES FOR GIVING DRINK TO PERSONS IN FEVERS, AND THE KINDS OF ALIMENT SUITED TO THE SEVERAL STAGES OF THE DISTEMPER, TOGETHER WITH SOME GENERAL OBSERVATIONS.

But patients are more easily managed with regard to food; because in spite of some inclination of their own, the stomach then refuses it. But in the article of drink the struggle is hard; and the more violent, the higher the fever is: for this inflames the thirst, and demands water most importunately, when it is most dangerous. But the patient is to be informed, that when the fever has abated, the thirst also will immediately decline; and that the paroxysm will be longer, if any nourishment be given to him: and that he that drinks none, is sooner freed from the thirst. However as even people in health can bear hunger a good deal easier than thirst, it is necessary to indulge the sick more with regard to drink than food. But on the first day no moisture ought to be given, unless the pulse has suddenly sunk so low, that there is a necessity for giving food also; but on the second and following days likewise, where food is not to be allowed, yet if the thirst be violent, drink may be given.

What was said by Heraclides of Tarentum is not altogether without reason; that when either bile or crudity make a patient uneasy; it is expedient by a moderate quantity of a drink to mix new matter with the corrupted. This rule ought carefully to be observed, that the same times be chosen for drink as for food: when it is to be given without the other, let it be at a time, when we would desire the patient to sleep, which commonly thirst prevents. It is generally allowed, that as too much moisture is hurtful to every person in a fever, it is especially so to such women, as have fallen into fevers after child-bearing.

But as the fever and the manner of its remission direct to the proper seasons for food and drink, so it is not very easy to know, when the patient has a fever upon him, when he is better, or when his strength fails; without which these cannot be properly administered. For we principally trust the pulse, a most fallacious mark; because this is often slower or more quick from the age, and sex, and difference of constitutions. And generally when the body is in good enough health, if the stomach be weak, sometimes also in the beginning of a fever, it rises and sinks; so that the person may seem to be weak, when he can very well stand a severe fit that is just approaching. On the other hand, the pulse is often raised, and the vessels relaxed by the influence of the sun, and the bath, and exercise, and fear, and anger, and any other passion of the mind. So that, when a physician first comes in, the anxiety of the patient, doubtful how he may think him, accelerates the pulse. For this reason it is the business of a skilful physician not to take hold of the patient’s arm with his hand, as soon as he comes in; but first to sit down with a cheerful countenance, and ask him how he does; and if he has any apprehension, to encourage him with plausible discourse: then to apply his hand to his wrist[(5)]. Now if the sight of the physician quickens the pulse, how easily may a thousand other accidents disorder it! Another mark, to which we trust, is heat, equally deceitful; for this is excited by warmth, labour, sleep, fear, and anxiety.

Wherefore it is fit to consider those things; but not to trust entirely to them. And we may at once assure ourselves that a person has no fever, whose pulse moves regularly, and who has such a heat as is common to people in health; and that a fever is not necessarily breeding, when there is heat and motion; but only with these circumstances, if the surface of the skin, be unequally dry; if there be a heat in the forehead, and at the same time arising from the internal part of the præcordia; if the breath rushes out of the nostrils very hot; if the colour be changed either for a redness or an unusual paleness; if the eyes are heavy, and either very dry or somewhat moist; if when a sweat comes on, it is partial; if the pulse does not beat at equal intervals. Upon this account the physician ought to sit down neither in the dark, nor at the patient’s head, but in a light place opposite to him, that he may take all the marks from the countenance of the patient as he lies.

Now where there has been a fever, and it has decreased, it is, proper to take notice, whether the temples or other parts of the body grow a little moist, so as to portend an approaching sweat. And if there is any prognostic of it, upon that to give warm water to drink, the effect of which is salutary, if it diffuse a sweat over the whole body. For this purpose the patient ought to keep his hands under a good quantity of clothes; and to cover his legs and feet in the same manner. By laying on such a load many people mismanage patients in the very height of the fever, and especially where it is of the ardent kind. If the body begins to sweat, it is necessary to warm a linen cloth, and slowly to wipe every part. But when the sweat is entirely off, or if it have not come on, when the patient is warmest, and seems fit for food, he is to be gently anointed under the clothes, then wiped, and after that food is to be given him.

Liquid food is most proper for persons in fevers, at least as near as possible to liquids, and that of the lightest kind, particularly gruel; and even this, if the fever be violent, ought to be very thin. Clarified honey also is properly added to it, that the body may be more nourished: but if that offends the stomach, it should be omitted; and so should the gruel itself in like case. Instead of it may be given either intrita,[(6)] mixed with hot water, or washed alica; if the stomach is firm, and the belly bound, with hydromel; or if the first is weak, and the other loose, with vinegar and water. And this kind of food is sufficient for the first day: but on the second day something may be added, yet of the same nature, either greens, or conchylia, or apples. And while fevers are increasing, this is the only proper food. But when they either go off, or abate, we must always begin with something of the lightest nature, and make an addition of the middle kind, having in the mean time a regard both to the strength of the patient, and of the disease.

To set a variety of food before a patient (as Asclepiades directs) is never proper, but when he is oppressed with a nausea, and his strength fails; that by tasting a little of each he may escape being famished. But if the patient wants neither strength nor appetite, he must be tempted by no variety; lest he take more than he is able to concoct. Neither is that true, which he alleges, that food of various kinds is more easily concocted; it is indeed taken in more easily; but to concoction the genus and quantity of the food are material. Neither is it safe during great pains, nor in an encreasing distemper, for a patient to fill himself with food; but when there is already a turn towards recovery.

There are also other observations necessary to be made in fevers: and that indeed must be considered, which some regard solely, whether the body be bound or loose: the one of which suffocates, and the other dissipates. For if it is bound, the belly must be opened by clysters, urine promoted, and a sweat sollicited by every method. In this kind of disorder it is serviceable even to let blood, to agitate the body by strong gestations, to keep the person in the light, to enjoin fasting, thirst, and watchfulness. It does good also to take the person into the bath, first to plunge him into the warm bath, then anoint him. Then he should return to the warm bath, and foment his groin plentifully with water; sometimes mix oil in the bath with warm water; take food more seldom, and at greater distances than ordinary, and such as is slight, simple, soft, warm, and small in quantity; especially greens, such as dock, nettles, mallows, or the broth of shell-fish, or muscles, or locustae; and eat no flesh, but what is boiled. But the quantity of drink ought to be more liberal, both before meat, and after it, and while eating too, beyond what thirst will require. And after the bath may be given even fat broth, or wine of the sweeter kind: during which course once or twice salt Greek wine may be used.

But on the contrary, if the body incline to discharge excessively, then sweat must be restrained, and rest enjoined; and the patient may have his room darkened, and go to sleep, whenever he shall chuse it; the body is not to be agitated, unless by a gentle gestation, and to be relieved according to the nature of its disorder. For if the belly is loose, or the stomach does not retain, when the fever has abated, it is proper to give warm water to drink plentifully, and make him vomit; unless there is a pain either in the fauces, or praecordia, or side, or the distemper be inveterate.

If again a sweat prevails, the skin must be hardened, either by nitre or salt, mixed with oil. But if that disorder is more slight, the body must be anointed with pure oil: if more violent, with oil of roses, or of quinces, or of myrtles, with an addition of austere wine.

Whoever is disordered by any discharge, upon coming to the bath, must first be anointed, and then go in. If the disorder is in the skin, it will be better for him to use cold water than warm. As to his meals, his food should be substantial, cold, dry, simple, and the least liable to corruption, toasted bread, roasted flesh, austere wine, or at least inclining to austerity; and if the belly is loose, let him drink it hot; if sweating be the disorder, or vomiting, it must be cold.

CHAP. VII. OF THE CURE OF PESTILENTIAL AND ARDENT FEVERS.

The case of pestilential fevers demands attention and a peculiar treatment. In this it is by no means good to try fasting, or medicines, or clysters. If the strength will admit, it is best to let blood; especially if the fever be attended with a burning heat. If that is not safe, when the fever is either abated, or less violent, to cleanse the breast by a vomit. But there is a necessity to order the bath sooner in this than in other distempers; to give wine strong and hot, and every thing glutinous; amongst which flesh of the same kind. For the more quickly that such constitutions of the air destroy, so much the sooner must remedies be laid hold of, even with a degree of rashness. But if he be a boy, that labours under it, and have not sufficient strength for bleeding, he must be cupped, and have a clyster either of water, or the cream of ptisan; then lastly he is to be nourished by light food. It is a general rule, that boys ought to be treated altogether in a different method from men. Wherefore in this, as well as in every other kind of distemper, greater caution must be used at that age in the following articles: not to bleed, not to give a clyster without necessity, nor to torment by watching, or fasting, or excessive thirst, nor to attempt the cure by wine. The patient must vomit after the fever: then the lightest kind of food is to be given; after that he is to sleep: the day following, if the fever continue, he must fast; on the third day return to the same diet. And we must endeavour, as much as possible in the midst of a seasonable abstinence to nourish him by food at proper times, laying aside every thing else.

Of an Ardent fever.

If an ardent fever is very violent, no medicinal potion is to be given; but during the paroxysms the patient must be cooled by water and oil: which are to be agitated together, till they grow white. He is also to be kept in a spacious room, where he can draw a great deal of pure air; and not be suffocated by many cloaths, but be covered very lightly. Vine leaves also dipped in cold water may be put upon his stomach. And he is not to be tormented with excessive thirst. He is to be allowed nourishment sooner; that is after the third day: and before meat he must be anointed all over with the above-mentioned liquor. If there is a collection of phlegm in his stomach, upon the decline of the paroxysm he must be forced to vomit; and then he must eat cold greens, or fruit of the apple kind, such as agrees with the stomach. If the stomach remains dry, there must be immediately given the cream either of ptisan, or alica, or rice, boiled with recent fat. When the distemper is at the height, but not before the fourth day, after a great thirst preceding, cold water is to be given copiously, that he may drink even beyond satiety; and when the belly and praecordia are filled above measure, and sufficiently cooled, he ought to vomit. Some indeed do not insist upon vomiting; but make use of cold water as a medicine, given only to satiety. After either of these methods he is to be well covered with cloaths, and laid so as to go to sleep. And commonly after long thirst and wakefulness, after being satiated with full draughts, after a remission of the heat, a sound and long sleep comes on; by means of which a great sweat breaks out, and that is a most immediate relief; but only in those, who have the burning heat, but no pains, nor tumour of the praecordia, and nothing to prevent it in the lungs, or fauces; or have had no ulcer, nor faintings, nor looseness of the belly. But if one in such a fever as this coughs gently[(7)], he ought neither to struggle with a violent thirst, nor drink cold water; but to be treated in the same manner, as is directed in other fevers.

CHAP. VIII. THE CURE OF A SEMITERTIAN.

But where there is that kind of tertian, which the physicians call semitertian, it requires careful observation to prevent being deceived. For it has generally more frequent paroxysms and intervals, so as it may seem a different kind of distemper; and the fit is protracted to twenty-four hours[(8)] and thirty-six: that what is really the same, does not seem to be so. And it is highly necessary both that food should not be given, unless in that remission, which is certain: and as soon as that comes, to give it immediately. And many patients die suddenly by the mistake of their doctor either way. And unless there is some important reason against it, blood ought to be let in the beginning; and then food should be given, such as will not raise the fever, and yet support under its long continuance.

CHAP. IX. THE CURE OF SLOW FEVERS.

Sometimes too we find slow fevers continuing without remission, and no room left either for food or any remedy. In this case it ought to be the care of the physician to change the distemper: for perhaps it may become more easy to cure. For this reason the body of the patient is often to be gently rubbed with cold water with oil infused, because sometimes it thus happens, that a shuddering arises, which may be some beginning of a new commotion; after that, when the body has grown hotter, a remission may follow too. In these cases friction with oil and salt seems to be a useful method.

But if coldness of the extremities, and numbness, and restless changes of postures continue long, it is not amiss, even during the fever, to give three or four cyathi of mulse, or well diluted wine together with food. For the fever is often encreased by it; and a greater heat arising at the same time both removes the former disorders, and affords hope of a remission, and from that of a cure.

And indeed the method of cure is not new, to make use of contrary medicines, by which at this time some recover patients committed to their charge, who were long under the care of more cautious physicians. For even amongst the ancients before Herophilus and Erasistratus, but after Hippocrates, was one Petron, who, as soon as he was called to a person in a fever, laid a great many cloaths upon him, that he might at once excite a great heat and thirst. After that, when the fever began to be a little abated, he gave cold water to drink; and if it once raised a sweat, he pronounced the patient to be out of danger: if it had not procured that discharge, he gave still more cold water, and then obliged him to vomit. If by either method he freed the person from the fever, he immediately gave him roast pork and wine. If it did not give way to these methods, he boiled water with salt, and obliged him to drink it, that by vomiting he might cleanse his belly[(9)].

And these particulars made up his whole practice. Which was not less acceptable to those, whom the successors of Hippocrates had not recovered, than it is to those in this age, who have been long unsuccessfully treated by the followers of Herophilus or Erasistratus. Nor is this kind of medicine upon this account not to be esteemed rash; because if it has been pursued from the beginning, it kills more, than it cures. But since the same things cannot agree with every body, those commonly, who are not restored by a rational method, are relieved by temerity; and for that reason physicians of that class manage another’s patients better than their own. But it is a practice not unbecoming even the man of circumspection, at times both to change a distemper, and to increase one, and to inflame fevers; because where the disorder, that is present, does not admit of a cure, another may, which is to succeed in its place.

CHAP. X. REMEDIES FOR THE CONCOMITANT SYMPTOMS OF FEVERS.

It is necessary also to consider, whether fevers are simple, or whether other disorders are not likewise concomitant; that is, whether the head be pained, the tongue rough, or the præcordia tense. If there be pains in the head, it is proper to mix oil of roses with vinegar, and to apply that[(10)]; then to have two pieces of cloth, which are as broad and as long as the forehead; to have one of these alternately in the vinegar and rose-oil, and the other on the forehead; or to put on sordid wool dipped in the same. If vinegar is offensive, pure oil of roses must be used. If even the rose-oil is offensive, bitter oil. If these do little service, dry iris, or bitter almonds, or any of the cooling herbs may be powdered. Any of them mixed with vinegar and laid upon the part lessens the pain: but in some one of these is more successful, and in others another. Relief is also procured by bread laid on with poppies, or with oil of roses, cerus, or litharge. It is also not improper to smell at either serpyllum or dill.

But if there is an inflammation and pain in the præcordia, in the first place restringent cataplasms must be applied; and not the hotter kind, lest there should be a greater flux of matter thither. After that, as soon as the inflammation has abated, recourse must be had to hot and moist, in order to discuss what remains. Now the marks of inflammation are four, redness, and swelling, together with heat, and pain. So much was Erasistratus mistaken, when he declared there was no fever without it.

Wherefore if there is pain without inflammation, nothing is to be applied at all; for the fever itself will presently remove that. But if there is neither an inflammation, nor fever, but only a pain of the præcordia, warm and dry fomentations may be immediately used. If the tongue is dry and scabrous, it is first to be wiped with a penecillum dipped in hot water; and then anointed with a mixture of rose-oil and honey. The honey cleanses, and the oil of roses restringes, and at the same time does not suffer it to grow dry. But if it is not rough, but only dry, after wiping it with the penecillum it ought to be anointed with rose-oil mixed with a little wax.

CHAP. XI. REMEDIES AGAINST A COLDNESS OF THE EXTREMITIES PRECEDING A FEVER.

It is common also for a coldness to precede fevers, which of itself is a very troublesome kind of disorder. When it is expected, the patient must be forbid all drink: for giving this a little before much increases the malady. He is also to be timely covered with many cloaths. Dry and hot fomentations are to be used to those parts, for which we are apprehensive; in such a manner that the most violent heat may not begin immediately, but increase gradually. And those parts are to be rubbed with the hands anointed with old oil, and some of the warming medicines may be added to it. And some physicians are content with one friction with any kind of oil. In the remissions of such fevers some give three or four cyathi of gruel, while the fever still continues; and then, when it is quite over, refresh the stomach with cold and light food. I think this ought to be then tried, when food once given, and that after the fever, does little service.

But great care must be taken, that we be not deceived as to the time of the remission; for even in this kind of distemper, often the fever seems to abate, and again increases. Wherefore we must trust no remission, but that, which both continues, and lessens the restlessness, and excessive heat of the body, which the Greeks call[(11)] zesis[ BD ]. This is a rule generally received, if every day the fits are equal, to give a little food every day: if unequal, food must be given after the most severe; after the milder hydromel.

CHAP. XII. THE CURE OF A SHUDDERING BEFORE FEVERS.

A shuddering commonly precedes those fevers, that have a certain period, and a perfect remission, and for this reason are the most safe, and most easily admit of a cure: for where the periods are uncertain, neither clysters, nor the bath, nor wine, nor any other remedy can be duly administered. For it is uncertain when the fit will come: so that if it come on suddenly, the greatest detriment may happen to accrue from that, which was intended to give relief. And nothing else can be done, than that the patient practise a strict abstinence in the first days of the disease: then upon the decline of that fit, which is most severe, let him take food.

But where the period is certain, all these things are more easily tried; because we can more readily inform ourselves of the succession both of the fits and the intervals. Now in this kind, when they are of long standing, fasting is not good: in the first days only we are to make use of it to oppose the distemper; after that the cure is to be divided, and first the shuddering, then the fever is to be removed. Wherefore as soon as a person has shuddered, and after the shuddering has grown hot, it is fit to give him warm water to drink a little salt, and force him to vomit: for generally such a shuddering arises from something bilious oppressing the stomach. The same method is to be pursued, if at the next period also it has again appeared: for thus it is often removed. And by this time one may find out the species of the fever.

Wherefore when the third fit is expected, which may possibly come on, the patient must be brought to the bagnio, and care must be taken that he be in the bath at the time of shuddering. If he have felt it there also, let him do the same nevertheless, when the fourth fit is expected: for by this repetition it is often removed. If the bath proves unsuccessful, before the fit let him eat garlick, or drink hot water with pepper: for these too raise a heat, which repels the shuddering. After that, before the shuddering has time to come on, let him cover himself up in the manner above directed under the article of coldness: and it is proper immediately to apply all round his body pretty hot fomentations, and chiefly extinguished tiles, and coals wrapped up in cloths.

If notwithstanding the shuddering has broke out, he must be anointed within the cloaths plentifully with hot oil; to which also may be added some of the warming substances: and friction may be used, to as great a degree as he is able to bear, and especially in his hands and feet, and let him hold in his breath. And it must not be given over, although the shuddering do return: for often the perseverance of the physician overcomes the distemper of the body.

If he has vomited, warm water must be given, and he obliged to vomit again; and the same methods must be repeated, till the shuddering is removed. But beside these a clyster must be given, if the shuddering gives way slowly: for that has a good effect by exonerating the body. The last remedies after these are gestation and walking. Now in distempers of this kind, the fittest food is such as may prove laxative, and glutinous flesh. When wine is given, let it be austere.

CHAP. XIII. THE CURE OF A QUOTIDIAN FEVER,

Now these observations relate to the periodical returns of all fevers: but the several species of them are to be distinctly treated, according to their different natures. If it be a quotidian, for the first three days by all means abstinence should be observed; then food be taken every other day. If the distemper has become inveterate, after the fit it is proper to try the bath and wine, especially if, when the shuddering is removed, the fever remains.

CHAP. XIV. THE CURE OF A TERTIAN FEVER.

But if the fever be either a tertian, which has a perfect intermission, or a quartan, on the intermediate days, it is proper to walk, and make use of other exercises and unctions. Cleophantus, one of the more ancient physicians, in these distempers used to pour a great quantity of hot water upon the head of the patient long before the fit, and then to give him wine. Yet Asclepiades, though he adopted most of his precepts, has justly omitted this: for it is of doubtful effect.

When there is a tertian fever, he says it is proper to administer a clyster the third day after the fit; on the fifth, after the shuddering to procure a vomiting; then after the fever, according to Cleophantus’s practice, to give the patients food and wine, while they are yet hot; on the sixth day to keep them in bed: for thus it will happen, that the fit will not return on the seventh day. That this may often answer is very probable. Yet it is safer in this order to make trial of these three remedies, vomiting, purging by clysters, and drinking of wine, for three days, that is, on the third, and fifth, and seventh; and not to drink wine, till after the fit upon the seventh day.

But if the distemper is not removed in these first days, and it grows inveterate, on the day the fit is expected, let the patient keep his bed; after the fit be rubbed; and after eating let him drink water: the day following, when he takes no food, let him intermit his exercise and unction, and rest content with water alone. And this indeed is best. But if his weakness bear hard upon him, he ought both to take wine after the fit, and a little food on the intermediate day.

CHAP. XV. THE CURE OF A QUARTAN FEVER.

The same method is to be followed in a quartan. But since this is very slowly terminated, unless it have been removed in the beginning, greater accuracy must be observed in prescribing from its first appearance, what ought to be done it. Wherefore if a person is attacked with a fever and shuddering, and it has gone off, all that day and the following, and the third, he ought to confine himself to a stricter regimen, and on the first day drink only warm water after the fever; the two following days to abstain from that as much as possible; on the fourth day, if the fever returns with the shuddering, to vomit, as has been directed before; then after the fit, to eat sparingly, and drink a quadrans of wine; the day after that, and the third to abstain; taking only warm water if he be thirsty. On the seventh day he should prevent the coldness, by going into the bath before its time, fast and observe the former regimen strictly[(12)]; if the fever has returned, have a clyster: when the body has rested after that, he should be anointed and brushed briskly; take food and wine in the same way, and for the two following fast, not neglecting the friction. On the tenth day he must try the bath again; and if the fit has come on after, brush in the same manner, and drink wine more plentifully. And thus the consequence is, that a rest of so many days, and abstinence, with the practice of the other injunctions, may remove the fever.

If notwithstanding these it continues, another method of cure entirely different is to be pursued; and all our measures must be directed to this point, that the body may easily bear what is to be long endured. For this reason the practice of Heraclides of Tarentum ought to be less approved, who prescribed clysters in the beginning, after that fasting to the seventh day. Which course though a person should be able to undergo, yet when he is even freed of the fever, he will scarcely have strength to recruit; and so if the fever frequently returns, he must sink under it. Wherefore if the distemper shall continue upon the thirteenth day, the bath must neither be tried before the fever nor after it, unless sometimes when the shuddering is already removed. Now the shuddering is to be repelled by the same means, as have been directed before. Then after the fever it is proper to be anointed, and rubbed briskly; to eat heartily of substantial food; to take as much wine as he inclines; the day following, when he has rested sufficiently, to walk, take exercise, be anointed, and stoutly brushed; to take food without wine; on the third day to abstain.

On the day that he shall expect the return of the fever, it is proper for him to rise before its hour, and exercise himself, and to endeavour to have its time coinciding with his exercise: for thus it is often dispelled. But if it has seized him in the midst of his exercise, in that case to give over. In a disorder of this kind the remedies are unction, friction, exercise, food and wine. If the belly is bound, it must be opened.

Now these things are easily performed by the more robust; but if the patient be grown weak, gestation must stand instead of exercise. If he cannot even bear this, yet friction must be used. If this also when vehement distresses him, the cure must be confined to rest, unction, and diet: and care must be taken, lest any crudity change the distemper into a quotidian. For a quartan kills no body: but if it be changed into a quotidian, the patient is in a bad way: which however never happens, unless by the fault either of the patient or the physician.

CHAP. XVI. THE CURE OF A DOUBLE QUARTAN.

But if there are two quartans, and those exercises, which I have prescribed cannot be used, there is a necessity either entirely to rest, or if that is difficult, to walk gently, then sit down, with the feet and head carefully wrapped up; as often as the fit has come on, and gone off, to eat sparingly, and drink a little wine; at other times, unless the weakness be very great, to abstain. But if there is hardly any intermission between two fits, to take food after both are over: then in the interval both to move a little, and after unction to eat. Now since an inveterate quartan is very seldom cured unless in the spring, in that season especially attention must be given, that nothing be done, which may obstruct the recovery of health. And it is of service in an old quartan to alter now and then the manner of living, to change from wine to water, from water to wine, from mild food to such as is acrid, and on the contrary; to eat radish, then vomit, or open the belly by chicken broth; to add warming medicines to the oil for friction; before the fit to take two cyathi of vinegar, or one of mustard, with three of Greek salt wine; or pepper, castor, laser[(13)], and myrrh, mixed in equal proportions, and diluted with water; for by these, and such like the body must be agitated, that so a change may be made from its present state.

If the fever has disappeared, it is proper to be long mindful of its periodical day; and on that day to guard against cold, heat, crudity, and fatigue: for it easily returns, unless it be feared for some time after the recovery of health.

CHAP. XVII. THE CURE OF A QUOTIDIAN ARISING FROM A QUARTAN.

But if a quotidian is formed from a quartan, when that has happened in the beginning[(14)], it is proper to abstain for two days; in the evening to make use of friction, and give only water to drink. On the third day it often happens, that the fit does not come. But whether it has appeared or not, food must be given after the time for the fit: and if it continue, the strictest abstinence possible must be enjoined for two days, and friction used every day.

CHAP. XVIII. OF THE SEVERAL KINDS OF MADNESS AND THEIR CURE.

I have now gone through the treatment of fevers. There remain other disorders of the body, which come on after them: some of which, that cannot be assigned[(15)] to any certain part, I shall immediately subjoin. I shall begin with madness, and treat of the first kind of it, which is both acute, and happens in a fever; the Greeks call it phrenitis[ BE ].

First of all it is necessary to know, that sick people sometimes in a febrile paroxysm lose their judgment, and talk incoherently. Which, though it be not trifling, and cannot happen unless in a violent fever, yet is not equally dangerous; for it is commonly of short continuance: and when the violence of the fit is abated, the judgment presently returns. Nor does this kind of distemper require any other remedy, than what has been already directed for curing a fever.

It becomes then a phrenitis, when the delirium begins to continue without interruption; or when the patient, though he still have his reason, yet forms to himself some vain images: it is perfect, when the mind gives itself up to these images. Now there are several kinds of it: for amongst phrenitic people some are merry, others sad; some are more easily commanded, and their disorder goes no farther than words; others grow outrageous, and do acts of violence; and of these last again some only employ force, others even make use of cunning, and present a specious appearance of judgment, while they are catching at opportunities of doing mischief; but they are discovered by the issue.

Such of them as only rattle, or do no harm but in trifles, it is needless to load with severe restraints. Those, who are more violent in their actions, it is proper to bind, lest they should hurt either themselves or any other person. Nor should we trust any of them, if in order to get rid of his chains he pretends to be well, though he speak sensibly, and make lamentable complaints; because this is nothing else but the cunning of a mad person.

Generally the ancients kept such patients in the dark; for this reason, that it hurts them to be terrified: and they judged, that darkness of itself contributed something to the quiet of the mind. But Asclepiades, alleging that darkness itself strikes terror, ordered them to be kept in the light. But neither of these holds always. For one person is more disturbed by the light, and another by darkness: and some are to be met with, in whom no difference can be found either the one way or the other. Therefore it is best to try both methods; and to keep him, that has a horror at darkness, in the light; and him, that is afraid of light, in darkness. But where there is no such difference, if the patient have strength, he must be confined in a light place; if not, in a dark one.

To make use of remedies in the greatest violence of the phrenzy is needless: for at the same time the fever also increases. Wherefore nothing is to be done then, besides confining the patient. But when the circumstances allow, speedy help must be administered. Asclepiades asserted, that to bleed such was just the same as to murder them: upon this principle, that there was no madness, but when the fever was very high; and that bleeding could not be properly performed, unless in its remission. He himself endeavoured to procure sleep in such cases by much friction. But since both the violence of the fever prevents sleep, and friction is not useful unless in its remission, he ought to have omitted this remedy too. What then is to be said to this case? Many things are properly done in imminent danger, which should not be practised on any other occasion. And even a continued fever has times, in which, though it does not remit, nevertheless it does not increase. And this though not the best, yet is a pretty favourable season for the application of remedies. And if the strength of the patient admits of it, he may also lose blood.

There may be the same reason[(16)] for doubting whether a clyster should be administered. Then after the interval of a day, it is fit to clip the hair of the head close to the skin; then to foment it with a decoction of some of the restringent herbs; or to foment it first, after that clip, and foment it again; and lastly to embrocate the head and nostrils with oil of roses; to hold also to the nostrils rue bruised with vinegar, and to provoke sneezing by medicines efficacious for that purpose. These things however are to be done only to persons, who don’t want strength. If there be a weakness, the head is only to be moistened with oil of roses, adding to it serpyllum or something of the like nature. Also whatever be the degree of strength, two herbs are useful, nightshade and the wall-herb, if the head be bathed with the expressed juice of them both. When the fever has remitted, friction must be used; but more sparingly in those, that are too merry, than in those, that are too sad.

It is necessary to apply to the minds of people thus mad in a manner suitable to the temper of each. For the groundless apprehensions of some are to be alleviated: as was done to a very rich man in fear of starving, whom they relieved by frequent accounts of estates bequeathed to him. The audaciousness of others must be restrained, as is practised in the case of those, who require even stripes to keep them under government. The unseasonable laughter of some must be checked by chiding and threats. The sorrowful thoughts of others must be dispelled: for which purpose concerts of music, and cymbals and noise are useful. Yet these patients must be oftener humoured than contradicted: and the mind is to be led by slow degrees, and not evidently, from their irrational assertions to better notions. Sometimes also the attention of the person must be strongly engaged; a method taken with studious men, to whom a book is read, either with propriety of accent, if they be pleased with it, or with an improper tone of voice, if that offends them: for by correcting they begin to give their attention. Moreover they must be obliged to repeat any thing they may remember. Some also have brought those to eat, that had no inclination for it, by placing them in the midst of people at a feast.

To every body thus affected, sleep is both hard to be obtained, and highly necessary; for by this most of them recover. For this purpose, and at the same time for composing the mind, the ointment of saffron[(17)] with that of iris rubbed upon the head is useful. If notwithstanding they continue wakeful, some endeavour to procure them sleep by giving them to drink a decoction of poppies or henbane; others put mandrake apples under their pillow: others apply to their forehead either amomum or sycamine tear. This name I find among the physicians. But why do the Greeks call the mulberry-tree sycaminus[ BF ], when there is no tear of the mulberry-tree? But this name they give to the tear of a tree growing in Egypt, which they call sycomorum[ BG ]. Many physicians now and then foment the face and head with a sponge dipt in a decoction of poppy-heads.

Asclepiades affirmed these things to be hurtful: because they often change the distemper into a lethargy. His advice is, that the first day the patient should abstain from meat, drink, and sleep; on the evening water should be given him to drink; then friction should be used so gentle, that even the hand that rubbed, should not press strongly; the day after, all these things being repeated, on the evening gruel and water should be allowed him, and the friction again repeated: for by this we would procure sleep. This sometimes happens; insomuch that by his own confession, too much friction may even endanger a lethargy. But if by these means sleep is not obtained, then at last it must be procured by the medicines above-mentioned: still with the same moderation, which is also necessary in this case; lest it be not in our power afterwards to wake the person, whom we desire to sleep. A fall of water near is also some help to sleep; or gestation after meat, and in the night time; especially the motion of a suspended bed.

Nor is it improper, if bleeding has not gone before, and the understanding be still disturbed, and there be no sleep, to make an incision in the occiput, and apply a cucurbital: because this, by lessening the distemper, may bring on sleep. Moderation must also be used as to his diet: for the patient must neither be full-fed, lest he grow outrageous, nor must he be tormented with hunger, lest from his weakness he fall into a cardiac disorder. He must use weak food, and especially gruel, and drink hydromel, three cyathi of which are sufficient in winter, and four in summer.

There is another kind of madness, which continues a longer time; because generally it begins without a fever, afterwards excites slight feverish fits; and goes no farther than a sadness, which seems to proceed from atrabilis. In this bleeding is useful. If there be any reason against that, the first remedy is abstinence; the second to purge by white hellebore and vomiting: after either of these friction is to be used twice a day; if the patient be pretty strong, frequent exercise too, a vomit fasting, food of the middle kind is to be given without wine. As often as I mention this kind of food, I would be understood, that it may be given even of the weakest, provided one be not confined to that alone: that only the strongest is to be refrained. Besides, the belly is to be kept as soft as possible: terrors are to be dispersed, and rather good hopes are to be given. Entertainment must be sought in amusing stories and diversions, such as the person in health used to be most pleased with. If there are any works of his performing, they must be commended, and placed before his eyes. His groundless sorrow is to be mildly reprimanded. Arguments must be offered now and then to persuade him, that in those very things, which disturb him, there is more matter for joy than anxiety. If a fever has also come on, it must be cured in the same manner as other fevers.

The third kind of madness is the longest of all; insomuch that it does not shorten life. Which kind is most incident to people of strong constitutions. Now there are two species of this: for in some the deception arises from false images, not from the understanding: such a madness the fables of the poets represent that of Ajax, or Orestes[(18)]: others are disordered in their judgment. If imaginations mislead, first of all it must be observed, whether they be melancholy or merry. If melancholy, black hellebore ought to be given as a purge; in the merry kind, the white as an emetic. And if the patient will not take it in a potion, it must be added to bread, that it may the more easily deceive. For if he be thoroughly purged, it will in a great measure lessen the distemper. And therefore if hellebore once given has done little service, after a proper interval it ought to be repeated. And it should be known that this distemper is more mild, when attended with laughter, than with gravity. And this rule also is universal in all diseases, when any person is to be purged in the inferior parts[(19)], that the belly be first opened; when the superior parts, it must be bound.

But if the madness affect the judgment, the patient is best treated by some kind of tortures. When he has said or done any thing wrong, he is to be punished by hunger, chains, and stripes: he must be forced both to attend and get something by heart, and retain it in his memory. For thus it will happen, that gradually by fear he may be obliged to consider, what he does. It is also serviceable in this disorder to be put into sudden consternation and fear; and the same tendency commonly has every thing, that disturbs the mind greatly; for some change may be brought about, when the mind is withdrawn from that state, in which it was before. It likewise makes a difference, whether the patient laugh now and then without cause, or be sorrowful and dejected. For the merriment of a mad person is better cured by those terrours, which I mentioned above. If sadness be his extreme, gentle, but long friction twice a day is useful; also pouring of cold water upon the head, and dipping the body in water and oil.

The following are general rules: that mad people ought to be strongly exercised; to make much use of friction; to take neither fat flesh nor wine; to take food, after purging, of the middle kind, and as light as possible; that they should neither be alone, nor amongst strangers, nor those which they either despise, or look upon with indifference: they ought to go into other countries, and, if their judgement returns, to take a journey into distant parts once a year.

Sometimes, though seldom, a delirium arises from fear; which kind of madness is of a similar species, and is to be cured by a like diet: except that in this kind of madness alone wine is properly given.

CHAP. XIX. OF THE CARDIAC DISORDER AND ITS CURE.

That kind of distemper, which by the Greeks is called cardiacus[ BH ], is directly contrary to the last mentioned; although phrenitic people often fall into it: for the mind in that is disordered, in this it is sound. This is nothing else but an excessive weakness of the body; which from a languishing stomach is dissipated by immoderate sweating. And one may immediately know that this is the disease, when the pulsations of the arteries are small and weak, and sweat uncommon both in degree and continuance, breaks out from the whole breast, and neck, and even from the head, the feet only and legs being more dry and cold. This distemper is of the acute kind.

The first step in the cure is to apply restringent cataplasms to the præcordia; the second to restrain the sweat. That is accomplished by bitter oil, or that of roses, or quinces, or myrtles. With any of these the body is to be gently anointed; and then a cerate of some one of them is to be applied.

If the sweat nevertheless prevails, the person is to be rubbed over with gypsum, or litharge, or Cimolian chalk, or to be sprinkled now and then with the powder of these. The same purpose is answered by the powder of dry myrtle or bramble-leaves, or the dried lees of austere and strong wine. And there are a great many more things of the same nature, which if they cannot be had, sprinkling of common dust will have a good effect. And besides these, that the body may sweat less, the person ought to be covered with a light garment, and set in a place not hot, with the windows open, so that he may be even sensible of the stream of air.

The third remedy is to succour the weakness of the patient by eating and wine. Food is not to be given in great quantity indeed, but often, both in the night and day; so as it may nourish, and not load. It ought to be of the weakest kind, and agreeable to the stomach: and unless there be a necessity, we ought not to be in haste to give wine. If there is reason to fear the person is fainting, then both intrita with wine, and wine itself, austere but small, and somewhat diluted, with the cold taken off it, may be given pretty frequently and freely; with the addition of polenta[(20)], provided the patient takes little food. And the wine ought to be neither very weak nor very strong: and the patient in a day and a night may very well drink two or three heminæ; if it be a person of a large make, even more: if he has no appetite for food, it is fit first to anoint him, then to pour cold water all over him, and then give it him.

But if his stomach be so relaxed, that it hardly retains, both before meat and after it, he ought to vomit spontaneously[(21)]; and again after vomiting to take food. If even that do not stay, to sup a cyathus of wine, and at the distance of an hour to eat again. If the stomach return that too, the whole body must be rubbed over with bruised bulbous roots[(22)]: when these have grown dry, the effect is, that the wine may be retained in the stomach, and from that, the heat may return to the whole body, and the tone of the vessels be restored.

The last remedy is to inject by way of clyster[(23)] the cream either of ptisan or alica, for that also will support the strength. Nor is it amiss to hold something refreshing, such as rose oil and wine, to the nose of the person, when he is restless and hot: and if there is any coldness in the extremities, to cherish them with hands anointed and warm. By which means if we have been able to gain these points, that the violence of the sweat abates, and life is prolonged, time itself now begins to work a cure. When he seems to be out of danger, yet we must be cautious, that he do not relapse quickly into the same weakness. Therefore omitting only the wine, he ought every day to take more substantial food, till his body recover sufficient strength.

CHAP. XX. OF THE LETHARGY, AND ITS CURE.

There is also another distemper, which in a different way is opposite to the phrenitic one. In phrensies sleep is hardly obtained, there is a disposition to fool-hardy enterprises: in this there is a languor, and an almost invincible necessity of sleeping. The Greeks call it lethargus[ BI ]. This too is of the acute kind, and unless it is cured, kills quickly.

Therefore some endeavour to rouse such patients by holding to their nose those things, which provoke sneezings, and such as excite by their offensive smell; for instance, burnt pitch, sordid wool, pepper, hellebore, castor, vinegar, garlick, onion. They also burn galbanum by them, or hartshorn; if this is not to be got, any other horn; for when these are burnt, they stimulate by their offensive smell.

But a certain author, Tharrias, affirmed, that this disposition to sleep is concomitant upon a febrile paroxysm, and that it abates, when the latter is gone off: and therefore that such practitioners, as rouse them frequently, give them unnecessary pain. Now it makes a considerable difference whether the patient awakes upon the termination of the fit, or whether the weight of sleep oppresses him, when the fever is abating, or even after its going off. For if he awakes, it is needless to treat him as one asleep: for he is not made better by being awake; but if he be better, he will keep awake of himself. If his sleep is continual, he must in such a case be roused; but at those times, when the fever is lowest, that he may discharge somewhat, and take food. Cold water suddenly poured on excites more powerfully than any thing. After the remission therefore the whole body must be anointed over with a great quantity of oil, and three or four amphorae of water must be poured upon the head, so as to stream over all the body. But this we shall make use of, if the patient’s breathing be equal, if the præcordia be soft. But if the case shall be different, the other remedies are preferable, which were mentioned before. And as to the sleep, this method is the most suitable.

With regard to the cure of the distemper, the head must be shaved; then fomented with a decoction of bay-leaves, or of rue in vinegar and water. And the day after, castor must be applied, or rue bruised with vinegar, or bay-berries, or ivy with rose-oil and vinegar. And mustard is of singular use, both held to the nostrils in rouzing the patient, and if applied to the top of the head or forehead, in removing the distemper itself. Gestation is also useful in this distemper, and especially food seasonably given, that is, in the greatest remission, that can be found. Now gruel is most proper till the distemper begins to decline. And if every day there is a severe fit, this may be given daily: if every other day, gruel after the most severe; after the milder hydromel. Wine also given with seasonable food is of no small use.

But if such a torpor has come after long fevers, all the other rules are to be observed: but three or four hours before the fit, if the belly be bound, castor with a mixture of scammony must be given; if that is not the case, castor alone must be given with water. If the præcordia are soft, the diet must be pretty full; if hard, we must keep to the gruels above-mentioned; something being applied to the præcordia, which can at once repel and soften.

CHAP. XXI. OF THE SEVERAL SPECIES OF THE DROPSY AND THEIR CURE.

The foregoing is an acute distemper; but the case of those, who are troubled with water under the skin, may turn to a chronical disease: for unless it is speedily cured, such patients fall into what the Greeks call hydrops[ BJ ] (dropsy). There are three species of it; for at times the belly is very tense, and there is a frequent rumbling within from the motion of the air: sometimes the surface of the body is unequal, with tumours of different sizes rising over the whole: sometimes water is confined within the abdomen, and upon the body’s being moved, it moves in such a manner, that the course of it may be seen. The first the Greeks call tympanites[ BK ]; the second leucophlegmatia, or hyposarca[ BL ]; the third ascites[ BM ]. An excess of moisture however is common to them all: for which reason ulcers in such patients are not easily healed. This disease often begins of itself; and often succeeds another distemper of long standing, and especially a quartan.

It is more easily cured in slaves, than in free people; because as it requires fasting, enduring of thirst, and a thousand other hardships, and long patience, such are more readily relieved, that are easily commanded, than those, whose liberty is hurtful to them. But even those, that are under the authority of another, if they cannot entirely command themselves, are not to be recovered. And upon this account no inconsiderable physician, a disciple of Chrysippus, residing with king Antigonus, declared that a certain friend of that prince, of known intemperance, though not very ill of this disease, could not possibly be cured: and when another physician, Philip of Epirus, undertook to cure him, he answered, that the other considered only the distemper of the patient; he, his dispositions. And he was not deceived; for though he was watched with the greatest diligence not only by the physician, but even by the king too, yet by devouring his malagmas[(24)], and drinking his own urine, he quickly killed himself.

However at the beginning the cure is not very difficult, if rest, thirst, and fasting be strictly enjoined. But if the disease has continued long, it is not removed without great trouble. Yet they tell us, that Metrodorus, a disciple of Epicurus, when he was afflicted with this distemper, and could not patiently endure the necessary thirst, after refraining long, used to drink, and then vomit it again. Now if whatever has been taken, be brought up again, it lessens the uneasiness considerably: if it is retained in the stomach, it increases the disorder; therefore it must not be attempted in every one.

But if it be attended with a fever, that in the first place must be removed by such means as have been prescribed for the cure of that distemper. When the patient is free of a fever, then we may apply the usual remedies of the dropsy. And with regard to this, whatever species it is, if it has not got too deep root, the very same remedies are necessary. The person must walk much, run sometimes, and his superior parts especially must be rubbed, so as to bring a warmth into the skin. In the mean time he must keep in his breath. Sweat is likewise to be procured, not by exercise only, but also by hot sand, or the laconicum, or clibanum, and such like means: and natural and dry sweating places are very beneficial: such as we have at Bajæ amongst the groves of myrtles. The bath and all moisture is hurtful. Catapotia[(25)], composed of two parts of wormwood and one of myrrh, are properly given to the patient fasting.

The food ought to be of a middle nature, but of the harder kind of it. No more drink given than to support life: and that is best, which provokes urine. It is better to attempt that by diet[(26)], than medicine. However, if there is a necessity, some of the things, which have that effect, must be boiled, and the decoction of them given to drink. This faculty seems to be possessed by the iris, nard[(27)], saffron, cinnamon, cassia, myrrh, balsam[(28)], galbanum, labdanum, flower of the wild vine, panaces[(29)], cardamom[(30)], ebony, cypress seed, stavesacre, which the Greeks call staphis agria[ BN ], southernwood, rose-leaves, acorum[(31)], bitter almonds, goat’s marjoram, storax, costus, the flower of long and round cyperus[(32)]; the first of these the Greeks call cyperus[ BO ], and the other schœnus[ BP ]. Whenever I mention these, I intend not such as grow here, but those that are imported amongst the spices. However the mildest of these must be tried first, that is the rose-leaves, or spikenard. Austere wine also, but very weak, is good.

It is convenient likewise to measure the belly every day with a thread, and to put a mark upon this, where it meets: and each succeeding day to observe, whether the bulk be enlarged or diminished; for that which lessens, feels the effect of the medicine. And it is not improper to measure the patient’s drink, and his urine; for if more moisture is excreted, than is taken, in such a case there is hope of recovery. Asclepiades tells us in his writings, that to a person, who had fallen into a dropsy after a quartan, he prescribed abstinence for two days, and friction; on the third he gave him food and wine, finding him free both of the fever and dropsy. Thus far general rules may be laid down for all the species of the distemper: if the malady rises to a greater height, different methods of cure are required in each.

Wherefore if there is a flatulency, and from that frequent pain, a vomit after meat every day, or every other day, is of service. After that dry and warm fomentations must be used. If the pain is not removed by these means, cupping without scarification is necessary. If the pain does not even yield to that, the skin must be cut, and the cucurbitals applied again. The last remedy, if the cupping has done no service, is to inject into the belly plenty of warm water, and to take it back again. Moreover it is necessary to make use of friction three or four times a day, with oil and some heating medicines. But in this friction the belly must be avoided; mustard must be applied to it frequently, till it corrode the skin; and several ulcers must be made in the belly with hot irons, and these kept open for some time. Boiled squils also bound upon the skin[(33)] are good. But for a long time after these flatulencies all windy food must be avoided.

But if the distemper be what is called leucophlegmatia, it is fit to expose the swelled parts to the sun; but not too much, lest it inflame the fever. If the sun is too powerful, the head must be covered, and friction made use of, the hands being only moistened with water mixed with salt, and nitre, and a little oil; and that by the hands either of a child or a woman, as their touch is softer: and if the strength will allow, it may be continued a whole hour in the forenoon; in the afternoon for half an hour. Restringent cataplasms also are good; especially if the body be pretty tender. An incision must likewise be made on the inside of the leg, about four fingers breadth above the ancle; from which for some days a good quantity of water may be discharged, and it is proper also to make deep gashes in the tumours: and the body must be well agitated by frequent gestation; and when the wounds are cicatrized, the exercise and food must be increased, till the body return to its former habit. The food ought to be strong and glutinous, and chiefly flesh. The wine pretty sweet, if the stomach will bear it; but in this course, that alternately for two or three days together, sometimes water and sometimes wine be drunk. It is proper also to give the seed of sea spurge, which grows large near the sea, to drink with water. If the person be strong, boiled squills may be tied upon his belly at the same time. And many authors advise, that the tumours be beat with inflated bladders.

But if the disease be of that kind, in which there is a large collection of water within the abdomen, it is fit to walk, but more moderately; to keep a discutient malagma applied to the part, with a triple cloth above it, and to bind it on with a roller, though not too tight. Which practice, introduced by Tharrias, I observe is still continued by the greatest number of physicians. If it is evident, that the liver or spleen is affected, it is proper to apply over it a mellow fig bruised, with the addition of honey. If by such remedies the belly is not dried, but the water notwithstanding abounds, a more speedy method must be taken to relieve, that is, to discharge it by the belly itself. Nor am I ignorant, that Erasistratus disapproved of this method of cure: for he imagined this to be a distemper of the liver; and therefore that means should be used to restore that part to a sound state, and that it was to no purpose to draw off the water, which, while that bowel is distempered, Would be presently collected again. But in the first place, this bowel is not only the seat of this disease: for it arises both in the case of an affected spleen, and a bad habit of the whole body. And secondly, supposing it to have begun thence, yet unless the water be discharged, which stagnates there preternaturally, it hurts both the liver and the other internal parts. And it is granted, that care should be taken nevertheless to cure the whole body. For discharging of the water does not work a cure, but makes room for the operation of medicine, which that obstructs, while it remains there. Neither does this admit of any dispute, that all in this disease are not to be thus treated: but robust young men may, who are either entirely free of a fever, or at least have pretty long intermissions: for those, who have a vitiated stomach, or have fallen into this disorder from the atrabilis, or those, who are in a bad habit of body, are not fit subjects for this treatment. On the day, that the water is first discharged, giving of food is improper, unless the patient feels a want of strength. In the following days indeed wine not much diluted ought to be given, but not in a large quantity, and the patient must be again gradually accustomed to exercises, frictions, the heat of the sun, sweatings, fatigues, and proper food, till he be entirely well. The case requires seldom bathing, and frequent vomits when fasting. If it be the summer-time, it is proper to swim in the sea. For a long time after his recovery venery is hurtful.

CHAP. XXII. OF THE SEVERAL KINDS OF CONSUMPTION AND THEIR CURE.

A consumption is a distemper often of longer continuance, and attended with greater danger. And of this also there are several species. One of them is, where the body is not nourished, and as something is naturally always flying off, and nothing comes in to supply its place, the person becomes extremely emaciated, and unless it be removed, it proves mortal. This the Greeks call atrophia[ BQ ]. It commonly proceeds from one of two causes: for one man through excessive fear takes less, another from too great voraciousness takes more food, than he ought to do: so that either the defect of aliment weakens, or what is redundant is corrupted.

There is another species, which the Greeks call cachexia[ BR ], where the habit of the body is bad, and therefore all the aliments are corrupted: which commonly happens, when bodies depraved by a long distemper, although they have got quite rid of it, yet do not receive any recruit; or when the body has been disordered by bad medicines; or when one has long wanted the necessaries of life; or has made use of victuals to which he is not accustomed, and bad, or from some such accident. In this last case besides the consumption it sometimes happens, that the skin is exasperated with frequent pimples[(34)], or ulcers, or some parts of the body swell.

The third and by far the most dangerous species is that, to which the Greeks give the name of phthisis[ BS ]. It generally takes its rise from the head[(35)]: and thence falls down upon the lungs. From this an exulceration proceeds, and there comes a slight fever, which, although it may have abated, yet returns; in this also there is a frequent cough, and pus expectorated, and sometimes something bloody. Whatever comes up, if it be thrown upon the fire, has a bad smell. Therefore those, that are doubtful of the distemper, try it by this mark.

As these are the several species of a consumption, it is necessary first to consider, which of them is the disease of the patient. Then if it appears, that the body is only not supplied with nourishment, to attend to the cause of that; and if the person has taken less food, than he ought to have done, it is proper to make an addition: but gradually, lest, if he overload the body unaccustomed to it by too great a quantity at once, the stomach be oppressed, and and that retard concoction. If a person has been used to take more than what was proper, he should fast for one day; then begin with a little food; making every day some small addition, till he come to a just measure. It is like-wise proper to walk in places as cold as possible, and avoid the heat of the sun; to use those exercises, which employ the hands: if he is weaker, to use gestation, unction, and friction, by his own hands rather than other if he be able, frequently in the day, both before meat and after it; and sometimes to add some of the warming medicines to the oil, till he sweats. It does service too when he is fasting to take hold of his skin in many parts, and to draw it out, that it may be relaxed; or to do the same by often impressing a bit of resin upon it, and quickly pulling it away again. Bathing also is sometimes good, but after a small meal; and even in the bath itself, some food is properly given; or if without the bath friction has been used, it may be immediately after. The food ought to be of that kind, which is easily concocted and most nourishing. Therefore the use of wine also, but austere, is necessary to promote urine.

But if the habit of the body is bad, the first thing to be done is to fast; then a clyster must be administered; next we should give food, adding exercises, unctions, and frictions. Frequent bathing is more beneficial to such, but when they are fasting, even till they sweat. Their diet should be plentiful and varied, of good juices, and such as does not very easily corrupt, and austere wine. If these methods do not relieve, blood must be let; but by small quantities, and every day for some days together, the other rules above laid down being also observed.

But if the distemper is more violent, and there is a true phthisis, it is necessary to oppose its beginnings: for if this distemper continue long, it is not easily overcome. If the patient’s strength allow, he must take a long voyage, change his climate, taking care to remove into a grosser air, than that he leaves; and therefore from Italy to Alexandria is a very agreeable change. And generally at the beginning the body may be well supposed able to stand that fatigue, since this distemper generally comes on at the strongest age, that is, from the eighteenth year to the thirty-fifth. If the weakness will not admit of that, it is very proper however to sail in a ship, but not far. But if any circumstance render the sailing unfit, the body must be moved in a litter or some other way; then business must be laid aside, and every thing, which disturbs the mind; sleep must be indulged; catarrhs avoided, lest they exasperate, what may have been mitigated by care; and for that reason crudity must be guarded against, and at the same time both the heat of the sun and cold, the face defended, the throat wrapped up, and the cough removed by its peculiar remedies. And as long as the fever continues to attack, it must be treated sometimes by abstinence, sometimes also by seasonable food: and at such time water must be drunk. Milk likewise, which is poison in pains of the head, and acute fevers, and excessive thirst, occasioned by these, and when the præcordia are swelled, or the urine is bilious, or in hæmorrhages; yet in a phthisis, as well as in all tedious and obstinate febriculas, it may very well be given.

But if a fever does not yet come on, or has already remitted, recourse must be had to moderate exercise, and especially walking and gentle friction. The bath is hurtful. The food at first ought to be pungent, such as garlick, leeks, and the same in vinegar, or in the same way endive, basil, lettuce; afterwards mild, as gruel[(36)] made from ptisan, or alica, or from starch, with the addition of milk. Rice also, and, if there is nothing else, far will answer the same end. Then these two sorts of food are to be alternately used; and something of the middle kind is to be added, and especially brains[(37)], and small fish, and such like. Flour also mixed with mutton or goat’s suet, and boiled, serves for a medicine. Wine ought to be taken light and austere.

Thus far the distemper is combated with no great difficulty. If it is more grievous, and neither the fever nor the cough abate, and the body appears to be wasting, there is a necessity for more powerful remedies. An ulcer must be made with a hot iron in one place under the chin, another in the throat, two at both breasts, and under the extremity of the blade-bones, which the Greeks call omoplatæ[ BT ]; and these ulcers must not be allowed to heal, unless the cough should cease: which, it is plain, must also require a distinct method of cure. Then the extremities are to be brushed briskly three or four times a day; the chest must be rubbed gently with the hand; after meat, at the interval of an hour, the legs and arms must also be rubbed. After ten days the patient is to be put into a bath consisting of warm water and oil. On the other days he is to drink water; at that time wine must be given to drink cold, if the cough is gone; if it is not, with the cold taken off. It is proper also in the remissions to give food every day; to make use of friction and gestation in like manner; on the fourth or fifth day to take sometimes the blood herb with vinegar, or to eat plantain. The juice of plantain alone, or that of horehound boiled up with honey, is a remedy; of the first of which a cyathus may be supped, and a spoonful of the other may be licked at times; or one part of turpentine, and another of butter and honey, mixed together and boiled. But the most material of all these things, are the diet, gestation, sailing, and gruel. A loose belly is particularly to be avoided. A frequent vomiting in this distemper, and especially of blood, is pernicious. When a person begins to grow a little better, he ought to increase his exercises, friction and food; and then keeping in his breath to rub himself; to abstain long from wine, the bath, and venery.

CHAP. XXIII. OF THE EPILEPSY AND ITS CURE.

Amongst the best known distempers is that, which is called comitial[(38)], or the greater. A man falls suddenly down, foams at the mouth; then after some time returns to himself, and rises of his own accord. This disorder more frequently attacks men than women; and it commonly continues long, even to the dying day, and is not dangerous to life. Sometimes however, when it is recent, it kills a person; and if it has not been removed by remedies, it is often cured in boys by their first venereal liberties, in females by the first appearance of the menses. Sometimes a person falls down with a convulsion of the limbs or nerves, sometimes without it.

Some endeavour to rouze these by the same means as lethargic people; which is quite needless: both because even a lethargic person is not cured by this method; and because he may never awake, and thus perish for want, whereas the other returns to himself.

When one falls down, if the fit be not attended with a convulsion, blood ought to be let immediately: if it is, that is not to be done, unless other circumstances also encourage it. But it is necessary to give clysters, or to purge with black hellebore, or to do both, if the strength will allow; then to clip the hair of the head close, and anoint it over with oil and vinegar; to give food the third day after, as soon as the hour, at which the patient fell down, is past. Neither are gruels, or victuals otherwise soft and easy of digestion, or flesh, and least of all pork, fit for such persons; but diet of the middle kind: for the case requires strength; and crudities are to be guarded against. At the same time they should avoid the heat of the sun, the bath, fire, and every thing heating; also cold, wine, venery, the sight of a precipice, and every thing that terrifies, vomiting, lassitude, anxieties, all business; and when food has been given on the third day, they should intermit the fourth, and so on every other day; observing the same hour for food for fourteen days. When the distemper has proceeded so far, it has lost the force of an acute one; and if it continues, it must be treated as a chronic.

But if a physician has not been called on the day, that the person first fell, but has a man recommended to his care, who is already used to these falling fits; first of all the regimen above prescribed being followed, the day is to be expected, on which the fit may return: and then either bleeding must be used, or a clyster, or black hellebore, as has been already directed. Then in the following days, he is to be nourished by the food mentioned before, omitting all such as I said were to be avoided.

If the distemper should not be removed by these means, recourse must be had to the white hellebore; and that must be used three or four times, at the distance of a few days betwixt doses; provided however that he never repeat it, unless the fit have recurred. On the intermediate days his strength must be supported by adding some other things to those, which have been mentioned before. When he has waked in the morning, his body may be gently rubbed over with old oil, excepting his head and belly; then let him take a walk, as long and as straight as possible; after the walk let him be rubbed, in a tepid place briskly and long, and not less than two hundred times; unless he be infirm; then let a good quantity of cold water be poured over his head; let him eat a little; and rest; take a walk again before night; be briskly rubbed a second time, without touching either his belly or head; afterwards let him take supper, and with intervals of three or four days, let him for a day or two together make use of a pungent diet.

If the patient should not be cured even by these means, let his head be shaved, anointed with old oil, adding to it vinegar and nitre, and salt water poured upon it; when he is fasting, let him drink castor and water; make use of no water for drink, unless it has been boiled. Some have cured themselves of such a disorder by drinking the warm blood of a gladiator slain. With such people a miserable remedy is rendered tolerable by a more miserable distemper. As to the assistance of medicine, the last remedy is to let a little blood from both legs near the ancle; to make an incision on the back of the head, and apply cucurbitals; with a hot iron also to make an eschar in two places, in the back of the head, and below, where the first vertebra is joined to the head; that by these the noxious humour may be discharged. If by this method the distemper has not been removed, it will probably continue for life. To alleviate it, exercise must only be used, and such food, as has been directed above; and especially every thing avoided, against which we have given cautions.

CHAP. XXIV. OF THE JAUNDICE AND ITS CURE.

The distemper is equally known, which is called sometimes arquatus[(39)], sometimes regius. If this comes on after the seventh day of a fever, Hippocrates pronounces the patient to be safe, provided only the præcordia be soft. Diocles declares without reserve, that if it comes after a fever, it even does good; if a fever follows it, it is mortal. Now this distemper is discovered by the colour, especially of the eyes, in which, what ought to be white, becomes yellow. And it is generally attended by a thirst, pain of the head, frequent hiccough, hardness of the præcordia on the right side; and upon violent motion, a difficulty of breathing, and relaxation of the limbs: and when the distemper continues long, the whole body turns white, with a certain sickly paleness.

For the first day it is proper to enjoin the patient to abstinence; on the second to give a clyster; then if there is a fever, to remove it by proper diet; if there is not, to give scammony to drink, or white betes shred in water, or in hydromel bitter almonds, wormwood, anise, but of the last the smallest quantity. Asclepiades ordered also the drinking of salt water, and that for two days, with an intention to purge, rejecting the use of diuretics. Some omitting the former, by the latter and extenuating diet affirm they obtain the same purpose.

For my part if there be sufficient strength, I prefer the stronger medicines; if but little, the weaker remedies. If the patient has been purged, after that it is fit for the three first days to eat sparingly food of the middle kind, and drink Greek salt wine, that the belly may continue lax; then for other three days to eat more substantial food and some flesh too; and hold to the use of water for drink; then to return to the former diet, only eating more freely of it; and omitting the Greek, to drink black austere wine; and vary this course by using sometimes acrid food, sometimes returning to the salt wine. But through the whole time exercise and friction must be used, and if it be winter, the bath, if summer, swimming in cold water; a bed and room elegant, company, place, diversions, frolicks, and every thing else, that has a tendency to exhilarate the mind: upon which accounts it seems to be called the royal distemper. A discutient malgama also applied to the præcordia has a good effect; or a dry fig laid on there, if the liver or spleen be affected.

CHAP. XXV. OF THE ELEPHANTIASIS, AND ITS CURE.

That distemper, which the Greeks call elephantiasis[ BU ], is almost entirely unknown in Italy, but in some countries is very common, and is ranked amongst the chronic kind. The whole body is affected with it in such a manner, that even the bones are said to be spoilt. Upon the surface of the body are spots and tumours. Their redness by degrees degenerates into a black colour, the skin is unequally thick and thin, hard and soft, and is roughened with something resembling scales, the body wastes, the face, legs, and feet swell. When the distemper is inveterate, the fingers and toes are hid under the swelling; a slight fever comes on, which easily destroys the person sunk under so many maladies.

Wherefore without delay, at the beginning of the disease, blood ought to be let two days successively; or the belly purged with black hellebore. For three days the person should fast, or eat no more than is necessary to support him; then the strength is to be recruited a little, and a clyster administered. After that, when he is somewhat relieved, exercise must be used, especially running; sweat must be procured, first by pure labour, and then by dry sweating-rooms; friction applied; but these with such moderation, that the strength may be preserved; bathing should be rare; the food without any thing fat, or glutinous, or flatulent. It is fit to allow wine, but not in the first days of the disorder. Plantain bruised and rubbed upon the body seems to be an excellent defence for it.

CHAP. XXVI. OF APOPLECTIC PATIENTS, AND THEIR CURE.

In this country we sometimes, though rarely see apoplectic people, who are stupified both in body and mind. It happens sometimes from being thunderstruck, sometimes from a distemper. The last case the Greeks call apoplexia[ BV ]. Such people must be bled. And either white hellebore be made use of, or a clyster given. Then friction is to be applied; and food taken of the middle kind, by no means fat; some of the acrid kinds too; and wine must be refrained.

CHAP. XXVII. OF THE PALSY, AND ITS CURE.

But a relaxation of the nerves is a distemper every where common. But sometimes it attacks the whole body, sometimes particular parts. Ancient authors called the first apoplexia, the other paralysis: now I observe the name of paralysis is given to both. And it is common for those, who have all their limbs extremely relaxed, to be quickly carried off. And if they are not snatched away, they live indeed for some time, but yet seldom recover their health; and for the most part draw out a miserable life, with the loss of their memory too. When it is partial, it is sometimes an acute distemper, often chronic, generally incurable.

If all the limbs are greatly affected, bleeding either kills or cures. Any other method scarcely ever restores health; often only delays death; in the mean time renders life uneasy. After bleeding, if both motion and the judgment don’t return, there is no hope left: if they do return, there is a prospect of recovery.

But where a particular part is relaxed, either blood is to be let, or a clyster administered, according to the strength of the body and the distemper. All the other methods to be pursued are the same in both cases. For the principal thing is to avoid cold: and the patient must return gradually to exercise, so as immediately to apply to walking, if he can. If the weakness of his legs be too great for that, he may either use gestation, or be agitated by moving his bed to and fro: then that member, which is diseased, may be moved of itself if possible; if that cannot be done, let another person move it, and so return it to its ordinary habit by a kind of force. It does good also to irritate the skin of the benumbed limb, either by beating it with nettles, or keeping mustard upon it, till the part begins to grow red; when they may be removed. Bruised squills likewise, or bulbous roots bruised with frankincense, are proper applications. Neither is it amiss, to vellicate the skin with resin for some time every third day, and that in several places; and sometimes to make use of cupping without scarification. Old oil is fittest for unction, or nitre mixed with vinegar and oil. Further, it is highly necessary to foment with warm sea-water; or if that is not to be got, with salt-water at least. And if any where there is a natural or artificial place for swimming in this kind of water, by all means to make use of it; and the limbs, which are most disordered, are to be principally agitated there. If that conveniency cannot be had, nevertheless the bath is useful. The food ought to be of the middle kind, and chiefly venison; the drink warm water, without wine. But if the distemper is of long standing, Greek salt wine may be given as a purge every fourth or fifth day. A vomit after supper is good.

Of pain of the nerves.

Sometimes there occurs also a pain of the nerves. In this case it is not convenient, either to vomit, or promote urine by medicines, or sweats by exercise, a practice advised by some physicians. Water must be drunk twice a day. The body must be rubbed all over gently in bed for a pretty long time; then the upper parts especially are to be moved, keeping in the breath even in the time of the exercise. Bathing must be seldom practised. The air must be changed now and then by travelling. If there is a pain in any part, it must be anointed with nitre and water without oil, then wrapped up, and a small quantity of live coals with sulphur held below it; and thus it is to be fumigated; and this is to be continued for some time, but when the patient is fasting, and after he has concocted well. Cucurbitals also are to be often applied to the part pained, and the same place is to be beat gently with inflated ox-bladders. It is good also to mix suet with the powdered seed of cummin or nettle, in equal quantities, and apply that; to foment with a decoction of sulphur in water. Bottles filled with warm water are also proper to be clapped on, or bitumen mixed with barley. Violent gestation must be used, especially in the very article of the pain, which in other pains is very pernicious.

Of a tremour of the nerves.

A tremour of the nerves is equally increased by vomiting, and diuretic medicines. The bath and dry sweatings also are hurtful. Water must be drunk; the patient must walk briskly, also anoint, use friction, chiefly performed by himself; his superior parts must be opened by playing at the ball and the like exercises. He may take any food he chuses, only consulting the concoction. After meat he must avoid cares; make very little use of venery. If at any time he falls into that, after it he ought to be rubbed for a long time in his bed with oil, by the hands of a boy rather than a man.

Of internal sup­pur­ations.

As for suppurations[(40)], which happen in any internal part, when they begin, our first business is to endeavour by repellent cataplasms to prevent a hurtful collection of matter; and then, if these have no effect, to disperse it by discutient malagmas. If we fail in that, it follows that it be encouraged; next, that it be maturated. And then the end of every vomica is, that it breaks; and the symptom of this is an evacuation of matter, either by the mouth or anus. But nothing ought to be done, by which a full discharge of the pus may be prevented. Gruels and warm water must be chiefly used. When the pus has ceased to be discharged, we are to change to such food, as is indeed of easy concoction, but yet more substantial and cold; also cold water, but beginning with taking the cold off both: and at first some things may be eaten with honey, as pine-nuts, or sweet almonds, or hazel-nuts. Afterwards even the honey must be omitted, that a cicatrix may be the sooner formed. At that time the proper medicine for the ulcer is taking the juice of leeks or horehound, and adding leeks to every meal. It will be convenient also to use frictions in those parts, that are not affected, and gentle walks. And care must be taken not to irritate the healing ulcers either by struggling or running, or any other means; for in this distemper, a vomiting of blood is destructive, and therefore by all means to be guarded against.

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A. CORNELIUS CELSUS

OF

MEDICINE.

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BOOK IV.

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CHAP. I. OF THE INTERNAL PARTS OF THE HUMAN BODY.

Thus far we have spoken of those kinds of distempers, which so affect the whole body, that no certain seats can be assigned to them: I shall now treat of those which belong to particular parts. Now the diseases of all the internal parts, and their method of cure will be more easily understood, when I shall have first given a short description of the parts they afflict.

The head then and what is contained in the mouth are bounded not only by the tongue and palate, but by the external parts, which lie exposed to view. On the right and left side about the throat are large veins, which are called sphagitides[ BW ]; and arteries, named carotides[ BX ], running upwards, which reach beyond the ears. And in the neck itself are placed small glands, which sometimes swell, and are painful. Then two passages begin: one of which is called the aspera arteria, or wind-pipe; the other the gullet. The wind-pipe is more external, and goes to the lungs; the gullet more internal, and leads to the stomach. The former receives the breath, the latter the food. Their courses being different, where they meet there is something like a small tongue[(1)] in the wind-pipe at the entrance of the fauces: when we breathe this stands erect; when we take meat or drink, it shuts the wind-pipe. Now the wind-pipe being hard and cartilaginous, is prominent in the throat; and elsewhere falls back. It is composed of certain circles formed like the vertebræ in the spine, yet so, that it is rough on the external part, on the internal smooth like the gullet; and thus descending to the præcordia it is connected with the lungs: these are of a spongy nature, and therefore capacious of air; and behind being joined to the spine, they are divided into two lobes like an ox’s hoof. With these the heart is connected, being muscular, situated in the thorax under the left breast: and it has what we may call two ventricles. But under the heart and lungs is the transverse septum, consisting of a strong membrane equally nervous, which divides the abdomen from the præcordia, many vessels also being dispersed over it: it separates from the superior parts not only the intestines, but the liver and spleen too. These bowels are next to it, but placed below it, the one on the right side, and the other on the left. The liver having its origin under the præcordia from the very septum itself, on the inside is concave, and the outside gibbous. This projecting rests gently upon the stomach, and is divided into four lobes. On the lower part, the gall-bladder adheres to it. But in the left side the spleen is not connected with the septum, but to an intestine; it is of a soft and loose texture, of a moderate length and thickness; and this proceeding a little beyond the region of the ribs into the abdomen, is chiefly covered by them. And these indeed are joined. But the kidneys are divided: which adhere to the loins below the last ribs[(2)], and the sides next these are round, on the other they turn inward; they are both stocked with vessels, and covered over with coats[(3)]. These then are the situations of the bowels. But the gullet, which is the beginning of the intestines, arises nervous from the seventh vertebra of the spine, and about the præcordia is united with the stomach. The stomach, which is the receptacle of food, consists of two coats, and is placed betwixt the spleen and liver, each of these going a little over it. There are also some fine membranes, by which these three are connected together, and are joined to the transverse septum above-mentioned. After that the lower part of the stomach turning a little to the right side grows narrower, till it meet the first intestine. This juncture the Greeks call pylorus[ BY ]; because like a gate it emits into the lower parts, what we are to discharge by excrement. There begins the intestine jejunum, not much folded: this name is given to it, because it never retains what it has received; but immediately transmits it into the lower parts. Next to this, is the smaller intestine, very much folded into sinuses: each of whose rings are by small membranes connected with the more internal, which being turned toward the right side, and ending at the right hip, yet fill more the superior parts. Then this intestine is joined with another thicker, and running across; which beginning on the right side, towards the left is open and long; to the right is not so; and therefore it is called cæcum. But that, which is open, is of large compass and sinuous, and less nervous than the former intestines, on both sides rolled different ways, but occupying more of the left and lower parts, it touches the liver and stomach: then it is joined with some small membranes, that come from the right kidney; and there turning to the right, it is directed downward, where it discharges the excrements: and therefore at that place it takes the name of the intestinum rectum. All these parts are covered by the omentum, which on the lower part is smooth and contracted, and on the upper softer. Fat also grows to it, which like the brain and marrow is insensible. From each kidney proceeds a tube of a white colour to the bladder; the Greeks call them ureteres[ BZ ], because by them they believe the urine to be distilled into the bladder. The bladder in its sinus is nervous and double; in the neck full and fleshy, and joined by veins to the intestine and to that bone, which is under the pubes: itself is loose, and more at liberty. It is differently placed in men and in women: for in men it is close to the intestine rectum, rather inclined to the left side: in women it is situated above their genital parts, and as it hangs, is sustained by the womb. Then in men the passage of the urine is extended longer and narrower from its neck to the penis: in women it is shorter, and wider, and shows itself above the neck of the womb. Now the womb in virgins is very small: in women, when not pregnant, not much larger, than to be held in the hand. It begins with a straight and small neck, which is called the vagina[ CA ], in a line with the middle of the belly, then is turned a little to the right hip; then mounting above the intestine rectum, its sides are connected to the ilia of the woman. The ilia are situated betwixt the hips and pubes in the lower belly. From which and the pubes the abdomen reaches upwards to the præcordia; on the external side the skin appears; on the inside it is lined by a thin membrane, which is joined to the omentum, and is called by the Greeks peritonæum[ CB ].

CHAP. II. OF THE DISORDERS OF THE HEAD, AND THEIR CURE.

Having as it were presented these parts to view, as far as it is necessary for a physician to know them, I shall proceed to the remedies of the disorders of each, beginning with the head: under which name I now intend that part, which is covered with hair: for pains of the eyes, ears, and teeth, and such like, will be treated of elsewhere.

Of pains of the head, and a hydro­ceph­alus.

Now in the head there is sometimes an acute and dangerous distemper, which the Greeks call cephalæa[ CC ]. The marks of which are a strong shuddering, relaxation of the nerves[(4)], dimness of the eyes, delirium, vomiting, and withal a suppression of the voice; or an hæmorrhage from the nose, and with that a coldness of the body, and fainting; besides these an intolerable pain, especially about the temples, or occiput. Sometimes too there is a long weakness of the head, but neither severe nor dangerous, through the whole life. Sometimes the pain is more violent, but short, yet not fatal; which is contracted either by drinking wine, or crudity, or cold, or heat of a fire or the sun. And all these pains are sometimes accompanied with a fever, and sometimes not: sometimes they afflict the whole head, at other times a part of it; sometimes the pain extends to a contiguous part of the face. Besides these there occurs another disorder, which may continue long: where a humour inflates the skin, and it swells, and yields to the impression of the finger. This the Greeks call hydrocephalus[ CD ].

I have already spoken of the treatment of the second of these kinds, while it is slight, where I laid down rules to be observed by men in health, troubled with a weakness in any part. What remedies also are proper, when the pain is attended with a fever, has been shewn in that place, where the cure of fevers was considered. Now I shall treat of the rest.

That, which is acute, and that, which rises to an unusual height, and that, which proceeds from some sudden cause, and though not mortal, yet is very violent, demands venesection for the first step in the cure. But unless the pain be intolerable, that is needless. And it is better to abstain from food; if possible, from drink too; if not, to drink water. If the pain continues the following day, to give a clyster, to procure sneezings, to take nothing but water: for this discipline often removes it in a day or two, especially if the origin be from wine, or crudity.

But if these methods afford small relief, it is proper to clip the hair close to the skin: then it must be considered, what was the cause of the pain. If heat, it is expedient to pour a great quantity of cold water over the head, to apply a concave sponge frequently dipped in cold water and squeezed, to anoint with rose-oil and vinegar, or rather to apply sordid wool dipped in these, or some other cooling cataplasms. But if cold has brought on the disorder, it is proper to pour upon the head sea water, or at least salt water warm, or a decoction of laurel; then to rub the head briskly; next to embrocate it with warm oil, and to cover it. Some even bind it up; others clap on cervicalia[(5)] and cloaths, and thus are relieved; others are assisted by hot cataplasms. And therefore, where the cause is not known, it is proper to try, whether cooling things, or heating give most relief, and to use those, which upon experiment shall be found best.

But if the cause cannot be discovered, it is proper to pour over the head first warm water, as has been prescribed, or salt water, or a decoction of laurel, then cold vinegar and water. The following methods are of general use in all inveterate pains of the head: to excite sneezings, to rub the lower parts briskly, to use gargarisms of such things as promote saliva, to apply cucurbitals to the temples and back of the head, to sollicit an hæmorrhage from the nose, to vellicate the temples now and then with resin, and by applying mustard to ulcerate those parts, that are affected, first putting linen below, that it may not corrode too severely, or to make ulcers where the pain is, by hot irons, to eat always moderately, and drink water; when the pain is abated, to go into the bath, there to pour over the head first a great quantity of hot water, and then cold. If the pain is wholly removed, to return even to the use of wine; but ever after to drink water before any thing else.

That kind is different, where a humour is collected within the head. In this it is necessary to clip to the skin; then to apply mustard, so as to ulcerate it; if that does not prove effectual, the knife must be made use of. The management must be so far the same with dropsical cases, that the patient must be exercised, sweated, briskly rubbed, and take such food and drink, as are powerful diureticks.

Of the cyni­cus spas­mus.

There is a distemper incident to the face, which the Greeks call cynicus spasmus[ CE ]. It comes on an acute fever. The mouth is turned aside with a kind of grin, and therefore it is nothing else than a distortion of the mouth. There is also a frequent change of colour in the face and the whole body, and a great propensity to sleep.

It is very proper to let blood in this disorder. If it is not removed by this, to give a clyster. If it does not yield even to that, to vomit by white hellebore. Besides it is necessary to avoid the heat of the sun, fatigue, and wine. But if it is not cured by these methods, running must be used, and gentle and long friction upon that part, which is diseased; in the other parts shorter, but brisk. It does service also to procure sneezings, to shave the head, and to pour upon it hot, either sea water, or at least salt water, with sulphur added to it: after this bathing, to rub again, to chew mustard, and at the same time to apply cerate to the parts of the face that are affected, and to the sound parts mustard, till it corrode them. The most proper diet is of the middle kind.

Of a palsy of the tongue.

But if the tongue be paralytick, which sometimes happens of itself, sometimes is occasioned by distemper, so that the pronunciation is indistinct; it is necessary to use a gargarism of a decoction of thyme, or hyssop, or catmint; to drink water; to rub briskly the head, mouth, and the parts under the chin, and the neck; to rub the tongue itself with laser; to chew the most acrid things, such as mustard, garlick, onion; to make strong efforts to articulate words clearly; to take exercise, keeping in the breath; to pour cold water upon the head often; sometimes to eat plentifully of radishes, and then to vomit.

Of a catarrh and gravedo.

A humour distils from the head sometimes into the nose, which is a slight disorder; sometimes upon the fauces, which is worse; sometimes even upon the lungs, which is worst of all. If it have fallen upon the nose, a thin rheum flows from the nostrils, the head is slightly pained, a weight is felt in it, and there are frequent sneezings. If upon the fauces, it irritates them, and raises a slight cough. If upon the lungs, beside the sneezings and cough, there is also a weight in the head, lassitude, thirst, heat, and bilious urine.

Another (though not very different) disorder is a gravedo. This obstructs the nostrils, blunts the voice, raises a dry cough: at the same time the saliva is salt, there is a sounding in the ears, the veins of the head move, and the urine is turbid. All these disorders Hippocrates calls coryzæ[ CF ]. I observe that this is now by the Greeks appropriated to the gravedo: and catarrhs are called by them catastagmi[ CG ]. These are common, and of short continuance; but if they be neglected, are usually lasting. None of them is dangerous, but such as ulcerate the lungs.

When we perceive any such symptoms, we ought immediately to avoid the heat of the sun, the bath, and venery[(6)]. And at the same time nevertheless unction may be used, and the ordinary diet. The patient should take a straight, but not too quick walk; and after it the head and face must be rubbed above fifty times. And it seldom happens, if we have restricted ourselves for two days or three at most, that the disorder is not mitigated. When it is abated, if in the catarrh the phlegm turns thicker, or in a gravedo, if the nostrils are more open[(7)], the bath is to be used, and the face and head fomented plentifully first with hot water, and then with egelid; after that, the patient may eat heartily and drink wine. But if on the fourth day the phlegm is equally thin, or the nostrils appear equally obstructed, austere Arminæan wine[(8)] is to be taken; then again for two days successively water; after which the person may return to the bath, and his usual way of living.

Neither even on these days, in which some things are to be refrained, is it proper to live like sick people; but in all other respects the same liberties may be taken as in health, except by one, who uses to be long and severely afflicted with these disorders; for such a person requires a management somewhat nicer. Therefore if the defluxion be upon his nose or fauces, besides what I mentioned before, he ought immediately in the first days of his indisposition to walk much, to rub the inferior parts briskly, the friction must be more gentle upon the thorax, and gentler still upon the head, the ordinary diet must be diminished to half the quantity, eggs must be used, starch, and such like things, which generate a thicker phlegm; thirst, as much as he can bear, must be one part of the cure. When by these means one has been rendered fit for the bath, and has used it, a small fish, or flesh is to be added to his diet; with this caution however, that he do not immediately take his ordinary quantity of victuals. Pure wine must be used pretty plentifully.

But if it distils also upon the lungs, there is a much greater necessity for walking and friction, still observing the same rules in diet. If these have not the desired effect, he must use the more acrid kinds, indulge sleep more, and abstain from all business, sometimes try the bath, but not soon.

In a gravedo it is necessary for the first day to rest, neither to eat nor drink, to cover the head, and put wool round the throat; the day following to rise, to abstain long from drinking, or if he is obliged to do it, not to take above a hemina of water; on the third day to take a little soft bread with a small fish or some light flesh, and to drink water. If a person should not be able to forbear eating heartily, he must vomit: when he comes into the bath, he is to foment his head and face plentifully with warm water, till he sweat, then return to the use of wine. After which it can scarcely happen, that the same indisposition will continue. But if it remain, use must be made of cold, dry, and light food, as little moisture as possible, friction and exercise being still continued, which are necessary in every indisposition of this nature.

CHAP. III. OF THE DISEASES OF THE NECK, AND THEIR CURE.

From the head we proceed to the neck, which is liable to very severe diseases. Nor is there a more troublesome or more acute distemper than that, which by a kind of spasm of the nerves draws sometimes the head to the shoulders, sometimes the chin to the breast, sometimes stretches the neck and holds it straight and immoveable. The first the Greeks call opisthotonus[ CH ], the second emprosthotonus[ CI ], and the last tetanus[ CJ ], although some with less accuracy make use of these names indiscriminately. They often kill within four days: if the patients have escaped that time, they are out of danger.

All these are cured by the same method; so far physicians agree. But Asclepiades believed, that blood should be let: some again affirmed that ought by all means to be avoided: for this reason, that the body then stood most in need of heat; and that this resides in the blood of the veins. This indeed is false. For it is not the nature of the blood to be peculiarly hot; but amongst the several things, which compose the human body, it most quickly grows either hot or cold. Whether or no it be proper to make this discharge, may be understood from the general directions, which were given about bleeding. But it is evidently proper to give castor, and with it pepper or laser. Then a moist and hot fomentation is needful. Therefore most physicians pour warm water frequently upon the neck. That relieves for the present; but renders the nerves more liable to cold, which is to be particularly avoided.

It is more proper then first to anoint the neck over with liquid cerate[(9)]: next to apply ox-bladders or bottles filled with hot oil, or a hot cataplasm made of meal, or pepper bruised with a fig. But it is most suitable to foment with moist salt; the manner of doing which I have already shewn. When any of these has been done, it is fit to bring the patient to the fire, or if it be the summer-time to the sun; and to rub his neck, and shoulders, and spine with old oil, which is fittest for that purpose; if that cannot be had, with Syrian[(10)]; if that cannot be got neither, with the oldest fat.

As friction is serviceable to all the vertebræ, so it is particularly to those of the neck. Wherefore day and night, but at proper intervals, this remedy must be used. When it is intermitted, some heating malagma must be applied. And cold is of all things to be avoided. And upon that account there ought to be a constant fire in the chamber, where the patient is nursed, and especially in the morning before day-light, when the cold is most intense. Neither will it be improper to keep the head close clipped, and to moisten it with hot ointment of iris, or the cyprine, and to keep it covered with a cap; sometimes to dip the whole body in warm oil, or in a warm decoction of fenugreek, with the addition of a third part of oil. A clyster also often relaxes the superior parts.

But if notwithstanding the pain has grown more severe, cucurbitals are to be applied to the neck, and an incision made in the skin. Eschars are to be made either by irons, or mustard. When the pain has abated, and the neck has begun to move, we may know, that the disease yields to the remedies. But all food that requires chewing must be long avoided. Gruels must be used, also sorbile eggs, or broth made of chickens, or some other tender flesh. If this has succeeded, and the neck shall appear to be entirely well, we must begin with pulse or intrita well moistened. But the patient may sooner venture to chew bread than taste wine; for the use of this is very dangerous, and therefore to be deferred for a longer time.

CHAP. IV. OF THE DISEASES IN THE FAUCES, AND THEIR CURE.

As the former kind of distemper afflicts the whole neck, so there is another common one equally dangerous and acute, the seat of which is in the fauces. Our authors call it angina: amongst the Greeks the name varies according to the species. For sometimes there appears neither any redness nor tumour; but the body is dry, the breath is fetched with difficulty, the limbs are relaxed. This they call [ CK ]synanche[(11)]. Sometimes the tongue and fauces are red and swelled, the voice is stopped, the eyes are turned, the face is pale, and there is a hiccough. That is called quasi synanche[ CL ]. These symptoms are common to both: the patient is not able to swallow either food or drink; his breathing is obstructed. It is more slight, when there is only a swelling and redness, and the rest of the symptoms do not follow. That they call parasynanche[ CM ].

Whatever species it be, if the patient’s strength will allow, blood must be let, although there is not a plethora; the next thing is to give a clyster. A cucurbital also is properly applied below the chin, and about the fauces, in order to evacuate the suffocating matter. Then there is a necessity for moist fomentations. For dry ones cut the breath. Therefore it is fit to apply sponges, which are better dipped now and then in warm oil, than in warm water. And it is of great efficacy in this case too, to put on salt in warm bags. Then it is convenient to make a decoction of hyssop, or cat mint, or thyme, or wormwood, or even bran, or dry figs, in hydromel, and use it as a gargarism; after that to touch the palate either with ox-gall, or the medicine, which is composed of mulberries. Fine flour of pepper is also proper to sprinkle upon it.

If from these things there is little benefit, the last remedy is to make pretty deep incisions under the jaws above the neck, and in the palate about the uvula, or to open the veins, that lie under the tongue, that the distemper may be discharged through these wounds. If this method don’t relieve the patient, we may be assured, that the distemper has got the better of him. But if the disorder is mitigated by them, and his throat is capable of admitting meat and drink, health will be easily recovered again. And sometimes nature assists too, if the disorder passes from a more contracted place to a larger. For this reason, when a redness and swelling begins in the præcordia, it is a sign that the malady has begun to leave the throat.

Whatever has relieved it, he must begin with a moist diet, and especially hydromel; then take soft food, and not acrid, till the fauces return to their former soundness. It is a vulgar opinion, that if a person eats a young swallow, he will be in no danger of an angina for the whole year: and that if it be preserved in salt, to burn it, and powder the coal of it, and give it to drink in hydromel, does service in this distemper. And as this is confidently reported by men of good credit among the common people, and the practice can be attended with no danger, although I have not read of it in medical treatises, yet I thought fit to give it a place in this work.

Of a dif­fi­culty of breath­ing.

There is also a disorder about the fauces, which amongst the Greeks has different names, according to its different degrees. The whole consists in a difficulty of breathing: but while it is moderate, and does not wholly suffocate, it is called dyspnœa[ CN ]; when it is more severe, that the patient cannot breath without a noise, and quick fetches, asthma[ CO ]; when the difficulty is so great, that respiration cannot be performed, unless the neck be kept erect, orthopnœa[ CP ]. The first of these may be of long continuance without endangering life: the two following are commonly acute. These symptoms are common to them all, that by the straitness of the passage, through which the breath comes, a wheezing is occasioned; there is a pain in the breast and præcordia, sometimes also in the shoulders, and that goes and comes; besides these there is a slight cough.

Now the remedy, unless there be some contra-indication, is letting of blood. Nor is that sufficient; but goat’s milk must be given warm to the patient fasting, and if he has no fever, his belly must be opened[(12)]; and sometimes purged; and sometimes a clyster must be given, by which means the body being extenuated, the patient begins to breathe more freely. The head also ought to be placed high on the bed, and the thorax assisted with fomentations, and hot cataplasms, either dry or moist; and after that a malagma applied, or a cerate of the cyprine ointment, or that of iris. Then the patient must drink fasting either hydromel, or a decoction of hyssop, or bruised caper-roots in water. It is proper also to give nitre, or cresses, or garlick, toasted, and then ground and mixed with honey: another medicine is thus prepared, honey, galbanum, resin, and turpentine are boiled up together: and when they have come to a consistence, the bigness of a bean is put every day in the mouth, and suffered to lie under the tongue, till it be dissolved: or p. *. & a quadrans of crude sulphur, and p. *. of southernwood are powdered, and mixed in a cyathus of wine, and that is supped warm. And it is not an idle opinion, that a fox’s liver dried ought to be beat, and the powder of it sprinkled upon the drink; or that the lungs of the same animal should be eaten roasted as soon as possible after he is killed, but nothing of iron used in the dressing. Besides these, gruels and light food must be used, sometimes also small austere wine, and sometimes a vomit taken. Whatever is diuretic, is also good; but nothing more so, than walking slowly almost to lassitude, much friction, especially of the lower parts, either in the sun or at the fire, and both by the patient himself and by others, till he sweat.

Of an ulcer in the fauces.

In the internal part of the fauces there sometimes happens an exulceration. In this case most people make use of hot cataplasms externally, and moist fomentations. They advise also the warm vapour to be received by the mouth: by which, others say these parts are rendered softer, and more fit to afford entertainment to the disorder, that already possesses them. But if the distemper can be prevented by these methods, those remedies are safe: if there is reason to fear it is already begun, they are improper. It is undoubtedly dangerous to rub the fauces, for it ulcerates them. Neither are diuretics good: because as they pass, they may possibly attenuate the phlegm of the part affected, which it is better to repel.

Asclepiades, to whom we are indebted for many useful discoveries, in which I have also followed him, recommends the sipping of very strong vinegar, and asserts, that this without any danger suppresses the ulcers. That may possibly prevent a flux of blood, but cannot heal the ulcers. A more proper application is lycium[(13)], which the same author also equally approves; or the juice of leek, or horehound, or sweet almonds rubbed with tragacanth, and mixed with passum, or lint-seed bruised, and mixed with sweet wine. The exercise also of walking and running is necessary. And smart friction is to be used from the breast downwards to all the inferior parts.

The food ought to be neither too acrid, nor rough: honey, lentils, tragum, milk, ptisan, fat flesh, and especially leeks, and whatever is mixed with the latter. The drink ought to be as little as possible, water may be given, either pure, or boiled to a decoction with a quince or dates. Also mild gargarisms: but if these are not successful, repellent ones are good.

This disease is not acute, and yet may not continue long: but requires a speedy cure, lest it turn very severe and tedious.

Of a cough.

A cough, which is contracted in many different ways, is generally a troublesome concomitant of an exulceration of the fauces; and in this case, when the fauces are cured, the cough ceases. Yet it is sometimes found by itself without any other distemper: and when it becomes inveterate, it is hardly possible to remove it entirely. And sometimes it is dry, sometimes it either generates or discharges phlegm.

In this it is proper to drink hyssop every other day; to keep in the breath and run, but by no means in dusty places; and to read aloud, which at first is obstructed by the cough, but afterwards overcomes it; then to walk; then to use also those exercises that employ the hands, and to rub the breast for a long time: after these to eat three ounces of the mellowest figs stewed over the fire.

Besides if it be moist, strong frictions are good with some heating medicines, the head being briskly rubbed at the same time; also cucurbitals used to the breast, mustard applied to the external part of the fauces, till it be a little ulcerated; the drink may be prepared from mint, and sweet almonds, and starch; and beginning with dry bread he may proceed to any other light food.

But if it be a dry cough, when it is most severe, taking a cyathus of austere wine relieves; provided that be not oftener done than three or four times after proper intervals. It is likewise necessary to swallow a little of the best laser, to take the juice of leeks or horehound, to lick squils, to sup vinegar of squills, or at least sharp vinegar, or two cyathi of wine with a clove of bruised garlick infused in it.

In every cough it does service to take journies, long voyages, and to live near the sea, and to swim. The diet must be sometimes soft, as mallows and nettles; sometimes acrid, as milk boiled with garlick; gruels, to which laser has been added, or such as have had leeks boiled in them, till they have lost all their verdure. A sorbile egg also with an addition of sulphur may be supped; for drink warm water may be taken first, then alternately, some days water, and other days wine.

Of a spitting of blood.

A spitting of blood may strike a greater terror. But that sometimes is less, and sometimes more dangerous. For it issues sometimes from the gums, sometimes from the mouth; and indeed from the latter very plentifully at times, but without a cough, without an ulcer, or any distemper of the gums, and without expectorating any thing; but breaks out from the mouth in the same manner, as from the nose. And sometimes pure blood is discharged, at other times something like water, in which fresh meat has been washed. Sometimes it comes from the upper part of the fauces, which may happen by means of an exulceration in that part; or when it is not ulcerated, either from the mouth of some vein opened, or tubercles rising there, and discharging the blood. When this is the case, neither meat nor drink do harm, nor is any thing expectorated, as from an ulcer. But sometimes, when the throat and wind-pipe are ulcerated, a frequent cough forces out blood too. Neither is it uncommon for it to come either from the lungs, or the breast, or the side, or the liver. Women, whose menses are suppressed, often have these spittings. And medical writers say, that blood is discharged either by the erosion, or the rupture of some part, or the dilatation of the mouth of some vein. The first they call diabrosis[ CQ ], the second rhegmochasmus[ CR ], the third anastomosis[ CS ]. The last does least hurt; the first is most dangerous. And it often happens, that the blood is followed by pus.

Now sometimes stopping the blood is alone sufficient to effect a cure. But if ulcers have followed, if pus, if there be a cough, diseases are formed, which differ in nature and danger according to the parts they possess. If blood only is discharged, both the remedy is easier, and the termination of the distemper quicker. And we ought not to be ignorant, that a moderate discharge of blood, is not hurtful to those, who are accustomed to hæmorrhages, or such, whose spine or hips are pained, or to any after violent walking or running, provided there be no fever: and that passing off in the urine, it removes even the lassitude. And that it is not terrible in the case of a person, who has fallen from a height, if nothing else appears uncommon in his urine. That neither is a vomiting of blood dangerous, although it return, if opportunity has been allowed to strengthen and fill up the body beforehand: and in general that no such discharge can hurt, when it happens in a strong body, and is neither excessive, nor raises a cough, nor heat. These observations are universal. Now I shall return to those particular places, which I have mentioned.

If it comes from the gums, it is sufficient to chew purslane; if from the mouth, to hold pure wine in it; if that is not effectual, vinegar. If notwithstanding these it breaks out with violence, because it may waste a person, it is most proper to divert its force by applying a cucurbital to the back of the head, and making an incision in the skin; if this happens to a woman, whose menses are stopped, to apply the cucurbital to her groin, with scarification.

But if it has proceeded from the fauces, or the more internal parts, there is more to be feared, and greater care must be taken in the cure. Blood must be let: and if notwithstanding that, it breaks out from the mouth, the operation must be repeated a second, and a third time, and every day a little taken away: the patient ought immediately to sup either vinegar, or the juice of plantain, or leek with frankincense[(14)]: and some sordid wool dipped in vinegar and squeezed, should be applied externally upon the place, which is diseased, and it must be cooled now and then with a sponge. Erasistratus made many ligatures in the legs, and thighs, and arms of such patients. Asclepiades was so far from thinking this useful, that he even judged it hurtful. But a number of experiments gives proof of its often answering very well.

Nevertheless there is not a necessity for making ligatures in many places: but it is sufficient to do it below the groin, and above the ancles, and near the top of the shoulders, and fore arms. Then if the patient have a fever, gruel must be given; and for drink some astringent decoction. But if there is no fever, either washed alica, or bread dipped in cold water, and a soft egg too may be given; and for drink either what was above-mentioned, or sweet wine, or cold water. But in the allowance of drink we must remember, that thirst is serviceable in this disorder.

Besides these, rest, security from apprehensions, and silence are necessary. The patient’s head, when he lies, should also be high, and it is proper to clip it close. The face is to be often bathed with cold water. But wine, the bath, venery, oil amongst meat, all acrid things, warm fomentations, a hot and close room, many cloaths thrown upon the body, are all prejudicial; also frictions, unless when bleedings have entirely ceased. Then indeed he may begin with the arms and legs, but not touch the chest. In this case he should reside near the sea-coast in the winter time, and in the inland places in the summer.

CHAP. V. OF THE DISORDERS OF THE STOMACH, AND THEIR CURE.

The stomach[(15)] is below the fauces; to this many tedious disorders are incident. For sometimes a great heat affects it, sometimes a flatulency, or an inflammation, or an exulceration; at other times phlegm or bile attacks it. But the most frequent disease is a relaxation: nor is there any thing from which the stomach either suffers more itself, or more affects the whole frame.

As its disorders are different, so are the remedies. Where it is distressed with heat, it must be embrocated now and then with vinegar and rose oil, and a powder[(16)] with oil applied, and such cataplasms as at the same time both repel and soften. Cold water may be given to drink, unless there be some particular reason against it.

When there is a flatulency, the application of cucurbitals does service, and there is no necessity for scarification. Dry and warm fomentations, but not very strong, are serviceable. Abstinence must be enjoined at times. To drink wormwood, or hyssop, or rue fasting is good. Exercise must be used, at first gentle, and afterwards stronger; especially such as may move the superior parts, which kind is most proper in all disorders of the stomach. Exercise should be followed by unction and friction; also the bath sometimes, but seldom, and sometimes clysters; after these warm food, and not flatulent; and in the same manner warm drink, first water, afterwards when the inflation has subsided, austere wine. This rule must be laid down in all distempers of the stomach, that by whatever means any patient has been recovered, he must pursue the same method when he is well: for his weakness returns, unless health be preserved by the same regimen, by which it was restored.

But if there be any inflammation, which is commonly followed by a swelling and pain, the chief remedies are, rest, and abstinence, sulphurated wool[(17)] applied round it, the use of wormwood fasting. If there is a burning heat in the stomach, it must be embrocated now and then with vinegar and rose-oil; and then food must be taken sparingly; and the external applications must be such, as both repel and soften; then withdrawing these, warm cataplasms of meal must be used, to discuss the remains of it; a clyster must be given now and then; exercise must be used, and a fuller diet.

But if the stomach is infested with an ulcer, the same course almost must be pursued, as has been prescribed in ulcerated fauces. Exercise and friction of the lower parts must be practised. Light and glutinous food must be used, but not to satiety. Every thing acrid and acid is to be avoided. If there is no fever, sweet wine may be used, or if that inflates, at least mild; but neither very cold, nor too hot.

If the stomach is loaded with phlegm, a vomit is necessary, sometimes fasting, sometimes after meat. Exercise, gestation, sailing, friction, are good. Nothing is to be eaten or drunk, but what is warm; only avoiding such things, as usually generate phlegm.

It is a more troublesome disorder, where the stomach is vitiated with bile. Those that are thus affected, usually at the interval of some days throw it up, and indeed, which is worst of all, of a black colour. It is proper to give such patients clysters, and potions of wormwood; gestation, and sailing are necessary, and vomiting by sea sickness, if it can be procured; crudity must be avoided; food used easy of concoction, and not ungrateful to the stomach, and austere wine.

The most common and worst disorder of the stomach is a relaxation, that is, when it is not capable of retaining food, and the body ceases to be nourished, and thus is wasted by a consumption. The bath is very hurtful in this species. Reading, and exercising of the superior parts are necessary, also unctions and frictions; then to have cold water poured all over the body, and to swim in cold water, and to lay the stomach itself under canals, and more especially that part below the shoulders, which is opposite to the stomach; to stand in cold and medicinal springs is a salutary practice, such as those of Cutiliæ[(18)] and Subruinæ; food is also to be used cold, and such rather, as is of difficult concoction than what is easily corrupted: for this reason most people, that can concoct nothing else, concoct beef. Whence we may infer, that neither birds, nor venison, nor fish ought to be given, except the harder kinds. Cold wine indeed is fittest to drink, or at least the strong well warmed, particularly the Rhetic or Allobrogic[(19)], or any other, which is both austere, and seasoned with resin; if that is not to be had, the roughest possible, and especially Signine[(20)].

If the food does not stay upon the stomach, water is to be drunk, and a plentiful vomiting procured; and food must be given a second time, and then cucurbitals are to be applied two fingers breadth below the stomach, and kept there for two or three hours. If there is both a vomiting and pain at the same time, sordid wool, or sponge dipped in vinegar, or a cooling cataplasm, must be applied to the stomach. The arms and legs must be rubbed briskly, but not long, and heated.

If the pain is more severe, the cupping must be performed four fingers below the præcordia; bread dipped in cold vinegar and water must be given immediately; if it has not staid, then after the vomiting, some light thing not ungrateful to the stomach; if even that is not retained, a cyathus of wine every hour, till the stomach be settled. The juice of radishes is also a powerful medicine; but a stronger is the juice of the acid pomegranate, with an equal quantity of the juice of the sweet pomegranate, and an addition also of the juice of endive and mint, but the least proportion of this; with which it is very proper to mix as much cold water, as equals the quantity of them all together. For that is more efficacious for composing the stomach than wine. A vomiting, which comes of itself, is to be stopped, although there be a nausea.

But if the food has grown sour or putrid within the stomach, both which accidents are known by the eructations, it must be evacuated; and the stomach must be immediately recruited by taking the same kind of food, that I have just mentioned. When the present danger is removed, we must return to those things which have been prescribed before.

CHAP. VI. OF PAINS OF THE SIDES, AND THEIR CURE.

The stomach is surrounded by the sides; and in these there happen sometimes violent pains. They arise either from cold, or a blow, or from excessive running, or from a distemper. But sometimes the disorder goes no farther than a pain; which is sometimes slowly, and sometimes quickly removed. At other times it grows extremely dangerous; and there arises an acute distemper, which by the Greeks is called pleuriticus[ CT ]. To this pain of the side is added a fever and cough: and by the last is expectorated, if the distemper be tolerable phlegm; if severe, blood. Sometimes also the cough is dry, and brings up nothing, and this is worse than the first, but more tolerable than the second.

Now the cure of a violent and recent pain is letting of blood. But if the case is more slight or of a longer standing, that remedy in the first is needless, and for the other is too late; and recourse must be had to cupping, first making an incision in the skin. Mustard with vinegar is also proper to apply upon the breast, till it produce ulcuscles and pimples; and after that, a medicine which can derive the humour thither. Besides these it is fit first to put sulphurated wool round the side; and then when the inflammation has a little abated, to make use of dry and warm fomentations. From these a transition is made to malagmas.

If an inveterate pain still continues, in the last place it is discussed by the application of resin. Warm food and drink must be used, and cold avoided. In the mean time, it is not amiss to rub the extremities with oil and sulphur: if the cough has abated to read softly: and by that time to take both acrid food and stronger wine. Such then are the prescriptions of the physicians. But without these it is said, that our peasants find it sufficient for their cure to drink germander in water.

These rules are common in every pain of the side: the cure is more difficult, if the distemper has grown acute. In such a case, besides what has been already directed, these cautions are to be observed: that the food be extremely thin and mild, especially gruel, and particularly that, which is made of ptisan; or chicken broth with leeks, and that is not to be given till the third day, and with this condition then, that the strength will admit of it: and for the drink a decoction of hyssop, or rue in hydromel. Now the seasons for giving these will appear from the consideration of the fevers increasing or abating, so that they be given in the greatest remission. At the same time however we should know, that in a cough of this kind we are not to allow the fauces to be dry. For often, where there is nothing to be expectorated, it continues and suffocates: for which reason I said, that a cough, which evacuates nothing, was still worse than one, which brought up phlegm. But the distemper itself in this case will not allow wine, which we prescribed before: instead of it the cream of ptisan is to be used.

As the patient is to be supported in the violence of the distemper by these things; so when it has abated a little, a fuller diet and also some wine may be allowed; provided nothing be given, which may either refrigerate the body, or irritate the fauces. If the cough remains upon the recovery, it will be proper to intermit for one day, and the day after to take a little more wine with meat. But if the cough still prevails, it will not be amiss, as above directed, to drink some cyathi of wine. But in this kind of disorder sweet wine, or at least mild is more proper. If it grows inveterate, the body must be strengthened by a robust diet.

CHAP. VII. OF A PERIPNEUMONY, AND ITS CURE.

From the frame of the body we must proceed to the bowels; and first of all to the lungs. Whence a violent and acute distemper arises, which the Greeks call peripneumonia[ CU ]. The nature of it is this. The whole lungs are affected. And their disorder is followed by a cough bringing up bile, or pus, a weight of the præcordia and the whole breast, difficulty of breathing, violent fevers, continual watching, prostration of appetite, and a consumption. This kind of distemper is attended with more danger than pain.

It is fit, if the strength will admit of it, to let blood: if not, to make use of dry cupping to the præcordia; and if the patient can endure it, by gestation to dissipate; if he cannot bear that, to move him gently within the house; to give him in drink hyssop boiled with a dry fig; or a decoction of hyssop or rue in hydromel; to use friction longest upon the shoulders, a little shorter on the arms, and feet, and legs, gentle over the lungs, and to do this twice every day.

As to diet, he ought never to have salt things, nor acrid, nor bitters, nor astringents; but what is of the milder kind. Therefore at the beginning is to be given gruel either of ptisan, or alica, or rice, in which recent fat has been boiled; along with it a sorbile egg, pine-nuts, bread with honey, or washed alica with hydromel. After that, not only pure water must be allowed to drink, but hydromel too egelid; or if it be the summer time, even cold; unless there be some particular reason against it. It is sufficient to give these every other day, when the distemper is increasing.

When it ceases to increase, as much as the circumstances will allow, he must abstain from every thing, except egelid water. If the strength fails, it must be supported by hydromel. And against the pains the application of hot fomentations is good, or such things as both repel and soften. It does good also to lay salt ground fine upon the breast, mixed with cerat; because it corrodes the skin gently, and thus diverts the course of the matter, which oppresses the lungs. Some malagmas too of such things as make a derivation are useful. And it is not improper, during the violence of the distemper, to keep the windows close upon the patient: when it has a little abated, three or four times a day to open them a little and let in fresh air. Then when he begins to recover, for several days to abstain from wine: to use gestation and friction; to add to the gruels and former diet, amongst the pot-herbs leeks; of flesh, the heels, and trotters; and small fish; so that for a long time nothing else be taken, but what is soft and mild.

CHAP. VIII. OF THE DISEASE OF THE LIVER, AND ITS CURE.

The distemper of another bowel, that is the liver, in like manner happens to be sometimes long and sometimes acute. The Greeks call it hepaticus[ CV ]. There is a violent pain to the right below the præcordia; and the same reaches to the right side, and to the clavicle, and the shoulder of the same side: sometimes also the right hand is benumbed, and there is a strong shuddering. When it is severe, bile is vomited; sometimes the hiccough almost suffocates. And these are its symptoms, when it is acute. But it is chronical, when there is a suppuration in the liver; and the pain sometimes ceases, at other times increases; on the right side the præcordia are hard and swelled; after eating, the difficulty of breathing is increased. There is also a sort of paralytic relaxation of the jaws. When the disorder has continued long, the belly, and legs, and feet swell; the breast, and arms, and the parts about both clavicles are emaciated.

In the beginning, the best thing is to let blood: then the belly must be opened; if that cannot be done otherwise, by means of black hellebore. Cataplasms are to be applied externally; first such as may repel, then hot ones, which can discuss; to these it is proper to add iris, or wormwood; after them a malagma. The diet should be gruels, and all the food should be warm, not very nourishing, and generally such as is proper in a peripneumony; and those besides that are diuretic, and such drink as will promote the same end. Thyme is good in this distemper, savory, hyssop, catmint, sweet marjoram, sesamum[(21)], bay-berries, pine-flowers, blood herb, mint, the pulp of a quince, the fresh and raw liver of a pigeon. Of these some may be eaten alone, and others added to the gruel, or the drinks, but in small quantities; and it is not improper to swallow every day a catapotium composed of powdered wormwood, honey, and pepper. But all cold things must be refrained, for nothing hurts the liver more. The extremities must be rubbed. All labour and violent motion avoided: even the breath must not be long kept in. Anger, flutter, lifting any thing weighty, throwing, running are hurtful. Pouring water plentifully upon the body does good, if it be the winter time, hot; if the summer, tepid; also plentiful unction, and sweating in the bath.

If the liver is oppressed with a vomica, the same method must be followed as in other internal suppurations. Some even make an incision over it[(22)], and cauterize the vomica itself.

CHAP. IX. OF THE DISORDER OF THE SPLEEN, AND ITS CURE.

But when the spleen is affected, it swells, and together with it the left side, which is both hard and resists pressure; and the belly is tense: there is some swelling also in the legs. Ulcers either do not heal at all, or at least scarcely cicatrize. In walking briskly or running, there is a pain, and some difficulty.

This malady is increased by rest. Therefore there is a necessity for exercise and labour: care being taken however that these be not carried too far, lest they produce a fever. Unction and friction, and sweatings are necessary. Every thing sweet is hurtful; also milk, and cheese. Acids are most agreeable; therefore it is good to sup sharp vinegar alone, and more especially that, which is tinctured with squills. Salt fish is to be eaten, or olives in hard brine; lettuce in vinegar; endive also, and betes in the same manner; and mustard, wild radish, and parsnips: of animal food the heels, and cheeks, lean birds, and venison of the same kind. A decoction of wormwood in water may be given for drink fasting: but after meat the water, in which a smith has often extinguished hot iron, for this very powerfully contracts the spleen: the discovery of which property we owe to an observation made upon animals bred in the houses of smiths, that they have very small spleens. Small and austere wine may also be given; and every thing in food or drink, which is diuretic: of great efficacy for that purpose is trefoil seed, or cummin, or smallage, or serpyllum, or cytisus[(23)], or thyme, or hyssop, or savory: for these seem very proper to promote a discharge of the humour from it. It is good also to eat of the spleen of beef: and rocket and cresses are remarkable for attenuating the spleen. There must be some external application to ease the pain. Such is composed from a kind of acorns[(24)] used by the Unguentarii, which the Greeks call myrobalani[ CW ]: or the seeds of lint, and cresses mixed with wine and oil: also of green cypress and dry figs: or of mustard and a fourth part of the suet of a goat’s kidneys, and this is rubbed in the sun and applied immediately. And the caper too is fit for this disorder in many forms; for it may both be eaten itself with meat, and its pickle with vinegar supped. Moreover the root powdered or its bark with bran, or the caper itself powdered, and mixed with honey, may be applied externally. There are also malagmas calculated for this purpose.

CHAP. X. OF THE DISEASES OF THE KIDNEYS, AND THEIR CURE.

But where the kidneys are affected, the disorder continues long. It is worse if attended with a frequent bilious vomiting. It is proper to rest; to lie soft; to open the belly; and even to give a clyster if it will not do without it; to sit down often in warm water; to take neither meat nor drink cold; to abstain from every thing salt, acrimonious, acid, and fruit of the apple kind; to drink freely; to add sometimes to the meat, and sometimes to the drink, pepper, leeks, ferula[(25)], white poppies, which usually cause a great discharge of urine from the kidneys.

If they be ulcerated, and the ulcers are to be cleansed, the remedy is sixty seeds of cucumber blanched, fifteen kernels of the wild pine, as much anise as can be held betwixt three fingers, a little saffron; all these powdered, and divided into two draughts of mulse.

If the pain only is to be relieved, the medicine is thirty seeds of cucumber, and twenty of the kernels mentioned before, five sweet almonds, a little saffron powdered, and given to drink with milk. And besides these it is proper to apply some malagmas; especially such as are fit for drawing out moisture.

CHAP. XI. OF THE CHOLERA, AND ITS CURE.

From the bowels we proceed to the intestines, which are obnoxious both to acute and chronic distempers. And first of all we shall make mention of the cholera; because that seems at once to affect equally the stomach and intestines. For at the same time there is both a purging and vomiting: besides these, there are flatulencies, the intestines are racked, bile is forced both upwards and downwards, first resembling water, then as if fresh meat had been washed in it, sometimes white, sometimes black, or variously coloured. Upon this account the Greeks gave this distemper the name of cholera[ CX ]. And besides what we have taken notice of already, the legs and hands too are often contracted, thirst torments, and there are faintings. Where all these concur, it is not to be wondered, if the patient die suddenly. And nevertheless there is no distemper obviated with less trouble.

Wherefore upon the first appearance of these symptoms it is proper to drink plenty of tepid water and to vomit. That scarce ever fails to vomit: but although it miscarries in that, yet it is of use to mix new matter with the corrupted; and it is a step in the recovery, if the vomiting be stopped. If that happens, all drink must immediately be abstained from. But if there be bloody stools, it is fit to bathe the stomach with something cold, or if the belly be pained, with the same egelid, the belly itself being assisted by medicines moderately warm. But if the vomiting, and purging, and thirst, all at once torment greatly, and what is vomited is yet somewhat crude, it is not a proper time to give wine: water must be given, and that not cold, but rather egelid. And penny-royal with vinegar must be applied to the nostrils, or polenta sprinkled with wine, or mint, or what is comfortable or refreshing to nature[(26)].

But when the crudity is removed, then there is more apprehension of the person fainting. Wherefore at such time recourse must be had to wine: which ought to be small, aromatic, and mixed with cold water, either with the addition of polenta, or a piece of bread, which also it is proper to eat: and as often as the stomach or belly has discharged, so often to recruit the strength by these means. Erasistratus directed to mix at first three or five drops of wine with every draught, and then to add more wine by degrees. He was in the right, if he gave wine from the beginning, and then found reason to fear a crudity: but if he imagined a great weakness could be relieved by three drops of wine, he was mistaken.

But if the patient be empty, and his legs contracted, wormwood must be given to drink now and then. If the extremities be cold, they must be anointed with hot oil, with the addition of a little wax; and cherished with hot fomentations. If even by these relief has not been procured, a cucurbital must be applied externally over the stomach itself, or mustard put upon it. When that is composed, it is proper for him to sleep; and on the day following to abstain from drinking; on the third day to go into the bath; to recruit himself gradually by food; and sleep, if he can rest easily; and to avoid fatigue and colds. If after the suppression of the cholera a feverishness remains, it is necessary to give a clyster, then to take food and wine. Now this distemper is both acute, and so much seated betwixt the intestines and the stomach, that it is hard to say, to which it peculiarly belongs.

CHAP. XII. OF THE COELIAC DISTEMPER OF THE STOMACH, AND ITS CURE.

At the lower orifice of the stomach is seated a distemper, which is usually long, called cœliacus[ CY ] by the Greeks. In this the abdomen grows hard, and is pained; there is no passage by stool, and not so much as wind can escape; the extremities grow cold; and there is a difficulty in breathing.

It is most proper in the beginning to apply warm cataplasms over all the belly to ease the pain; after meat to vomit, and thus to empty the belly; then on the following days to apply cucurbitals (without making any incision) to the belly and hips: to loosen the belly itself by giving milk and salt wine cold; green figs also, if it be the season for them; with this caution however, that neither the allowance of food nor drink be given all at once, but gradually. Wherefore at intervals it is sufficient to take two or three cyathi, and food in proportion to this. And a cyathus of milk mixed with an equal quantity of water, and so given, does very well. Warm and acrid food is proper; so that even bruised garlic with milk is no bad mixture.

In a little time the case requires gestation, and especially sailing; to be rubbed three or four times a day with oil and nitre together; to have warm water poured on after meat; then to apply mustard to all the parts of the body, except the head, till they be corroded and grow red; and more especially if the body be firm and strong. Then there must be a gradual change to such things as bind the belly. Strong roasted flesh is to be given, and such as is not easily corrupted: boiled rain water may be given to drink, to the quantity of two or three cyathi at a time.

If the disorder be of long standing, it is proper to swallow the bulk of a pepper-corn of the best laser; and every other day to drink wine or water, at times to sup single cyathi of wine, taking food between; to give a clyster of rain-water egelid; and more especially if the pain continues in the lower parts.

CHAP. XIII. OF THE DISTEMPER OF THE SMALL GUT, AND ITS CURE.

To the intestines themselves two distempers are peculiar; one of which is in the small, and the other in the large gut. The first is acute: the other may continue long. Diodes the Carystian called the distemper of the small intestine chordapsus[ CZ ], that of the larger he named ileus[ DA ]. But I observe, that most people now call the first ileus, and the other colicus[ DB ]. Now the first occasions a pain, sometimes above, sometimes below the navel. In either place there is an inflammation: neither the excrements nor wind can pass downwards. If the upper part is affected, the food, if the lower, the excrements are returned by the mouth: in either case there is danger; which is increased, if the vomiting be bilious, fetid, or various, or black.

The cure is letting of blood; or applying cucurbitals in several places, but not to make incisions of the skin every where; for that is sufficient in two or three places: from the rest it suffices to evacuate air. Then it is proper to observe, where the seat of the disorder is; for there is commonly a swelling over it. And if it be above the navel, a clyster signifies nothing: if it is below, it is most proper, in the opinion of Erasistratus, to give clysters sometimes; and this remedy is often of very great service in these parts. The liquor proper for this is strained cream of ptisan, with the addition of oil and honey without any thing else. If there is no swelling, it is most proper to apply the two hands to the top of the belly, and to bring them down gradually; for thus the seat of the disorder will be discovered, as it will necessarily resist the pressure: and from thence it may be determined, whether it is fit to use clysters or not.

The following remedies are general: to apply hot cataplasms from the breasts as far as the groin and spine, and to change them often; to rub the legs and arms; to dip the patient all over in warm oil. If the pain does not abate, to give even a clyster of three or four cyathi of warm oil. When by these means we have procured a passage for the wind downward, to give tepid mulse to drink, but in small quantity, for before great care must be taken that he drink nothing: if that has succeeded well, to add gruel.

When the pain and feverishness have ceased, then we may venture upon a fuller diet; but neither flatulent nor strong, lest the intestines yet weak be hurt. Nothing should be drunk but pure water; for every thing either vinous or acid is prejudicial in this distemper. And even afterwards it is proper to avoid the bath, walking, gestation, and other motions of the body: for the disease is apt to return upon slight occasions; and cold, or any violent motion, before the intestines have fully recovered their strength, brings it back again.

CHAP. XIV. OF THE DISEASE OF THE LARGE INTESTINE, AND ITS CURE.

That distemper, which is seated in the large intestine, principally affects that part, where I mentioned the cæcum to be situated. There is a violent inflation; vehement pains, especially on the right side: the intestine seems to be inverted, which almost forces out the wind. In most people it comes after colds and crudity, then ceases; and while they live, it often returns, and torments, but does not shorten life.

When this pain has begun, it is proper to apply dry and warm fomentations, but first of all mild, and then stronger; and at the same time by friction to make a derivation of the matter to the extremities, that is, the legs and arms: if it is not removed, to make use of dry cupping, where the pain is. There is also a medicine calculated for this distemper, which is called colicon[ DC ]. Cassius claimed the glory of this invention. It has the best effect given by way of potion; but even externally applied by dispersing the wind it eases the pain.

Neither food nor drink should be given, till the pain be over. The regimen for such patients I have already mentioned[(27)]. The composition, which is called colicon, consists of the following ingredients: of costus, anise, castor, each p. * iii. parsley, p. * iv. long pepper and round, each p. * v. tears of poppy, round cyperus, myrrh, nard, of each p. * vi. these are incorporated in honey. Now this may be both swallowed alone, and taken with warm water.

CHAP. XV. OF A DYSENTERY, AND ITS CURE.

The next disorder of the intestines to this is by us called tormina, and by the Greeks dysenteria[ DD ]. The intestines are ulcerated within; blood flows from them; and together with that either excrements, which are always liquid, or something mucous are discharged; sometimes along with it, something fleshy is excerned. There is a frequent desire of going to stool, and a pain in the anus: with this pain a very small quantity is excreted; and even by that the pain is increased; and after some time it abates, and there is a small interval of ease; sleep is interrupted; a slight fever comes on; and when this distemper grows inveterate, it either kills a man in time, or though it terminates at last, torments him long.

The first rule to be observed, is to rest; for all kinds of agitation ulcerate: then to sup a cyathus of wine fasting, with the bruised root of cinquefoil; to apply restringent cataplasms over the belly, which is not expedient in the abovementioned disorders of this part; and as often as he has gone to stool, to wash his lower parts with a warm decoction of vervains; to eat purslane, either boiled or preserved in strong brine; to take such food and drink as bind the belly.

If the distemper is of longer standing, it is fit to administer a tepid injection of the cream of ptisan or milk, or melted fat, or deer’s marrow, or oil, or butter with rose oil, or the raw whites of eggs with the same, or a decoction of lintseed; or if there is no sleep, the yolks with a decoction of rose leaves: for these ease the pain, and render the ulcers milder, and are especially useful, if the disorder be also attended with a nausea. Themison asserts, that the roughest brine should be used in the same manner.

The food ought to be such, as is gently astringent to the belly. But diureticks, if they have their natural effect, are useful by making a derivation of the humour: if they do not gain that point, they increase the malady; therefore they must not be administered, but to such, as they usually affect in that way easily. If there be a fever, pure warm water must be given to drink, or such as has an astringent quality: if that is not to be got, light, austere wine. If for several days these remedies have done no good, and the distemper is now inveterate, drinking of water pretty cold binds the ulcers, and begins a recovery. But when the belly is once bound, they must immediately return to warm drink.

Sometimes also there happens to be a discharge of putrid sanies, which has an intolerable stench: and sometimes pure blood comes away. In the first of these cases, the belly should be washed with hydromel; after that the injections above prescribed must be used. And a piece of minium[(28)] powdered with a hemina of salt, is powerful against a gangrene of the intestines: or they may be mixed with water, and given for a clyster. But if pure blood is evacuated, the food and drink ought to be astringent.

CHAP. XVI. OF A LIENTERY, AND ITS CURE.

From a dysentery sometimes proceeds a lientery, in which the intestines can retain nothing, and whatever is taken they presently pass unconcocted. This sometimes is tedious, and sometimes carries off people quickly.

Now in this disorder it is proper to administer astringents, to enable the intestines to retain. Wherefore mustard should be applied over the breast; and when the skin is ulcerated, a malagma to discharge the humour: and let the patient sit down in a decoction of the vervains; and take such food and drink as bind the belly, and have cold water poured over him.

Care should be taken, however, that upon the application of all these remedies at once, there do not arise a malady on the contrary extreme by means of immoderate flatulencies. Wherefore the intestines will require to be strengthened gradually by the daily addition of somewhat. And as in every flux of the belly, so in this, it is particularly necessary to go to stool not as often as there is a motion, but as often as there is an absolute necessity, that this very delay may bring the intestines to a habit of bearing their burden.

There is another direction, which belongs equally to all similar disorders, to be principally regarded in this; that since most of the things proper for the disorder are disagreeable to the palate, such as plantain, and bramble berries, and whatever is mixed with pomegranate bark, such of these are to be chosen as the patient prefers. Then if he has an aversion to them all, let something less beneficial, but more grateful, be given at times to excite his appetite. Exercise and friction are necessary also in this distemper: and with these, according to Hippocrates, the heat of the sun, the fire, the bath, and vomiting, even by white hellebore, if the other means for that purpose prove unsuccessful.

CHAP. XVII. OF WORMS IN THE BELLY, AND THEIR CURE.

Worms too sometimes infest the belly; and they are sometimes discharged downwards, at other times, which is more disagreeable, from the mouth: and sometimes we observe them to be broad, which are the worst kind, and sometimes round.

If they are broad, a decoction of lupines, or mulberry bark in water may be given to drink: or either hyssop, or an acetabulum of pepper powdered, and a scammony with water. Or let the patient on one day, after eating plentifully of garlick, vomit; and the day following take a handful of the small stalks of the pomegranate, and boil these, after bruising them, in three sextarii of water, till a third part remains; let him add to this a little nitre, and drink it fasting: then after the interval of three hours let him take two draughts of this decoction, or the same with the addition of hard brine; then go to stool, having hot water in a vessel below him.

If again they are round, which chiefly molest children, both the same medicines may be given, and something more gentle, as the seed of nettles powdered, or of cabbage, or cummin with water, or mint with the same, or a decoction of wormwood, or hyssop in hydromel, or the seed of cresses powdered with vinegar. It is good also to eat lupines, and garlick, or to have clysters of oil administered.

CHAP. XVIII. OF A TENESMUS, AND ITS CURE.

There is also another distemper, which is more mild than any I have been treating of, called by the Greeks tenesmus[ DE ]. This ought to be ranked neither with the acute nor the chronic disorders, since it may be easily removed, and by itself never proves mortal. In this, as well as in a dysentery, there is a frequent motion to stool; and equal pain, when any thing is excreted. Something like to phlegm and mucus is discharged, sometimes too, slightly tinctured with blood; but with these is sometimes mixed what has been duly concocted from the food.

It is proper to sit down in warm water; to apply something to the anus itself pretty often. For which purpose many medicines are suitable: butter with oil of roses; acacia dissolved in vinegar; that plaister, which the Greeks call tetrapharmacum[(29)], melted with rose oil; alum wrapped in wool, and thus applied; and the same injections which relieve in the dysentery; the same decoction of vervains to foment the lower parts. Every other day, water and light austere wine are to be drunk alternately. The drink ought to be egelid, and nearer to cold: the diet of the same nature as we have directed for a dysentery.

CHAP. XIX. OF A SIMPLE PURGING, AND ITS CURE.

A purging, while recent, is still a more gentle distemper, in which the discharge is both liquid, and more frequent than ordinary. In this the pain is sometimes tolerable, at other times very severe; and that shews a greater violence of the disease. But for the belly to be loose for one day is often salutary; and even for several days, provided there be no fever, and it cease in seven days. For thus the body is cleansed; and what would have hurt internally, is advantageously evacuated. But the continuance of it is dangerous; for sometimes it brings on a dysentery, and febriculas, and wastes the strength.

It is sufficient to rest the first day; and not to stop the flux of the belly. If it has ceased spontaneously, to make use of the bath, to take a little food: if it continues, to abstain, not only from food, but from drink also. On the day following, if the belly still be loose, to continue at rest; and take a very little astringent food. On the third day to go into the bath; to rub every part of the body briskly, except the belly; to expose the loins and shoulders to the heat of the fire; to take food, but such as is astringent to the belly; a little wine undiluted. If on the day following the purging shall continue, to eat more, but likewise to vomit. Upon the whole, to struggle against it by thirst, fasting, and vomiting, till it ceases: for it is scarcely possible, that after this care the belly should not be bound.

There is another method, when one has a mind to stop the flux, to take supper, and then to vomit; on the day after, to rest in bed; to be anointed in the evening, but gently; then to eat half a pound of bread in neat Aminaean wine; next, something roasted, and especially a bird; and afterwards to drink the same wine mixed with rain water; and to continue in this course till the fifth day, and vomit again. Asclepiades, contrary to former authors, affirmed, that the drink ought always to be cold, and indeed as cold as possible. My opinion is, that every one may determine by his own experience, whether he should use it hot or cold.

But it sometimes happens, that this disorder, neglected for several days, may be more difficult to cure; it is proper to begin with a vomit; then on the evening of the following day, to be anointed in a tepid place; to eat moderately, and drink wine undiluted and as rough as can be got; to keep rue with cerate applied over the belly. And in this state of the body, neither walking nor friction are proper: riding in a chariot is good, on horseback much better; for nothing strengthens the intestines more.

If medicines are to be made use of, those composed of the apple kind are most suitable. At the time of vintage, pears and crab apples are to be thrown into a large vessel; if these cannot be had, green tarentine pears, or signine, the apples called scandiana or amerina, or pears called myrrhapia[(30)]; and to these quinces must be added, and pomegranates with their bark, service fruit, and, which are more used, the torminalia, and let these take up the third part of the jar; after that it must be filled with must, and boiled till the whole contents being dissolved unite into one mass. This is not unpleasant to the taste; and whenever the case requires it, taken moderately, without any prejudice to the stomach it binds the belly: it is sufficient to take two or three spoonfuls in one day. Another stronger medicine is, to gather myrtle berries, and press the wine from them, to boil it to the tenth part, and sup a cyathus of that. The third, which may be got at any time, is to scoop a pomegranate, and taking out all the seeds, to put in again the membranes, that were betwixt them; then to drop in raw eggs, and mix them up with a small wooden stirrer; then to put the shell over the fire, which does not burn, while there is any moisture within; when it begins to grow dry, it is proper to remove it, and taking out the contents with a spoon, to eat them. This acquires great efficacy by the addition of some other things: therefore it is even put into pepper wine, and mixed with salt, and pepper, and eaten with these: and pulse may be taken also boiled with some old honeycomb. And lentils boiled with pomegranate bark, and bramble tops boiled in water, and eaten with oil and vinegar, are efficacious: as also to drink the decoction either of dates, or quinces, or dry service fruit, or bramble berries; and I mean this kind of liquor, whenever I direct such drink to be given as is astringent. A hemina of wheat also is boiled in austere Aminaean wine; and the wheat is given to a person fasting and thirsty, and after that the wine is supped: this may justly be ranked amongst the most powerful medicines. And the signine wine is given also to drink, or resinated austere, or any other austere kind. And the pomegranate is bruised with its shells and seeds, and is mixed with such wine; and a person either sups this alone, or drinks it mixed. But the use of medicines is needless, unless where the disorder is violent.

CHAP. XX. OF THE DISEASES OF THE WOMB, AND THEIR CURE.

From the womb in women proceeds a violent distemper; and next to the stomach, this part both suffers most sensibly itself, and most affects the rest of the body. Sometimes it destroys the senses, so as to occasion their falling as in an epilepsy: but with this difference, that the eyes are not turned, nor is there any discharge of froth, nor convulsions: there is only a profound sleep. In some women this distemper returns frequently, and attends them during the whole course of their lives.

When it attacks, if there be sufficient strength, bleeding relieves: if there is not, yet cucurbitals must be applied to both sides of the groin. If the patient lies long in this state, or used to do so, it is proper to hold to the nostrils the extinguished wick of a lamp, or some other of these things I have mentioned of a remarkably bad smell, in order to rouse the woman. The same purpose is obtained by the pouring on of cold water. And rue bruised small with honey is good, or cerate of cyprine oil, or any other hot and moist cataplasm, applied from the pudenda up to the pubes. In the mean time, the hips and hams ought also to be rubbed.

After this, when she returns to herself, she must be forbid wine for a whole year, even although the disorder do not return. Friction must be practised every day over the whole body, but chiefly on the belly and hams. Food of the middle kind must be given: mustard be applied to the lower belly every third or fourth day, till the skin grow red.

If the hardness continue[(31)], nightshade dipt in milk, and then rubbed small, seems to be a proper emollient, and white wax and deers marrow with iris ointment, or beef suet, or goat’s, mixed with rose oil. In drink must be given either castor, or git, or dill. If she is not in good habit, she may be purged with the cyperus. If the womb is ulcerated, a cerate may be made of rose oil, also fresh hogs lard mixed with whites of eggs may be applied: or the white of an egg mixed with rose oil, with the addition of some powder of roses to help the consistence. But when the womb is pained, it ought to be fumigated with sulphur.

But if an excessive discharge hurts a woman, the remedy is to make an incision in the skin, and apply cucurbitals either to the groin or below the breasts. If the discharge is malignant,[(32)] restringents must be used. This intention is answered by white olives, black poppies taken with honey, and gum liquified, together with the powdered seed of smallage, and given in a cyathus of passum.

Besides these, in all disorders of the womb, such drink is proper as is made of the aromaticks, that is, spikenard, saffron, cinnamon, cassia, and the like. The mastich tree boiled to a decoction has the same effects. But if the pain be intolerable, and blood is discharged, even bleeding is proper; or at least the application of cucurbitals to the hips, after making an incision in the skin.

Of an ex­ces­sive dis­charge of urine.

But when urine is made beyond the measure of what is drunk, and coming away without pain emaciates, and creates danger, if it be limpid, there is a necessity for exercise and friction, especially in the sun, or at the fire. The bath ought to be seldom used, and the stay in it but short; the food astringent; the wine austere and undiluted, in summer cold, in winter egelid, but as little as possible. The belly should be either opened by a clyster, or purged with milk. If the urine is thick, both the exercise and friction ought to be more violent; the stay in the bath longer; the food tender; wine as above directed: in both cases, every thing that provokes urine must be avoided.

CHAP. XXI. OF AN EXCESSIVE DISCHARGE OF SEMEN, AND ITS CURE.

There is also a distemper about the parts of generation, an excessive profusion of semen, which without venery or dreams, runs off in such quantities, that in time it destroys a man by a consumption.

In this disorder brisk frictions, pouring water over the body, and swimming in water extremely cold are salutary: no food nor drink but what is taken cold. It is proper also to avoid crudities, and every thing flatulent; and to take nothing that seems to generate semen: such are siligo, fine flour of wheat, eggs, alica, starch, all glutinous flesh, pepper, rocket, bulbous roots, pine nuts. And it is not improper to foment the lower parts with a decoction of the astringent vervains, and to apply a cataplasm composed of the same to the lower belly and groin; and especially rue with vinegar[(33)]; and the person should be cautious not to sleep supine.

CHAP. XXII. OF THE DISEASE OF THE HIPS, AND ITS CURE.

It remains that I come to the extremities, which are connected together by articulations. I shall begin with the hips. In these a violent pain arises, which often weakens, and some people it never leaves: and for this reason that species is most difficult to cure, which after long diseases turns upon this part with a pernicious force: and as it relieves other parts, so it takes a fast hold of this, which it affects.

Fomentations of hot water must be used first; then warm cataplasms. The applications, which appear to be most useful in this case, are the bark of capers cut small and mixed with barley-meal, or with a fig boiled in water; or the meal of darnel boiled with diluted wine, and mixed with dry lees. It is more convenient to apply these malagmas in the night-time, because they are apt to grow cold. The root of elicampane also bruised, and after boiled with austere wine, and spread all over the hip is amongst the most powerful remedies. If these do not discuss the malady, hot and moist salt must be made use of.

If the pain is not removed by this method neither, or a swelling comes on, the skin must be cut and cucurbitals applied; urine must be promoted; and if the belly be bound a clyster must be given. The last remedy, which is also of great efficacy in disorders of the womb, is to make ulcers in the skin with hot irons in three or four places above the hip. To make use of friction too, chiefly in the sun, and several times in one day: that this hurtful collection of humours may be more easily discussed. The hips themselves may be rubbed, if there be no ulcer; if there is, the other parts of the body. Now since an ulcer is frequently to be made with hot iron, that noxious matter may be evacuated, this is always to be observed, that ulcers of this kind be not healed, as soon as may be; but kept open, till the distemper, which we propose to cure by them ceases.

CHAP. XXIII. OF A PAIN IN THE KNEES, AND ITS CURE.

The knees are next to the hips, in which there sometimes happens to be a pain. The cure consists in the same cataplasms and cupping: which are the remedies also when any pain arises in the shoulders, or the other joints. It is most hurtful of all things for one, whose knees are pained, to ride on horseback. Now all pains of this kind, when they have continued long, are scarcely cured without the use of the actual cautery.

CHAP. XXIV. OF THE DISEASES IN THE JOINTS OF THE HANDS AND FEET, AND THEIR CURE.

In the hands and feet the diseases of the joints are more frequent, and continue longer. Such as happen to gouty people in these places, seldom disturb either eunuchs, or boys before coition, or women unless their menses be suppressed.

When they begin to feel them, blood must be let. For this done immediately at the beginning often procures good health for a whole year, sometimes for life. Some too by cleansing themselves thoroughly by drinking asses milk, have prevented its ever returning; Others by abstaining from wine, mulse and venery for a year, have rendered themselves secure from it for their whole life. And this method is to be pursued after the first attack of the pain, although it has ceased. But if the fits of it are grown customary, one may indeed be more secure at such times as the pain has remitted: but more care ought to be taken at such seasons, as it returns[(34)], which happens commonly in the spring or autumn.

Now when the pain is not violent, the patient ought to use gestation in the morning; then to be carried, or to exercise himself by walking gently, and if the gout be in the foot, at small intervals alternately sometimes to sit, sometimes to walk; next before he takes food, without bathing to be rubbed gently in a warm place, to sweat, and have egelid water poured over him; after that to take food of the middle kind, making use at times of diuretics; and whenever he turns plethoric to vomit.

When the pain is very violent, it makes a difference, whether there be no swelling, or a tumour with heat, or a swelling already grown callous. For if there is no tumour, hot fomentations are required. It is proper to heat sea-water, or strong brine, then to pour it into a bason, and when the patient can bear it, to put his feet into it, and spread his gown over them, and cover them beside with cloaths, pouring in gradually at the edge of the vessel some of the same liquor, that the heat within may not decrease; and then in the night-time to apply heating cataplasms, and especially the root of marshmallows boiled in wine. But if there be a swelling and heat, coolers are more proper, and it is fit to keep the joints in the coldest water; but neither every day, nor long at a time, lest the nerves be indurated. And a cooling cataplasm must be applied: nor must even that be continued long; but a change must be made to those things, which are repellent, and at the same time emollient.

If the pain be more severe, the bark of poppies must be boiled in wine, and mixed with cerate made of rose-oil: or equal quantities of wax and hogs lard must be melted together, then wine mixed with them; and whenever an application of this medicine has grown hot, it must be removed, and another put on immediately.

But if the tumours have grown callous, and are painful, they are relieved by the application of a sponge squeezed now and then out of oil, or vinegar, or cold water; or by equal parts of pitch, wax and alum mixed together. There are also several malagmas proper for the hands and feet. But if the pain will allow nothing to be laid on, it is fit to foment the part, which is not swelled, with a sponge dipped in a warm decoction of poppy-bark, or the roots of wild cucumber; then to put over the joints saffron with the juice of poppies and ewes milk.

But if there is a swelling, it ought to be fomented with an egelid decoction of mastic-tree, or any other of the restringent vervains; and be covered with a medicine composed of bitter almonds powdered, and vinegar; or ceruss with an addition of the juice of the wall-herb bruised. The stone also, which eats flesh, by the Greeks called [ DF ]sarcophagus[(35)], cut into such a form as to receive the feet, usually relieves their pain, when they are put into it and kept there. Of this they make sepulchres in Assus. And the Asian stone[(36)] also has its merit for giving ease.

When the pain and inflammation have remitted (which happens within thirty days, unless the patient has been faulty) moderate exercises, abstinence, gentle unctions must be used, the joints being at the same time rubbed with an acopon[(37)], or liquid cerate of cyprine oil. Riding is hurtful, to those that have the gout in their feet.

Those, who have stated returns of this pain, before them ought both by a strict regimen to take care to prevent the redundancy of hurtful matter in the body, and to use frequent vomiting, and if there is reason to apprehend a present plethora, either clysters, or purging by milk. Which Erasistratus declared against, when the feet were gouty; lest the course of the humours downward should occasion a redundancy in the feet: though it is evident in every purgation, that not only the superior parts, but the inferior also are emptied.

CHAP. XXV. OF THE TREATMENT OF PATIENTS RECOVERING.

From whatever distemper a person is recovering, if he gathers strength slowly, he ought to awake at day-light, nevertheless to lie still in bed; about the third hour to rub his body gently with his hands anointed. Then to amuse himself by walking as long as he finds it agreeable, laying aside all attention to business; then to use gestation for a long time, much friction; to change often his situation, air, and food. When he has drunk wine for three or four days, for one or even two to interpose water. For by these methods he shall both escape those distempers, that bring on a consumption, and may quickly recover his strength. But when he is entirely recovered, it will be dangerous for him to change his course suddenly, and turn irregular. Therefore he ought by slow degrees to lay aside these restraints, and change to the way of life most agreeable to his humour[(38)].

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A. CORNELIUS CELSUS

OF

MEDICINE.

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BOOK V.

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