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If you are not located in the United States, you -will have to check the laws of the country where you are located before -using this eBook. - -Title: Of Medicine in Eight Books - -Author: Aulus Cornelius Celsus - -Translator: James Greive - -Release Date: January 03, 2021 [eBook #64207] - -Language: English - -Character set encoding: UTF-8 - -Produced by: Thiers Halliwell, Turgut Dincer and the Online Distributed - Proofreading Team at https://www.pgdp.net (This file was - produced from images generously made available by The Internet - Archive) - -*** START OF THE PROJECT GUTENBERG EBOOK OF MEDICINE IN EIGHT BOOKS *** -Transcriber’s notes: - -This e-book has an unusual structure, being a compilation of eight -smaller books accompanied by eight related sets of _numbered_ -explanatory notes provided by the author. It also contains several -hundred footnotes scattered throughout the text (many being Greek -spellings of words in the text). These have been given _alphabetic_ -labels and are now grouped together as endnotes. - -Numerous asterisks are present in parts of the text; these represent -uncertain quantities, not footnotes. The text also contains archaic -characters that may not display correctly with all viewing devices or -fonts. For best viewing, the device’s character encoding should be set -to Unicode (UTF-8), and one of the following fonts selected: Arial -Unicode MS, DejaVu, Segoe UI Symbol or FreeSerif. - -The text has been preserved as in the original, including inconsistent -punctuation, capitalisation and hyphenation. Archaic and -inconsistent spellings have been retained except where obviously -misspelled in the original. A list of these and other corrections has -been appended at the end. - - - - -A. CORN. CELSUS - -OF - -MEDICINE - - -_IN EIGHT BOOKS_. - - -TRANSLATED - -WITH NOTES CRITICAL AND EXPLANATORY - -BY - -JAMES GREIVE, M.D. - - -_A NEW EDITION._ - - -EDINBURGH: -Printed at the University Press; -FOR DICKINSON AND COMPANY, INFIRMARY-STREET. - -1814. - - - - -TO - -MR SHARP, - -SURGEON TO GUY’S HOSPITAL, - -FELLOW OF THE ROYAL SOCIETY, - -AND - -MEMBER OF THE ROYAL ACADEMY OF SURGERY AT PARIS. - - - SIR, - -The favourable opinion you have been pleased to express of the -following translation, and the trouble you have taken to revise the -chirurgical part, are obligations, which I embrace this opportunity of -acknowledging with the highest pleasure. - -And though I had not received such marks of your friendship, yet there -is no person, to whom a translation of CELSUS can be more properly -addressed; since no writer in this age appears to have a more just -esteem for this excellent author, or to have imitated his conciseness -and elegance, with so much success. - - I am, - - with great esteem, - - SIR, - - your most obedient, - - humble servant, - - JAMES GREIVE. - - LONDON, _January 26th, 1756_. - - - - -PREFACE. - - -It has been a question much debated, whether, and how far the writings -of the ancient physicians are of service to direct our practice in -the cure of diseases; but without repeating what has been already -said on this point, I imagine their usefulness may be inferred from -this single consideration, that the mechanism of the human body being -always and every where the same, a faithful history of diseases must -necessarily be one of the surest guides to the application of proper -remedies. Moreover, if the diagnostics and prognostics be of the -greatest moment in physic, and are only to be collected from long and -accurate observation, then the records left us by the ancients, who -were so assiduous in their observations, so clear and exact in their -descriptions, must be allowed to contain a valuable treasure of medical -knowledge. - -We have seen, in the present age, many learned physicians, who, though -they readily admit the improvements of the moderns, nevertheless apply -themselves with great industry to the study of the ancients; and -indeed, to say nothing of the superiority of some of the ancients in -stile and composition, as a matter of taste, I think it can hardly -be denied, that a man, capable of making proper allowances for the -variations in respect of climate and manner of living, may receive -great benefit from the materials left us by these ingenious writers -of antiquity, and find many hints, which, pursued with diligence, and -applied with caution, may both correct and enlarge his practice. - -Celsus is justly esteemed one of the most valuable amongst the -ancients. He is so often quoted, with approbation, by our best writers -in physic, and so much admired by the learned world for propriety, -ease, and elegance, that it is a needless attempt in these days to draw -his character. However, he is so little mentioned by the ancients, that -our curiosity cannot be gratified with any particulars of his life; nor -can we even determine what was his profession, if it does not appear -from his writings. - -Quintilian often mentions a treatise of his upon rhetoric, which though -he hardly ever quotes, but where he differs from him, he allows to be -composed with accuracy. But whatever he thought of his oratory, he -gives an honourable testimony to the extent of his learning. For to -persuade his student of eloquence to make himself master of all the -sciences, after mentioning the greatest geniuses that ever appeared in -Greece or Rome, as Homer, Plato, Aristotle, Cato the censor, Varro, -and Cicero, he adds, “Why should I name any more instances? when even -Cornelius Celsus, a man of a moderate share of genius, has not only -composed treatises on all these arts, but has also left precepts of -the military art, agriculture, and medicine. The bare attempt requires -us to believe he understood all these subjects: but to give perfection -to so great a work is a difficult task, to which no man was ever found -equal[A].” - - [A] Fab. Quintilian, lib. xii. c. 11. - -Some have complained of the partiality, or jealousy of the rhetorician, -who allows Celsus only a moderate share of genius. Others esteem it -no diminution to be placed in a rank below the writers above named. -Without doubt, this would do him very great honour: but if we even -take the character literally, still we are to consider Quintilian as -having every where in view the perfection of oratory. Now this, it -should appear, Celsus hardly affected, by his confining the orator -to questions in dispute[B]; which in great measure excludes the -descriptive and moving parts of the art: therefore Quintilian’s man -of middling genius may be a perfect writer in the instructive manner, -though he want the qualifications for the bar or the forum. But to do -Celsus some farther honour, may it not be supposed, that had Quintilian -been as competent a judge of his medical, as of his rhetorical -writings, he would not have stiled him, _Vir mediocri ingenio_. I -have made bold to hazard this observation from an opinion, that none -but a physician can form a just idea of the excellence of this work; -much less could any but a physician be the author of it. Celsus the -physician might very well write on agriculture, &c. but it by no means -follows, that Celsus, not versed in the practice of physic, could -have written accurately on diseases. If then this notion be just, it -may reasonably be concluded, that his medical writings were the most -perfect, as being the fruit of his principal and particular studies. - - [B] Id. lib. iii. c. 5. - -Columella (_De re rustica_) often quotes him with great deference to -his authority; he equals him to the most learned writers on husbandry; -and when he is correcting a vulgar error, expresses his surprise -that Cornelius Celsus could be misled, “who was not only skilled in -agriculture, but took in the whole compass of natural knowledge[C].” I -shall not recite all the passages, where he mentions Celsus, but cannot -help transcribing one, it is so expressive of our author’s manner. It -is on the article of bees, “concerning which (says he) it is impossible -to surpass the diligence of Hyginus, the profusion of ornaments in -Virgil, and the _elegance_ of Celsus. Hyginus has with great industry -collected the precepts, which lay scattered in the ancients; Virgil -has adorned the subject with poetic flowers; and in Celsus we find a -judicious mixture of both these manners[D].” - - [C] Columell. lib. 2. c. 2. - - [D] Id. lib. ix. c. 2. - -From Columella’s mentioning Celsus as a contemporary, but not as -a living writer[E], and our author’s speaking of Themison in the -same manner[F], Le Clerc infers, with great probability, that Celsus -wrote towards the latter end of the reign of Augustus, or at latest, -in the beginning of Tiberius; in which last period he is placed by -Fabricius[G]. And that he cannot have been later, appears not only from -these authorities, but almost undeniably from the purity and elegance -of his style, more nearly allied to the Augustan, than any of the -succeeding ages. - - [E] Id. lib. i. c. 1. - - [F] Celsi praefat. lib. i. - - [G] Biblioth. Latin. lib. ii. c. 4. - -Both Columella and Quintilian seem to speak of him as a Roman, and -indeed our author himself, when he is giving the Greek name for any -distemper, and is to add the Roman, frequently uses this phrase, -_nostri vocant, our countrymen call it_, or some other expression of -the same nature[H]. - - [H] _Nostri anginam vocant_, lib. iv. c. 4.--_Apud nos indecorum, sed - commune his herniae nomen est_, lib. vii. c. 18.--_Nostri vero sub - eodem nomine, quo priora habent_, ib. - -We have seen by the above quotations, how many treatises were composed -by Celsus, which have all perished in the barbarous ages, except this -work on medicine; which from the manner of its beginning, _Ut alimenta -sanis corporibus agricultura, sic medicina ægris sanitatem promittit_, -seems to have immediately followed his book on husbandry: for this -easy transition is very common with our author in connecting different -subjects. What confirms this is, that H. Stephens, upon the authority -of an ancient manuscript, has prefixed as the title, _Aurelii Cornelii -Celsi de re medica libri octo; operis ab eo scripti de artibus pars -sexta_. It would be still more evident, if we could depend upon the -manuscript in the library of Alex. Paduan: in which, at the end of -the fourth book is written, _Artium Cornelii Celsi liber nonus, idem -medicinæ liber quartus explicit feliciter_[I]. For his agriculture -contained five books[J], with which the first four of this work make up -the nine. - - [I] Morgagni Ep. 2. p. 41. - - [J] _Quippe Cornelius totum corpus disciplinae quinque libris - complexus est_, Columell. lib. 1. c. 1. - -Every trifling circumstance relating to our author has employed the -industry of his learned commentators. The English reader will therefore -forgive me for observing, that in most of the manuscripts, his name -is written A. Cornelius Celsus. And Rubeus informs us, the ancient -manuscript in the Vatican library has this title, _Auli Cornelii Celsi -liber sextus, idemque medicinæ primus_. As _Aurelius_ was the name of -a Roman family, it is not probable that this would be his praenomen; -on the contrary, _Aulus_ is found to be a common praenomen in the -Cornelian family[K]. For these reasons, I read his name A. that is -_Aulus, &c._ instead of _Aurelius_, as most of the printed copies have -it. - - [K] Morgagni Ep. iv. p. 75. - -From our author’s admirable abstract of the history of physic, it is -easy to see he had studied and thoroughly digested the writings of the -preceding physicians, and been attentive to the practice, as well as -to the arguments of the several sects. We have no reason to doubt he -made the best use of them; for we see that he confined himself to no -one party, but selected from each what he judged to be most salutary. -Though he has quoted many authors, sometimes with a view to recommend -their practice in particular cases, at other times to shew the -impropriety of it; yet through the whole, Hippocrates and Asclepiades -seem to have been highest in his esteem; but he does not give up his -judgment implicitly to these for he often leaves both, and advances -very good reasons for differing from them. He ingenuously owns[L], -that he has borrowed the prognostics from Hippocrates, “because,” says -he, “though the moderns have made alterations in the method of curing, -nevertheless they allow, that he has left the best prognostics.” With -regard to the critical days, he entirely condemns his doctrine, and -follows Asclepiades in rejecting the notion as idle and chimerical[M]. -But from both these authors he dissents in his rules about bleeding. - - [L] Præfat. lib. ii. - - [M] Lib. iii. c. 4. - -It would be superfluous for me to prefix to this translation a general -view of Celsus’s practice in the various diseases; for besides that -this is already done by the learned Le Clerc[N], our author’s method -is so clear and concise, that the reader will acquire, with ease, the -most perfect idea from the book itself. - - [N] Histoire de la medicine, P. ii. liv. iv. sect. ii. chap. 4, &c. - -Whenever he differs in opinion from writers, whose authority he -otherwise reveres, we find his reasoning modest, concise, close, and -admirably well adapted to the subject in dispute; but the delicacy -of his expression, when he condemns others, and the caution with -which he avoids speaking of himself, have led some to believe he was -not a practitioner: though the strongest argument against his having -practised physic is drawn from the silence of Pliny, who names Celsus, -in several books, among the authors from whom he took his materials, -and never ranks him in the list of physicians, whom he separates -from the others. But I am surprised it has escaped the observation -of the critics, that these catalogues of physicians consist only of -foreigners, whom Pliny distinguishes from other foreigners, who were -not physicians; whereas Celsus stands always amongst the Romans. Now -Pliny, in his list of Roman writers, has not noted their several -professions: for in most of the places, where we read the name of -Celsus, we also find that of Antonius Castor, without any mention of -his profession, though Pliny himself in another place tells us[O], he -was a physician of great reputation, whom he saw living in retirement, -and cultivating a kind of physic-garden, when he was above an -hundred years old. Thus, the name of Antonius Castor would have been -lost with his writings, notwithstanding the figure he made among his -contemporaries, had he not happened to be mentioned by Pliny. And hence -it appears, that nothing can be inferred from the silence of Pliny and -the other ancients, in regard to the profession of Celsus; though he -should not be Cornelius the physician, mentioned by Galen, as Le Clerc -thinks it probable he is. - - [O] Plin. Nat. Hist. lib. xxv. c. 2. - -I might have urged many passages in this book to prove that he was a -physician, if I had not reason to think the present age is already -satisfied in that point. There are two, however, so remarkable, that -they ought not to be omitted. When our author is considering the proper -time for allowing nourishment, after saying that some gave their -patients food in the evening, he gives reasons against that method, -and then adds, “_Ob haec ad mediam noctem decurro_, i. e. For these -reasons I defer it till midnight.” Thus most of the older copies read, -and also Morgagni’s manuscript; so that Linden is not easily to be -forgiven for making alterations in so material a place[P]. In the other -passages there is no variation in the reading. In that species of the -ancyloblepharon, where the eye-lid unites with the white of the eye, -our author, after describing the method of cure, immediately adds, -“_Ego sic restitutum neminem memini. Meges se quoque multa_, &c. _i. -e._ I do not remember an instance of any person cured in this way. -Meges also has told us that he has tried many methods, and never was -successful, because the eye-lid always united again to the eye[Q].” The -form of expression here used by our author, in a manner peculiar to -a practitioner, would come very improperly from a mere compiler. The -connection of these two sentences by _quoque_ seems to put our author’s -own observation upon the same footing with that of Meges, whom he -quotes on several occasions as a most accomplished surgeon[R]. - - [P] Lib. iii. c. 5. - - [Q] Lib. vii. c. 7. See Le Clerc. - - [R] Though numberless passages will occur in the course of the book, - where Celsus expressly delivers his own judgment, yet as the reader - may perhaps chuse to have some of the most remarkable at one view, - the following references will serve for that purpose. Lib. i. c. 3. - p. 30. _Neque ignoro_, &c. _Commoneo tamen_, &c. Lib. ii. c. 14. p. - 88. _Quas tamen_, &c. p. 89. _Neque ignoro quosdam_, &c. Lib. iii. c. - 2. p. 140. _Ego tum hoc puto_, &c. c. 14. p. 144. _Tutius tamen_, &c. - c. 18. p. 150. _Quid igitur est_, &c. Lib. iv. c. 4. p. 200. _Melius - huic rei_, &c. c. 17. p. 227. _Interdum teretes videmus_, &c. c. 19. - p. 230. _Ego experimentis_, &c. Lib. vi. c. 4. p. 345. _Sed nihil - melius est_, &c. Lib. vii. c. 12. p. 446. _Ego autem cognovi_, &c. - c. 14. p. 450. _Sed abunde est_, &c. Lib. viii. c. 2. p. 509. _Neque - audiendi_, &c. c. 3. p. 512. _Ut quando os perrumpitur, sentiamus_, - &c. c. 4. p. 517. _Sed multo melius est_, &c. c. 8. p. 528. _Ex - dolore colligimus_, &c. c. 13. p. 546. _Ponendum autem hoc esse - credidi_, &c. Any person, who will be at the pains to examine these - passages, will easily see, that they strongly support the conclusion - drawn from the two above recited. [See Linden or Almeloveen’s - edition.] - -It may not be amiss, however, to take notice of a distinction Celsus -makes between two kinds of professors of physic. When he is shewing -the necessity of circumspection in the physician, he adds, “From[S] -these things it may be inferred, that many people cannot be attended -by one physician; and that the man to be trusted is he, who knows his -profession, and is not much absent from the patient. But they, who -practice from views of gain, because their profits rise in proportion -to the number of patients, readily fall in with such rules, as do not -require a close attendance, as in this very case. For it is easy for -such as seldom see the patient, to count the days and the paroxysms: -but it is necessary for him to sit by his patient, who would form a -true judgment of what is alone fit to be done, when he will be too -weak, unless he get food.” As his censure is so severe upon a practice, -which he thought too extensive, it is natural to suppose, that his -was confined to his acquaintance, and that his fortune and generosity -rendered him superior to the view of living by the profession. - - [S] Lib. iii. c. 4. - -To all the later copies of Celsus is prefixed an index of the several -editions, which makes it needless for me to give an account of them. -All the older ones, printed in the fifteenth and sixteenth centuries, -abound with numberless gross errors, that in many places utterly -destroy the construction. These, Vander Linden undertook to correct, -and the authorities he used for that purpose are contained in a -catalogue annexed to his preface, in which he tells us he has made very -few changes from his own conjecture, and none of these, but where the -subject evidently required them. In the dedication he says, “Who would -imagine, that after the diligent labours of so many illustrious men, -as Egnatius, Cæsarius, Constantine, Stephens, Pantinus, Ronsseus, and -Rubeus, I should have corrections to make in more than two thousand -places?” - -As it was proper I should translate from one particular edition, I -chose for that purpose Linden’s; or Almeloveen’s, who has followed -him almost in every letter; as these are generally esteemed by far -the most correct: though it must be owned, that Linden has made many -alterations without necessity, and sometimes for the worse. Where the -sense was either obscure or inconsistent with the context, I have -often been assisted by the more ancient editions. On such occasions I -have given my authority and reasons in the notes. In passages where I -found a reading in the old copies much preferable to Linden’s, but not -altogether necessary upon account of the sense, I have marked it in a -note, without adopting it into the next. - -There are very few places, where I have ventured to alter the reading -on my own conjecture, and these are all noted in the margin, where I -have assigned my reasons, which, I hope, will convince the learned -reader. My notes will shew in how many instances I have been obliged to -the excellent epistles of Morgagni. This learned and ingenious author -has, in my opinion, entered more into the spirit and true meaning of -Celsus, than any of the preceding commentators[T]. - - [T] The first three of these epistles were annexed to an edition - of Celsus, by Vulpius, at Padua, in the year 1722; five more were - added to another by the same editor in the year 1752; in both which - editions he has every where followed (only correcting typographical - errors) the text of Almeloveen. - -Had there been so correct an edition of Celsus, as I think may be made, -with proper judgment, from the editions and manuscripts extant, it -would have shortened my labour. - -That Celsus divided his books into chapters, appears from several -passages: whereas no person, as far as I can find, pretends, that the -marginal contents came from the author himself. The editions differ -in these; but as it is of small importance, I have not troubled the -reader with any remarks on that article. Where I found those of Linden -evidently wrong, I have endeavoured to supply the defect. - -With regard to the materia medica, the notes are drawn chiefly from -Pliny and Dioscorides, whom I esteemed the best authors on that -article. When I have given English names to any of the simples, I -follow the most judicious moderns; though it must be remembered, that -many of them cannot be determined with absolute certainty. - -Through most of the compositions the text is miserably corrupted; and -what is worse, I do not find, that by comparing the various editions -this part can be restored. I had once some thoughts of labouring this -point particularly, but as it would have been expected I should support -every alteration with proper reasons, and as I despaired of executing -it so, as to meet with universal approbation, and after all it would -have been more a matter of curiosity than of real use, I omitted that -part of my design; besides, this must have considerably increased the -number of my notes, which I have endeavoured should be as few as the -nature of the undertaking would admit of. For these reasons I have -closely adhered to the text of Linden, without even departing from it, -where the nature of the whole composition will evidently demonstrate -the proportions of several ingredients to be highly incongruous. - -It has been my principal care to convey the precise meaning of my -author, and also to preserve the genius of his style, where the English -idiom would allow. I have likewise been careful not to wrest any -expression of Celsus, in order to deceive the reader into a greater -opinion of his knowledge, than he really deserves. His merit is -sufficiently great without pretending to find in him any discoveries, -the honour of which is due to the moderns. Every man of learning, who -is acquainted with the state of physic among the ancients, and knows -how far it differs from the modern, must be sensible of the difficulty -of translating an author so elegant and concise, with the strictness -necessary in a work of this nature. Such judges, I hope, will censure -the faults, which cannot escape their observation, with the candour -inseparable from true criticism. - -It only remains, that I return thanks to my ingenious and learned -friends of the faculty, who have favoured me with their opinions on -several passages, particularly to Dr. Maghie of Guy’s hospital. - - - - -CONTENTS. - - - BOOK I. Page - - PREFACE 1 - - CHAP. I. Rules for the healthy, 16 - - II. Rules for valetudinary people, 17 - - III. Observations suited to new incidents, and the different - constitutions, sexes, and ages; and the seasons of the - year, 19 - - IV. Rules for those that have a weakness in the head, 26 - - V. Directions for those that labour under a lippitude, - gravedo, catarrh, and disorders of the tonsils, 27 - - VI. The proper regimen for people liable to a purging, 28 - - VII. Rules for those that are liable to a pain of the colon, 29 - - VIII. Rules for one that has a weak stomach, 29 - - IX. Directions for those that are liable to pains of the - nerves, 30 - - X. Directions in a pestilence, 31 - - - BOOK II. - - PREFACE, 33 - - CHAP. I. Of the different seasons, weather, ages, constitutions, - and the diseases peculiar to each, 34 - - II. Of the signs of an approaching illness, 38 - - III. Good symptoms in sick people, 39 - - IV. Bad symptoms in sick people, 40 - - V. Signs of long sickness, 42 - - VI. The symptoms of death, 43 - - VII. Of the signs in particular diseases, 46 - - VIII. What symptoms are dangerous, or hopeful in particular - diseases, 52 - - IX. Of the cure of diseases, 59 - - X. Of bleeding, 60 - - XI. Of cupping, 64 - - XII. Of purging by internal medicines and clysters, 65 - - XIII. Of vomiting, 67 - - XIV. Of friction, 68 - - XV. Of gestation, 70 - - XVI. Of abstinence, 71 - - XVII. Of sweating, 72 - - XVIII. The different kinds of food and drink, 74 - - XIX. General properties of different foods, 77 - - XX. Of things containing good juices, 78 - - XXI. Of foods containing bad juices, 78 - - XXII. Of mild and acrid things, 79 - - XXIII. Of those things which generate a thick and a fluid phlegm, 79 - - XXIV. Of what agrees with the stomach, 80 - - XXV. Of things hurtful to the stomach, 80 - - XXVI. Of those things which occasion flatulencies; and the - contrary, 81 - - XXVII. Of those things which heat and cool, 81 - - XXVIII. Of what is easily corrupted in the stomach, 82 - - XXIX. Of what opens the belly, 82 - - XXX. Of what binds the belly, 83 - - XXXI. Of diuretic meats and drinks, 83 - - XXXII. Of soporiferous, and exciting substances, 84 - - XXXIII. Of those things which draw, repel, or cool, or heat, or - harden, or soften, 84 - - - BOOK III. - - CHAP. I. General division of distempers, 86 - - 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, 87 - - III. Of the several kinds of fevers, 89 - - IV. Of the different methods of cure, 91 - - V. Particular directions for giving food in the different - species of fevers, 95 - - VI. The proper times for giving drink to persons in fevers; - and the kinds of aliments suited to the several stages of - the distempers; together with some general observations, 99 - - VII. The cure of pestilential, and ardent fevers, 103 - - VIII. The cure of a semitertian, 105 - - IX. The cure of slow fevers, 105 - - X. Remedies for the concomitant symptoms of fevers, 107 - - XI. Remedies against a coldness of the extremities, preceding - a fever, 108 - - XII. The cure of a shuddering before fevers, 109 - - XIII. The cure of a quotidian fever, 110 - - XIV. The cure of a tertian, 111 - - XV. The cure of a quartan, 112 - - XVI. The cure of a double quartan, 113 - - XVII. The cure of a quotidian arising from a quartan, 114 - - XVIII. Of the several kinds of madness, and their cure, 115 - - XIX. Of the cardiac disorder, and its cure, 121 - - XX. Of the lethargy, and its cure, 123 - - XXI. Of the several species of the dropsy, and their cure, 124 - - XXII. Of the several species of consumptions, and their cure, 129 - - XXIII. Of the epilepsy, and its cure, 133 - - XXIV. Of the jaundice, and its cure, 135 - - XXV. Of the elephantiasis, and its cure, 136 - - XXVI. Of apoplectic patients, and their cure, 137 - - XXVII. Of a palsy, and its cure, 138 - - Of a pain of the nerves, 139 - - Of a tremor of the nerves, 139 - - Of internal suppurations, 140 - - - BOOK IV. - - CHAP. I. Of the Internal parts of the human body, 141 - - II. Of the disorders of the head, and their cure, 144 - - Of pains of the head, and a hydrocephalus, 144 - - Of the cynicus spasmus, 146 - - Of a palsy of the tongue, 147 - - Of a catarrh and gravedo, 147 - - III. Of diseases of the neck, and their cure, 149 - - IV. Of diseases of the fauces, 151 - - Several species of angina, 151 - - Difficulty of breathing, 152 - - An ulcer in the fauces, 154 - - A cough, 154 - - A spitting of blood, 155 - - And their cure, 157 - - V. Of the disorders of the stomach, and their cure, 158 - - VI. Of pains of the sides and a pleurisy, and their cure, 161 - - VII. Of a peripneumony, and its cure, 162 - - VIII. Of the diseases of the liver, and their cure, 164 - - IX. Of the diseases of the spleen, and their cure, 165 - - X. Of the diseases of the kidneys, and their cure, 166 - - XI. Of the cholera, and its cure, 167 - - XII. Of the coeliack distemper of the stomach, and its cure, 169 - - XIII. Of the distemper of the small gut, and its cure, 170 - - XIV. Of the distemper of the large intestine, and its cure, 171 - - XV. Of a dysentery, and its cure, 172 - - XVI. Of a lientery, and its cure, 174 - - XVII. Of worms in the belly, and their cure, 175 - - XVIII. Of a tenesmus, and its cure, 175 - - XIX. Of a simple purging, and its cure, 176 - - XX. Of the diseases of the womb, and their cure, 178 - - XXI. Of an excessive discharge of semen, and its cure, 180 - - XXII. Of the diseases of the hips, and their cure, 181 - - XXIII. Of a pain in the knees, and its cure, 182 - - XXIV. Of the diseases of the joints of the hands and feet, and - their cure, 182 - - XXV. Of the treatment of patients recovering, 184 - - - BOOK V. - - PREFACE, 186 - - CHAP. I. Medicines for stopping blood, 187 - - II. Agglutinants and restringents, 187 - - III. Medicines for promoting a suppuration, 188 - - IV. Medicines for opening wounds, 188 - - V. Cleansers, 188 - - VI. Corroding medicines, 189 - - VII. Eating medicines, 189 - - VIII. Caustics, 190 - - IX. Medicines for forming crusts upon ulcers, 190 - - X. Resolvents for crusts, 190 - - XI. Discutients, 191 - - XII. Evacuating and drawing medicines, 191 - - XIII. Lenients, 191 - - XIV. Incarning medicines, 192 - - XV. Emollients, 192 - - XVI. Cleansers of the skin, 192 - - XVII. Of the mixture of simples, and the proportion of the - weights, 193 - - XVIII. Of malagmas, in all thirty-six recited, 194 - - XIX. Of plaisters, in all twenty-nine recited, 201 - - XX. Of troches, in all seven recited, 207 - - XXI. Of pessaries, in all seven recited, 208 - - XXII. Medicines, used either in a dry form, or mixed with - liquids, 210 - - XXIII. Of antidotes, and their use, 212 - - XXIV. Of acopa, 213 - - XXV. Of catapotia, 214 - - XXVI. Of five different kinds of disorders incident to the - body; and of the nature, symptoms, and cure of wounds, 217 - - Bad consequences from wounds, 230 - - Cure of an old ulcer, 231 - - Cure of an erysipelas, 232 - - Cure of a gangrene, 232 - - XXVII. Of wounds caused by bites, poisons taken internally, - and burns, 235 - - XXVIII. Of external disorders proceeding from internal causes, - and their cure, 240 - - Of a carbuncle, 241 - - Of a cancer, 242 - - Of a therioma, 244 - - Of the ignis sacer, 245 - - Of the chironian ulcer, 246 - - Of ulcers occasioned by cold, 247 - - Of the scrophula, 247 - - Of a furuncle, 248 - - Of phymata, 248 - - Of a phygethlon, 248 - - Of abscesses, 248 - - Of fistulas, 250 - - Of the cerion ulcer, 253 - - Of the acrochordon, &c. 254 - - Of pustules, 256 - - Of the scabies, 257 - - Of the impetigo, 258 - - Of the papula, 258 - - Of the vitiligo, 259 - - - BOOK VI. - - CHAP. I. Of hairs falling off the head, 261 - - II. Of a porrigo, 261 - - III. Of the sycosis, 262 - - IV. Of the areæ, 263 - - V. Of vari, lenticulæ, and ephelides, 264 - - VI. Of the disorders of the eyes, carbuncles of the eyes, - pustules, wasting, lice in the eye-lids, dry lippitude, - dimness, a cataract, palsy, mydriasis, a weakness, and - external hurts in the eyes, and the various collyriums - adapted to each disorder, 265 - - VII. Of the diseases of the ears; pain, pus in the ears, - worms, dulness of hearing, a noise, extraneous bodies - in the ears, 281 - - VIII. Of the diseases of the nose, 287 - - IX. Of the toothach, 288 - - X. Of the diseases of the tonsils, 290 - - XI. Of ulcers of the mouth, 291 - - XII. Of ulcers of the tongue, 293 - - XIII. Of parulides and ulcers in the gums, 293 - - XIV. Of an inflammation of the uvula, 295 - - XV. Of a gangrene of the mouth, 295 - - XVI. Of parotid swellings, 297 - - XVII. Of a prominent navel, 297 - - XVIII. Of the diseases of the private parts, 298 - - Diseases of the anus, rhagadia, and condylomata, 303 - - Of the hæmorrhoides, 304 - - Of a prolapsus of the anus or womb, &c. 305 - - XIX. Of ulcers in the fingers, 306 - - - BOOK VII. - - PREFACE, The province of surgery, &c. 306 - - CHAP. I. Of contusions 310 - - II. Of the operations necessary in suppurated tumours 310 - - III. Of the good or bad symptoms of suppurations 313 - - IV. Of fistulas, in the ribs, belly, and anus 314 - - V. Of extracting weapons out of the body 317 - - VI. Of a ganglion, meliceris, atheroma, steatoma, and other - tubercles of the head 320 - - VII. Of the diseases of the eyes cured by manual operations; - of vesicles in the upper eye-lids 321 - - Of a crithe, chalazium, and unguis 322 - - Of an encanthis 324 - - Of the ancyloblepharon, and the ægilops 324 - - Of hairs in the eye-lashes irritating the eye 326 - - Of the lagopthalmus 328 - - Of an ectropium, and the staphyloma 328 - - Description of the eye 329 - - Of a cataract 330 - - Of a flux of gum, and the requisite operations 331 - - VIII. Of the operations required in the ears 334 - - IX. The operation necessary in a want of substance in the - ears, lips, and nose 335 - - X. Of the extirpation of a polypus in the nose 337 - - XI. The chirurgical cure of an ozæna 337 - - XII. Of the operations in the mouth; of the teeth 338 - - Of indurated tonsils, of the uvula 339 - - Of the tongue, an abscess under it, and chopt lips 340 - - XIII. Of the bronchocele 341 - - XIV. Of the operations performed at the navel 342 - - XV. The method of discharging the water in hydropic people 344 - - XVI. Of wounds in the belly and intestines 345 - - XVII. Of a rupture of the peritonæum 346 - - XVIII. A description of the testicles, and their diseases 347 - - XIX. General directions for operations in the foregoing - diseases about the testicles 351 - - XX. Of the cure of a rupture of the intestine into the - scrotum 354 - - XXI. Of the cure of a rupture of the omentum into the scrotum 356 - - XXII. Of the cure of a ramex of the scrotum 357 - - XXIII. Of the cure of a sarcocele 359 - - XXIV. Of the cure of a ramex in the groin 359 - - XXV. The operations requisite in the disorders of the penis 360 - - XXVI. Of the operation necessary in a suppression of urine; - and lithotomy 362 - - XXVII. Of a gangrene after cutting for the stone 370 - - XXVIII. Of the operations required, when a membrane or flesh - obstructs the vagina in women 373 - - XXIX. The method of extracting a dead fœtus out of the womb 373 - - XXX. The operations required in diseases of the anus 376 - - XXXI. Of varices in the legs 378 - - XXXII. Operations required in cohering and crooked fingers 379 - - XXXIII. Of the operation required in a gangrene 380 - - - BOOK VIII. - - CHAP. I. Of the situation and figure of the bones of the human - body 381 - - II. General division of disorders in the bones. Of a - blackness and caries, and their treatment 388 - - III. Of the use of the modiolus, and perforator, and other - instruments, especially for the bones of the head 390 - - IV. Of fractures of the skull 393 - - V. Of fractures of the nose 399 - - VI. Of fractures of the ears 400 - - VII. Of a fractured maxilla, together with some general - observations relating to fractures 401 - - VIII. Of a fractured clavicle 402 - - IX. Of fractures of the ribs and spine 404 - - X. Of fractures of the humerus, fore-arm, thigh, leg, - fingers, and toes 406 - - XI. Of luxations 414 - - XII. Of a luxated maxilla 416 - - XIII. Of a luxation of the head 417 - - XIV. Of a luxation of the spine 418 - - XV. Of a luxation of the humerus 419 - - XVI. Of a luxation of the cubitus 420 - - XVII. Of a luxated hand 421 - - XVIII. Of luxations in the palm 422 - - XIX. Of luxations of the fingers 422 - - XX. Of a luxation of the femur 423 - - XXI. Of a luxation of the knee 424 - - XXII. Of a luxated ancle 425 - - XXIII. Of luxations in the soles of the feet 425 - - XXIV. Of luxated toes 426 - - XXV. Of luxations attended with a wound 426 - - - ROMAN MEASURES OF CAPACITY FOR THINGS LIQUID, REDUCED TO ENGLISH WINE - MEASURE, THE WINE PINT HOLDING 28-7/8 SOLID INCHES. - -No. I. - - |_Pints_ |_Sol. in. dec._ - Ligula |0,-1/48 |0,117-5/12 - +------+ | | - | 4 |Cyathus |0,-1/12 |0,469-2/3 - +------+-----+ | | - | 6 | 1 |Acetabulum |0,-1/8 |0,704-1/2 - +------+-----+-----+ | | - | 12 | 3 | 2 |Quartarius |0,-1/4 |1,409 - +------+-----+-----+-----+ | | - | 24 | 6 | 4 | 2 |Hemina |0,-1/2 |2,818 - +------+-----+-----+-----+----+ | | - | 48 | 12 | 8 | 4 | 2 |Sextarius|1 |5,636 - +------+-----+-----+-----+----+ | | - -Possibly No. I. may be better understood in the following form. - -No. II. - - _Eng. wi. _Solid - _Ligulæ. Cyathi. Acetab. Quart. Hem. Sext._ pint._ inch._ - 48 or 12 or 8 or 4 or 2 == 1 == 1. and 5.636 - 24 or 6 or 4 or 2 == 1 -- - == 0. 17.255-1/2 - 12 or 3 or 2 == 1 -- - -- - == 0. 8.627-3/4 - 6 or 1-1/2 == 1 -- - -- - -- - == 0. 4.313-7/8 - 4 == 1 -- - -- - -- - -- - == 0. 2.875-11/12 - 1 -- - -- - -- - -- - -- - == 0. 0.718-47/48 - - - ROMAN MEASURES OF CAPACITY FOR THINGS DRY, REDUCED TO ENGLISH CORN - MEASURE, THE ENGLISH CORN PINT HOLDING 33-3/5 INCHES. - -No. III. - - |_Pints_ |_Sol. in. dec._ - Ligula |0,-1/48 |0,01 - +------+ | | - | 4 |Cyathus |0,-1/12 |0,04 - +------+-----+ | | - | 6 |1-1/2|Acetabulum |0,-1/8 |0,06 - +------+-----+-----+ | | - | 24 | 6 | 4 |Hemina |0,-1/2 |0,24 - +------+-----+-----+----+ | | - | 48 | 12 | 8 | 2 |Sextarius|1, |0,48 - +------+-----+-----+----+ | | - -THE SAME TABLE IN ANOTHER FORM. - -No. IV. - - _Eng. corn _Solid - _Ligulæ. Cyathi. Acetab. Heminæ. Sextarius._ pint._ inches_ - 48 or 12 or 8 or 2 == 1 == 1. and 0.48 - 24 or 6 or 4 == 1 -- -- == 0. 17.04 - 6 or 1-1/2 == 1 -- -- -- -- == 0. 4.26 - 4 == 1 -- -- -- -- -- -- == 0. 2.84 - 1 -- -- -- -- -- -- -- -- == 0. 0.71 - -Note, The tables, No. I. and No. III. are exactly copied from Dr -Arbuthnot, No. XII. and XIII. I have here gone no higher than the -sextarius, as that is the greatest measure mentioned by Celsus; it has -its name from making the sixth part of the Roman congius. - -I would have taken the table of weights from Dr Arbuthnot also, if -he had given one accommodated to Celsus; but as he has not, I have -composed the following, No. VI. according to the division of Celsus -himself, who tells us[U], that he divides the _uncia_, or _ounce_, into -_seven denarii_, and the _denarius_ into _six sextantes_. - - [U] Lib. v. cap. 17. - -Besides these, in several compositions our author uses _semuncia_ and -_sescuncia_, that is _half an ounce_ and _ounce and half_; and to save -the reader the trouble of reduction, I have given them also a place in -the table. - -The accurate Mr Greaves[V], from repeated experiments, concluded the -_Roman denarius_ to contain 62 grains English Troy weight, from which -the proportions of the other weights are determined. - - [V] Dissertation on the Denarius. - -No. V. - - _Grains._ _Scruples._ _Drachms._ _Ounces._ _Pound Troy._ - gr. ℈ Ʒ ℥ ℔ - 5760 or 288 or 96 or 12 == 1 - 480 or 24 or 8 == 1 - 60 or 3 == 1 - 20 == 1 - 1 - -CELSUS’S WEIGHTS COMPARED WITH APOTHECARIES’ WEIGHTS. - -No. VI. - - Grains of Sextan- Dena- Semun- Ses- Li- Apothecaries’. - Troy wt. tes. rii. ciæ. Unciæ. cun. bra. ℥ Ʒ ℈ gr. - 5208 or 504 or 84 or 24 or 12 or 8 == 1 == 10 : 6 : 2 : 8 - 651 or 63 or 10-1/2 or 3 or 1-1/2 == 1 -- - == 1 : 2 : 2 : 11 - 434 or 42 or 7 or 2 == 1 -- -- -- -- - == 0 : 7 : 0 : 14 - 217 or 21 or 3-1/2 == 1 -- -- -- -- -- -- - == 0 : 3 : 1 : 17 - 62 or 6 == 1 -- -- -- -- -- -- -- -- -- - == 0 : 1 : 0 : 2 - 10-1/3 == 1 -- -- -- -- -- -- -- -- -- -- -- - == 0 : 0 : 0 : 10-1/2 - 1 -- -- -- -- -- -- -- -- -- -- -- -- -- - == 0 : 0 : 0 : 1 - -Note 1st. The Romans divided all integers, as they did their _as_, -into twelve equal parts called _unciæ_. Thus the _sextans_ was the -sixth part of the _as_, containing _two of these unciæ_, _quadrans_ one -fourth, or _three unciæ_, _triens_ the third part, or _four unciæ_, -_semis_ one half, or _six unciæ_, _bes_ or _bessis_ two-thirds, or -_eight unciæ_, _dodrans_ three-fourths being _nine unciæ_. The weight -of these then differs, as the integer is the _libra_, the _uncia_, or -_denarius_, which the attentive reader will easily reduce, if he is -disposed to calculate the quantities, observing that they are not to -be taken for aliquot parts of the denarius, but when they follow the -mark of the denarius. The integer preceding, and the nature of the -composition will be the best explication. - -Note 2. The denarius mark was X or Ӿ, as containing originally -ten small asses. This by the copiers has been often confounded with X, -denoting the number of _ten denarii_; so that after all the pains of -critics and commentators, the proportions of the ingredients in several -compositions seem to be irrecoverably lost. For this reason, I suppose -the later editors have thought fit to change it for the common asterisk. - -Note 3. The characters for quantities are variously marked in different -authors, and the same note has several values. There is one of this -uncertainty in Celsus, that is _Z_, which we are told expresses the -_libra_, the _sescuncia_, the _sextans of a pound_, the _denarius_ and -the _sextans of a denarius_[W]. Which of these different values it -bears in any particular place must be determined by the connection. -When it follows the mark of the _denarius_, it can mean no more than -the _sextans_ of a _denarius_. - - [W] Rhodius de Ponderib. et Mensur. Cels. - -Note 4. p. stands for _pondo_, which is an indeclinable word, and when -joined with numbers, signifies _libra_ or a _pound_; when with other -weights, it stands for no more than _pondus_ or _weight in general_. - -For an example of the reduction of Celsus’s weights to ours, the -following may serve. - -Lib. v. cap. 19. no. 7. Philotas’s plaister contains, - - Of Eretrian earth ℥ Ʒ ℈ gr. - -- chalcitis, each p. iv.*. == 1/2 : 0 : 0 : 8 viz. Ʒi. gr. ii. - -- myrrh multiplied by 4 - -- calcined copper, each p. x.*. == 1 : 2 : 1 : 0 --and so all - -- isinglass p. vi. *. == 0 : 6 : 0 : 12 the rest. - -- rasile verdigrease - -- round allum - -- crude misy - -- birthwort, of each p. viii.*. == 1 : 0 : 0 : 16 - -- copper scales p. xx.* == 2-1/2 : 0 : 2 : 0 - -- male frankincense, p. ii.*. == 0 : 2 : 0 : 4 - -- oil of roses - -- Bitter oil, of each three cyathi, or 1 quartarius == between 1/4 - and 1/3 of an English pint. - -- vinegar, a sufficient quantity. - - - - - ERRATA, - - IN THE TEXT. - - Page 110 line 9 _for_ substances, _read_ medicines. - ---- 189 ---- 26 _for_ flour _read_ flower. - ---- 240 ---- 22 _for_ warm ingremedies _read_ warming remedies. - ---- 249 ---- 14 _for_ comes _read_ come. - ---- 257 ---- 30 _for_ verjuice _read_ omphacium. - ---- 271 ---- 16 _for_ wines _read_ wine. - ---- 323 ---- 31 _for_ straight _read_ strait. - ---- 350 ---- 18 _dele_ also. - - - - -A. CORNELIUS CELSUS - - OF - - MEDICINE. - - - - -_BOOK I._ - - - - -PREFACE. - - -As agriculture promises food to the healthy, so medicine promises -health to the sick. There is no place in the world, where this art is -not found: for even the most barbarous nations are acquainted with -herbs, and other easy remedies for wounds and diseases. However it has -been more improved by the Greeks than any other people: though not -from the infancy of that nation, but only a few ages before our own -times; as appears by their celebrating Æsculapius as its most ancient -author; who, because he cultivated this science with somewhat more -accuracy, which, before him, was rude and of low esteem, was received -into the number of their gods.(1) After him his two sons, Podalirius -and Machaon, following Agamemnon to the Trojan war, were not a little -useful to their fellow soldiers. But even these, according to Homer’s -account, did not undertake the plague, nor the other various kinds of -diseases, but only cured wounds by incisions, and medicines: from which -it appears, that they entirely confined themselves to the chirurgical -part of medicine, and that this was the most antient branch. From the -same author we may also learn, that diseases were then believed to -arise from the anger of the immortal gods,(2) and that relief used -to be sought from them. It is also probable, that though there were -few remedies for distempers known, men nevertheless generally enjoyed -good health from the sobriety of their lives, yet untainted by sloth -and luxury. For these two vices, first in Greece, and then among -us, rendered men liable to many diseases. And hence that variety of -remedies now used, which was neither necessary in ancient times, nor -is yet in other nations, scarcely protracts the lives of a few of us -to the verge of old age. For the same reason, after those, whom I have -mentioned, no men of eminence practised medicine, till learning began -to be pursued with greater application; which, as it is of all things -most necessary to the mind, so it is no less hurtful to the body. And -at first the science of healing was accounted a branch of philosophy; -so that the cure of diseases, and the study of nature, owed their rise -to the same persons: and for this very good reason, because they, who -had impaired their bodies by anxious thought, and nightly watchings, -stood most in need of its assistance. And thus we find, that many -amongst the philosophers were skilled in this science; of whom the most -celebrated were Pythagoras, Empedocles, and Democritus. Hippocrates -of Cos, who, according to some authors, was the disciple of the last -mentioned of these, and is so justly admired both for his knowledge in -this profession, and for his eloquence, was the first worthy of notice, -who separated medicine from the study of philosophy. After him, Diocles -the Carystian, then Praxagoras and Chrysippus; after these, Herophilus -and Erasistratus applied themselves to this art, and differed widely -from each other in their methods of cure. - -(1) For references 1, 2, 3, &c. see Notes at the end. - -During this period, physick was divided into three parts: the -first cured by diet, the second by medicines, the third by manual -operations: the first they termed, in Greek, Diætetice,[X] the second -Pharmaceutice,[Y] and the third Chirurgice.[Z] The most illustrious -professors of that branch, which treats diseases by diet, endeavoured -to extend their views farther, and took in the assistance of natural -philosophy; being persuaded that, without it, medicine would be a -weak and imperfect science. After these came Serapion, who first -of all maintained, that the rational method of study was foreign to -the art of medicine, and confined it to practice and experience. In -his steps followed Appollonius and Glaucias, and some time after -Heraclides of Tarentum, and others of no small note; who, from the -doctrine they asserted, stiled themselves Empiricks[AA]. And thus the -Dietetick branch was also divided into two parts, one set of physicians -pursuing theory, the other following experience alone. However, after -these we have enumerated above, no one attempted any thing new, till -Asclepiades, who greatly changed the art of medicine. And Themison, one -of his successors, has also lately, in his old age, departed from him -in some things. And these are the men, to whom we are chiefly indebted -for the improvements made in this salutary profession. - - [X] Διαιτητικὴ. - - [Y] Φαρμακευτικὴ. - - [Z] Χειρουργικὴ. - - [AA] Εμπειρικοὶ. - -As that branch of medicine, which respects the cure of diseases, is the -noblest, as well as the most difficult of the three, we shall first -treat of that part. And because in this the chief dispute is, that some -alledge an acquaintance with experiments to be only requisite, while -others affirm experience alone to be insufficient, without a thorough -knowledge of the constitution of bodies, and what naturally happens -to them; it will be proper to recite the principal arguments on both -sides, that we may the more easily deliver our own opinion upon the -question. - -Those then, who declare for a theory in medicine, look upon the -following things as necessary: the knowledge of the occult and -constituent causes of distempers; next, of the evident ones; then, of -the natural actions; and, lastly, of the internal parts. They call -these causes occult, in which we inquire of what principles our bodies -are composed, what constitutes health, and what sickness. For they -hold it impossible that any one should know how to cure diseases, if -he be ignorant of the causes, whence they proceed; and that it is not -to be doubted, but one method of cure is required, if the redundancy -or deficiency in any of the four principles(3) be the cause of -diseases, as some philosophers have affirmed; another, if the fault -lie wholly in the humours, as Herophilus thought; another, if in -the inspired air, as Hippocrates believed; another, if the blood be -transfused into those vessels(4), which are designed only for air, -and occasion an inflammation, which the Greeks call phlegmone[AB], and -that inflammation cause such a commotion as we observe in a fever, -which was the opinion of Erasistratus; another, if the corpuscles -passing through the invisible pores should stop, and obstruct the -passage, as Asclepiades maintained: that he will proceed in the proper -method of curing a disease, who is not deceived in its original cause. -Nor do they deny experience to be necessary, but affirm, it cannot be -obtained without some theory; for that the more ancient practitioners -did not prescribe any thing, at hazard, for the sick, but considered -what was most suitable, and examined that by experience, to which they -had before been led by some conjecture. That it is of no moment _in -this argument_, whether most remedies were discovered by experiment, -provided they were at first applied with some rational view: and that -this holds in many cases; but new kinds of distempers often occur, in -which practice has hitherto given no light; so that it is necessary -to observe whence they arose; without which no mortal can find out, -why he should make use of one thing, rather than another. And for -these reasons they investigate the occult causes. They term those -causes evident, in which they inquire, whether the beginning of the -distemper was occasioned by heat or cold, fasting or surfeit, and the -like. For they say, he will be able to oppose the first appearances, -who is not ignorant of their rise. Those actions of the body which -they call natural, are inspiration and exspiration, the reception and -concoction of our meat and drink, as also the distribution(5) of -the same into the several parts of the body. They also inquire how it -happens, that our arteries rise and fall; from what causes proceed -sleep and watching; without the knowledge of which, they conceive it -impossible for any person either to oppose the beginnings of diseases, -that depend on these particulars, or cure them when formed. As of -all these things they look upon concoction to be of the greatest -importance, they insist chiefly upon it; and some of them following -the opinion of Erasistratus, affirm that the food is concocted in -the stomach by attrition; others, after Plistonicus, the disciple of -Praxagoras, by putrefaction; others, upon the credit of Hippocrates, -believe concoction is effected by heat. After them follow the disciples -of Asclepiades, who hold all these hypotheses to be vain and idle; -for that there is no concoction at all, but the matter, crude as it -is received, is distributed through the whole body. And in these -things they are by no means agreed: however, it is not disputed, that -according to the different hypotheses, a different regimen of diet is -to be observed by sick people. For if it be performed by attrition, -such food is to be chosen, as will most easily be broken to pieces; if -by putrefaction, such as most quickly undergoes that change; if heat -be the cause of concoction, then such as most effectually cherishes -heat. But if there be no concoction at all, then none of these kinds -of aliment are to be chosen: but such are to be taken, as are least -liable to change from the state in which they are received. And, by -the same way of reasoning, when there is a difficulty of breathing, -when sleep or watchings oppress, they are of opinion, that the man, -who has first learned in what manner these happen, will be capable of -curing them. Besides, as pains, and various other disorders, attack -the internal parts, they believe no person can apply proper remedies -to those parts, which he is ignorant of; and therefore, that it is -necessary to dissect dead bodies, and examine their viscera and -intestines; and that Herophilus and Erasistratus had taken far the best -method _for attaining that knowledge_, who procured criminals out of -prison, by royal permission, and dissecting them alive, contemplated, -while they were even breathing, the parts, which nature had before -concealed; considering their position, colour, figure, size, order, -hardness, softness, smoothness, and asperity(6); also the processes -and depressions of each, or what is inserted into, or received by -another part; for, _say they_, when there happens any inward pain, a -person cannot discover the seat of that pain, if he have not learned -where every viscus or intestine is situated; nor can the part, which -suffers, be cured by one, who does not know what part it is; and that -when the viscera happen to be exposed by a wound, if one is ignorant of -the natural colour of each part, he cannot know what is sound and what -corrupted; and for that reason is not qualified to cure the corrupted -parts; besides they maintain, that external remedies are applied with -much more judgment, when we are acquainted with the situation, figure, -and size of the internal parts; and that the same reasoning holds in -all the other instances above mentioned. And that it is by no means -cruel, as most people represent it, by the tortures of a few guilty, -to search after remedies for the whole innocent race of mankind in all -ages. - - [AB] Φλεγμονὴ. - -On the other hand, those, who from experience, stile themselves -empiricks, admit indeed the evident causes as necessary; but affirm the -inquiry after the occult causes and natural actions to be fruitless, -because nature is incomprehensible. And that these things cannot be -comprehended, appears from the controversies among those, who have -treated concerning them, there being no agreement found here either -amongst the philosophers or the physicians themselves: for, why should -one believe Hippocrates rather than Herophilus? or, why him more than -Asclepiades? that if a man inclines to determine his judgment by -reasons assigned, the reasons of each of them seem not improbable; -if by cures, all of them have restored the diseased to health; and -therefore we should not deny credit either to the arguments or -authority of any of them. That even the philosophers must be allowed to -be the greatest physicians, if reasoning could make them so; whereas -it appears, that they have abundance of words, and very little skill -in the art of healing. _They say also_ that the methods of practice -differ according to the nature of places; thus one method is necessary -at Rome, another in Egypt, and another in Gaul. That if the causes of -distempers were the same in all places, the same remedies ought also -to be used every where. That often too the causes are evident; as for -instance in a lippitude(7), or a wound, and nevertheless the method -of cure does not appear from them: that if the evident cause does -not suggest this knowledge, much less can the other, which is itself -obscure. Seeing then this last is uncertain and incomprehensible, it is -much better to seek relief from things certain and tried; that is, from -such remedies as experience in the method of curing has taught us, as -is done in all other arts; for that neither a husbandman nor a pilot -is qualified for his business by reasoning, but by practice: and that -these disquisitions have no connection with medicine, may be inferred -from this plain fact, that physicians, whose opinions in those matters -have been directly opposite to one another, have notwithstanding -equally restored their patients to health: that their success was to -be ascribed to their having derived their methods of cure, not from -the occult causes, or the natural actions, about which they were -divided, but from experiments, according as they had succeeded in the -course of their practice. That medicine, even in its infancy, was not -deduced from these inquiries, but from experiments: for of the sick, -who had no physicians, some from a keen appetite, had immediately -taken food in the first days of their illness, while others feeling a -nausea, had abstained from it; and that the disorder of those, who had -abstained, was more alleviated; also, some in the paroxysm of a fever -had taken food, others a little before it came on, and others after its -remission; and that it succeeded best with those who had done it after -the removal of the fever: in the same manner some used a full diet in -the beginning of a disease; others were abstemious; and that those -grew worse, who had eaten plentifully. These and the like instances -daily occurring, that diligent men observed attentively, what method -generally answered best, and afterwards began to prescribe the same to -the sick. That this was the rise of the art of medicine, which by the -frequent recovery of some, and the death of others, distinguishes what -is pernicious from what is salutary; and that when the remedies were -found, men began to discourse about the reasons of them: that medicine -was not invented in consequence of their reasoning, but the theory -was sought for after the discovery of medicine. They ask too, whether -reason prescribes the same as experience, or something different; if -the same, they infer it to be needless, if different, mischievous. -That at first, however, there was a necessity for examining remedies -with the greatest accuracy, but now they are sufficiently ascertained; -and that we neither meet with any new kind of disease, nor want any -new method of cure. That if some unknown distemper should occur, the -physician would not therefore be obliged to have recourse to the occult -things; but he would presently see to what distemper it is most nearly -allied, and make trial of remedies like to those, which have often been -successful in a similar malady, and by the resemblance between them -would find some proper cure. For they do not affirm, that judgment is -not necessary to a physician, and that an irrational animal is capable -of practising this art; but that those conjectures, which relate to the -occult things, are of no use; because it is no matter what causes, but -what removes a distemper: nor is it of any importance in what manner -the distribution is performed, but what is most easily distributed; -whether concoction fails from this cause or that; or whether it be -properly a concoction, or only a distribution: nor are we to inquire -how we breathe, but what relieves a difficult and slow breathing; nor -what is the cause of motion in the arteries, but what each kind of -motion indicates. That these things are known by experience: that in -all disputes of this kind, a good deal may be said on both sides; and -therefore genius and eloquence obtain the victory in the dispute; but -diseases are cured not by eloquence, but by remedies; so that if a -person, without any eloquence, be well acquainted with those remedies, -that have been discovered by practice, he will be a much greater -physician than one who has cultivated his talent in speaking without -experience. That these things, however, which have been mentioned, are -only idle: but what remains is also cruel, to cut open the abdomen and -præcordia of living men, and make that art, which presides over the -health of mankind, the instrument, not only of inflicting death, but -of doing it in the most horrid manner; especially if it be considered, -that some of those things, which are sought after with so much -barbarity, cannot be known at all, and others may be known without -any cruelty; for that the colour, smoothness, softness, hardness, -and such like, are not the same in a wounded body, as they were in -a sound; and further, because these qualities, even in bodies that -have suffered no external violence, are often changed by fear, grief, -hunger, indigestion, fatigue, and a thousand other inconsiderable -disorders; which makes it much more probable, that the internal parts, -which are far more tender, and never exposed to the light itself, are -changed by the severest wounds and mangling. And that nothing can be -more ridiculous than to imagine any thing to be the same in a dying -man, nay one already dead, as it is in a living person: for that the -abdomen(8) indeed may be opened(9), while a man breathes; but as -soon as the knife has reached the præcordia(10), and the transverse -septum is cut, which by a kind of membrane divides the upper from the -lower parts, (and by the Greeks is called the Diaphragm[AC]) the man -immediately expires; and thus the præcordia, and all the viscera never -come into the view of the butchering physician, till the man is dead; -and they must necessarily appear as those of a dead person, and not -as they were while he lived; and thus the physician gains only the -opportunity of murdering a man cruelly, and not of observing, what are -the appearances of the viscera in a living person: if, however, there -be any thing which can be observed in a person, that yet breathes, -chance often throws it in the way of such as practise the healing art; -for that sometimes a gladiator on the stage, a soldier in the field, -or a traveller beset by robbers, is so wounded, that some internal -part, different in different people, may be exposed to view; and thus -a prudent physician finds their situation, position, order, figure, -and the other particulars he wants to know, not perpetrating murder, -but attempting to give health; and learns that, by compassion, which -others had discovered by horrid cruelty. That for these reasons it is -not necessary to lacerate even dead bodies; which, though not cruel, -yet may be shocking to the sight, since most things are different in -dead bodies; and even the dressing of wounds shows all that can be -discovered in the living. - - [AC] Διάφραγμα. - -Since these points have often been, and still continue to be disputed -with great warmth by physicians in large volumes, ’tis proper to add -some reflections, that may seem to come the nearest to the truth, and -which neither slavishly follow either of these opinions, nor are too -remote from both, but lie, as it were, in the middle, betwixt these -opposite extremes; which those, that inquire after truth without -partiality, may find to be the surest method for directing the judgment -in most warm controversies, as well as in this now before us. For, -with regard to the causes of health or diseases, in what manner the -air, or food, is either conveyed or distributed, the philosophers -themselves do not attain to an absolute certainty; they only make -probable conjectures. Now, when there is no certain knowledge of a -thing, a mere opinion about it cannot discover a sure remedy. And it -must be owned, that nothing is of greater use, even to the rational -method of curing, than experience. Altho’ then many things are taken -into the study of arts, which do not, properly speaking, belong to -the arts themselves, yet they may greatly improve them by quickening -the genius of the artist; wherefore the contemplation of nature, -though it cannot make a man a physician, yet may render him fitter -for the practice of medicine. Indeed, it is very probable, that both -Hippocrates and Erasistratus, and all the others, who were not content -with treating fevers and ulcers, but examined in some measure into the -nature of things, tho’ they did not by such study become physicians, -yet became more able physicians by that means. And medicine itself -requires the help of reason, if not always amongst the occult causes, -or the natural actions, yet often; for it is a conjectural art; and -not only conjecture in many cases, but even experience is found not -consistent with its rules. And sometimes neither fever, nor appetite, -nor sleep, follow their usual antecedents in the regular course. A new -distemper sometimes, though very seldom, appears; that such a case -never happens is manifestly false; for, in our own time, a certain -lady, from a quantity of flesh(11) falling down from her private -parts, and growing dry, expired in a few hours; so that the most -celebrated physicians neither found out the genus of the distemper, -nor any remedy for it. I suppose the reason they forbore to attempt -any thing was, that none of them was willing to run a risk upon his -own conjecture only in a person of her quality, for fear he should be -thought to have killed, if he did not save her; yet it is probable -that some one, without that regard to the opinion of the world, might -have contrived something, which upon trial would have succeeded. Nor -is a similitude always serviceable in this kind of practice; and -where it is, this properly belongs to the rational part, to consider -amidst a number of similar kinds, both of diseases and remedies, what -particular medicine ought to be preferred. When such an incident -occurs, the physician ought to invent something, which though perhaps -it does not always answer, yet most commonly may: and he shall draw -his new method, not from the occult things (for they are dubious and -uncertain) but from those, that can be fully known, that is, from the -evident causes. For it makes a considerable difference, whether the -distemper was occasioned by fatigue, or thirst, or cold, or heat, -or watching, or hunger; or whether it arose from too much food and -wine, or excess of venery. And he ought not to be ignorant of the -constitution of his patient, whether his body be too moist, or too dry: -whether his nerves(12) be strong or weak; whether he be frequently -or seldom ailing; and whether his illnesses are severe or slight, of -long continuance or short; what way of life he has pursued, laborious -or sedentary, luxurious or frugal; for from these, and such like -circumstances, he must often draw a new method of cure. - -Nevertheless even these things ought not to be so passed over, as -if they were uncontroverted; for Erasistratus has affirmed, that -distempers were not occasioned by them, because other people, and even -the same person at different times, would not fall into a fever upon -them. And some of the Methodists of our own age, from the authority of -Themison (as they would have it thought) assert, that the knowledge of -no cause whatever bears the least relation to the method of cure; and -that it is sufficient to observe some general symptoms of distempers; -and that there are three kinds of diseases, one bound, another -loose(13), and the third a mixture of these. For that sometimes the -excretions of sick people are too small, sometimes too large; and -sometimes one particular excretion is deficient, while another is -excessive. That these kinds of distempers are sometimes acute, and -sometimes chronic; sometimes increasing, sometimes at a stand(14), -and sometimes abating. As soon then as it is known, to which of these -classes a distemper belongs if the body be bound, it must be opened; -if it labours under a flux, it must be restrained; if the distemper be -complicated, then the most urgent malady must be first opposed. And -that one kind of treatment is required in acute, another in inveterate -distempers; another, when diseases are increasing; another, when at -a stand; and another, when inclining to health. That the observation -of these things constitutes the art of medicine, which they define -as a certain way of proceeding, which the Greeks call _Method_[AD], -and affirm it to be employed in considering those things, that are in -common to the same distempers: nor are they willing to have themselves -classed either with the rationalists, or with those, who regard only -experiments; for they dissent from the first sect, in that they will -not allow medicine to consist in forming conjectures about the occult -things; and also from the other in this, that they hold the observation -of experiments to be a very small part of the art. - - [AD] Μέθοδος. - -As to what Erasistratus maintains; in the first place, plain fact -contradicts his opinion; because a distemper very seldom happens, -unless after some of these occurrences, that have been mentioned. And -then it does not follow, that what does not affect one person, may not -hurt another; nor what does not affect the same person at one time, may -not hurt him at another; for there may be some latent circumstances in -a body, either in respect of weakness, or some disorder, which either -are not in another, nor were in the same body at a different time; -and these, though of themselves not considerable enough to cause a -distemper, yet may render a body more liable to other injuries: but if -he had been sufficiently skilled in the contemplation of the works of -nature (which the physicians with very good reason endeavour to attain) -he must have known this also, that nothing happens from one single -cause; but that is to be taken for the cause, which seems to have -contributed most to the effect. Now it is possible, that what does not -move at all while alone, may in conjunction with other things excite a -great commotion. Besides, Erasistratus himself, who says, that a fever -arises from a transfusion of the blood into the arteries, and that this -happens in a plethoric body, can assign no reason, why of two persons -equally plethoric, the one should fall into a distemper, and the other -be free from all danger, which manifestly happens every day. From hence -it appears, that supposing this transfusion to be real, nevertheless, -when there is a plethora, it does not happen of itself, but when some -one of the conditions above-mentioned goes along with it. - -But the followers of Themison, if they assert their maxims to hold -universally, are still more rationalists than those, that pass under -that name; for though one rationalist does not maintain all that -another approves, there is no necessity to invent a new appellation -for him; provided, which is the principal thing, he does not proceed -upon memory alone, but takes in reason too. But if, which is nearer -to the truth, the art of medicine hardly admits of any universal -precepts, then they are in the same class with those, who depend upon -experiments alone: and the more so, because any unskilful person can -discover, whether a distemper has bound up a man, or rendered him -lax. Now if what relaxes a constringed body, or restrains a loose, be -drawn from reason, such a practitioner is a rational physician: but if -from experience, as he must confess, who will not allow himself to be -a rationalist, then he is an empirick. And so, according to him, the -knowledge of the distemper is foreign to the art, but the remedy lies -within the bounds of experience. Nor is any improvement made by them -upon the profession of the empiricks, but on the contrary, something -is taken from it; the empiricks attending with great circumspection to -many circumstances; whereas these regard only the easiest, and no more -than the common things. For in like manner those, who are employed in -curing cattle, since it is impossible for them to be informed by the -dumb animals, what is peculiar in the case of each, regard only what -is common to them all: and foreign nations, as they are not acquainted -with any subtile theory of medicine, take notice only of the common -symptoms: those also, who take under their care a great number of -patients, because they are not able to consult the distinct necessities -of each with the utmost attention, have respect only to those generals. -Nor indeed were the ancient physicians ignorant of this method, but -they were not content with it; for even the most ancient writer -Hippocrates said, that in practice it is necessary to regard both the -general and peculiar circumstances. Nor is it possible even for them to -confine themselves within the narrow limits of their own profession; -for there are different kinds both of the bound, and lax disorders; -which is more easily observed in the lax, for it is one thing to vomit -blood, another to vomit bile, and another to vomit the food: and -there is also a difference betwixt labouring under a simple purging, -and a dysentery; between being weakened by sweats, and wasted by a -consumption. A humour also breaks out upon particular parts, as the -eyes, for instance, and the ears; and no member of the human body is -free from that danger. Now not one of these disorders is cured exactly -in the same manner as another; so that in these, medicine descends from -the general observation of the lax kind, to the peculiar. And in this -again another kind of knowledge of peculiarity is often necessary; -because the same thing will not relieve all, that labour under similar -distempers. For though there are certain things, which either bind -the belly, or open it in most people; yet some are to be met with, in -whom the same intention is gained by means contrary to the common. So -that in such, the general observation is hurtful, and the peculiar -only salutary. And a right apprehension of the cause often removes a -distemper. Upon this account it was, that the most ingenious physician -of our age, the late Cassius, being called to one in a fever distressed -with violent thirst, when he found, that his complaints began after -hard drinking, ordered him to drink plentifully of cold water. When -his patient had drank this, and by the mixture had weakened the force -of the wine, he was presently freed from the fever by a sleep, and a -sweat. Which remedy the physician very judiciously adapted to the case, -not from the consideration of his body being either bound or loose, but -from the cause that had preceded. There is also another peculiarity -to be regarded, which is that of place and season, according to these -authors themselves; who, when they are giving directions for the -management of the healthy, order them more carefully to avoid cold, -heat, satiety, labour, and venery, in sickly places or seasons; and -to take more rest in such seasons or places, if they have any sense -of weight hanging upon their body; and in such circumstances neither -to disturb the stomach by vomiting, nor the belly by purging. These -things indeed are certain; yet they descend from generals to some -things that are particular: unless they would have us believe, that -healthy men should observe the temper of the air, and the season of -the year, and that sick people don’t need to take that care, to whom -all precaution is so much the more necessary, by how much an infirm -state of health is more liable to receive injury. Besides, there are -very different properties of distempers in the same person. And one, -who has been sometimes unsuccessfully tried by medicines, which seemed -proper for his disorder, is often recovered by the contrary. There are -also many distinctions to be observed in the giving of food, of which -I shall only name one instance. A youth bears hunger more easily than -a boy; better in a thick, than a clear air; more easily in winter than -summer; with more ease, one, that is accustomed to a single meal, than -another, who eats a dinner also(15); a sedentary person more easily, -than one that takes exercise. Now generally food ought to be prescribed -so much the sooner, as the person is less able to bear the want of it -in health. For these reasons I am apt to think, that he, who is not -acquainted with the peculiarities, ought only to consider the general: -and that he, who can find out the peculiar, ought not to neglect, but -take them in too for the direction of his practice. And therefore, -where the knowledge is equal, yet a friend is a more useful physician, -than a stranger. To return to my point then, my opinion is, that -medicine ought to be rational, but to draw its methods from the evident -causes, all the obscure being removed, not from the attention of the -artist, but from the practice of the art. Again, to dissect the bodies -of living men is both cruel and superfluous. But the dissection of dead -subjects is necessary for learners: for they ought to know the position -and order of the parts, which dead bodies will show better, than a -living and wounded man. But as for the other things, which can only be -observed in living bodies, practice itself will discover them in the -cure of the wounded, somewhat more slowly, but with more tenderness. -Having delivered my sentiments upon these points, I shall lay down the -proper rules for the management of people in health, and then proceed -to what relates to diseases and their cure. - - - - -CHAP. I. - -RULES FOR THE HEALTHY. - - -A sound man, who is both in health, and his own master, ought to -confine himself to no rules; and neither call for the assistance of a -physician nor an iatroalipta(16). ’Tis good for him to diversify his -way of life; to be sometimes in the country, sometimes in the city, -and frequently in the fields; to sail, to hunt; sometimes to rest, -but exercise himself frequently: for indolence enervates the body, -labour strengthens it: the first brings on a quick old age, the other -makes a long youth. ’Tis also proper to make use sometimes of the -warm bath(17), and sometimes of the cold; to anoint sometimes, and -at other times to neglect it; to avoid no kind of food, that may be -in common use; sometimes to eat in company, at other times to retire -from it; sometimes to eat more than is sufficient, and at other times -no more; to take food rather twice in the day than once; and always -as much as he can, provided he concoct it. But as exercise and food -of this kind are necessary, so the exercise and diet of wrestlers are -inconvenient: both because the order of exercise being interrupted by -some necessary business of life, hurts the body; and because those -bodies, which are very high fed, like their’s, soonest decay, and are -most liable to diseases. - -[Sidenote: _Of Coition._] - -Coition is neither to be too much desired, nor too much feared. Seldom -used, it excites the body; frequent, relaxes. But as the frequency -is to be judged of, not by the number of repetitions, but by nature, -regard being had to the age and constitution, we may know it not to -be useless, when it is neither followed by a languor of the body, nor -pain. It is worse in the day-time, but safer in the night; _but the -general rule will hold for both_, if neither meat be taken after the -first, nor the other be followed by wakefulness and labour. These -things are to be observed by strong people; and care must be taken, -that the reliefs of sickness be not wasted in good health. - - - - -CHAP. II. - -RULES FOR VALETUDINARY PEOPLE. - - -But greater precaution is necessary for the valetudinary; amongst -whom are the greatest number of those that live in cities, and almost -all that are fond of study: that care may rectify the disorders which -arise from their constitution, situation, or study. Any of these -then, who has concocted well, will rise in the morning safely; he -that finds the concoction not completed, ought to lie still; and if -he be under a necessity of rising, to go to sleep afterwards. He that -has not concocted at all, should be entirely at rest, and neither -venture upon labour, nor exercise, nor business. He that is troubled -with crude belching, without pain of the præcordia, ought now and -then to drink cold water, and withal to confine himself to certain -rules; to live in a house well lighted, that enjoys the summer’s -breeze and the winter’s sun; to avoid the meridian sun, the morning -and evening cold, as also the air of rivers and lakes; and by no means -to expose himself to the sun breaking out in a cloudy sky, lest he -be sometimes affected with heat, and sometimes with cold, which very -often occasions gravedoes(18) and catarrhs. These inconveniences -are to be guarded against with greater diligence in sickly places, -in which they even cause a pestilence. We may know a body to be in -health, when every day in the morning the urine is first white, and -then of a light red colour: the first shows that the concoction is -going on, and the other, that it is compleated. When any person awakes, -he ought to wait a little, and then, unless it be the winter time, to -wash his mouth plentifully with cold water; in long days, to take the -air in the middle of the day, before meat; or, if he cannot do that -conveniently, after it. In winter especially, to rest the whole night; -but, if he is obliged to study in the night, to do it not immediately -after eating, but after concoction. He, that in the day-time has been -employed either in domestic or civil business, ought to set apart some -time for the refreshment of his body; the principal part of which -is exercise, which ought always to go before meat: in one that has -laboured little(19), and has concocted well, it should be stronger; -in one who has been fatigued, and has not concocted well, it may be -more gentle. Proper exercises are, reading aloud, handling of arms, the -ball, running, and walking; which last is better not upon plain ground: -for an ascent and descent agitates the body with some variety, unless -it be very weak. And it is better in the open air, than in a portico; -better in the sun, if the head can bear it, than in a shade; better -in a shade formed by walls, or parks, than under a roof; a straight -walk is better than a winding. In most cases a beginning sweat should -put an end to exercise, or at least lassitude, that does not amount to -fatigue; and that sometimes in a less, sometimes in a greater degree. -In all these exercises, there should neither be, as among wrestlers, an -inviolable rule, nor too violent labour. Exercise is rightly followed, -sometimes by unction, either in the sun, or before a fire, at other -times by the bath, which is best in a room as high, light, and spacious -as may be. Neither of these should be always done; but either one of -them oftner than the other, as agrees best with the constitution. After -these, it is necessary to take some rest. When food is to be taken, it -is never proper to overload: but too great abstinence is often hurtful: -if there be any small excess committed, it is often safer in drinking -than eating. It is best to begin with salt fish(20), greens, and -such like. After these flesh, which is best roasted, or boiled. All -preserves, upon a double account, are hurtful, both because people are -tempted by their agreeable taste to exceed in quantity, and though the -quantity be moderate, they are of difficult concoction. A desert is not -hurtful to a good stomach, but turns sour upon a weak. And therefore -one, that is less firm in that part, will do better to use dates, -apples, and such fruit for that purpose. After drinking somewhat more -than thirst requires, no more should be eaten. With a full stomach -a man should set about no action. When one has eat plentifully, the -concoction is more easy, if he concludes the meal with a drink of cold -water, then continues awake for a little while, and afterwards has a -sound sleep. If a person has made a hearty meal in the day-time, he -ought not to expose himself after it, either to cold, heat, or labour; -for these do not so readily hurt with an empty as a full body. If -upon any occasion one is to want food for a time, all labour is to be -avoided. - - - - -CHAP. III. - - SOME OBSERVATIONS SUITED TO NEW INCIDENTS, AND THE DIFFERENT - CONSTITUTIONS, SEXES, AND AGES, AND THE SEASONS OF THE YEAR. - - -What we have delivered above, is nearly of universal extent: but some -precautions are necessary for new incidents, and for the constitutions, -sexes(21), and ages, and the seasons of the year. For it is neither -very safe to remove from a healthy place into a sickly; nor from a -sickly into a healthy. It is best to remove from a healthy place to a -sickly, in the beginning of winter; from a sickly to a healthy, in the -beginning of summer. It is neither fit to overload with food after much -fasting, nor is fasting good after too full eating. And those persons -endanger themselves, who, contrary to their custom, either once or -twice a day eat immoderately. Again, sudden ease is very hurtful after -great labour, and sudden labour after too great inactivity. For this -reason, when one has a mind to make any change in his way of living, -he must accustom himself to it gradually. All kinds of labour are more -easily endured even by a boy or an old man, than by a man that is not -used to it. And upon this account too, a life over inactive is not -good; because there may happen to be a necessity for labour. But if at -any time a person altogether unused has occasionally laboured, or even -one, that is accustomed to it, has laboured much harder than ordinary, -he ought to sleep with an empty stomach; and so much the rather, if -he have a bitter taste in his mouth, or a dimness in his eyes, or his -belly be disordered, For then he must not only sleep with an empty -stomach, but even continue to fast the following day, unless rest has -quickly carried off the disorder. And if that be the case, he should -get up, and walk a little at a slow pace. But if a person has been -at more moderate labour, so that he was not obliged to go to sleep, -nevertheless he ought to walk in the same manner. - -What follows is to be generally observed by those, that after fatigue -are to eat: when they have walked a little, if they have not an -opportunity of bathing, they ought to be anointed in a warm place, -either in the sun, or before a fire, and then to sweat. But if they -have that conveniency, they should first of all sit down in the -tepidarium; next, after they have rested a little, go down into the -warm bath; then anoint with a good deal of oil, and rub gently, and -again go into the bath; this done wash the mouth with warm water, -and then with cold. A very hot bath is not fit for such people. And -therefore if any one is so much over fatigued as to be feverish, it is -sufficient for him, in a tepid room, to dip himself up to the groin in -warm water, with a small mixture of oil: after that, to rub over the -whole body, but principally those parts, that have been in the water, -with oil, in which there is an addition of wine and a little powdered -salt. Afterwards it is proper for all people, that are fatigued, to -take food, and that of a moist nature; to be content either with water, -or at most a diluted drink, especially such as is diuretic. It is fit -also to know this, that drinking cold water is very pernicious to one, -that is sweating by labour; and hurtful to those, that are fatigued by -a journey, even when the sweat has abated. Asclepiades believed it to -be bad for those too, that had immediately come from the bath. This -holds true in those, who are easily purged, but not with safety, and -are liable to shudderings, but is not universal; because it is most -agreeable to nature, that a hot stomach should be cooled by drinking, -and a cold one heated. Which rule when I lay down, I own at the same -time, that cold water should not be given to one, that is in a sweat, -though occasioned by bathing. It is common also after various food, -and frequent diluted drinks, for a vomit to be serviceable, and the -following day a long rest, and then gentle exercise. If one be troubled -with frequent yawning(22), he should drink wine and water by turns, -and seldom make use of the bath. A change of labour also relieves from -fatigue; and when any person is distressed by some unusual kind of -labour, that which he is accustomed to, refreshes him. It is very safe -for a person, who is fatigued, to rest upon a couch, if he has before -made it a daily practice; on the contrary, it wearies one, that is not -used to it. For whatever is contrary to custom proves hurtful, whether -it be indulgence or severity. - -There are some methods peculiarly adapted to the case of a man fatigued -by walking. Frequent friction, even upon the journey, relieves him; at -the end of the journey first sitting down, and then unction; afterwards -he may foment with warm water, or use the warm bath, rather to his -lower, than his upper parts. But if any one has been scorched in the -sun, he must immediately go to the bagnio, and rub over his body -and head with oil, and then go down into the bath, warmed to a good -degree; after that, first warm water must be poured over the head, and -then cold. But he, that has been chilled with cold, must wrap himself -up, and sit down in the laconicum, till he sweat; then anoint, and -afterwards bathe; eat moderately, and drink wine unmixed. - -He that has been upon sea, and is troubled with a nausea, if he has -vomited much bile, ought to abstain from food wholly, or take very -little: if he has brought up acid phlegm, he may notwithstanding -take food, but lighter than ordinary: if he has had a nausea without -vomiting, he should abstain from food, or take a vomit after meat. He -that has sat the whole day, either in a chariot or in the theatre, -should by no means run, but walk slowly. It has been frequently -serviceable to stay a long while in the bath, and then to sup slightly. -If one grows hot in the bath, it will refresh him to take vinegar, and -hold it in his mouth: if that is not at hand, cold water may be used in -the same manner. Above all things it is proper to know the constitution -of the body: because some are slender, others fat; some hot, others -cold; some moist, others dry; some costive, and others lax. There are -very few instances of men, who have not a weakness in some part or -other of their body. A person of a slender habit should take methods -to gain flesh, one of a plethoric should diminish his bulk; one of a -hot temperament ought to cool himself, the cold to warm him; one of a -humid should dry, and one of a dry should moisten; he that is loose in -the belly should harden it, and he that is bound should relax; and in -general, means must always be used to help that part which is most -liable to disorders. - -[Sidenote: _The means of fattening the body._] - -The body is fattened by gentle exercise, frequent rest, unction, and -the warm bath, if it be after dinner; a costive belly, moderate cold in -the winter, a full sleep, but not over long, a soft couch, tranquillity -of mind, the eating and drinking of sweet and fat things, frequent -meals, and as much food as it is possible to digest. - -[Sidenote: _Of extenuating the body._] - -The body is extenuated by going into warm water(23), and especially -if it be salt, the bath with an empty stomach, a scorching sun, and all -heat, care, watching, either too short or too long sleep; lying upon -the ground in the summer time, and upon a hard couch in the winter; -running, much walking, and all violent exercise, vomiting, purging, -acid and austere things, and a single meal in the day, also a custom of -drinking wine, that’s not very cold, upon an empty stomach. - -Since I have classed vomiting and purging amongst the methods for -extenuating, I must say something in particular about them. I observe, -that vomiting is rejected by Asclepiades in that book, which he -composed upon the preservation of health; nor do I blame him, if he -was offended with the custom of those, who by such daily evacuation -endeavour to procure a voracious appetite. But he has gone something -farther. He has also in the same book forbid purging. And indeed -this is hurtful, if it be procured by too strong medicines. It can -be no universal maxim however, that these should be laid aside -entirely; because it is possible, that the nature of constitutions -and particular junctures may make them necessary, provided they be -used with moderation, and not without necessity; and even he himself -has granted, that if any thing be corrupted, it ought to be expelled. -So that this method is not to be altogether condemned, but there may -be many occasions for it, and it requires a more particular and nice -observation. - -[Sidenote: _Of vomits._] - -A vomit is more useful in the winter than summer, because in that -season there is more phlegm, and a greater heaviness in the head. It -does no good to those, that are slender, and have a weak stomach; -but it is useful to those, that are of a full habit, and all bilious -people, if they have either overloaded themselves, or their concoction -has been impaired: for if they have taken a greater quantity than -can be concocted, they ought not to run the risk of its corrupting; -or if it is already corrupted, nothing is more proper than to have -it expelled in the most expeditious way possible. For this reason, -whenever they are attacked with bitter eructations, attended with pain -and weight of the præcordia, they must immediately have recourse to -this remedy. It is likewise proper for one, who has a scorching heat -in the breast, and a frequent spitting or a nausea, or for one who -has noise in his ears, or a humour in the eyes, or a bitterness in -the mouth; as also for one, who changes either his air or situation, -and to those, who are troubled with a pain of the præcordia, if they -have not vomited for several days. I am sensible, that in these cases -rest is prescribed, which cannot always be had by those, who are under -a necessity of stirring about; nor indeed has it the same effect in -every body. I grant then, that vomits should not be taken with a -view of indulging the luxurious appetite: that they are sometimes -useful remedies, I believe upon the credit of experience; but I would -advise any, who wishes to be healthy, and live to old age, not to -make a daily practice of it. When one chuses to vomit after meat, if -he does it easily, he should first drink only warm water; if with -difficulty, let him add a little salt or honey to the water; but he, -that intends to vomit in the morning, should first drink mulse(24), -or eat hyssop(25), or radish, and then drink warm water, as has been -directed already. All the other things which the ancient physicians -prescribed, are hurtful to the stomach. If it is weak after the vomit, -a little food is to be taken, but of a proper kind; and if the fauces -have been much irritated, three cyathi of cold water may be drunk. He, -that has vomited, if it was in the morning, ought to take a walk, then -anoint, afterwards sup; but if after supper, on the following day he -should bathe, and sweat in the bagnio; he will do well to make the next -meal slight, and the bread he uses at it should be stale, wine austere -and unmixed, the flesh roasted, and all the food of the driest kind. -He that chuses to vomit twice in the month, will find it answer the -purpose better, if he do it for two days successively, than if he were -to repeat it on the fifteenth day, unless such an intermission should -cause a weight at his breast. - -[Sidenote: _Of purging._] - -When the belly is costive, so as to evacuate very sparingly, and from -that cause flatulencies, dimness of sight, pains of the head, and other -disorders of the superior parts, grow troublesome, then ’tis fit to -take a purge: for what assistance can rest or abstinence afford in -these disorders, of which they are the principal causes? He that wants -to be lax, let him first use such food and wine as produce that effect: -and if they don’t succeed, let him take aloes. But purging, though it -be sometimes necessary, yet, when it is frequent, becomes dangerous; -for thus the body will be habitually deprived of its nourishment, and -by that means become valetudinary, for a body in a weak state is the -most liable to all kinds of distempers. - -[Sidenote: _What heats and cools the body._] - -The body is heated by unction, salt water, and more so if it be warm; -all salt provisions, and austere wine. On the contrary, it is cooled -by bitter and fleshy substances, taken with an empty stomach; the bath -after meals, and sleep, unless it be too long, and all acids; the -coldest water; oil, if it be mixed with water; and lotus(26). - -[Sidenote: _What moistens and dries the body._] - -The body is rendered humid(27) by less exercise than ordinary, -frequent bathing, a full diet, much drink, a walk after it, and -continuing awake. Walking long, and briskly, has of itself the same -tendency; and morning exercise, if one does not eat presently after -it; and those kinds of food, which come from cold climates, or rainy, -or otherwise damp. On the contrary, dryness is caused by immoderate -exercise, hunger, unction, heat without moisture, immoderate use of -salt, cold water, and the taking of food immediately after exercise, -and such particularly as comes from dry and hot climates. - -[Sidenote: _What binds and relaxes the belly._] - -The belly is bound by labour, sitting still, rubbing potter’s chalk -upon the body, and by diminishing the usual quantity of food, as also -if it be taken but once a day by one who is accustomed to it twice; by -drinking little, and not till one has eat as much, as he designs for -the time; rest after meat. On the other hand, the belly is relaxed -by an increase of walking and food, motion after meat, and drinking -frequently in the time of meals. ’Tis necessary also to know this that -a loose belly is bound by a vomit, and a costive one is loosened by the -same: and a vomit immediately after meat binds it; but one that comes -some time after, renders it lax. - -[Sidenote: _Of the different ages_.] - -As to the different ages, people in middle life bear want of food most -easily; young men not so well; least of all boys, and very old men. -The more uneasiness one finds from it, he ought to take victuals the -oftener; and that frequency is more especially necessary for one, that -is growing. Warm bathing is fit both for boys and old men. Wine should -be given to boys more diluted, to old men less; but such as occasions -flatulencies, to neither of them. It is of less consequence what -victuals young men eat, and how dressed. Those that are loose in the -belly while young, for the most part are costive when they grow old; -such as are costive, in their youth, are often loose in old age. It -is best for a young man to have a lax belly, and for an old man to be -bound. - -[Sidenote: _Of the seasons. Winter._] - -It is necessary also to consider the seasons of the year. It is proper -to eat more in the winter; to take a smaller quantity of drink, but -less diluted; to make much use of bread, and flesh rather boiled -_than roasted_, and greens sparingly; to take food once a day, unless -the belly be too much bound. If one dines, it is better to take some -trifling thing, and that dry, without flesh, and without drink. In that -season of the year, all warm things, or such as promote heat, are best. -Nor is venery altogether so hurtful then, as at some other times. - -[Sidenote: _Spring._] - -But in the spring the quantity of food is to be lessened, and the -drink increased, but more diluted; more use is to be made of flesh and -greens, and there must be a gradual change from boiled to roast flesh. -Venery is most safe in that season of the year. - -[Sidenote: _Summer._] - -But in summer the body requires meat and drink more frequently; -therefore it is convenient to take a dinner. Flesh and greens are most -proper in that season; drink very much diluted, that it may at once -remove thirst, and not inflame the body; bathing in cold water; roast -flesh, cold food, or such as is cooling. As food must be often taken, -so it must be in small quantities. - -[Sidenote: _Autumn._] - -Now in autumn there is the greatest danger, upon account of the -frequent changes of the air. And for this reason one should never go -abroad, especially in the colder days, without warm cloaths and shoes, -nor sleep in the air in the night-time, or at least be well covered. -At this time the diet may be something more full, the drink less, but -stronger. Some imagine apples(28) to be hurtful, which for the most -part are eaten immoderately through the whole day, while no abatement -is made from the more substantial food. Thus the mischief does not -proceed from them, but from the aggregate of all that is taken; for -none of them contribute less to it than these. But it is not fit to -use them oftener than the other kinds. Lastly, it is necessary when -an addition is made in this article, to lessen the quantity of the -stronger food. Venery is neither good in the summer, nor in autumn; but -is less hurtful in autumn; in summer, if possible, there ought to be a -total abstinence from it. - - - - -CHAP. IV. - -RULES FOR THOSE THAT HAVE A WEAKNESS IN THE HEAD. - - -Our next business is to consider the cases of those, who have a -weakness in any particular part of the body. He, that has a weakness -in his head, if he has concocted well, ought to rub it gently with -his hands in the morning; and never, if he can avoid it, put any -covering upon it, or clip the hair close to the skin; it is proper for -him to avoid exposing it to the moon, and more especially before her -conjunction with the sun, but never to go out after meat: if he have -his hair, to comb it every day; to walk much, but if he can, neither -under a roof, nor in the sun; and also to avoid the scorching heat -of the sun, particularly after meat or wine. He should rather anoint -than bathe, and the unction should be performed, never before a flame, -sometimes at a glowing red fire. If he come to the bath, he ought first -to wrap himself up, and sweat a little in the tepidarium, anoint there, -and then go into the calidarium; when he has sweat, not to go into the -bath, but to pour hot water over his head, so that it may run over all -his body, then tepid water in the same manner, and lastly cold; and -the last longer upon his head than the other parts; after which to rub -it for some time; lastly, to dry and anoint. Nothing is so beneficial -to the head as cold water; for this reason, he that has a weak head, -should every day in the summer hold it for some time under a pretty -strong stream. And though he has anointed without going into the bath, -and is not able to bear dipping in cold water, nevertheless he should -always pour cold water upon his head. But when he is unwilling to have -the other parts of his body touched, he must bend his head forward, so -that the water may not fall down into his neck; and that it may not -offend his eyes, or any other part, he is to throw it back now and then -with his hands, as it runs down. It is necessary for him to use a spare -diet, which is easily concocted; and if he finds his head uneasy, when -his stomach is empty, he must eat in the middle of the day; if fasting -does not injure it, once a day is more eligible. Mild diluted wine is -more proper for his common drink than water, that when his head grows -worse, he may have some refuge left; and it is neither fit for him -to drink wine always, nor water; each of them is a remedy, when used -alternately. He must neither write nor read, nor speak with vehemence, -especially after supper; at which time neither is thinking very safe -for him; but above all things a vomit is hurtful. - - - - -CHAP. V. - - DIRECTIONS FOR THOSE THAT LABOUR UNDER A LIPPITUDE, GRAVEDO, CATARRH, - AND DISORDERS OF THE TONSILS. - - -Nor is the use of cold water beneficial to those only, who are -distressed with a weakness in their head; but also to such as are -troubled with constant lippitudes, or gravedoes, catarrhs, and -disorders in their tonsils. Such people must not only pour cold water -upon their head every day, but also wash their mouth with a large -quantity of it; and all, that find relief from this practice, must -especially make use of it, when the air has been rendered unwholesome -by southerly winds. And as all strong attention or fatigue of mind -after meat is hurtful to every body, so it is more particularly to -those, who are liable to pains in their head, or windpipe, or any other -disorders in their mouth. A person subject to gravedoes and catarrhs, -may avoid these disorders by changing his air, place, or water, as -little as possible; and by covering his head in the sun, so as it may -neither be overheated, nor suffer by cold from the sudden intervention -of a cloud; by shaving his head with an empty stomach after concoction, -and neither reading nor writing after meat. - - - - -CHAP. VI. - -THE PROPER REGIMEN FOR PEOPLE LIABLE TO A PURGING. - - -He, that is frequently troubled with a purging, ought to exercise his -upper parts by the ball, and such like motions; to walk, while his -stomach is empty; to avoid too great heat from the sun, and constant -bathing; to anoint without sweating. He should not use a variety of -food, and by no means meat stewed into broth, or vegetables of the -leguminous kind, or those greens that pass quickly through the body; -in fine, to take all such things as are slowly concocted. Venison, -hard fish, and the roasted flesh of tame animals, are very proper. It -is never fit to drink salt wine(29), nor even the weak, nor sweet -wine, but the austere, of a strong body, and not over old. If he chuses -mulse, it must be prepared with boiled honey. If cold drinks don’t -disturb his belly, he must use them principally. If any thing has -disagreed with him at supper, he ought to vomit, and to repeat it the -day following; on the third day to eat a small quantity of bread dipped -in wine, or eggs fried in oil, or in defrutum(30), and things of a -like nature: after that to return to his usual diet. After meat always -to rest, and neither apply his thoughts to any subject closely, nor -give himself a shock by walking however gently. - - - - -CHAP. VII. - -RULES FOR THOSE THAT ARE LIABLE TO A PAIN OF THE COLON. - - -But if the large intestine, which is called colon[AE], is often pained, -since that disorder is nothing else but a kind of flatulence, the -intention to be pursued is, that concoction may be duly performed; the -patient must practise reading, and other exercises, make use of the hot -bath, and take his food and drink hot; lastly, let him avoid cold by -all means, every thing that is sweet, and leguminous vegetables, and -whatever generally causes flatulencies. - - [AE] κόλον. - - - - -CHAP. VIII. - -RULES FOR ONE THAT HAS A WEAK STOMACH. - - -A man, whose stomach is infirm, ought to read aloud, after reading to -walk, then to exercise himself with the ball or arms, or any other -kind, which agitates the superior parts; upon an empty stomach, not -to drink water, but hot wine; to take food twice a day, but in such -quantity, as he can easily concoct; to make use of small and austere -wine, and to take his drink after meat rather cold. The indications of -a weak stomach are paleness, leanness, pain in the præcordia, nausea, -involuntary vomiting, a pain of the head, when the stomach is empty: -where these signs are not found, the stomach is strong. And we are not -to believe our countrymen, who, when they are indisposed, and have -a strong inclination for wine or cold water, defend their luxury by -pretending the stomach does not do its office. But those that concoct -slowly, and whose præcordia on that account are inflated, or who, by -reason of any heat, are accustomed to be thirsty in the night-time, -before going to rest may drink two or three cyathi of wine through a -small pipe. It is good also against a slow concoction to read aloud, -then to walk, afterwards to anoint or bathe, to drink always cold wine, -and after meat to drink largely, but in the way I mentioned already by -a siphon: lastly, to conclude all the drinks with cold water. He, whose -food grows sour in his stomach, before he eats, should drink egelid -water, and vomit. But if the use of this should occasion a looseness, -whenever he is relieved of that complaint, he should by all means make -use of cold drinks. - - - - -CHAP. IX. - -DIRECTIONS FOR THOSE THAT ARE LIABLE TO PAINS OF THE NERVES. - - -He that is subject to pains in the nerves, as is common in the gout -of the hands or feet, ought as much as possible to exercise the part -affected, and expose it to labour and cold; unless the pain has -become violent, in which case rest is best. Venery is always hurtful. -Concoction is necessary, as well in this, as in all disorders of -the body: for crudity injures it more than any thing; and whenever -the body is out of order, the diseased part feels it most sensibly. -As concoction is an adversary to all diseases, so some again are -relieved by cold, and others by heat. Either of which every one ought -to procure, according to the habit of his body. Cold is hurtful to an -old or slender man, to a wound, to the præcordia, intestines, bladder, -ears, hips, shoulders, private parts, teeth, bones, nerves, womb, and -brain. It also renders the surface of the skin pale, dry, hard, and -black. From this proceed shudderings and tremours. But it is beneficial -to young people, and all that are of a full habit. The mind also is -more brisk, and the concoction goes on better, when ’tis cold, if -due care is taken to guard against it. Cold water poured on, besides -being useful to the head, does good to the stomach. It is likewise of -service to the joints, and pains, which are not attended with ulcers; -also to persons, that are too ruddy, if they be free from pain. Heat -helps whatever cold hurts; and those too that have blear eyes, if they -have neither pain nor an effusion of tears; also contracted nerves, -and especially those ulcers which arise from cold. It causes a good -colour in the body, and promotes the excretion of urine. In too great -a degree, it enervates the body, softens the nerves, and relaxes -the stomach. But neither cold nor heat is by any means safe, coming -suddenly upon persons unaccustomed to it; for cold occasions pains -in the sides, and other disorders, and cold water causes scrophulous -swellings; heat hinders concoction, prevents sleep, wastes by sweat, -and renders the body obnoxious to pestilential distempers. - - - - -CHAP. X. - -DIRECTIONS IN A PESTILENCE. - - -There are some rules necessary to be observed in a pestilence by a -man, who continues in good health, but cannot however be secure. At -that time it is proper to take journies and to sail. When that can’t -be done, to use gestation, gentle walking in the open air before the -heat of the day, and unction with the same moderation; and as has been -directed above, to avoid fatigue, crudity, cold, heat, and venery, and -confine himself to a strict regimen. If he feel any heaviness hanging -about his body, then he is neither to rise in the morning, nor walk -barefooted at any time, much less after meat or the bath; nor to vomit -either with an empty stomach, or after supper: neither should the belly -be purged; and if it grow loose of itself, it must be restrained. -Abstinence should rather be observed, if the body is plethoric. Also it -is proper to avoid the bath, sweating, sleeping in the middle of the -day, especially after meat; which by the way, it is more convenient to -take once a day, and that sparingly, lest it should occasion crudity: -every other day to drink alternately water and wine. These rules being -carefully observed, as little alteration as possible should be made -in the usual course of life. And as they are to be practised in every -pestilence, so principally in that, which is occasioned by southerly -winds. And the very same precautions are necessary for those that take -journies, when they have set out from home in a sickly season of the -year, or have come into sickly countries. But if the nature of any -engagements should prevent the observance of the other rules, yet it -will be necessary to live abstemiously; and thus to change from wine -to water, and from that to wine again, in the manner that has been -prescribed above. - - - - -A. CORNELIUS CELSUS - - OF - - MEDICINE. - - - - -_BOOK II._ - - - - -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. - - [AF] ἀποστήματα. - - [AG] μελαγχολία. - - [AH] φθίσις. - - [AI] στραγγουρία. - - [AJ] εἰλεος. - - [AK] λειεντερία. - -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. - - [AL] σπασμὸς. - - [AM] τέτανος. - - [AN] παράλυσις. - - [AO] φρεν̃ιτιϛ.̃ - -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. - - [AP] ἄφθαι. - - [AQ] ἀκροχορδ́ονες. - - [AR] αἱμοῤῥοίδες. - - [AS] καχεξία. - - - - -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. - - [AT] Εἱλικρινὲς, sincere, or unmixed; so that it is explained - naturally enough by our author _integrum_, _sound_, which I chuse to - render by _free from all complaint_, because we never apply the term - _sound_ to a body, that has any distemper hanging about it. - - - - -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. - - [AU] στρόφος. - -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. - - [AV] καυσώδης. - - [AW] φύματα. - -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. - -[Sidenote: _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. - - [AX] αὐτόπυρον. - -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. - - [AY] εὔχυμα et κακόχυμα. - - - - -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. - - [AZ] πολύγονον. - - [BA] στρύχνος. - -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. - - - - -A. CORNELIUS CELSUS - - OF - - MEDICINE. - - - - -_BOOK III._ - - - - -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]. - - [BB] ἑμιτριτα̃ιος. - -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. - - [BC] κρισίμοι. - -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. - -[Sidenote: _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. - - [BD] ζίσις. - - - - -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]. - - [BE] φρεν̃ιτις. - -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. - - [BF] συκάμινος. - - [BG] συκόμορον. - -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. - - [BH] καρδιακὸς. - -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. - - [BI] λήθαργος. - -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. - - [BJ] ὕδρωψ. - - [BK] τυμπανίτης. - - [BL] λευκοφλεγματία vel ὑπὸ τὴν σάρκα. - - [BM] ἀσκίτης. - -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. - - [BN] σαφὶς ἀγρία. - - [BO] κύπειρος. - - [BP] σχο̃ινος. - -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. - - [BQ] ἀτροφία. - -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. - - [BR] καχεξία. - -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. - - [BS] φθίσις. - -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. - - [BT] ὠμοπλάται. - - - - -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. - - [BU] ἐλεφαντίασις. - -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. - - [BV] ἀποπληξία. - - - - -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. - -[Sidenote: _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. - -[Sidenote: _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. - -[Sidenote: _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. - - - - -A. CORNELIUS CELSUS - - OF - - MEDICINE. - - - - -_BOOK IV._ - - - - -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]. - - [BW] σφαγίτιδες. - - [BX] χαρωτίδες. - - [BY] πυλωρὸς. - - [BZ] οὐρητ̃ηρες. - - [CA] _Canalis_ is our author’s word. - - [CB] περιτόναιος. - - - - -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. - -[Sidenote: _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]. - - [CC] κεφαλαία. - - [CD] ὑδροκέφαλος. - -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. - -[Sidenote: _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. - - [CE] κυνικὸς σπασμὸς. - -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. - -[Sidenote: _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. - -[Sidenote: _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. - - [CF] κορύζαι. - - [CG] κατασταγμοὶ. - -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. - - [CH] ὀπισθότονος. - - [CI] ἐμπροσθότονος. - - [CJ] τέτανος. - -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]. - - [CK] συνάγχη. - - [CL] ὡς συνάγχη. - - [CM] παρασυνάγχη. - -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. - -[Sidenote: _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. - - [CN] δύσπνοια. - - [CO] ̃ἀσθμα. - - [CP] ὀρθόπνοια. - -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. - -[Sidenote: _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. - -[Sidenote: _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. - -[Sidenote: _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. - - [CQ] διάβρωσις. - - [CR] ῥηγμοχασμὸς. - - [CS] ἀναστόμωσις. - -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. - - [CT] πλευριτικὸς. Our author uses here the masculine adjective to - the Latin word _morbus_. - -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. - - [CU] περιπνευμονία. - -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. - - [CV] ἡπατικὸς the adjective is used here in the same manner, as - pleuriticus before. - -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. - - [CW] μυροβάλανοι. - - - - -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. - - [CX] χολέρα. - -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. - - [CY] κοιλιακὸς. - -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. - - [CZ] χόρδαψος. - - [DA] εἰλεὸς. - - [DB] κολικὸς. - -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. - - [DC] κολικὸν. - - [DD] δυσεντερία. - -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. - - [DE] τεινεσμὸς. - -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. - -[Sidenote: _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. - - [DF] σαρκοφάγος. - -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). - - - - -A. CORNELIUS CELSUS - - OF - - MEDICINE. - - - - -_BOOK V._ - - - - -PREFACE. - - -Having gone through those disorders of the body, which are principally -relieved by diet, we must now proceed to that branch of physic, which -depends more upon medicines. The ancient authors put great confidence -in them; so did Erasistratus, and those, who stiled themselves -empiricks. Their efficacy was still more extolled by Herophilus and his -followers; insomuch that they attempted to cure no distemper without -them. They have written a great deal too concerning the virtues of -medicines: such are the treatises of Zeno, or Andreas, or Apollonius, -who was sirnamed Mus. Not without reason Asclepiades in a great -measure laid aside the use of them: and because almost all medicines -offend the stomach, and afford bad juices, he chose to apply all his -care to the management of the diet. But though this be more useful in -most distempers, yet many disorders are incident to our bodies, which -cannot be totally removed without medicines. It is fit to observe in -the first place, that all the branches of medicine are so connected -together, that they cannot be entirely separated; but each derives its -appellation from that, which is principally made use of in it. And -therefore as that, which cures by diet, sometimes employs medicines; so -the other, which chiefly works by medicines, ought also to take in the -diet, which is of great service in all disorders of the body. But since -all medicines have some peculiar powers, and often give relief single, -often mixed, it seems not improper first of all to mention both their -names and virtues, and the compositions of them; that our work may be -shortened, when we come to the curative part. - - - - -CHAP. I. - -MEDICINES FOR STOPPING BLOOD. - - -A bleeding is stopped by copperas, which the Greeks call -chalcanthus[DG], chalcitis(1), acacia, lycium with water, -frankincense, aloes, gum(2), calcined lead(3), leeks, blood herb, -either Cimolian, or potter’s chalk, misy(4), cold water, wine, -vinegar, allum(5), melinum(6), scales both of iron(7) and copper; -and of this last there are two species, the one of common copper, the -other of red copper. - - [DG] χάλκανθος. - - - - -CHAP. II. - -AGGLUTINANTS AND RESTRINGENTS. - - -A wound is agglutinated by myrrh, frankincense, gum, especially -acanthine, fleawort, tragacanth, cardamom, bulbusses, lintseed, -cresses, white of an egg, glue, isinglass, the white vine(8), snails -bruised with their shells, boiled honey, sponge squeezed out of cold -water or wine or vinegar; or sordid wool dipped in the same, if the -wound be slight; also cobwebs. - -Both scissile alum, which is called schiston[DH] and the liquid are -restringent, also melinum, orpiment, verdigrease, chalcitis, copperas. - - [DH] σχιστὸν. - - - - -CHAP. III. - -MEDICINES FOR PROMOTING A SUPPURATION. - - -Maturating and suppurating medicines are nard, myrrh, costus, balsam, -galbanum, propolis(9), storax, both the soot of frankincense(10) -and its bark, bitumen, pitch, sulphur, resin, suet, fat, and oil. - - - - -CHAP. IV. - -MEDICINES FOR OPENING WOUNDS. - - -Wounds are opened like mouths in bodies, which in Greek is called -anastomoun[DI], by cinnamon, balsam, panaces, long cyperus, -penny-royal, white violet flowers, bdellium, galbanum, turpentine -and pine resin, propolis, old oil, pepper, pellitory, ground pine, -stavesacre, sulphur, alum, seed of rue. - - [DI] ἀναστομο̃υν. This word Celsus here translates literally _to - open like a mouth_. - - - - -CHAP. V. - -CLEANSERS. - - -Cleansers are verdigrease, orpiment, which by the Greeks is called -arsenicon[DJ] (this in all respects has the same properties with -sandarach(11), but is stronger) copper scales, pumice, iris, balsam, -storax, frankincense, incense bark, both pine and turpentine resin -liquid, flower of the wild vine, lizard’s dung, blood of a pigeon, -and ring-dove, and swallow, ammoniacum, bdellium (which has the same -virtues with the ammoniacum, but is not so strong) southern-wood, dry -figs, gnidian berry(12), shavings of ivory, omphacium(13), radish, -the coagulum of blood, but especially that of a hare (which has the -same properties of others, but in this case is more efficacious) -ox gall, raw yolk of an egg, hartshorn, glue, crude honey, misy, -chalcitis, saffron, stavesacre, litharge, galls, copper scales(14), -blood-stone, minium, costus, sulphur, crude pitch, suet, fat, oil, rue, -leeks, lentils, vetches. - - [DJ] ἀρσενικὸν. - - - - -CHAP. VI. - -CORRODING MEDICINES. - - -Corrosives are liquid alum, but more especially the round, verdigrease, -chalcitis, misy, copper scales, especially of the red kind, calcined -copper(15), sandarach, minium from Sinope, cassia, balsam, myrrh, -incense bark, galbanum, liquid turpentine resin, both kinds of -pepper, but chiefly the round, cardamom, orpiment, lime, nitre, and -aphronitre(16), seed of smallage, narcissus-root, omphacium, bastard -sponge, oil of bitter almonds, garlic, crude honey, wine, mastich-tree, -iron scales, ox-gall, scammony, stavesacre, cinnamon, storax, seed of -rue, resin, seed of narcissus, salt, bitter almonds, as well as their -oil, copperas, chrysocolla(17), calcined shells. - - - - -CHAP. VII. - -EATING MEDICINES. - - -The medicines, which eat flesh, are the juice of acacia, ebony, -verdigrease, copper scales, chrysocolla, Cyprus ashes(18), nitre, -cadmia(19), litharge, hypocistis(20), diphryges(21), salt, -orpiment, sulphur, rocket, sandarach, salamander(22), bastard sponge, -flour of copper(23), chalcitis, copperas, ochre, lime, vinegar, -galls, alum, milk of the wild fig-tree, or of sea spurge, which by the -Greeks is called tithymallus[DK], animal gall, soot of frankincense, -spodium(24), lentil, honey, olive-leaves, horehound, blood-stone, and -the Phrygian(25), and Asian, and Scissile(26) stones, misy, wine, -and vinegar(27). - - [DK] τιθύμαλλος. - - - - -CHAP. VIII. - -CAUSTICS. - - -Caustics are orpiment, copperas, chalcitis, misy, verdigrease, lime, -burned paper(28), salt, copper scales, burned lees, myrrh, dung of -a lizard, and pigeon, and ring-dove, and swallow, pepper, gnidian -berry, garlick, diphryges, both the milks mentioned in the last -chapter, hellebore both white and black, cantharides, coral, pellitory, -frankincense, salamander, rocket, sandarach, stavesacre, chrysocolla, -ochre, scissile alum, sheep’s dung, flower of wild vine. - - - - -CHAP. IX. - -MEDICINES FOR FORMING CRUSTS UPON ULCERS. - - -The same medicines form crusts upon ulcers, as if they were burnt by -fire, but particularly chalcitis, especially if it be calcined, flower -of copper, verdigrease, orpiment, misy, and the efficacy of the last is -increased by calcination. - - - - -CHAP. X. - -RESOLVENTS FOR CRUSTS. - - -The crusts (eschars) of ulcers are resolved by wheat meal with rue or -leeks or lentils, with the addition of some honey. - - - - -CHAP. XI. - -DISCUTIENTS. - - -For discussing any collections, which have been formed in any part -of the body, the following things are very powerful, southernwood, -elicampane, sweet marjoram, white violet, honey, lilies, -sansucus(29), cyperus, milk, mellilot, serpyllum, cypress, cedar, -iris, purple violet, narcissus, roses, saffron, white horehound, -long rooted cyperus, nard, cinnamon, cassia, ammoniacum, wax, resin, -stavesacre, litharge, storax, dry figs, goat’s marjoram, seeds of -lint, and of narcissus, bitumen, the dust of the gymnasium, the -pyrites-stone, or mill-stone, raw yolks of eggs, bitter almonds, and -sulphur. - - - - -CHAP. XII. - -EVACUATING AND DRAWING MEDICINES. - - -Evacuant and drawing are labdanum, round alum, ebony, lintseed, -omphacium, gall, chalcites, bdellium, turpentine and pine resin, -propolis, dry figs boiled, pigeon’s dung, pumice, meal of darnel, green -figs boiled in water, elaterium, bay-berries, nitre, and salt. - - - - -CHAP. XIII. - -LENIENTS. - - -Lenients for what is exasperated are spodium, ebony, gum, white of -eggs, milk, tragacanth. - - - - -CHAP. XIV. - -INCARNING MEDICINES. - - -Pine resin, attic ochre, honey, asteriace(30), wax, and butter, -incarn and fill up ulcers. - - - - -CHAP. XV. - -EMOLLIENTS. - - -Emollients are, calcined copper, Eretrian earth(31), nitre, -poppy-tears(32), ammoniacum, bdellium, wax, suet, fat, oil, dry -figs, sesamum, mellilot, the root and seed of narcissus, rose-leaves, -coagulum, yolk of egg raw, bitter almonds, all marrow, antimony(33), -pitch, boiled snails, hemlock-seed, dross of lead(34), by the Greeks -called scoria molybdou[DL], panaces, cardamom, galbanum, resin, -stavesacre, storax, iris, balsam, dust of the gymnasium, sulphur, -butter, rue. - - [DL] σκορία μολύβδου. - - - - -CHAP. XVI. - -CLEANSERS OF THE SKIN. - - -The skin is cleansed by honey, for which purpose it is more effectual -when mixed with galls, or vetches, or lentils, or horehound, or iris, -or rue, or nitre, or verdigrease. - - - - -CHAP. XVII. - -OF THE MIXTURE OF SIMPLES; AND OF THE PROPORTION OF THE WEIGHTS. - - -Having mentioned the virtues of the simples, we are next to shew in -what manner they are to be mixed, and what compositions are made from -them. Now they are mixed variously, and there is no certain method for -it, since of similar ingredients some are taken away, and others are -added; and though the very same simples are all used, the proportion -of their weights may be changed. And therefore though the number of -medicinal simples be not so very great, there are innumerable kinds -of mixtures; which it would be needless to enumerate, though it were -possible: both because the same effects are found within the compass -of a few compositions; and because it is easy for any person, who -is acquainted with their virtues, to change them. I shall therefore -confine myself to the most esteemed. Now in this book I shall give an -account of those, which may either have been wanted in the preceding, -or are employed in the cures, which I am to treat of, only throwing -together these compositions, which are of more general use. Such as -are accommodated to one particular disorder, or even to a few, I will -insert in their proper places. - -But before I proceed, I would have it understood, that in an ounce -is contained the weight of seven denarii. Next, that I divide each -denarius into six parts, that is sextantes, so that I have the same -quantity in the sextans of a denarius, that the Greeks have in their -obolus[DM]. That being reduced to our weights makes a little more than -half a scruple. - - [DM] ὀβολὸς. - -[Sidenote: _Of the difference betwixt malagmas, plaisters, and -troches._] - -Now malagmas, and plaisters, and troches, which the Greeks call -trochischi[DN], though in many things they are the same, differ in -this, that malagmas are chiefly made from flowers, and even their -stalks, plaisters and troches are more generally composed of some -metallic ingredients. Then malagmas being beat up are abundantly soft: -for they are applied, where the skin is unbroken: but those things, of -which plaisters and troches are made, are carefully powdered; lest they -hurt wounds, when they are laid on. Betwixt a plaister and a troche -there is this difference, that a plaister admits of something melted: -in a troche there are only dry medicines united by some liquid. Again, -a plaister is made in this manner: The dry medicines are powdered by -themselves: when they are mixed, vinegar is dropped into them, or any -other liquor belonging to the composition, that is not greasy; and they -are again rubbed with that. Those things, that are capable of being -melted, are melted altogether at the fire; and if any oil is to be in -the mixture, it is then poured in. Sometimes too, some one of the dry -ingredients is first boiled with oil. When these things are finished, -which ought to be done separately, the whole is mixed together into one -mass. But the way of making troches is this: The dry medicines being -powdered are formed into one body with a liquor not greasy, such as -wine or vinegar, and again after being brought to a consistence, grow -dry: and when they are to be used, are diluted by a liquor of the same -kind. _There is also a difference in the manner of using these_: for a -plaister is simply applied, a troche is rubbed on, or else mixed with -something softer than itself, or with cerate. - - [DN] τροχίσχοι. - - - - -CHAP. XVIII. - -OF MALAGMAS. - - -[Sidenote: _1. A cooling malagma for the hot gout._] - -These particulars being premised, I shall first subjoin malagmas, -which are commonly contrived not with an intention to cool, but to -heat. There is one however, which is cooling, adapted to the hot gout -in the feet. It contains of galls both unripe, and otherwise, of -coriander-seed, hemlock, poppy-tears, gum, of each an acetabulum, of -washed cerate, which the Greeks call peplumenon[DO], half a pound. - - [DO] πεπλυμένον. - -The other malagmas are mostly heating. But some of them discuss matter, -others draw it out, which are called epispastica[DP]: most of them are -adapted to particular parts of the body. - - [DP] ἐπισπαστικὰ. - -[Sidenote: _2. A drawing malagma._] - -If matter(35) is to be drawn out, as in a dropsical case, pleurisy, -a beginning abscess, and even a moderate suppuration, that is proper, -which consists of dry resin, nitre, ammoniacum, galbanum, each p. *. -wax, p. *. Or that, which contains rasile verdigrease, frankincense, -each p. ii. *. Sal ammoniac p. vi. *. copper scales, wax, each p. viii. -*. dry resin p. xii. *. and vinegar a cyathus. The same end is obtained -by the meal of cummin-seed with struthium(36) and honey p. ii. *. - -[Sidenote: _3. Malagma for the liver._] - -If the liver is pained, the proper malagma is that, which contains -balsam-tears p. xii. *. costus, cinnamon, cassia bark, myrrh, saffron, -round cyperus, balsam-seed, Illyrian iris, cardamom, amomum, nard, of -each p. xvi. *. To these is added nard ointment(37), till it be of -the consistence of cerate. And this must be used, while it is recent: -but if it be to be kept for some time, turpentine resin p. xvi. *. wax -p. x. *. must be beat up with mild wine, and mixed with it. - -[Sidenote: _4. Malagma for the spleen._] - -But if the spleen is pained, the bark of that acorn, which the Greeks -call myrobalanus, and nitre are beat together in equal quantities, and -are sprinkled over with the sharpest vinegar: when it comes to the -consistence of cerate, it is spread upon a linen cloth first moistened -in cold water, and thus applied, and over it is laid barley meal; but -it ought not to lie there above six hours, lest it waste the spleen; -and it is better to do it twice or thrice. - -[Sidenote: _5. Lysias’s malagma for several parts._] - -Lysias composed a malagma, at once calculated for the liver, and -spleen, and for abscesses, and the scrophula, and parotid swellings, -and the joints, and heels suppurating, or otherwise painful, likewise -to assist the concoction of the stomach, of the following materials: -opopanax, galbanum, resin, of each p. ii. *. ammoniacum, bdellium, wax, -beef suet, dry iris p. iv. *. with an acetabulum of cachrys(38) and -forty grains of pepper: which being powdered are brought to a proper -consistence by iris ointment. - -[Sidenote: _6. Apollophanes’s malagma._] - -The composition of Apollophanes is calculated for pains of the sides. -It consists of turpentine resin, soot of frankincense, each p. iv. -*. bdellium, ammoniacum, iris, suet from the kidneys either of veal -or a goat, viscum(39), each p. iv. *. Now this relieves all pains, -mollifies what is hard, and is moderately heating. - -[Sidenote: _7. Andreas’s malagma._] - -The malagma of Andreas also has the same effect; it likewise relaxes, -draws out humour, maturates pus, and when that is ripe, it breaks the -skin, and brings it to cicatrize. It does good applied either to small -or large abscesses; also to pained joints, hips, and feet: it restores -too any part, that has been damaged by bruises; softens hard and -inflated præcordia; extracts bones; and in fine is efficacious in every -case, where heat can be of service. It contains wax p. xi. *. viscum, -sycaminum (which others call sycamore) tears, each p. i. *. pepper both -round and long, ammoniacum thymiama(40), bdellium, Illyrium iris, -cardamom, xylobalsam, male frankincense, myrrh, dry resin, each p. x. -*. pellitory, gnidian berries, aphronitre, sal ammoniac, root of Cretan -birthwort, root of wild cucumber, liquid resin of turpentine, of each -p. xx. *. to these is added a sufficient quantity of iris ointment to -soften and reduce them to a proper consistence. - -[Sidenote: _8. Malagma for Polyarchus._] - -The principal composition for relaxing what is bound, softening what -is hard, and discussing any collection, is that, which is ascribed -to Polyarchus. It contains of long cyperus, cardamom, soot of -frankincense, amomum, wax, liquid resin, equal parts. - -[Sidenote: _9. Malagma of Nileus._] - -There is another by Nileus for the same purposes: of crocomagma(41), -which is, as it were, the refuse of saffron p. iv. *. ammoniacum -thymiama, wax, each p. xxx. *. the two first of these are rubbed down -with vinegar, the wax is melted with oil of roses, and then the whole -is mixed together. - -[Sidenote: _10. Moschus’s emollient malagma._] - -The malagma, that passes under the name of Moschus, has only the -property of softening what is hard. It contains of galbanum one ounce, -soot of frankincense p. iii. *. wax, ammoniacum thymiama, each a -triens, dry pitch p. ii. *. vinegar three heminae. - -[Sidenote: _11. Medus’s discutient malagma._] - -Medus’s malagma is used to discuss any collection. This contains wax p. -iii. *. panaces 1/2 p. *. copper scales, round alum, scissile alum, of -each p. i. *. calcined lead p. i. *. and 1/2. - -[Sidenote: _12. Panthemus’s malagma._] - -Panthemus for the same intention made use of lime 1/2 p. *. mustard -powdered, fenugreek, alum, each p. i. *. beef suet p. ii. *. and 1/2. - -[Sidenote: _13. Andreas’s malagma for the scrophula._] - -For the scrophula I find many malagmas. I believe indeed, that the -more malignant that distemper is, and the more difficult to discuss, -the greater number of remedies have been tried; which have succeeded -variously in different persons. Andreas is the author of the following -mixture: Nettle-seed p. i. *. round pepper, bdellium, galbanum, -ammoniacum thymiama, dry resin, of each p. iv. *. liquid resin, wax, -pellitory, long pepper, sea spurge-seed, crude sulphur, which is called -apyron[DQ], equal parts. - - [DQ] ἄπυρον, that has not passed the fire. - -[Sidenote: _14. Mico’s for the same._] - -Mico’s malagma is this: of dry lees, vinegar, aphronitre, sal ammoniac, -mustard, cardamom, wild cucumber-root, resin, each p. iv. *. which are -beat up with mild wine. - -[Sidenote: _15. Three others._] - -A more expeditious for the same purpose is that, which contains of -viscum, cat’s dung, resin, crude sulphur, equal parts. And another, -in which are of sulphur p. i. *. pyrites-stone p. iv. *. of cummin an -acetabulum. Likewise that, which consists of one part of pyrites, two -of sulphur, and three of turpentine resin. - -[Sidenote: _16. Malagma of an Arabian for the scrophula, &c._] - -There is a malagma of a certain Arabian for the scrophula, and -rising tubercles, which are called phymata, which discusses them. It -contains myrrh, sal ammoniac, frankincense, resin both liquid and dry, -crocomagma, wax, of each p. i. *. the pyrites-stone p. iv. *. to which -some add sulphur p. ii. *. - -[Sidenote: _17. Another for the same._] - -There is another of service in the scrophula, and in those tubercles, -which are with difficulty brought to maturate; and in those, that are -called carcinodea[DR], which consists of these things: sulphur p. ii. -*. nitre p. iv. *. myrrh p. vi. *. soot frankincense 1/2 p. *. sal -ammoniac p. iii. *. wax p. i. *. - - [DR] χαρχινωδὴ, cancerous. - -[Sidenote: _18. Protarchus’s malagma._] - -Protarchus for parotid swellings, and those tubercles, which are called -melicerides[DS], that is, honey-combs, or phymata, and for malignant -ulcers, made this mixture: of pumice, liquid pine resin, soot of -frankincense, aphronitre, iris, each p. viii. *. with wax p. ix. *. and -to these he added a cyathus and half of oil. - - [DS] μιλιχηρίδες. - -[Sidenote: _19. Malagma for a panus, &c._] - -But against the panus upon its first appearance, which the Greeks call -phygethlon[DT], and any tubercle, which is called phyma, a mixture is -made of attic ochre, with two parts of flour, and to these, while they -are beat up, honey is now and then dropped in, till it acquire the -consistence of a malagma. - - [DT] φύγεθλον. - -[Sidenote: _20. A malagma against all phymata._] - -That also discusses all the tubercles, that have the name of phyma, -which contains of lime, aphronitre, round pepper, each p. i. *. -galbanum p. ii. *. salt p. iv. *. which are incorporated with cerate -made of rose-oil. - -[Sidenote: _21. Malagma for beginning abscesses._] - -That malagma suppresses all beginning abscesses, which is composed of -galbanum, bruised beans, each p. i. *. myrrh, frankincense, bark of -caper-root, each p. iv. *. And the murex burnt, and reduced to a fine -powder, dropping in now and then a little vinegar, powerfully discusses -all beginning abscesses. - -[Sidenote: _22. Malagma for blood._] - -But if in such tumours, too great a quantity of blood is extravasated, -it is proper to use an application, which is also efficacious against -tubercles. It has the following ingredients: bdellium, storax, -ammoniacum, galbanum, pine resin both dry and liquid. Also mastich, -frankincense, iris, of each p. ii. *. - -[Sidenote: _23. Malagma for cancers, &c._] - -Cancers and tubercles are in a good measure eased by this composition: -galbanum, viscum, ammoniacum, turpentine resin, each p. i. *. beef suet -1/2 p. *. burned lees as great a proportion as may be, without making -it drier than a malagma ought to be. - -[Sidenote: _24. Malagma for the face._] - -But if there be a contusion in the face and a livor from an -extravasation of blood, the following composition, applied night and -day, removes it. Birthwort, thapsia(42), of each p. ii. *. bdellium, -storax, ammoniacum thymiama, galbanum, dry resin, and liquid, resin of -the mastich-tree, male frankincense, Illyrian iris, wax, of each p. iv. -*. The application of a bean also will do good in the same case. - -[Sidenote: _25. Opening malagmas._] - -There are also some malagmas, which by the Greeks are called -anastomotica[DU], because they have the power of opening. Such is that, -which is composed of the following things: long pepper, aphronitre, of -each p. ii. *. hedge mustard p. iv. *. which are mixed with honey: they -are also proper for opening scrophulous tumours. Of the same kind with -this, but stronger, is that, which contains lime p. iv. *. pepper six -grains, nitre, wax, of each p. x. *. honey p. iii. *. and a hemina of -oil. - - [DU] ἀναστομωτικὰ. - -[Sidenote: _26. Mico’s relaxing, &c. malagma._] - -There is one of Mico’s, which is relaxing, opening, and cleansing. It -contains of bastard sponge, sulphur, nitre, pumice, equal parts; to -these is added of pitch and wax a sufficient quantity to make it the -consistence of cerate. - -[Sidenote: _27. Aristogenes’s malagma for the bones, &c._] - -Aristogenes’s malagma for the bones consists of these ingredients: -of sulphur p. i. *. turpentine resin, aphronitre, and the pulp of a -squil, washed lead(43), each p. ii. *. soot of frankincense p. viii. -*. the mellowest dry figs, beef suet, each p. viii. *. wax p. xii. *. -Macedonian iris p. vi. *. sesamum toasted and acetabulum. And this -malagma is very agreeable to the nerves and joints. - -[Sidenote: _28. Euthycleus’s malagma for the joints, &c._] - -That, which was invented by Euthycleus, is proper for the joints, and -for all pains, particularly in the bladder, and any contraction of -the joints from a recent cicatrix, which the Greeks call anchyla[DV]. -It contains soot of frankincense an acetabulum, the same quantity of -resin, galbanum without its stalks an ounce and half, ammoniacum, -bdellium, of each p. *. wax 1/2 p. *----There is also another, which -consists of iris, ammoniacum, galbanum, nitre, each p. xiv. *. liquid -resin p. vi. *. wax p. xvi. *. - - [DV] ἀγκύλη. - -[Sidenote: _29. Sosagoras’s for the same._] - -Sosagoras’s malagma for pains of the joints: of calcined lead, -poppy-tears, bark of henbane, storax, hog’s fennel, suet, resin, and -wax, equal parts. - -[Sidenote: _30. Chrysippus’s._] - -Chrysippus also composed one: of liquid resin, sandarach, pepper, each -p. xii. * to these a little wax is added. - -[Sidenote: _31. Ctesiphon’s._] - -Ctesiphon’s: of Cretan wax, turpentine resin, the reddest nitre, each -1/2 p. *. three cyathi of oil. But the nitre is first rubbed for three -days with water dropped in upon it, and boiled with a sextarius of it, -till all the moisture be consumed.----This composition is also good -for parotids, tubercles, and the scrophula, and for softening every -collection of humour. - -[Sidenote: _32. For the joints._] - -To the joints one may properly apply a part of a dry fig mixed with -cat-mint; or staveacre without the seeds, with penny-royal. - -[Sidenote: _33. Ariston’s for the gout in the feet._] - -The same composition is useful for the gout in the foot. But for that -ailment Ariston has also composed one, containing of nard, cinnamon, -cassia, chamaeleon, round cyperus, each p. viii. *. goat’s suet melted -in iris ointment p. xx. *. iris p. i. *. which ought to lie in the -strongest vinegar for twenty days. The same also discusses recent -tubercles, and all pains. - -[Sidenote: _34. Theoxenus’s for pained feet._] - -But for pains of the feet Theoxenus mixed, of kidney suet a third part, -of salt two parts, and applied them spread upon a piece of leather; -then put over it ammoniacum thymiama dissolved in vinegar. - -[Sidenote: _35. Numenius’s for the gout, &c._] - -But Numenius mollified the gout in the feet, and other indurated joints -with the following composition: southernwood, dry roses, poppy-tears, -of each p. iii. *. turpentine resin p. iv. *. frankincense, aphronitre, -each p. viii. * iris, birthwort, each p. xii. *. wax p. iii. * to these -is added one cyathus of cedria(44), three cyathi of laurel oil(45), -and a sextarius of bitter oil. - -[Sidenote: _36. Dexius’s malagma for a callus, &c._] - -For a callus formed upon the joints, Dexius directed the following -application: of lime, p. iv. *. ceruss, p. viii. *. pine resin xx. -*. pepper thirty grains, wax p. ii. *. And while these are beat up a -hemina of mild wine is poured in. - - - - -CHAP. XIX. - -OF PLAISTERS. - - -Of plaisters there are none more useful, than those, which are -immediately applied to bloody wounds; the Greeks call them enaima[DW]. -For these repel an inflammation, unless it be excited by something very -violent, and even then they diminish its force, and agglutinate wounds, -which are not inflamed, and cicatrize them. They consist of medicines -not fat, and therefore by the Greeks are called alipaina[DX]. - - [DW] ἔναιμα. - - [DX] ἀλίπαινα. - -[Sidenote: _1. Barbarium plaister._] - -The best of these plaisters is that, which is called barbarum. It -contains of rasile verdigrease(46) p. xii. *. litharge p. xx. *. -alum, dry pitch, dry pine resin, each p. i. *. to which is added of oil -and vinegar each a hemina. - -[Sidenote: _2. The choacon._] - -There is another for the same, which is called choacon; it contains of -litharge p. x. *. dry resin as much. But the litharge is first boiled -in three heminæ of oil. The colour of both these plaisters is black, -which generally results from pitch and resin, as the blackest is from -bitumen; from verdigrease, or scales of copper, green; from minium, -red; from ceruss, white. - -[Sidenote: _3. The basilicon._] - -There are a very few compositions, in which the variety of the mixture -causes some different appearance; therefore that also is black, which -is called basilicon. It contains of opopanax p. i. *. galbanum p. ii. -*. pitch and resin, of each p. x. *. half a cyathus of oil. - -[Sidenote: _4. The smaragdine._] - -But that, which is very green, is called smaragdine, in which there are -of pine resin. p. iii. *. wax p. i. *. verdigrease 1/2 p. *. flour of -frankincense p. ii. *. as much oil and vinegar, with which _last_ the -flour and verdigrease are united. - -[Sidenote: _5. The rufum._] - -There is also one of a reddish colour, which seems to bring wounds to -cicatrize quickly: it consists of frankincense p. i. *. resin p. ii. -*. copper scales p. iii. *. litharge p. xx. *. wax p. c. *. of oil a -hemina. - -[Sidenote: _6. The paracolleticon._] - -Besides, there is another, which from agglutinating is called -paracolleticon[DY] It contains bitumen, scissile alum, p. iv. *. -litharge p. iv. *. and a hemina of old oil. - - [DY] παρακολλητικὸν. - -[Sidenote: _7. Philotas’s cephalic plaister._] - -Besides these there are some of the same kind, which, because they -are particularly adapted to fractures of the skull, are by the Greeks -called cephalica[DZ]. Philotas’s composition contains of Eretrian -earth, chalcitis, each p. iv. *. myrrh, calcined copper, each p. x. -*. isinglass p. vi. *. rasile verdigrease, round alum, crude misy, -birthwort, each p. viii. *. copper scales p. xx. *. male frankincense -p. ii. *. wax p. i. *. rose and bitter oil three cyathi, and a -sufficient quantity of vinegar for rubbing down all the dry ingredients. - - [DZ] κηφαλικὰ. - -[Sidenote: _8. A green one._] - -There is another for the same purpose green; which consists of calcined -copper, copper scales, myrrh, isinglass, each p. vi. *. crude misy, -rasile verdigrease, birthwort, round alum, each p. viii. *. wax p. vi. -*. a hemina of oil, and of vinegar a sufficient quantity. - -[Sidenote: _9. The tetrapharmacum._] - -For promoting a suppuration there is nothing better than that, which is -very quickly prepared, and by the Greeks is called tetrapharmacum[EA]. -It contains equal parts of wax, pitch, resin, and beef suet; if the -last cannot be had, veal suet. - - [EA] τετραφάρμακον, or consisting of four medicines. - -[Sidenote: _10. Ennea pharmacum._] - -There is another for the same intention, which is called ennea -pharmacum[EB], which cleanses more; it consists of nine ingredients, -wax, honey, suet, resin, myrrh, rose oil, marrow either of a deer or -calf, or beef, or œsypum(47), and butter. These also are mixed in -equal quantities. - - [EB] ἐννεαφάρμακον, of nine medicines. - -But there are some plaisters, that answer both these intentions at -once; which, unless the case requires distinct applications for each, -are preferable; otherwise they are worse, and never to be made use of, -but either when both intentions are proposed together, or when, though -the plaisters are wanted singly, they are not to be had by themselves. -But where there is choice, they are to be rejected, and such only -applied as are peculiarly suited to the end to be obtained. For example -I will mention two. - -[Sidenote: _11. Attallum plaister._] - -There is then the Attalum plaister for wounds: which contains of copper -scales p. vii. *. soot of frankincense p. xv. *. ammoniacum as much, -liquid turpentine resin p. xxv. *. beef suet the same quantity, three -heminæ of vinegar, a sextarius of oil. - -[Sidenote: _12. Judæus’s plaister._] - -But amongst those, which are proper for a fractured skull, some use -that, which is said to be invented by Judæus. It consists of the -following ingredients: salt p. iv. *. red copper scales, calcined -copper, each p. xii. *. ammoniacum thymiama, soot of frankincense, dry -resin, each p. vi. *. Colophonian resin, wax, veal suet cured, each p. -xx. *. a cyathus and half of vinegar is added, and less than a cyathus -of oil. What the Greeks call tetherapeumena[EC], we call curata, -_cured_; when for instance from the suet all the little membranes are -carefully taken away, and so in any other medicine. - - [EC] τεθεραπευμένα. - -[Sidenote: _13. Diadaphnidon._] - -There are also some plaisters greatly celebrated for drawing, which -are likewise distinguished by the name of epispastica[ED]. Such as is -that, which because bay-berries are among the ingredients, is called -diadaphnidon[EE]. In it there is turpentine resin p. x. *. nitre, wax, -dry pitch, bay-berries, each p. xx. *. and a little oil. Now as often -as I shall mention a berry or a nut, or any thing of that nature, -it will be proper to know, that before it be weighed, the exterior, -pellicle is to be taken from it. - - [ED] ἐπισπαστικὰ. - - [EE] διὰ δαφνίδων. - -[Sidenote: _14. Another._] - -There is another of the same name, which is also for promoting a -suppuration. Of veal suet, ammoniacum thymiama, pitch, wax, nitre, -bay-berries, dry resin, birthwort, pellitory, of each equal parts. - -[Sidenote: _15. Philocrates’s._] - -Besides these there is one of Philocrates: which contains sal ammoniac -p. vii. *. birthwort p. viii. *. wax, turpentine resin, soot of -frankincense, each p. xv. *. litharge p. xxxii. *. To these, that it -may serve also for promoting a suppuration, are added iris p. iii. *. -galbanum p. vi. *. - -[Sidenote: _16. Rhypodes._] - -However that is best for drawing, which from its resemblance to sordes, -the Greeks call rhypodes[EF]. It contains myrrh, saffron, iris, -propolis, bdellium, the heads of pomegranates, scissile and round -alum, misy, chalcitis, boiled copperas(48), opopanax, sal ammoniac, -viscum, each p. iv. *. birthwort p. viii. *. copper scales p. xvi. *. -turpentine resin p. lxxv. *. wax, and suet, either beef or goat’s, each -p. c. *. - - [EF] ῥυπω̃δες. - -[Sidenote: _17. Hecatæus’s._] - -Hecatæus also is the author of a plaister of the same kind, which is -thus composed: galbanum p. ii. *. soot of frankincense p. iv. *. pitch -p. v. *. wax and turpentine resin, each p. viii. *. with these a little -iris ointment is mixed. - -[Sidenote: _18. The green Alexandrian._] - -The green Alexandrian drawing plaister is efficacious for the same -purpose. It contains scissile alum p. viii. *. sal ammoniac p. vii. *. -copper scales p. xvi. *. myrrh, frankincense, each p. xviii. *. wax -p. cl. *. colophonian or pine resin p. cxc. *. a hemina of oil, and a -sextarius of vinegar. - -[Sidenote: _19. An eating plaister._] - -Some plaisters are eating, which the Greeks call septica[EG], such as -is that, which contains turpentine resin, soot of frankincense, of each -p. ii. *. copper scales p. i. *. labdanum p. ii. * the same quantity of -alum, litharge p. iv. *. - - [EG] σηπτικὰ. - -[Sidenote: _20. Another for eating, &c._] - -This plaister also eats away flesh vehemently, and even dissolves -the bones, and keeps down fungous flesh. It contains litharge, -copper scales, of each an ounce; nitre that has not felt the fire, -Asian stone, birthwort, of each a sextans, wax, turpentine resin, -frankincense, old oil, copperas, sal ammoniac, 1/2 p. rasile -verdigrease p. bessis, of squill vinegar a hemina, and a like quantity -of Aminæan wine. - -[Sidenote: _21. Diogenes’s black plaister._] - -There are also some calculated against bites; such as the black one of -Diogenes: which contains of bitumen, wax, dry pine resin, each p. xx. -*. litharge p. c. *. of oil a sextarius. Or that, which consists of -copper scales p. iv. *. ceruss and rasile verdigrease each p. viii. *. -ammoniacum p. xii. *. wax, pine resin, each p. xxv. *. litharge p. c. -*. of oil a sextarius. Or that, which is composed of copper scales p. -xiv. *. galbanum p. vi. *. ceruss and rasile verdigrease, each p. viii. -*. ammoniacum p. xii. *. wax, pine resin, of each p. lv. *. with these -the litharge is boiled. - -[Sidenote: _22. Red Ephesian plaister._] - -There is a red plaister of the same virtues, which is called Ephesian. -It contains turpentine resin p. ii. *. galbanum p. iv. *. Sinopian -minium p, vi. *. soot of frankincense p. vi. *. wax p. viii. *. -litharge, p. lvi. *. old oil a hemina. - -[Sidenote: _23. Another._] - -Likewise that which consists of the following materials; copper scales, -soot of frankincense, of each p. iv *. galbanum p. vi. *. sal ammoniac -p. xii. z. *. wax p. xxv. *. with three heminæ of oil. These also are -proper applications for other recent wounds. - -[Sidenote: _24. A white lenient plaister._] - -There are also white lenient plaisters, by the Greeks, _from their -colour_, called leuca[EH], generally calculated for slight wounds, and -especially those of old men: such as is that, which contains of ceruss -p. lii. *. veal suet cured and wax, each p. lviii. *. three heminæ of -oil, with which the ceruss is boiled up. - - [EH] λευκὰ. - -[Sidenote: _25. Elephantine plaister._] - -Another, which consists of ceruss p. xx. *. wax p. lv. *. a hemina of -oil, and a sextarius of water. Now as often as these are added, to -ceruss or litharge, we may take it for granted, that they are to be -boiled with them. This last composition is very white, and therefore it -is called elephantine. - -[Sidenote: _26. A lenient plaister._] - -There are also some lenient plaisters, which the Greeks commonly call -lipara[EI], as that which contains minium p. iv.*. litharge, p. xxv. *. -wax and hog’s lard, each p. xxxv. *. and the yolks of four eggs. - - [EI] λιπαρὰ. - -[Sidenote: _27. Another._] - -Another composition of the same kind: wax, turpentine resin, of each -p. v. *. ceruss p. viii. *. litharge, dross of lead (scoria molybdi -the Greeks call it) each p. x. *. cicine(49) and myrtle oil, each the -third part of a hemina. - -[Sidenote: _28. Archagathus’s._] - -Another, which is said to be invented by Archagathus: burnt misy, -calcined copper, each p. iv. *. burnt(50) ceruss p. viii. *. -turpentine resin p. x. *. litharge p. vi. *. - -[Sidenote: _29. Another for the same purpose._] - -For the same purpose: litharge, wax, hog’s lard, of each p. xxvii. *. -boiled yolks of eggs, with a hemina of rose oil. Or this composition: -cerate made of myrtle oil three parts, hog’s lard a fourth part, a -little lead dross. Or the following composition; of litharge half a -pound boiled with a hemina of oil, and a like quantity of sea water, -till it cease to bubble, with the addition of a little wax. Or this: -equal parts of wax, suet, antimony, litharge, and ceruss. - - - - -CHAP. XX. - -OF TROCHES. - - -[Sidenote: _1. Troche for agglutinating._] - -Troches also have different virtues. For there are some adapted to -agglutinate and heal recent wounds: such is that, which contains -chalcitis, misy, aphro-nitre, flower of copper, galls, scissile alum -moderately burnt, of each p. i. *. calcined copper, the heads of -pomegranates, each p. iii. *. This should be diluted with vinegar, and -so laid on, when a wound is to be agglutinated. But if it be a nervous -or muscular part, it is better to mix it with cerate, so as to have a -ninth part of the latter with eight of the other. - -[Sidenote: _2. Another._] - -Another for the same purpose. It consists of the following materials: -bitumen, scissile alum, of each p. i. *. calcined copper p. iv. *. -litharge p. xi. *. and a sextarius of oil. - -[Sidenote: _3. The sphragis of Polybus._] - -But that of Polybus(51) is by far the most celebrated: it is called -sphragis[EJ]. Which contains of scissile alum p. iv. *. copperas p. ii. -*. myrrh p. v. *. aloes a like quantity; the heads of pomegranates, ox -gall, each p. vi. *. which being rubbed together, are incorporated with -austere wine. - - [EJ] σφραγὶς. - -[Sidenote: _4. Troche for foul ulcers._] - -For foul ulcers, and blackness in the ears, nose, obscene parts, and -inflammation in any of these places: of chrysocolla p. i. *. copperas, -scissile alum, each p. ii. *. bark of winter cherry p. iv. *. minium p. -vi. *. litharge p. xii. *. ceruss p. xvi. *. these are compounded with -vinegar, and diluted when used. - -[Sidenote: _5. Andro’s troche._] - -Andro’s is for an inflamed uvula, for foulness in the obscene parts, -or gangrenes in the same; of galls, copperas, myrrh, each p. i. *. -birthwort, scissile alum, each p. ii. *. heads of pomegranates p. xxv. -*. compounded with passum, and when they are to be used, diluted with -vinegar or wine, according as the disorder, which is to be cured, is -more or less violent. - -[Sidenote: _6. A troche for fissures of the anus, &c._] - -For fissures in the anus, or an effusion of blood from the hæmorrhoidal -veins, or a gangrene, the following is of peculiar efficacy; of -verdigrease p. ii. *. myrrh p. iv. *. gum p. viii. *. frankincense p. -xii. *. antimony, poppy tears, acacia, each p. xvi. *. which are both -rubbed down with wine, and when used, diluted with the same liquor. - -[Sidenote: _7. Troche for expelling a stone from the bladder._] - -This composition seems proper to expel a stone out of the bladder along -with the urine: equal parts of cassia, saffron, myrrh, costus, nard, -cinnamon, liquorice root, balsam, hypericum are powdered; then mild -wine is dropped in, and the troches are formed. Each may contain p. i. -*. and one of these may be swallowed every day in the morning fasting. - - - - -CHAP. XXI. - -OF PESSARIES. - - -These three kinds of compositions, that is, malagmas, plaisters, and -troches, are extensive and various in their uses. But there are other -things also useful: as those, which are applied below to females: the -Greeks call them pessi[EK]. The manner of them is this: the composition -is received in soft wool, and this wool put into the vagina. - - [EK] πεσσοὶ. - -[Sidenote: _1. Pessary for evacuating blood._] - -For evacuating blood, to two of the small kind of figs called -cauneæ(52) is added nitre p. i. *. Or the seed of garlick -is powdered, and a little myrrh added and mixed with susine -ointment(53). Or the pulp of a wild cucumber is diluted in woman’s -milk. - -[Sidenote: _2. For softening the womb._] - -To soften the womb, the yolk of an egg, and fenugreek, and rose oil, -and saffron are mixed together. Or of elaterium p. iii. *. as much -salt, and stavesacre p. vi. *. are incorporated with honey. - -[Sidenote: _3. Boethus’s for the same._] - -There is another invented by Boethus, which contains saffron, -turpentine resin, each p. iv. *. myrrh p. iii. *. rose oil p. i. *. -veal suet p. iii. *. wax p. ii. *. mixed together. - -[Sidenote: _4. Numenius’s for an inflammation._] - -The best composition against an inflammation of the womb, is that of -Numenius, which contains saffron p. iii. *. wax p. i. *. butter p. -viii. *. goose fat p. xii. *. two boiled yolks of eggs, with less than -a cyathus of rose oil. - -[Sidenote: _5. For expelling a dead fœtus._] - -If a fœtus has died within the womb, that it may be the more easily -expelled, the bark of pomegranates must be rubbed down with water, and -then made use of. - -[Sidenote: _6. For hysterick fits._] - -If a woman from an hysterick disorder is subject to fits, snails -together with their shells must be burnt and powdered, and then honey -added to them. - -[Sidenote: _7. For conception._] - -If a woman does not conceive(54), lions fat must be softened with -rose oil. - - - - -CHAP. XXII. - -MEDICINES USED EITHER IN A DRY FORM, OR MIXED WITH LIQUIDS. - - -[Sidenote: _1. Powder for fungous flesh._] - -There are some mixtures of medicines made use of dry without being -brought to any consistence, which we sprinkle on, or mix with some -liquid, and lay them on. Such as that for eating down fungous flesh, -which contains of copper scales, soot of frankincense, each p. i. *. -verdigrease p. ii. *. Now this same composition with honey cleanses -ulcers; and with wax fills them up. Also, if misy, galls, and cadmia -be mixed in equal proportions, they consume the flesh; and these may -either be sprinkled on dry(55), or brought to a consistence and -spread on. - -[Sidenote: _2. For restraining putrid flesh._] - -Honey mixed either with lentils, or with horehound, or with olive -leaves first boiled in wine, restrains putrid flesh, and does not -suffer it to spread, and is gently corrosive. Also mellilot boiled in -mulse, and then rubbed small. Or lime with cerate. Or bitter almonds -with a third part of their quantity of garlick, and a little saffron -added to them. Or that, which contains litharge p. vi. *. burnt ox -horn p. xii. *. myrtle oil and wine, each three cyathi. Or that, which -consists of the following things: the flowers of pomegranate, copperas, -aloes, of each p. ii. *. scissile allum, frankincense, each p. iv. -*. galls p. viii. *. birthwort p. x. *. The following is stronger, -and even caustic; orpiment with chalcitis, and either nitre, or lime, -or burnt paper. Also salt with vinegar. Or that composition, which -contains chalcitis, pomegranate tops, aloes of each p. ii. *. scissile -alum, frankincense, each p. iv. *. galls p. viii. *. birthwort p. -x. *. and a sufficient quantity of honey to bring them to a proper -consistence. Or cantharides, sulphur, of each p. i. *. darnel p. -iii. *. with the addition of as much liquid pitch as will keep them -together. Or even chalcitis mixed with resin and rue: or diphryges with -the same resin; or stavesacre with liquid pitch. There is the same -property in burnt lees of wine, and equal parts of lime and nitre. Or -scissile alum p. i. *. frankincense, sandarach, nitre, each p. i. *. -galls p. viii. *. birthwort p. x. *. and a sufficient quantity of honey. - -[Sidenote: _3. Hera’s composition._] - -There is also a composition of Hera’s, which contains myrrh, chalcitis -of each p. ii. *. aloes, frankincense, scissile alum, each p. iv. *. -birthwort, unripe galls, each p. viii.*. pomegranate bark powdered p. -xx. *. - -[Sidenote: _4. Judæus’s._] - -There is likewise one by Judæus: in which are two parts of lime, and a -third of the reddest nitre; which are mixed with the urine of a young -boy, till they be of the consistence of strigment. But the part, upon -which this is spread, must be moistened now and then. - -[Sidenote: _5. Jollas’s._] - -But Jollas mixed of burnt paper, sandarach, each p. i. *. lime p. ii. -*. and the same quantity of orpiment. - -[Sidenote: _6. For an hæmorrhage._] - -[Sidenote: _7. For cicatrizing ulcers._] - -But if there is blood discharged from that membrane, which covers the -brain, the yolk of an egg ought to be burnt, powdered, and sprinkled -upon it. If the hæmorrhage is from any other part, orpiment, copper -scales, of each p. i. *. sandarach p. ii. *. burnt marble(56) p. iv. -*. ought to be sprinkled on. The same things also resist a gangrene. To -bring on a cicatrix, copper scales, soot of frankincense, of each p. -ii. *. lime p. iv. *. p. The same mixture also keeps down fungous flesh. - -[Sidenote: _8. Timæus’s for the ignis sacer._] - -Timæus made use of the following composition for the ignis sacer(57) -and a gangrene; of myrrh p. ii. *. frankincense, copperas, each p. iii. -*. sandarach, orpiment, copper scales, each p. iv. *. galls p. vi. *. -burnt ceruss p. viii. *. These have the same effect whether sprinkled -on dry, or mixed with honey. - -[Sidenote: _Sternutatory medicines._] - -Sneezings are excited by putting into the nose either white hellebore, -or struthium. Or this mixture: of pepper, white hellebore each p. iii. -*. castor p. i. *. aphronitre p. ii. *. struthium p. iii. *. - -[Sidenote: _Gargarisms._] - -Gargarisms are used either to alleviate, or to repel, or to evacuate. -Milk cream of ptisan, or bran, are lenients. A decoction either of -lentils, or roses, or brambles, or quinces, or dates, are repellent. -Mustard and pepper are evacuants. - - - - -CHAP. XXIII. - -OF ANTIDOTES, AND THEIR USES. - - -Antidotes, though seldom wanted, are sometimes extremely necessary, -because they relieve in the most dangerous cases. They are properly -exhibited, when bodies are bruised either by blows, or by falling from -a height, or in pains of the bowels, sides, fauces, and more internal -parts. But their principal use is against poisons either injected into -our bodies by bites, or received with meat or drink. - -[Sidenote: _1. Antidote._] - -There is one, which contains poppy tears p. *. z. acorum, -malobathrum(58) p. v. *. Illyrian iris, gum, of each p. ii. *. -anise p. iii. *. Gallican nard, dry rose leaves, cardamom, each p. -iv. *. parsley p. *. iii. z. trefoil p. v. *. black cassia(59), -silis, bdellium, balsam fruit, white poppy seed, each p. *. z. storax -p. *. v. z. myrrh, opopanax, Syrian nard, male frankincense, juice -of hypocistis, each p. vi. *. castor p. vi. *. costus, white pepper, -galbanum, turpentine resin, saffron, flower of round cyperus, each p. -vi. *. z. liquorice p. viii. *. z. these are incorporated with honey or -passum. - -[Sidenote: _2. Antidote called ambrosia._] - -Another antidote, which Zopyrus is said to have compounded for king -Ptolemy, and called it ambrosia, consists of the following things: -costus, male frankincense, of each p. v. *. white pepper p. *. z. -flower of round cyperus p. ii. *. cinnamon p. iii. *. black cassia p. -iv. *. Cilician saffron p. *. iv. z. the myrrh called stacte(60) p. -v. *. Indian nard p. *. v. z. which being powdered separately, are -incorporated with boiled honey: then when it is used, the bigness of an -Egyptian bean must be diluted in a draught of wine. - -[Sidenote: _3. Mithridates’s antidote._] - -But the most celebrated is that of Mithridates: by taking which every -day, this king is said to have rendered his body secure against the -danger or poisons. It contains the following things: of costus p. *. -z. acorus p. v. *. hystericum, cummin, sagapenum, juice of acacia, -Illyrian iris, cardamom, each p. ii. * anise p. iii. * Gallican nard, -gentian-root, dry rose leaves, each p. iv. *. poppy tears, parsley, -each p. *. iv. z. cassia, siler, darnel, long pepper, each p. vi. *. -storax p. *. v. z. castor, frankincense, juice of hypocistis, myrrh, -opopanax, each p. vi. *. malobathrum leaves p. vi. *. flower of round -cyperus, turpentine resin, galbanum, seed of Cretan carrot, each p. -*. v. z. nard, opobalsam, each p. *. vi. z. treacle mustard p. *. vi. -pontic root(61) p. vii. *. saffron, ginger, cinnamon, each p. *. -viii. These are powdered and mixed with honey, and against poison the -bigness of a sweet almond is given in wine. In other disorders of the -body, according to their violence, either the bigness of an Egyptian -bean, or a vetch, will be sufficient. - - - - -CHAP. XXIV. - -OF ACOPA. - - -[Sidenote: _Acopon for the nerves._] - -Acopa(62) are useful to the nerves. Such is that, which contains -flower of round cyperus p. *. ii. z. z. costus, long cyperus, bay -berries, ammoniacum, cardamom, each p. *. iv. z. myrrh, calcined -copper, each p. vii. *. Illyrian iris, wax, each p. iv. *. Alexandrian -reed, round cyperus, calambac wood, xylo-balsam, each p. xviii. *. suet -p. i. *. iris ointment a cyathus. - -[Sidenote: _Another called elæodes._] - -There is another, which they call elæodes[EL]; it is made in this -manner: of wax p. *. z. oil a like quantity, and of turpentine resin -the bulk of a walnut; these are boiled together: then being poured into -a mortar, are rubbed, and an acetabulum of the best honey is gradually -dropped into it, then three cyathi of iris ointment and of rose oil. - - [EL] ἐλαιω̃̃δες. - -[Sidenote: _Of enchrista. One for cleansing and filling ulcers._] - -The Greeks call liquids, that are daubed on, by the name of -enchrista[EM]. Such as is that for cleansing and incarning ulcers, -especially amongst nerves. It consists of a mixture of equal parts -of butter, veal marrow, veal suet, goose fat, wax, honey, turpentine -resin, rose and cicine oil. These are all melted separately, then -mixed while they are liquid, and afterwards rubbed together. And this -composition is indeed more cleansing: but it would be more emollient, -if instead of the rose oil, that of cyprus be infused. - - [EM] ἔγχριστα. - -[Sidenote: _For the ignis sacer._] - -For the ignis sacer: of litharge p. vi. *. ox-horn burnt p. ii. *. -these are beat up together, and there is added alternately wine, and -myrtle wine, till three cyathi of each be used. - - - - -CHAP. XXV. - -OF CATAPOTIA. - - -[Sidenote: _1. Anodyne catapotium for concoction._] - -There are catapotia of various kinds, and composed for different -intentions. They call those anodyna[EN], which mitigate pain by sleep: -which it is not fit to use, unless there be a very great necessity. For -they consist of medicines strong and ungrateful to the stomach. Yet -that even promotes concoction, which contains poppy tears, galbanum, -of each p. i. *. myrrh, castor, pepper, each p. ii. Of these it is -sufficient to swallow the bigness of a vetch. - - [EN] ἀνώδυνα. - -[Sidenote: _2. Another stronger._] - -Another, which is more powerful to promote sleep, but worse for the -stomach, consists of the following ingredients. Of mandrake p. *. z. -seeds of smallage and henbane, each p. iv. *. which are rubbed down -with wine. The same quantity of this, as was directed of the other, is -a plentiful dose. - -[Sidenote: _3. A quieting catapotium for pains of the head, &c._] - -If there be pains of the head, or ulcers, or a lippitude, or tooth-ach, -or difficulty of breathing, or pains of the intestines, or inflammation -of the womb, or the hip, or a pain in the liver, spleen, or side, or if -a woman falls into hysterick fits, and loses her speech, a catapotium -of the following kind removes the pain by sleep. Sil(63), acorum, -seed of wild rue, each p. ii. *. castor, cinnamon, each p. ii. *. -poppy-tears, root of panaces, dry mandrake fruit, flower of round -cyperus, of each p. ii. *. pepper lvi. grains. These being powdered -separately, are again all rubbed together, dropping in now and then -passum, till they acquire the consistence of sordes. A little of this -is either swallowed, or diluted in water, and given to drink. - -[Sidenote: _4. Another of more general use._] - -Moreover a handful of wild poppy, when it is just ripe for gathering -the tear, is put into a vessel, and upon it is infused a sufficient -quantity of water to cover it, and thus it is boiled. When this handful -has been well boiled, let it be squeezed and thrown away; and with the -liquor let an equal quantity of passum be mixed, and let them boil -together, till it be as thick as sordes. When it has cooled, it is made -into catapotia of the bigness of our bean, which have an extensive use. -For they both procure sleep, either taken alone, or given in water, -and with the addition of a little juice of rue and passum mitigate -ear-aches: and dissolved in wine they stop a dysentery: and mixed with -cerate made of rose oil, to which a little saffron is added, they -restrain an inflammation of the womb. And spread upon the forehead with -water, they stop the flux of gum to the eyes. - -[Sidenote: _5. For a pain of the womb._] - -Again, if a pain of the womb prevent sleep, a mixture is made of -saffron p. ii. *. anise, myrrh, each p. i. *. poppy tears p. iv. *. -hemlock seed p. viii. *. and these incorporated with old wine, and the -bigness of a lupin is diluted with three cyathi of water. But this is -dangerous to give in a fever. - -[Sidenote: _6. Catapotium for healing the liver._] - -For healing the liver, of nitre p. *. z. saffron, myrrh, Gallican nard, -each p. i. *. are mixed with honey, and the bigness of an Egyptian bean -serves for a dose. - -[Sidenote: _7. For pains in the sides._] - -For removing pains of the sides, equal parts of pepper, birthwort, -nard, and myrrh are mixed together. - -[Sidenote: _8. Of the thorax._] - -For pains of the thorax, of nard p. i. *. frankincense, cassia, each -p. iii. *. myrrh, cinnamon, each p. vi. *. saffron p. viii. turpentine -resin a quadrans, honey three heminæ. - -[Sidenote: _9. Athenio’s for a cough._] - -For a cough is that of Athenio: of myrrh, pepper, each p. i. *. castor, -poppy tears, each p. i. *. which are bruised separately, and afterwards -mixed, and two catapotia of the bulk of our bean are given in the -morning, and two, when the patient is going to sleep at night. - -[Sidenote: _10. Heraclides’s anodyne catapotium for a cough._] - -But if a cough prevents sleep, that of Heraclides the Tarentine is -calculated for both disorders: of saffron p. i. *. cinnamon, castor, -poppy tears, each p. i. *. myrrh, long pepper, costus, galbanum, each -p. *. z. - -[Sidenote: _11. Catapotium for foul ulcers in the fauces._] - -But if ulcers in the fauces of patients labouring under a cough require -to be cleansed, of panaces, myrrh, turpentine resin, each p. v. *. -galbanum p. *. z. hyssop p. *. z. are to be rubbed together, and to -these a hemina of honey is added, and as much as can be taken upon the -finger must be swallowed. - -[Sidenote: _12. The colice of Cassius._] - -The colice of Cassius consists of the following ingredients: of -saffron, anise, castor, each p. iii. *. parsley p. iv. *. pepper both -long and round, each p. v. *. poppy-tears, round cyperus, myrrh, nard, -each p. vi. *. which are incorporated with honey. And this may be both -swallowed alone, and taken in warm water. - -[Sidenote: _13. For expelling a dead fœtus._] - -A draught of water mixed with sal ammoniac p. i. *. or dittany of Crete -p. i. *. expels a dead fœtus or the secundines. - -[Sidenote: _14. To forward labour._] - -To women in labour hedge mustard ought to be given in tepid wine, when -they are fasting. - -[Sidenote: _15. For the voice._] - -The voice is assisted by p. i. *. of frankincense given in two cyathi -of wine. - -[Sidenote: _16. For a dysury._] - -Against a difficulty of urine: of long pepper, castor, myrrh, galbanum, -poppy tears, saffron, costus, each one ounce, storax, turpentine resin, -of each a sextans, wormwood, honey, a cyathus. Of these the bigness of -an Egyptian bean ought to be given in the morning, and after supper. - -[Sidenote: _17. The composition of arteriace._] - -Arteriace is made in this manner: of cassia, iris, cinnamon, nard, -myrrh, frankincense, each p. i. *. saffron, p. i. *. pepper thirty -grains, are boiled in three sextarii of passum, till they acquire the -consistence of honey. Or saffron, myrrh, frankincense, of each p. i. -*. are mixed with the same quantity of passum, and boiled in the same -manner. Or three heminæ of the same passum are boiled, till a drop of -it grows hard; and p. i. *. of powdered cassia is added to it. - - - - -CHAP. XXVI. - -OF FIVE DIFFERENT KINDS OF DISORDERS INCIDENT TO THE BODY; AND OF THE -NATURE, SYMPTOMS, AND CURE OF WOUNDS. - - -Having explained the virtues of medicines, I shall next consider five -different kinds of disorders, to which the body is incident. When it is -hurt externally, as in wounds. When any part is corrupted internally, -as in a gangrene. When any thing grows within some part, as the stone -in the bladder. When any part is preternaturally enlarged, as a vein, -which swelling is called a varix. Lastly, when somewhat is deficient, -or maimed. In some of these medicines, in others manual operations -are most useful. Deferring the consideration of the disorders, which -chiefly require manual operations, I shall now treat of such, as stand -mostly in need of medicines. And I shall divide this part of medicine -in the same manner as the former, and first speak of those, which may -happen in any part of the body; next of these, which attack certain -parts. I shall begin with wounds. - -[Sidenote: _Rules for the conduct of the physician._] - -Now a physician should above all things know, what are incurable, what -difficult to cure, and what more easy. For it is the part of a prudent -man first, not to undertake one, whose case is desperate, lest he -appear to have killed him, whom his own destiny has destroyed. Next, -in a case of great danger, but not quite desperate, to discover to the -friends of the patient, that it is a matter of difficulty: that if the -malady should prevail against the art, he may neither seem to have -been ignorant himself, nor to have deceived them. But as this is the -proper conduct for a prudent person, so on the contrary it is the part -of a quack to exaggerate a small matter, that he may appear to have -performed the greater cure. Where a case is easy, it is reasonable that -the physician by a free declaration of its easiness be obliged to the -greater diligence and circumspection; that what is in itself small may -not by his negligence become more considerable. - -[Sidenote: _Incurable wounds._] - -A person cannot be preserved, when the basis of the brain, or the -heart, or the gullet, or the portæ of the liver, or the spinal marrow -is wounded; or when the middle of the lungs, or the jejunum, or smaller -intestine, or stomach, or kidneys are wounded; or when the large veins -or arteries about the throat are cut through. - -[Sidenote: _Wounds difficult to cure._] - -The cure is difficult in such as are wounded either in any part of the -lungs, or the thick part of the liver, or the membrane that contains -the brain, or in the spleen, or womb, or bladder, or any intestine, or -the diaphragm. Such also are in a very dangerous situation, in whom the -point of a weapon has penetrated as far as the large blood vessels, -that lie deep in the arm-pits and hams. And all wounds are dangerous, -wherever there are large blood-vessels, because they may exhaust a -person by the profusion of blood. And this happens not only in the -arm-pits and hams, but likewise in the veins, which go to the anus and -testicles. Besides these, any wound in the arm-pits, or the inside -of the thighs, or in any cavity, or between the fingers(15)is bad. -Also by which a muscle, or nerve, or artery, or membrane, or bone, or -cartilage, is hurt. - -[Sidenote: _Safe wounds._] - -A wound in the flesh is safest of all, and these again from their -situation are either worse or better. But a wound when large is -dangerous from its size. - -[Sidenote: _The nature and figure of wounds._] - -The nature of the wound also and its figure make some difference; for -when a part is both cut and bruised, it is worse than when it is only -cut asunder; so that it is better to be wounded by a sharp weapon, than -a blunt one. And that wound is worse, out of which any substance is -cut, or where the flesh is carried off on one part, and hangs on the -other. In general, those wounds are the worst, that are crooked: and -those safest that are of a straight direction. And then, the nearer the -wound approaches to the first or second of these forms, it is more or -less dangerous. - -[Sidenote: _Consideration of the age, constitution, and season._] - -Moreover the age, constitution, the way of life _of the patient_, -and the season of the year, are of some importance: for a boy or a -youth recovers more easily than one that is older; the strong than -the infirm; one, that is neither too slender nor too plethoric, than -one, that is on either of these extremes; one of a sound than one of -a corrupt habit; one, that takes exercise, than an indolent person; -the sober and temperate than one given to wine and venery. Again, the -most convenient season of the year for curing a wound is the spring; or -at least when it is neither hot nor cold: for both excessive heat and -intense cold are prejudicial to wounds; but most of all an alternate -change of these: and for that reason the autumn is very hurtful. - -[Sidenote: _Of wounds of the internal parts._] - -Most wounds are exposed to our view: but there are some, of which we -judge from the situation of the parts, which we explained elsewhere, -when we demonstrated the position of the internal parts. Nevertheless, -because some of these lie superficial, and it makes a difference, -whether a wound be in the surface, or has penetrated deeper; it is -necessary to mention the appearances, by which we may know what is -hurt within; and from which we are either to hope or despair. - -[Sidenote: _Symptoms of the heart being wounded._] - -When the heart is wounded, there is a great effusion of blood, the -pulse is languid, the skin very pale, cold sweats with a bad smell -come on, the same as in sickness: the extremities grow cold, and death -quickly follows. - -[Sidenote: _Of the lungs._] - -When the lungs are wounded, there is a difficulty of breathing; frothy -blood is discharged from the mouth, and red blood from the wound; also -along with the latter the air issues with a noise; the patient has an -inclination to lie upon the wound; some start up without any reason. -Many when they are lying upon the wound, are able to speak: if upon -another part, they lose that faculty. - -[Sidenote: _Of the liver._] - -The symptoms of a wounded liver are these: there is a great effusion of -blood under the right side of the præcordia; the præcordia are drawn -backward towards the spine; there is a pleasure in lying upon the -belly; there are prickings and pains reaching as far as the clavicle -and the broad bone of the shoulder, that is joined to it; to these -there is sometimes added also a bilious vomiting. - -[Sidenote: _Of the kidneys._] - -When the kidneys are wounded, the pain reaches to the groin and -testicles; the urine is made with difficulty; and it is either bloody, -or grumous blood is voided. - -[Sidenote: _Of the spleen._] - -But when the spleen is wounded, black blood issues out from the left -side; the præcordia and stomach on the same side grow hard; a great -thirst ensues; and a pain strikes up to the clavicle, as when the liver -is wounded. - -[Sidenote: _Of the womb._] - -But when the womb is wounded, there is a pain in the groin, and hips, -and inside of the thighs; the blood is partly discharged by the wound, -partly by the vagina; and a bilious vomiting follows. Some women lose -their speech; some are delirious; others sensible, but complain, that -they are tormented with a pain of their nerves and eyes: and when -dying, have the same symptoms, as attend a wounded heart. - -[Sidenote: _Of the brain or its membrane._] - -If the brain or its membrane has received a wound, blood is discharged -by the nose, in some also by the ears and generally a bilious vomiting -follows. The senses of some are impaired, and they do not perceive when -they are called upon: the countenance of others is fierce; and their -eyes roll different ways, as in a palsy; and commonly on the third or -fifth day a delirium comes on. Many are likewise convulsed. Before -death most of them tear the bandages, with which their head is bound -up, and expose the naked wound to the cold. - -[Sidenote: _Of the gullet._] - -When the gullet is wounded, a hiccough and bilious vomiting follow; if -any meat or drink has been taken, it is quickly returned; the pulse -grows languid; thin sweats come on, in which the extremities grow cold. - -[Sidenote: _Of the stomach and jejunum, and other intestines._] - -The signs of a wound in the jejunum and stomach are the same; for -the food and drink pass through the wound: the præcordia grow hard; -sometimes bile is vomited. Only it must be observed, that the jejunum -is situated lower than the stomach. When the other intestines are -wounded, they emit either excrement, or its smell. - -[Sidenote: _Of the spinal marrow._] - -When the spinal marrow is cut through, there follows either a palsy or -convulsions; the patient becomes insensible; and after some time, the -lower parts discharge involuntarily either seed, or urine, or excrement. - -[Sidenote: _Of the diaphragm._] - -But if the diaphragm is wounded, the præcordia are drawn upward; there -is a pain in the spine, an oppression of the breath, and a discharge of -frothy blood. - -[Sidenote: _Of the bladder._] - -When the bladder is wounded, the groin is pained, there is a tension of -the parts immediately above the pubes; instead of urine comes blood; -and the urine is discharged at the wound; the stomach is affected, so -that the patients either vomit bile, or have a hiccough; a coldness -seizes them, and after that death. - -[Sidenote: _Of the discharge from wounds and ulcers._] - -[Sidenote: _Blood, sanies, and pus._] - -[Sidenote: _Ichor._] - -[Sidenote: _Melicera._] - -[Sidenote: _Elæodes._] - -These things being known, there still remain some other particulars to -be observed relating to the wounds and ulcers, which we are to treat -of. From wounds then and ulcers are discharged blood, sanies, and pus. -Blood is known to every one. Sanies is thinner than blood, unequally -thick, glutinous, and coloured. Pus is very thick and white, also more -glutinous than either blood or sanies. Now blood is discharged from a -recent wound, or one that is just healing: sanies appears betwixt these -times: pus in an ulcer beginning to heal. Further, both sanies and pus -are distinguished into several species by Greek names; for there is -one kind of sanies, which is called ichor[EO], another melicera[EP]. -There is also a species of pus called elæodes[EQ]. Ichor is thin, of -a whitish colour, and proceeds from a bad ulcer, and especially where -a nerve has been hurt, and an inflammation has followed. Melicera is -thicker, more glutinous, whitish, and somewhat resembling white honey: -this also is discharged from malignant ulcers, where the nerves about -the joints are hurt; and amongst the joints principally from the knees. -Elæodes is thin, whitish, somewhat unctuous, in colour and fatness not -unlike to white oil; and appears in large ulcers, that are healing. Now -blood is bad that is either too thin or too thick, in colour either -livid or black; or mixed with phlegm, or of various colours: the best -is warm, red, moderately thick, and not glutinous. Therefore from the -first the cure of a wound, which has yielded good blood, is more easy -and quick: and afterwards there is more hope of those, from which the -several discharges have been of the best kind. Sanies then is bad, -where it is in great quantity, over thin, livid, or pale, or black, -or glutinous, or fetid, or such as corrodes the ulcer itself and the -adjacent skin. It is better, when the quantity is small, indifferently -thick, of a reddish colour, or inclining to white. Ichor again is the -worst, that is plentiful, thick, inclining to a livid or pale colour, -glutinous, black, hot, fetid. It is more tolerable, if inclining to -white, and when in all other respects it is the reverse of the former. -But melicera is bad, when it is in great quantity, and very thick; -better, when thinner, and less in quantity. Pus is the best amongst -these. But even that too is bad, when it is copious, thin, diluted; -and the more so, if it be such from the beginning; also if in colour -it resemble serum, if it be pale, or livid, or feculent; moreover if -it be fetid; unless the smell arises from the nature of the particular -part, where the ulcer is. The less there is of it, and the thicker, -and whiter, so much the better; and also if it be smooth, if it have -no smell, if it be homogeneous. In quantity, however, it ought to -correspond both with the size and age of the wound: for a greater -quantity is discharged naturally from a larger one; and more before the -inflammation is removed, than afterwards. Elæodes also when plentiful, -and containing but little fat, is bad: but the less there is of it, and -the more oily so much the better. - - [EO] ἰχὼρ. - - [EP] μελίκηρα. - - [EQ] ἐλαιω̃δες. - -[Sidenote: _Cure of a hæmorrhage from a wound._] - -These things being considered, when any person is wounded, that can -be cured, two things are immediately to be regarded: that he do not -perish either by a hæmorrhage, or an inflammation. If we are afraid of -a hæmorrhage (which may be known from the situation of the wound and -its largeness, and from the force of the stream of blood) the wound -is to be filled with dry lint, and over it a sponge squeezed out of -cold water must be applied, and pressed down with the hand. If this -does not stop the blood, the lint is to be frequently changed: and if -it have not strength enough dry, it must be moistened with vinegar. -This is very powerful in stopping blood: and therefore some people -pour it into the wound. But here again it is to be feared, that the -matter being too forcibly retained there, may afterwards raise a great -inflammation. Which is the reason why neither corroding medicines, -nor such as are caustic, and therefore forming a slough, are to be -used, although most of these stop blood: but if recourse is ever had -to them, such ought rather to be employed, as are the mildest in their -operation. But if even these do not prevail against the hæmorrhage, -the vessels, which discharge the blood are to be taken hold of, and -tied in two places about the wounded part, and cut through, that they -may both unite together, and nevertheless have their orifices closed. -When the circumstances do not even allow of this measure, they may -be cauterized with a hot iron. And in this case too, when there is a -considerable hæmorrhage from a part, where there is neither nerve, nor -muscle, in the forehead for instance, or upper part of the head, it is -very proper to apply a cupping vessel to the opposite part, that the -current of blood may be diverted thither. - -[Sidenote: _Cure of the inflammation in wounds._] - -These then are the remedies against a haemorrhage: but for an -inflammation the flux of blood itself is the cure. This may be -apprehended, when either a bone has been hurt, or a nerve, or a -cartilage, or a muscle, or when the haemorrhage has been too small in -proportion to the size of the wound. Therefore when any thing of this -kind happens, it will not be proper to stop the blood quickly, but to -suffer it to flow as long as it is safe; insomuch that if the discharge -has appeared small, it ought also to be taken from the arm; especially -if the patient be young and robust, and used to exercise; much more, -if he was intoxicated before he received the wound. And if a muscle -shall appear to be wounded, it must be cut through: for when it is only -divided in part, it is mortal; cut quite through it admits of a cure. - -[Sidenote: _The agglutination of wounds._] - -The blood then being either stopped, when the haemorrhage is excessive, -or _more_ taken away _by phlebotomy_ when too small, it is far the best -method to agglutinate the wound. Now this may be done, either when it -is in the skin, or even in the flesh, if nothing else is hurt. It may -be done, where the flesh is hanging down in one part, and adhering -in another; provided however it be still sound, and nourished by its -continuity with the body. - -In wounds to be agglutinated there is a double method of cure. For if -the wound be in a soft place, it ought to be sewed: and especially, if -the extremity of the ear, or the lower part of the nose be cut, or the -forehead, or the cheek, or the eye-brow, or the lip, or the skin about -the throat, or the belly. But if the wound is in the flesh, and gapes, -and its lips cannot be easily brought together, a suture is improper: -and in this case fibulæ(64) are to be put on (the Greeks call them -ancteres[ER]) to draw the lips a little closer; that the cicatrix may -be the less broad after the cure. - - [ER] ἀγκτη̃ρες. - -Hence now it may be collected, whether a wound, in which the flesh -is in one part depending, and in another adhering, if it is not yet -corrupted, requires a suture, or a fibula. But neither of them ought -to be applied before the wound be cleansed within, lest any concreted -blood be left there. For that turns to pus, raises an inflammation, and -prevents the wound from being agglutinated. Even the lint, that is put -into it to stop the bleeding, must not be left there; for that also -inflames. - -It will be necessary to take up with the needle, or the fibula, not -only the skin, but also some of the flesh below it, that it may adhere -the more strongly, and not break away the skin. Both of them are best -done with soft thread(65), not too much twisted, that it may be the -less uneasy to the part. Neither of them are to be applied at too great -distances, nor too frequently: if at too great distances they will not -hold; if too frequently they are very hurtful; because the oftener -the needle has passed, and the more places are gauled by the fibula, -so much the greater will the inflammation be; and especially in the -summer-time. Neither of them requires any force; but the operation is -only so far useful, as the skin follows the hand as it were of its -own accord. Now the fibula commonly allows a wound to be broader: a -suture joins its lips, but these should not touch one another in every -part; that if any humour be collected within, there may be a passage -for it to escape. But if a wound admits of neither of these, it ought -nevertheless to be cleansed. - -In the next place, upon every wound should be applied first a sponge -squeezed out of vinegar: if any patient is not able to bear the -strength of vinegar, wine must be made use of: a slight wound is helped -by laying on a sponge squeezed even out of cold water. But in whatever -way it is put on, it does good no longer than it is moist: therefore -it must not be suffered to dry. A wound may be cured without foreign, -scarce, and compound medicines. But if one has not confidence in that -method, he ought to apply a medicine, that is composed, without suet, -of those things, which I mentioned to be proper for bloody wounds; and -particularly if it be in the flesh, the barbarum: if it be a nerve, -or cartilage, or any of the prominent parts, as the ears, or lips, the -sphragis of Polybus. The green Alexandrian also is fit for the nerves; -and for the prominent parts that, which the Greeks call rhuptousa[ES]. - - [ES] ῥύπτουσα.--Our author has not mentioned this plaister before, at - least not under the same name. - -It is common also, where there is a contusion, for the skin to be -a little broken. When this happens, it is not improper to make a -larger opening with a knife; unless there be muscles and nerves near -to it, which it is not fit to cut. When it is sufficiently opened, a -medicine must be applied. But if the bruised part cannot admit the -opening, though too small, to be enlarged, upon account of nerves or -muscles, such applications are to be used, as may draw out the humour -gently; and of that kind the fittest for the present purpose is the -composition, which I said was called rhypodes. It is not improper -also, wherever there is a severe wound, after applying(66) what is -agreeable to it; to cover the whole with sordid wool moistened with -vinegar and oil; or if the part be soft, a mild restringent cataplasm; -if nervous, or muscular, an emollient. - -[Sidenote: _The proper bandages for wounds._] - -For binding up a wound a linen roller is most convenient: and this -ought to be bandages for so broad, that a single application of it may -not only cover the wound, but take in a little on each side of it. If -the flesh has shrunk away more on one side, it is better to begin the -rolling from thence; if equally on both sides, it ought to lay hold of -the lips transversely; or if the nature of the wound does not admit of -that, the middle of it is first put on, that it may be drawn afterwards -both ways. Now it is to be bound on in such a manner, that it may both -hold, and not be over tight. When it does not hold, it slides off; and -that, which is over tight, hazards a gangrene. In the winter-time the -roller ought to be carried round oftener; in the summer, no more than -necessity requires. Then the extremity of it is to be sewed to the -lower part of the bandage. For a knot hurts a wound, unless it be at a -distance from it. - -Moreover every person ought to know, that the viscera, which I -mentioned before, require a particular method of cure. For the external -wound is to be cured either by a suture, or some other method. In the -bowels nothing is to be touched, unless some bit in the extremity of -the liver, or spleen, or lungs be hanging out, which may be cut away. -Otherwise the internal wound is to be cured by the diet and medicines, -which I mentioned in the former book as agreeable to each viscus. - -[Sidenote: _Directions for the patient’s diet._] - -These steps being taken on the first day, the patient must be put to -bed: and if the wound be severe, he ought to abstain from food, as -much as his strength will permit, before the inflammation comes on; -to satisfy his thirst with warm water, or if it be in summer, and he -have neither fever nor pain, the water may be cold. However no rule -is so constant, but that a regard must always be had to the strength -of the patient; so that his weakness may render it necessary to take -food immediately, but such as is thin, and in small quantity, just -sufficient to support him. And many sinking under a hæmorrhage, before -any thing else be done, are even to be refreshed with wine; which is -otherwise very prejudicial to a wound. - -[Sidenote: _Good and bad symptoms in wounds._] - -It is dangerous for a wound to swell too much: not to swell at all is -extremely dangerous. The first is a sign of a violent inflammation; -the other of a mortification. If the patient be sensible, and no fever -has come on, we may at once conclude, that the wound will be soon -healed: and even a fever ought not to alarm us, if in a large wound it -continue, while the inflammation subsists; it is bad, when it either -supervenes to a slight wound, or lasts longer than the inflammation, -or brings on a delirium; or if it does not remove a tetanus, or -convulsion, that arose from the wound. Also an involuntary bilious -vomiting coming on either immediately after the wound is received, -or while the inflammation continues, is a bad symptom in those only, -whose nerves, or nervous parts are wounded. However to take a vomit is -not hurtful; especially in those, who have been accustomed to it; but -neither immediately after meat, nor when the inflammation has begun, -nor when the wound is in the superior parts. - -[Sidenote: _Dressings for wounds._] - -The wound being kept thus for two days, on third it must be opened, -and the sanies must be wiped off with cold water, and the same kind -of dressings put on. On the fifth day it will be easy to judge to -what height the inflammation is to rise. On which day the wound must -be uncovered again, and its colour observed. And if it be livid, or -pale, or variegated, or black, we may be sure it is a bad wound: and -whensoever this appearance is observed, it may alarm us. It is best for -a wound to be white, or ruddy. Also a hard, thick, and painful skin -denotes danger. It is a good sign, when this is free from pain, thin -and soft. But if the wound is closed, or there be a slight swelling, -the same application must be used as at first. - -If the inflammation is violent, with no hopes of an agglutination, -and does not yield, the use of warm water too is necessary, that it -may dissipate the matter, and soften the hardness, and promote a -suppuration. It must be of such a degree of warmth, as to be agreeable -to the hand; and be continued so long, till it appear to have -diminished in some measure the swelling, and restored a more natural -heat to the ulcer. After this fomentation, if the wound does not gape -much, a plaister should be applied immediately, and if it be a large -wound, the tetrapharmacum would be best; in the joints, fingers, or -cartilaginous parts, the rhypodes. But if it gapes pretty much, that -same plaister must be softened with ointment of iris, and lint spread -with it must be laid over the wound; then the plaister applied above, -and over that sordid wool; and the rollers must be also less tight than -at first. - -[Sidenote: _Peculiar directions for wounds in the joints._] - -But there are some peculiarities to be attended to in the joints. If -the nerves, which secure them, are cut through, a weakness of that part -follows. If that is uncertain, and the wound is from a sharp weapon, -and that in a transverse direction, it is more easy to cure: and if it -be from a blunt and heavy one, the figure of it makes no difference: -but it must be observed whether the pus comes from above or below the -joint. If it come from under it, and continue a long time white and -thick, it is probable that a nerve is cut through, and the more so, the -greater the pains and inflammations are, and the sooner they began. But -although the nerve be not cut through, yet if a hard tumour continue -round it long, the ulcer of necessity must be tedious, and even when -that is healed, the tumour will remain; and it will be a considerable -time before that limb recover its power either of extension or -contraction. And it is longer before it can be extended, when the cure -has been conducted with the joint bent, than it is before one can be -bent, which we have kept straight. The limb, that is wounded, ought to -be placed also in a certain position: if it is to be agglutinated, it -must be laid high; if it is inflamed, so as to incline to neither side; -if the pus has begun to flow, it must be kept in a depending posture. - -Rest too is an excellent remedy. Motion and walking are prejudicial, -except to people in health: however, less dangerous to such as are -wounded in the head or arms, than those, that are wounded in the lower -parts. And walking is least of all proper, when the hurt is in the -thigh, or the leg, or the foot. The place, where the patient lies, -ought to be warm. Bathing also, while the wound is not clean, is -extremely bad: for that renders it both tumid and foul; from whence the -transition to a gangrene is common. Gentle friction is good; but in -those parts, that are at a great distance from the wound. - -[Sidenote: _Deterging of wounds._] - -After the inflammation is gone, the wound must be deterged. That end -is best obtained by lint dipt in honey; and over that must be applied -either the tetrapharmacum plaister, or the enneapharmacum. Now that -ulcer is clean, which appears red, and is neither too dry nor too -moist. But any ulcer that is deprived of its sensibility, or whose -feeling is unnaturally exquisite, or that is either too dry or too -moist, or that is either whitish or livid, or black, that ulcer is not -clean. - -[Sidenote: _Incarning of wounds._] - -After a wound is deterged, it must next be incarned; and for that -purpose warm water is so far necessary, as to remove the sanies. The -use of sordid wool is improper; it is better to cover it with such as -has been washed. And there are also some medicines, which conduce to -the filling up of the wound; therefore it is not amiss to make use -of them: such as butter with oil of roses, and a small proportion of -honey; or the plaister tetrapharmacum with the same proportion of -honey, or with the oil of roses; or lint dipped in oil of roses. But -the bath used sparingly is more efficacious; and food of a good juice, -avoiding every thing acrid. When they are almost filled up, birds and -venison and boiled pork may be given. Wine is always hurtful, while -there is a fever or inflammation; and indeed, till it be cicatrized, -if either nerves or muscles are wounded; or even the flesh, if it be -deep. But if the wound is of the safer kind, and only superficial, -wine not very old, given in moderate quantities however, may promote -the incarnation. If any thing is to be softened, which is necessary in -nervous and muscular parts, cerate must also be laid upon the wound. -But if fungous flesh has grown upon it, dry lint restrains it gently; -copper scales more powerfully. If the quantity to be taken away be more -considerable, things still stronger must be applied to eat down the -flesh. After these a cicatrix is very well formed by lycium diluted in -passum or milk; or dry lint laid on alone is still more efficacious. - -[Sidenote: _Bad consequences from unsuccessful cures._] - -This then is the process of a successful cure. But at times things will -happen to take a dangerous turn. For sometimes the ulcer grows ancient, -a callosity comes over it, and its lips are thick, and of a livid -colour: after which, whatever medicine is applied, does little good; -and this generally happens to an ulcer negligently treated. - -Sometimes from an excessive inflammation, or violent heats, or -excessive cold, or too tight bandages, or the old age or bad habit of -the patient, a gangrene seizes upon it. This kind of disorder by the -Greeks is divided into several species, for which we have no terms in -our language. Now every gangrene not only corrupts that, which it has -seized upon, but also spreads. But then the distinction is to be made -between the species by different symptoms. For sometimes beyond the -inflammation a redness surrounds the ulcer, and spreads with pain; the -Greeks call it erysipelas[ET].; sometimes the ulcer is black, because -the flesh of it is corrupted, and the blackness is greatly increased -as the putrefaction goes on, when the wound is moist, and from the -black ulcer is discharged a pale fetid liquor, and the flesh within is -corrupted(67): sometimes also the nerves and membranes are dissolved, -and a probe put in descends either laterally or downwards; sometimes -the bone is affected with that disorder: and sometimes there follows -what the Greeks call gangræna[EU]. - - [ET] ἐρυσίπελας. - - [EU] γάγγραινα. - -The former kinds happen in any part of the body: the last mentioned -about the extremities, that is, the nails, the armpits, or groin; and -generally in old people, or in such as are in a bad habit of body. The -flesh of such an ulcer is either black or livid, but dry and withered, -and the contiguous skin is for the most part covered with pustules of -a dark brown colour; then the next to that is either pale or livid, -and commonly of an æruginous colour, and void of sensation; the skin -a little farther off(68) is inflamed. And all these spread at once; -the ulcer into the pustulous part; the pustules to the part that is -pale or livid; the paleness or livor to that which is inflamed; and the -inflammation proceeds to that which is sound. In the mean time an acute -fever comes on, and a vehement thirst; some are also delirious; others, -though they be sensible, stammer, and with great difficulty can make -their meaning understood; the stomach begins to be affected; the breath -itself acquires a fetid smell. Now this disorder in the beginning -admits of a cure; but when it is thoroughly rooted, it is incurable; -and most of them die with a cold sweat. - -[Sidenote: _The cure of an old ulcer._] - -These are the dangers, to which wounds are liable. But when the ulcer -is old, it must be cut round with a knife, and its lips cut off, and -whatever beyond them is livid, must likewise be scarified. If there be -a small varix within, which prevents its healing, that also must be cut -out. Afterwards when blood has been discharged, and a new face thus -given to the wound, the same method of cure must be pursued, which has -been directed for recent wounds. If any person does not chuse to make -use of a knife, the plaister, which is composed of labdanum, may incarn -it, and when the ulcer has been eaten down by that, a plaister, which -brings on a cicatrix. - -[Sidenote: _Of an erysipelas._] - -Now that, which I said has the name of an erysipelas, is not only -consequent upon a wound, but often happens without it, and is sometimes -very dangerous; especially if its seat be about the neck or head. - -It is proper, if the strength will admit, to bleed; then to apply at -once repellents and coolers, and particularly cerus with the juice of -nightshade, or cimolian chalk with rain water; or meal made into a -paste with the same water, with the addition of cypress, or if it be in -a tender part, with lentils. Whatever is applied, must be covered with -a beet leaf, and upon that must be laid a linen cloth dipped in cold -water. If coolers alone do little service, the following mixture must -be made; of sulphur p. i. *. ceruss, saffron, each p. x. *. and these -to be rubbed down with wine, and spread over the part: or if the place -is not tender, leaves of nightshade powdered must be mixed with hog’s -lard, and applied spread upon linen. - -But if there be a blackness, which does not yet spread, such -applications must be used, as will gently eat away the putrid flesh; -and the ulcer being thus cleansed, must be dressed in the same manner -as others. If it be more putrid, and already begins to advance and -spread, there is a necessity for stronger corrosives. If even these -do not overcome it, the part must be cauterized, till no moisture -flow from it; for whatever is sound, is dry when it is burnt. After -the burning of a putrid ulcer, such applications must be used, as -may separate the sloughs from the quick part; the Greeks call them -apescharotica[EV]. When they have fallen off, the ulcer must be -cleansed, particularly with honey and resin; but it may be cleansed -also by those things with which purulent ulcers are dressed, and healed -up by the like methods. - - [EV] ἀπεσχαρωτικὰ. - -[Sidenote: _Of a gangrene._] - -It is not very difficult to cure a gangrene, if it has not got full -possession, but is only beginning, especially in a young person: and -easier still, if the muscles are sound; or if the nerves are either -untouched, or but slightly affected; and no large joint laid bare; or -there be but little flesh in that part, and consequently not much to -putrify, and if the disorder is confined to one place, which chiefly -happens in a finger. In such a case the first thing to be done, if the -strength will allow, is to let blood: after that, to cut through to the -sound flesh, whatever is dry, which by a kind of tension is uneasy to -the contiguous parts. - -While the disorder is spreading, no suppurating medicines are to be -applied; and for that reason not so much as warm water. Ponderous -medicines also, although they be repellent, are hurtful; but the -lightest of that nature are required; and over the parts, which are -inflamed, coolers must be applied. If the disease is not stopped by -these, so much as is betwixt the sound and corrupted parts, ought to be -cauterized. - -And in this case particularly help must be sought not from medicines -alone, but from a due regimen: for this disease never appears but in -a corrupt and vitiated habit. Wherefore in the first place, unless -weakness forbid, the patient must live abstemiously: and then for food -and drink must be given what will bind the belly, and consequently -the body also; but these must be of a light nature. Afterwards if -the disorder stop, the same applications must be used as have been -prescribed in a putrid ulcer. And then also a fuller diet may be -allowed of the middle class: only such however as tends to dry the -belly and the whole body; and the drink must be cold rain water. -The bath, unless we are confident of a cure, is hurtful; for the -ulcer softened by that means is quickly affected again with the same -disorder. But sometimes it happens, that all these remedies do no -service, and notwithstanding all their force, the gangrene spreads. In -which case the miserable but sole remedy is to cut off that limb, which -is perishing by degrees, to save the rest of the body. - -[Sidenote: _The cure of more slight wounds._] - -This then is the method of treating the most severe wounds. But even -such are not to be neglected, where the skin is entire, but the flesh -within(69) is bruised; or where any thing is razed or rubbed off the -surface; or when a splinter is fixed into the flesh; or when a wound, -though small, has penetrated deep. - -In the first case it is a very proper remedy to boil pomegranate bark -in wine, and bruising the inner part of it, to mix it with a cerate of -the oil of roses, which is to be laid upon the part; then where the -skin is razed, to cover it with a mild medicine, such as the lipara[EW]. - - [EW] λιπαρὰ. - -Upon the part, that has its surface razed and rubbed off, the -tetrapharmacum plaister must be applied, and the quantity of food -diminished, and wine denied. Nor should such a hurt be looked upon as -contemptible, because the wound is not deep: for from such accidents -gangrenes often arise. But if it be slight and of small extent, the -mild medicine abovementioned may be sufficient for the cure. - -A splinter, if possible, must be extracted either by the hand or -by an instrument: if it has either broke or penetrated deeper than -to admit of this, it must be drawn out by a medicine. Now the best -application for that purpose is the root of a reed; which if tender, -must be immediately bruised; if grown hard, it may be first boiled in -mulse: to this honey must always be added; or birthwort with honey must -be applied. The worst splinter is that of a reed, on account of its -asperity: the fern is also equally hurtful: but it has been found by -experience, that each of these bruised and applied is a cure for the -other. Every medicine, that has the faculty of drawing, has the same -effect in all splinters. The same kind of medicine is also finest for -deep and small wounds: the plaister of Philocrates is best adapted to -the former, that of Hecatæus to the latter case. - -[Sidenote: _Of cicatrizing ulcers._] - -In any wound, when we are to form the cicatrix (which is necessary -after the ulcers are thoroughly cleansed and incarned) in the first -place lint dipped in cold water must be applied, while the growth of -flesh is encouraged; afterwards when that is to be restrained, it -must be put on dry, till a cicatrix be formed; then white lead ought -to be bound over it, which both compresses the cicatrix, and gives -it a colour resembling the sound part of the body. The root of wild -cucumber has the same effect. Also the composition, which contains of -elaterium p. i. *. litharge p. ii. *. myrobalans p. iv. *. to which is -added turpentine resin, till the whole be brought to the consistence -of a plaister. But black cicatrices are gently cleansed by a mixture -of equal parts of verdigrease, and washed lead, and the same resin -boiled, whether the cicatrix be anointed with this, which may be -practised in the face, or it be applied like a plaister, which is more -convenient in other parts of the body. - -But if the cicatrix is either protuberant or hollow, it is ridiculous, -merely in regard to the appearance to submit a second time to the pain -and trouble of a cure; otherwise both cases might be remedied. For -either of these cicatrices may be converted into a wound by the knife. -If one rather chuses a medicine, the same purpose is answered by those -compositions, which eat down flesh. When the skin is taken off, upon -the prominent one must be applied eating medicines, upon the hollow one -such as tend to fill up, till both these kinds of ulcers be brought to -the level of the sound skin, and then they may be cicatrized. - - - - -CHAP. XXVII. - -OF WOUNDS CAUSED BY BITES; POISONS TAKEN INTERNALLY; AND BURNS. - - -I have treated of those wounds, which are most commonly inflicted -by weapons. It follows, that I speak concerning those, which are -occasioned by the bite, sometimes of a man, sometimes of an ape, often -of a dog, sometimes of wild beasts, or other animals, or serpents. Now -almost all bites(70) are in some degree venomous. - -Therefore if the wound be severe, a cupping vessel must be applied; -if slight, a plaister must be immediately put on, particularly that -of Diogenes; if that is not to be had, any of those, which I have -prescribed against bites; if these are not to be got, the green -Alexandrian; if that is not at hand neither, any of those, which are -not greasy, that are calculated for recent wounds. Salt is also a -remedy for them, and particularly for the bite of a dog, if it be -applied dry, and the part be chaffed with two fingers; for it brings -out the sanies. It is also of use to bind salt fish over such a wound. - -[Sidenote: _The bite of a mad dog._] - -If the dog was mad, it is more especially necessary to extract the -poison by cupping. After that, if the part is neither nervous nor -muscular, the wound must be cauterized. If it cannot be cauterized, -it is proper for the patient to be bled. Then upon the wound, after -burning, must be applied what is proper for other cauterized ulcers. -Such as have not been cauterized must be treated with those medicines, -that powerfully corrode the flesh. After which the wound must be filled -up, and healed by no other than the common method already laid down. -Some presently after the bite of a mad dog order such a patient into -the bath, and allow him to sweat there as long as he is able, with the -wound bare, that the poison may the more readily be discharged; then -they refresh him with plenty of strong wine, which is an antidote to -all poisons. And when this method has been pursued for three days, the -patient is thought out of danger. - -But it is usual for such a wound, if not effectually treated, to -produce a fear of water. The Greeks call it hydrophobia[EX]: a most -miserable kind of disease, in which the patient is tormented at once -with thirst, and a dread of water. When this happens, there is very -little hope left. But yet there is one remedy: to throw the patient -unawares suddenly into a pond, and if he cannot swim, to suffer him to -sink sometimes, and thus drink, and sometimes to lift up his head; if -he can swim, to keep him down at times, that even against his will he -may be satiated with water: for thus at once both the thirst and dread -of water is removed. But this practice is attended with another danger, -which is, that a weak body fatigued in cold water, may be destroyed by -a convulsion. To prevent which, from the pond he must immediately be -put into warm oil. An antidote (particularly that which I mentioned -first, or in its stead another) if the patient is not possessed with -the horror of water, may be given to drink in water; if he be offended -with its bitterness, honey must be added; but if that disease has -already come on, it may be taken in the form of catapotia. - - [EX] ὑδροφοβία. - -[Sidenote: _Of the bites of serpents in general._] - -The bites of serpents do not require a very different treatment: -although in this the ancients varied greatly; in so much that they -prescribed as many distinct methods as there were kinds of snakes; in -which too they differed widely from each other. But generally the same -remedies have the best success in all of them. Wherefore in the first -place the limb must be tied above the wound; but not too tight, lest -it become torpid. Then the poison must be extracted. This is best done -by cupping. Neither is it improper to cut round the wound first with a -knife, that the more of the blood already vitiated may be extracted. -If a cupping vessel cannot be had (which can scarcely happen) then any -other similar vessel will do, which will serve the same purpose. If -none such can be got, a person must be employed to suck the wound. - -Nor indeed have those, that are called Psylli(71), any peculiar -skill, but a boldness confirmed purely by custom. For the poison of -a serpent, as also some of those, which hunters make use of, and -especially in Gaul(72), are not hurtful, taken in by the mouth, but -injected by a wound: and for that reason even a snake itself is safely -eaten: its bite is mortal, and when it is in a state of stupidity -(which dealers in legerdemain can produce by the force of some drugs) -if one puts his finger into its mouth, and is not bit, he receives -no hurt from the saliva. Therefore any person that, like a Psyllus, -shall suck the wound, will both be safe himself, and save the patient. -In the mean time he ought to attend to this first, that he have no -ulcer either in his gums, or palate, or any other part of his mouth. -Afterwards the patient must be laid in a warm place, in such a posture, -that the part, which is wounded, may be in a depending posture. - -If no body can be got to suck the wound, nor a cupping vessel is at -hand, the patient ought to sup goose or veal broth, till he vomit. A -chicken must also be cut through the middle alive, and immediately -applied warm over the wound, with the internal part next the body. -The same effect is produced by a kid, or a lamb cut up, and the warm -flesh immediately laid upon the wound, and by the plaisters, that have -been mentioned before: the most proper of which is the Ephesian, or -that, which follows it. To take some antidote too immediately, is a -powerful protection against the danger. But if that cannot be had, -it is necessary to sup a little pure wine with pepper, or any thing -else, which serves to excite heat, and does not suffer the humour to -coagulate within. For the greatest part of poisons kills by cold. All -diuretics too, because they attenuate the humour, are useful. - -[Sidenote: _Of the bite of an aspis._] - -The former remedies are general, and good against bites: but experience -itself has taught us, that a person, who has been bit by an aspis, -ought rather to drink vinegar. Which is said to have been discovered -by the case of a certain boy, who, when he had been wounded by one, -and partly from the wound itself, and partly from the excessive heat -of the weather, was tormented with thirst, and the country being dry, -could find no other liquor, drank off vinegar, which he chanced to have -by him, and was cured. The reason of the effect in my opinion is, that -vinegar, though it refrigerate, yet has a faculty of dissipating at the -same time. Whence it happens, that earth sprinkled with it rises in a -froth. From the same virtue therefore it is very probable, that the -fluids of the human body beginning to be coagulated are dissipated by -it, and health thereby restored. - -[Sidenote: _Of the scorpion._] - -Against the poison of some other serpents also peculiar remedies are -well known. For the scorpion is a most excellent remedy against itself. -Some drink it bruised with wine. Some apply it in the same form to the -wound. Others laying it upon live coals fumigate the wound with it, -keeping a cloth all round it, that the smoke may not escape; and then -bind it on when burnt to a coal. Now it is proper to drink in wine -the seed, or at least the leaves of turnsole (which the Greeks call -heliotropium[EY].) And over the wound it is fit to apply bran with -vinegar, or wild rue, or salt toasted with honey. But I have known -physicians, who have done nothing else to people stung by a scorpion, -but bled them in the arm. - - [EY] ἡλιοτρόπιον. - -For the sting of a scorpion also, and a spider, garlick mixed with rue, -and rubbed down with oil, is a proper application. - -[Sidenote: _Of the cerastes, dipsas, and hæmorrhois._] - -For a wound given by a cerastes(73), or dipsas(74), or hæmorrhois(75), -the remedy is dried asphodel, about the bigness of an Egyptian bean, -with the addition of a little rue given in drink, and divided into -two doses. Trefoil also and horse-mint, and panaces with vinegar are -equally good. Also costus, and cassia, and cinnamon are proper to take -in drink. - -[Sidenote: _Of a chersydrus._] - -Against the wound of a chersydrus(76), panaces or laser, or each -scruples p. ii. *. Or the juice of a leek is to be taken with a hemina -of wine, and savory eaten plentifully. And let goat’s dung boiled in -vinegar be laid upon the wound; or barley meal in the same manner with -vinegar; or rue, or cat-mint, powdered with salt and mixed with honey. -And this is equally efficacious against the bite of a cerastes. - -[Sidenote: _Of a phalangium._] - -When a phalangium(77) has given a wound, beside the chirurgical part -of the cure, the patient should be frequently plunged into the warm -bath, and an equal quantity of myrrh and stavesacre is to be given in a -hemina of passum; or radish-seed, or darnel-root with wine; let there -be also applied to the wound bran boiled with vinegar, and he must be -ordered to continue quiet. - -[Sidenote: _Of Italian snakes._] - -But the kinds of serpents mentioned hitherto are foreign, and much more -dangerous than ours; especially those, which are in very hot countries. -Italy and the colder climates, besides that they are more healthful in -other respects, have the advantage in this, that they produce snakes -less formidable. Their bites are well enough cured by the herb betony, -or bindweed, or centory, or agrimony, or germander, or burdock, or -pastinaca fish(78), either singly, or any two of them taken together -powdered, and thus given to drink in wine, and also applied upon the -wound. It is necessary to observe, that the bite of every serpent is -more hurtful, when either the animal or the wounded person is fasting, -and therefore they are most pernicious when they are hatching; and it -is adviseable, when any one is apprehensive of meeting serpents, not to -go out, before he has taken some food. - -[Sidenote: _Of poisons._] - -It is not so easy to relieve those, who have swallowed poison, either -in their food or drink. In the first place, because they do not -perceive it immediately, as those do, who are bit by a snake; and -therefore cannot instantly apply the remedy. In the next place, because -the hurt does not begin in the skin, but in the internal parts. However -it is best, as soon as one discovers it, immediately to drink largely -of oil, and to vomit. And then, when he has emptied his praecordia, to -take an antidote in his drink; if that is not to be got, pure wine. - -[Sidenote: _Remedies against cantharides._] - -Nevertheless there are some peculiar remedies against certain -poisons, and chiefly of the milder kind. For if any person has drunk -cantharides, he ought to take panaces bruised with milk, or galbanum, -with the addition of wine, or milk by itself. - -[Sidenote: _Against hemlock._] - -If hemlock, let the patient drink as much hot pure wine with rue as he -can; then he must be forced to vomit; after that, laser with wine must -be given; and, if he be free of a fever, he must be put into the warm -bath; if not, be anointed with warm ingremedies. After these, rest is -necessary for him. - -[Sidenote: _Henbane._] - -If henbane, hot mulse must be drunk, or any kind of milk, but more -particularly asses milk. - -[Sidenote: _Ceruss._] - -If ceruss, the juice of mallows, or of a bruised walnut with wine are -most serviceable. - -[Sidenote: _A leech._] - -If one happens to swallow a leech in drinking, vinegar with salt must -be given. If milk has curdled in the stomach, either passum, or laser -with vinegar. - -[Sidenote: _Poisonous mushrooms._] - -If a person has eaten poisonous mushrooms, let him take radish -either out of vinegar and water, or salt and vinegar. These may both -be distinguished from the good by their form, and also be rendered -innocent by the manner of dressing. For they are perfectly freed from -all noxious qualities, by boiling them in oil, or with a twig of a -pear-tree. - -[Sidenote: _Of burns._] - -Burns are also to be reckoned amongst the effects of external violence. -The plan laid down, therefore, seems to oblige me to speak of them -in this place. They are best cured by the leaves either of lilly, or -hound’s-tongue, or betes boiled in wine and oil. Any of these presently -applied heals them. - -But the method of cure may also be divided into those things, which -being gently eating and repellent, at first both prevent pustules, and -excoriate the part; and those, which being lenient, restore the part -to its soundness. Of the former is the meal of lentils with honey, -or myrrh with wine; or Cimolian chalk, powdered with the bark of -frankincense, and worked up to a paste with water, and when it is to be -used, diluted with vinegar. Of the second class any of the lipara. But -the most suitable is that, which contains the dross of lead, or yolks -of eggs. - -Another way also of treating burns is, while the inflammation -continues, to apply to them lentils with honey; when that is gone off, -meal with rue, or leeks, or horehound, till the crusts fall off, then -vetches with honey, or iris, or turpentine resin, till the ulcer be -clean; last of all, dry lint. - - - - -CHAP. XXVIII. - -OF EXTERNAL DISORDERS PROCEEDING FROM AN INTERNAL CAUSE, AND THEIR CURE. - - -[Sidenote: _Of a carbuncle._] - -From external injuries, we proceed to disorders which have an internal -origin, when some part of the body is corrupted. Amongst these none is -worse than a carbuncle. The marks of it are these. There is a redness, -and above that pustules rise, not very high, mostly black, sometimes -inclining to a livid colour, or pale. There seems to be sanies in them; -below, the colour is black. The flesh is parched, and harder than it -ought to be naturally. And about it, there is a sort of crust; which is -surrounded with an inflammation. Neither can the skin be lifted up in -that place, but is, as it were, bound down to the flesh below. There -is a propensity to sleep. Sometimes a shuddering, or fever comes on, -or both. And this disease shoots out roots, as it were, below, and -spreads, sometimes quickly, sometimes more slowly. At the surface also -it spreads and grows white; then becomes livid; and all round it small -pustules break out. And if it happen to be near the gullet or fauces, -it often stops the breath suddenly. - -Nothing is better than to sear it immediately. Neither is that painful, -for it has no feeling, because such flesh is mortified. And the burning -should be continued, till there is a sense of pain on every side. After -this, the ulcer is to be cured in the same manner, as other burns. -For by eating medicines is produced an eschar, which being entirely -separated from the quick flesh, draws with it whatever was corrupted; -and the sinus, by this time clean, may be dressed with incarning -medicines. But if the disorder be in the surface of the skin, medicines -barely eating, or at most caustic, may be sufficient. The violence of -the cure is to be proportioned to the malady. Whatever medicine is -applied, if it has the desired effect, will immediately separate the -corrupted part from the quick. - -And we may generally be confident of success, if the corrupted flesh -falls off, wherever such medicine eats down; if that does not happen, -and the medicine is overcome by the disease, an immediate recourse -must be had to the actual cautery. But in such a case, the patient -must abstain from food and wine. It is also proper to drink water -plentifully. And these directions are to be observed more strictly, if -a febricula be added to the other complaints. - -[Sidenote: _Of a Cancer._] - -There is not so great danger of a cancer[EZ], unless it be irritated by -the imprudence of the physician. This disease generally happens in the -superior parts, about the face, the nose, ears, lips, and breasts of -women. It also rises from the liver, or spleen. About the place there -are pricking pains; it is immoveable, and unequally swelled; it is also -sometimes insensible. Around it the veins are inflated, and tortuous; -and either pale or livid; in some also, they are concealed from view. -Touching the part gives pain to some, to others none. Sometimes it is -harder, or softer, than it ought naturally to be, without any ulcer; at -other times, all other circumstances being as above described, there -is likewise an ulcer. Sometimes it has no peculiar characteristic to -distinguish it; at other times it resembles those which the Greeks call -condylomata[FA], but has an asperity and magnitude peculiar to itself. -And its colour is red, or resembling that of a lentil. Neither is it -safe to cut it; for immediately there follows either a palsy, or a -convulsion. Often when a person receives a blow upon it, he loses his -speech and faints. In some also if the tumour itself be compressed, -the contiguous parts grow tense and swell. Now this is a very bad -kind(79). Its general progress is this; first appears what the Greeks -call a cacoethes[FB], then it becomes a carcinoma, without an ulcer. -From that an ulcer; and from an ulcer a thymium. - - [EZ] καρκίνωμα. - - [FA] κονδυλώματα. - - [FB] κακόηθες. - -None of these can be removed but the cacoethes(80); the rest are -irritated by every method of cure; and the more violent the operations -are, the more angry they grow. Some have made use of caustic medicines; -others of the actual cautery; others cut them out with a knife. Nor -was any person ever relieved by medicine; but after cauterizing, the -tumours have been quickened in their progress, and increased till -they proved mortal; when they have been cut out, and cicatrized, they -have, notwithstanding, returned, and occasioned death. Whereas, at the -same time, most people, by using no violent methods to attempt the -extirpation of the disease, but only applying mild medicines, to sooth -it, protract their lives, notwithstanding the disorder, to an extreme -old age. But no body can pretend to distinguish a cacoethes, which is -curable, from a carcinoma, which is not, otherwise than by time and -experiments. - -Therefore, so soon as this disease is perceived, caustic medicines -ought to be applied; if the disorder is alleviated, and its symptoms -grow milder, we may proceed both to incision and the actual cautery; -if it is immediately irritated, we may conclude, that it is already a -carcinoma; and every thing acrid and severe is to be taken away. But -if the part is hard, without any ulcer, it is sufficient to apply a -very mellow fig, or the plaister called rhypodes. If there is an ulcer, -but not rising _above the surface of the skin_, the cerate of rose oil -is to be put on, with the addition of a powdered shell, with smith’s -forge water. If it grows fungous, copper scales (which is the gentlest -caustic) must be tried, till there is no rising above the other parts; -provided still that it does not exasperate; if it does, we ought to be -content with the same cerate. - -[Sidenote: _Of a therioma._] - -There is also an ulcer, which the Greeks call therioma[FC]. This both -comes of itself, and sometimes is consequent upon an ulcer produced -from another cause. The colour is either livid or black; the smell -is bad; it discharges copiously a humour like mucus; it is sensible -neither of the touch, nor of medicine; and is only disturbed by -itching. About it there is a pain and inflammation. Sometimes also a -fever comes on. Sometimes there is a haemorrhage from the ulcer, and -this disorder spreads, by which all the symptoms often increase. From -these proceeds the ulcer which the Greeks call herpes esthiomenos[FD], -_voracious herpes_; because by spreading quickly, and penetrating -even to the bones, it devours the body. The surface of this ulcer -is unequal, resembling dirt; and there is in it a great quantity of -glutinous humour, an intolerable smell, and an inflammation more -violent, than is found in an ulcer of that size. Both of them, as -indeed all the kinds of gangrenes, happen chiefly to old people, or -those, who are in a bad habit of body. - - [FC] θηρίωμα. - - [FD] ἕρπης ἐσθιόμενος. - -The manner of curing both is the same; but the greater disease requires -the sharper remedy. And the regimen must first be regulated; the -patient must rest in his bed, for some days abstain from food, drink -water very plentifully, and have a clyster given him. Then, when the -inflammation is gone, let him take food of a good juice(81), avoiding -every thing acrid; he may drink as much as he will, provided he be -content in the day-time with water but at supper, he may also drink -some rough wine. But the abstinence should not be equally severe in a -herpes, and a therioma. This then is the regimen necessary. - -Externally upon the ulcer, must be sprinkled powder of dry aloes, and -if that does but little service, chalcitis. But if any nerve, by the -flesh being destroyed, be laid bare, it must be covered first with -linen, lest it be burnt by that medicine. If there is need of remedies -still more powerful, we must make use of those compositions, that -cauterize more strongly. Now when any medicine is sprinkled on, it -ought to be done by the broad end of a probe(82). Over it should be -applied either lint with honey, or olive leaves boiled in wine, or -horehound: and these must be covered with linen dipped in cold water, -and then well squeezed. And all round, where there is a tumour from the -inflammation, repellent cataplasms must be applied. If by these methods -it grows no better, the place ought to be cauterized with a _hot_ iron; -the nerves that are in view being first covered. By what has been said -on other occasions, it will be clear enough to any body, that a part, -which is burned either by medicines or the actual cautery, must first -be cleansed, and then filled up. - -[Sidenote: _Of the ignis sacer._] - -The ignis sacer ought also to be numbered amongst bad ulcers. There -are two species of it. The one is of a colour inclining to ruddy, or -a mixture of red and pale, and the surface is roughened by contiguous -pustules, of which no one is bigger than another, but they are very -numerous, and exceeding small. In these there is almost always pus, and -often a redness attended with heat; and that spreads, sometimes when -the part first affected is healing, sometimes when it is ulcerated, -in which case, the pustules breaking, one continued ulcer is formed, -discharging a humour, which seems to be betwixt sanies and pus. It -attacks chiefly the breast, or sides, or extremities, and particularly -the soles of the feet. The other kind comes with an ulceration in the -surface of the skin, but without going deep, broad, inclining to a -livid colour, but unequal; and the middle part of it heals, while the -extremities spread; and often that, which seemed to be sound, ulcerates -again. But the skin round about it, which is to receive the disease, -grows tumid, and hardish, and the colour of it is a blackish red. And -this disease too generally attacks old people, or those, that are in a -bad habit, but chiefly in their legs. - -Now every ignis sacer, though it be the least dangerous of those -disorders, which have the disposition to spread, yet is, I had almost -said, the hardest to cure of them all. The most effectual remedy is a -fever for one day, which consumes the noxious humour. The thicker and -whiter the pus is, so much the less is the danger. It does good also -to excoriate the part below the ulcer by scourging, that the more -pus may be evacuated, and the matter drawn out, which corrupts the -flesh there. But notwithstanding if a slight fever comes on, there is -a necessity for abstinence, lying a-bed, and clysters. In every ignis -sacer, neither mild and glutinous food, nor salt and acrid are proper; -but what is betwixt these: such as unleavened bread, fish, kid, birds, -and except the wild boar, almost all venison. If there is no febricula, -both gestation and walking are serviceable, and rough wine, and the -bath; and in this disorder, as well as that mentioned before, the drink -ought to be more plentiful than the food. - -As for the ulcers themselves, if their progress be moderate, they -must be fomented with hot water; if more rapid, with hot wine. Next -wherever there are any pustules, they must be opened with a needle. -Then such applications used, as may consume the putrid flesh. When the -inflammation is removed, and the ulcer cleansed, a lenient medicine -ought to be applied. In the second species, quinces boiled in wine -and bruised may do good; as likewise the plaister of Hera, or the -tetrapharmacum, with the addition of a fifth part of frankincense; -likewise black ivy boiled in a rough wine, and if the disorder spread -fast, nothing is more efficacious. When the ulcer, which I observed to -be in the surface of the skin, is cleansed, the same lenient medicines -are sufficient to the cure. - -[Sidenote: _Of the Chironian ulcer._] - -The ulcer named Chironian(83) is large, and has hard, callous, and -swelled lips. A sanies is discharged not copious, but thin; the smell -is bad. There is no inflammation either in the ulcer or in the tumour -about it. The pain is tolerable. It does not spread, and therefore is -not dangerous; but it does not easily heal. Sometimes a thin cicatrix -comes on, and then breaks again, and the ulcer is renewed. It occurs -chiefly in the feet and legs. - -The application to it ought to contain both something lenient, and -something strong, and repellent. Such as the following composition made -for the purpose: of copper scales, calcined lead washed, each p. vi. -*. cadmia, wax, each p. viii. *. oil of roses a sufficient quantity to -soften the wax with the other ingredients. - -[Sidenote: _Of ulcers occasioned by cold._] - -There is a kind of ulcer occasioned by the cold of the winter. It is -most common in children, chiefly in their feet and toes, sometimes -also in their hands. There is a redness with a moderate inflammation. -Sometimes pustules break out, which are followed by an ulceration. -The pain is not great, the itching greater. Sometimes a humour is -discharged, but in small quantity, which seems to resemble either pus -or sanies. - -In the first place it must be fomented plentifully with a hot decoction -of turnips, or if these are not to be had, some of the repellent -vervains. If it is not yet ulcerated, copper, as hot as a person is -able to bear it, must be applied. When it is already ulcerated, allum, -powdered with an equal quantity of frankincense, ought to be put to it, -with the addition of wine; or pomegranate bark boiled in water, then -beat. If the surface of the skin be excoriated, in that case lenient -medicines succeed best. - -[Sidenote: _Of the scrophula._] - -The scrophula is a tumour, in which there are formed some concretions -of pus and blood, resembling small glands. These are extremely -troublesome to physicians, because they both generate fevers, and never -maturate kindly; and whether they be cured by incision or medicines, -for the most part they rise again close to the cicatrices; which they -are much more ready to do, after being treated with medicines; and what -is more, they are of long continuance. They grow chiefly in the neck; -but also in the armpits, the groin and the sides. Meges the surgeon -assures us, that he has met with them in the breasts of women too. - -For these reasons, it is proper to give internally white hellebore, and -that even frequently, till they be discussed; and externally to apply -medicines which may either draw out the humour, or discuss it; such as -have been mentioned before. Some also make use of caustics, which eat -down and constringe the part with an eschar; and then treat it like an -ulcer. Whatever method of cure be pursued, when the ulcer is clean, the -body must be exercised and nourished, till it come to a cicatrix. These -are the methods prescribed by physicians(84): but the experience of -some peasants has discovered, that eating a snake cures a scrophulous -patient. - -[Sidenote: _Of a furuncle._] - -A furuncle is an acute tubercle, attended with inflammation and pain; -and especially when it is just turning to pus. When this is opened, -and the pus is discharged, part of the flesh below appears converted -into pus, part corrupted, of a whitish colour, and reddish; which some -call the ventricle of the furuncle. There is no danger in it, though no -means be used for its cure, for it maturates of itself, and breaks. But -the pain makes a medicine, that can hasten the cure, eligible. - -The proper medicine for it is galbanum, but other things have also been -mentioned before. If none of these can be had, the first application -ought to be a plaister not greasy, to repel it; then if that has not -succeeded, something to promote a suppuration. If that cannot be got, -either resin or leaven(85). When the pus is squeezed out, no further -cure is necessary. - -[Sidenote: _Of phymata._] - -The name of phyma is given to a tubercle resembling a furuncle, but -rounder, and flatter in the surface, and often larger. For a furuncle -seldom rises to the bulk of half an egg, and never exceeds it: a phyma -is commonly of greater extent; but the inflammation and pain in it -are less. When it is broken, the pus appears in the same manner; no -ventricle is found here, as in the furuncle; but all the corrupted -flesh is turned into pus. Now this grows more frequently in children, -and is more easily cured; in young men it occurs more seldom, and is -more difficult to cure: when age has given firmness to the body, it -does not appear at all. The proper medicines for discussing it have -been mentioned before. - -[Sidenote: _Of a phygethlon._] - -A phygethlon is a low, but broad tumour, in which there is something -like to a pustule. The pain and tension are violent, and greater than -in proportion to the size of the tumour; sometimes also attended with -a slight fever. It ripens slowly, and no great part of it is converted -into pus. It is formed chiefly either in the neck, or in the armpits, -or the groin. From its figure our authors call it panus(86). The -proper medicine for this also we have pointed out before. - -[Sidenote: _Of abscesses._] - -But though all the foregoing are nothing else but small abscesses, -yet a larger collection, that tends entirely to suppuration, -appropriates to itself the general name of abscess. And this collection -happens generally after fevers or pains of some particular parts, -and especially after pains in the belly. It commonly shews itself -externally, for it sometimes swells to a pretty large compass, like -the phyma, and is red and hot, and in a little time contracts a -hardness. It is more troublesome as it advances, and occasions thirst -and watchfulness. But sometimes there is none of these appearances in -the skin; and more especially when the suppuration is pretty deep; but -inward prickings are felt, attended with thirst and watchfulness. It is -more kindly when it does not become hard of a sudden; and when, though -it be ruddy, yet it is changing to a white colour. Which symptoms occur -when the suppuration is beginning; for the swelling and redness comes -on long before. - -If the abscess be forming in any of the nobler parts, the accession -of matter there must be prevented by cataplasms, which are at the -same time repellent and cooling; such as I have mentioned under the -erysipelas and elsewhere. If it is grown pretty hard, we must have -recourse to discutients and resolvents; such as a dry fig bruised, or -lees of wine mixed with cerate, made up with hog’s lard; or the root of -wild cucumber, with the addition of two parts of meal, first boiled in -mulse. We may also mix equal parts of ammoniacum, galbanum, propolis, -viscum, adding of myrrh not half the quantity of any of the other -ingredients: and the plaisters and malagmas I have mentioned before, -have the same effect. - -What is not discussed by these, must necessarily maturate. And to -hasten this, must be applied barley meal mixed with water; to which -also it will be proper to add some herbs. The same applications(87) -are fit for the lesser abscesses too, whose names and properties I have -recited above. The general method of cure is the same in them all; and -only differs in the degree. Now that tumour is crude, in which there -appears a strong pulsation of the arteries, a weight, heat, tension, -pain, redness, and hardness; and if the abscess be large, a shuddering, -as also a slight fever continues; and the suppuration being pretty deep -and concealed, instead of the marks, which otherwise shew themselves -in the skin, there are prickings. When these have abated, and the part -begins to itch, and either becomes somewhat livid or whitish, the -suppuration, is perfected. And when it either breaks of itself, or is -opened by medicines, or by incision, the pus ought to be discharged. -And if it happens in the armpits or groin, it must be dressed without -lint. In other parts too, if it is narrow at the bottom, if the -suppuration has been moderate, if it has not penetrated deep, if there -is no fever, if the patient be strong, lint is equally needless. In -other circumstances it ought to be used, sparingly however, and not -unless the wound be large. It does well to spread honey upon the lint; -or without it, to apply lentils with honey, or pomegranate bark boiled -with wine. And these things are proper both alone and mixed. - -If any parts round it should be too hard, to soften them may be applied -either mallows beat, or fenugreek, or lintseed boiled in passum. And -then whatever is to be applied, ought to be secured not by a tight, -but an easy bandage. Every body ought to know, that in this kind of -disorder cerate may be used. What else belongs to the cleansing of the -ulcer, filling it up, and bringing on a cicatrix, and equally relates -to wounds, has been already pointed out. - -[Sidenote: _Of fistulas._] - -But sometimes from abscesses of this kind and other ulcers, arise -fistulas. That is the name of a deep, narrow and callous ulcer. It -occurs almost in every part of the body; and it has some peculiarities -in each place. I shall first treat of the general properties. There -are then several kinds of fistulas; for some are short, others deeper; -some point inward in a straight line; others, and by far the greatest -part, are transverse; some are simple, others are double, or triple, -which beginning from one orifice, branch out within, into three or -more sinuses; some straight, others bent and tortuous; some end in the -flesh, others penetrate to bones or a cartilage; or where neither of -these lies beyond them, reach to the more internal parts; some again -are easily cured, others with difficulty, and some are even found -incurable. - -The cure of a simple and recent fistula in the flesh is easy. It is an -advantage to it, if the person be young, and the constitution firm: -the contrary are very unfavourable circumstances; as also if the -fistula has injured a bone, or cartilage, or nerve, or muscles; if it -have seized upon a joint, or has penetrated either to the bladder, or -the lungs, or to the womb, or to the large veins or arteries, or to -the jaw-bones, throat, stomach, or thorax. When it points towards the -intestines too, it is always dangerous, and often mortal. In these -cases it greatly increases the malady, if the patient be either sick, -or old, or of a bad habit. - -First of all, it is proper to put a probe into the fistula, that we -may find its direction and depth: and at the same time whether it -be altogether moist, or drier than it should be, which appears upon -drawing out the probe. It may also be determined, whether the bone be -affected or not; and if the fistula has penetrated there, how far it -has injured it. For if that part is soft, which is touched by the end -of the probe, the disorder is confined to the flesh; if it resists -more, it has made way to the bone. And again, if the probe slides, -there is no caries begun: if it does not slip out(88) of the point -where it is placed, the caries is begun, but is slight yet: if it feels -unequal also, and rough, the bone is very much corroded. The situation -itself shews when there is a cartilage below; and that the fistula has -reached it, appears by its resistance. - -Now from these circumstances may be learnt the seats and extents of -fistulas, and what parts they have damaged. From the quantity of -the pus it may be known, whether they be simple, or divided into -more parts. If more of that comes away, than can issue from a single -cavity, it is evident there are more sinuses. And as flesh, nerves, -and some nervous substances, such as the greatest part of the coats -and membranes are, commonly lie together, the nature of the pus will -discover whether the several sinuses have eaten through these different -sorts of bodies. For from flesh a smooth and white pus is discharged -pretty copiously; from a nervous place the discharge is of the same -colour indeed, but thinner, and less in quantity; from a nerve fat -and not unlike to oil. Lastly, the posture of the body also discovers -whether the fistulas have penetrated into several parts, because often, -when one lies down with his body and limb in a different position, the -pus begins to flow again, which had before stopped, and shews not only -that there is another sinus, from whence it descends, but also that it -proceeds in a different direction. - -If it be confined to the flesh, and is recent and simple, neither -consisting of sinuses, nor having a large cavity: also if it be not -in a joint, but in a part, which is immoveable by itself, and is never -put in motion but with the whole body, a plaister for recent wounds -will be sufficient, if that contain either salt, or allum, or copper -scales, or verdigrease, or any of the metallic substances. And of this -a collyrium(89) ought to be made, at the one end smaller, and at -the other somewhat thicker. And this ought to be introduced with the -small end foremost into the fistula, till pure blood begins to appear. -This is universal in the application of all collyriums for fistulas. -And then the same plaister is to be put over it spread upon linen; and -above that must be applied a sponge first dipt in vinegar; and it is -sufficient to open the dressings on the fifth day. Such diet must be -used, as I have recommended for generating flesh. - -But if the fistula is at a distance from the præcordia, it is necessary -for the patient now and then to eat radishes fasting and then to vomit. - -When the fistula by time becomes callous (and it is impossible to -be mistaken in a callosity, because it is hard, and either white or -pale) then there is a necessity for stronger medicines. Such as that -composition, which contains of poppy tears p. i. *. gum p. iii. *. -cadmia p. iv. *. copperas p. viii. *. these are incorporated with -water, and made into a collyrium. Or that, which consists of galls -p. i. *. verdigrease, sandarach, Egyptian allum, each p. i. *. -calcined copperas p. ii. *. Or that, which is composed of chalcitis -and stone-lime, to which is added of orpiment less by one half than -each of the other ingredients; and these are mixed up with boiled -honey. The most expeditious is the prescription of Meges: to reduce to -powder of rasile verdigrease p. ii. *. then to dissolve in vinegar, of -ammoniacum thymiama p. ii. *. and with this to bring the verdigrease to -a consistence: and this is one of the choicest medicines. But though -the foregoing compositions are the most efficacious, yet if these are -not to be had, it is easy to destroy the callosity by some caustic -medicines: and it is sufficient to arm with these a twisted paper reed, -or some part of a penecillum, formed after the manner of a collyrium. -Squills also boiled, and mixed with lime consume a callus. - -If the fistula happen to be pretty long, and transverse, after -introducing a probe, it is very proper to make an incision over against -its origin, and to put in any collyrium you chuse. - -But if we judge the fistula to have two or more sinuses, provided it -be short and confined to the flesh, we ought not to make use of a -collyrium, which may cure one part, and not touch the rest; but the -same medicines dry are to be put into a writing reed, which being -applied to the orifice, the medicines must be blown into the fistula. -Or the same things may be dissolved in wine; or if the fistula be -somewhat foul, in mulse; if somewhat, callous, in vinegar; and -whatever is injected, must be infused in this liquid form. Coolers -and repellents must be applied above; for generally the parts about a -fistula are a little inflamed. Neither is it improper, when one has -removed the dressings, before he make another injection, to wash the -fistula by means of a syringe; if there be much matter, with wine; if -the callosity be pretty hard, with vinegar; if it is already cleansing, -with mulse, or a decoction of vetches in water, with a little honey -added to it. It commonly happens that the membrane, which is betwixt -the orifice and the sound flesh, being overcome by so many medicines, -casts off, and the ulcer is clean below. Whenever this happens, -agglutinants are to be applied, and especially spunge armed with boiled -honey. I know it is a practice approved of by many in this case, to -have lint rolled up into the form of a collyrium, and dipt in honey, -introduced for incarning. But this method more quickly agglutinates, -than incarns. And there is no fear, that clean flesh brought into -contact with clean flesh can fail to unite, especially when medicines -proper for that purpose are made use of; since often an ulceration of -the fingers, unless great care is taken to prevent it, will join them -together in the healing. - -[Sidenote: _Of the cerion ulcer._] - -There is also a kind of ulcer, which from its resemblance to a -honeycomb, by the Greeks is called cerium[FE]. And of this there are -two species: the one is of a whitish colour, and like to a furuncle, -but larger, and attended with great pain. When it maturates, it has -openings, through which is discharged a glutinous and purulent matter; -nevertheless it does not come to a due ripeness. If it be divided by -incision, there appears to be a great deal more corruption within, than -in a furuncle, and it reaches deeper. It seldom occurs but amongst the -hair of the head. - - [FE] κηρίον. - -The other is less, and eminent upon the top of the head, hard, broad, -of a pale green colour, and more ulcerated; for there are openings -at the roots of each of the hairs, through which issues a glutinous, -palish humour, in consistence like honey, or viscum, or sometimes oil; -and if an incision be made upon it, the flesh within appears green. -There is a great pain and inflammation, insomuch that they often bring -on an acute fever. - -To that kind, which has fewer openings, it is proper to apply dry figs, -and lintseed boiled in mulse, and drawing plaisters and malagmas, or -the medicines, of that quality above recited. - -Upon the other, the same medicines, likewise meal boiled in mulse, and -half the quantity of turpentine resin added to it; and a fig boiled in -mulse; to which a little powdered hyssop is added; likewise a fourth -part of stavesacre added to the fig. But if medicines do but little -service in either kind, the whole ulcer must be cut out to the sound -flesh. When the ulcer is taken away, medicines must be applied over the -wound; first such as promote pus, next detergents, then such as incarn. - -[Sidenote: _Of the acrochordon, acrothymium, myrmecia, and the clavus._] - -There are also some resembling warts, which have different names, as -they are different disorders. The Greeks call that an acrochordon[FF], -where a substance pretty hard is collected within the skin, which -sometimes is rough, and of the same colour with the adjacent parts; -near the skin it is narrow, and broader above. This is small, rarely -exceeding the size of a bean. They are hardly found to grow single; -generally a number together, and chiefly in children. They sometimes -suddenly disappear, sometimes they excite a moderate inflammation. Some -are also converted into pus. - - [FF] ἀκροχορδὼν. - -That is called acrothymium[FG], which rises like a small wart above -the flesh, broader at the skin, smaller above, hardish and very -rough upon the top, where in colour it resembles thyme, whence it has -its name; and it is easily divided there, and made bloody; sometimes -it discharges some blood; and is generally about the bigness of an -Egyptian bean, seldom larger, sometimes very small. Sometimes only one, -at other times more grow in the palms of the hands, and soles of the -feet; they are worst in the private parts, and aptest to bleed there. - - [FG] ἀκροθύμιον. - -Those called myrmecia[FH] are lower and harder than an acrothymium, fix -their roots deeper, and occasion a greater pain; below they are broad, -and above small, and less blood comes from them: in size they scarce -ever exceed a lupine. These likewise grow either in the palms of the -hands, or lower parts of the feet. - - [FH] μυρμήκια. - -The clavus grows elsewhere sometimes, but chiefly in the feet, and -principally form a contusion, though sometimes from other causes; and -it gives pain, if not at other times, at least when one is walking. - -Of these the acrochordon, and the acrothymium often terminate of -themselves, and the more readily, the less they are. Myrmecia and -clavi are scarce ever removed without medicine. If the acrochordon be -cut off, it leaves no root, and for reason does not grow again. When -the acrothymium and clavus are cut off, a small roundish root grows, -which descends deep into the flesh, and that being left, they sprout up -again. The myrmecia adhere by very broad roots, and therefore cannot -be taken off without a great ulceration. It is very proper to pare the -clavus now and then: for thus without any violence it grows soft: but -if a little blood be let out, it often dies away. It is also removed, -if one cleans it round, and then applies to it resin mixed with a -little of the powder of a milstone. But the other kinds are to be eaten -away by medicines. For the two first, that which is made from the lees -of wine; for the myrmecia the most proper is that, which consists of -alum and sandarach. But the contiguous parts ought to be covered with -leaves, lest they also be corroded; and after that a lentil must be -applied. A fig also boiled in water destroys an acrothymium. - -[Sidenote: _Of pustules._] - -Pustules break out chiefly in the spring season. Of these there are -several kinds. For sometimes there is a certain asperity over the whole -body, or a part, resembling those pustules, which are occasioned by a -nettle, or from sweat; the Greeks call them exanthemata[FI]. And they -are sometimes red, at other times of the same colour with the skin. -Sometimes a great many grow resembling vari, sometimes larger. The -pustules are livid or pale, or black, or otherwise different from the -natural colour; and there is a humour contained in them. When they are -broke, the flesh below appears as it were ulcerated. By the Greeks they -are called phlyctænæ helcodes[FJ]. They arise either from cold, or from -fire, or from medicines. - - [FI] ἐξανθήματα. - - [FJ] φλύκταιναι ἑλκώδεις. - -The phlyzacium[FK] is a pustule somewhat harder, of a whitish colour, -and sharp pointed. What is squeezed from it is moist. The pustules -sometimes turn to small ulcers, either dry or moist; and sometimes -attended only with an itching, at other times with an inflammation -and pain: pus or sanies issues from them, or both. And this occurs -in children chiefly; seldom in the trunk of the body; often in the -extremities. - - [FK] φλυζάκιον. - -The worst kind of pustule is that, which is called epinyctis[FL]. Its -colour either inclines to livid, or is a dark brown, or white. There -is a violent inflammation round it; and when it is opened, a mucous -ulceration is found within, in colour resembling its humour. The pain -of this is greater than in proportion to its bulk; for it is not -larger than a bean. And this likewise grows in the extremities, and -generally in the night-time: whence the Greeks have given it the name -of epinyctis. - - [FL] ἐπινυκτὶς. - -Now in the cure of all pustules, the first thing is to walk much, and -to take exercise: if that cannot be complied with, to use gestation. -The second rule is, to lessen the quantity of food; to abstain from -every thing acrid and extenuating. And nurses ought to observe the -same rules, if their sucking child is thus affected. Besides these, -one, that can bear it, if the pustules be small, ought to sweat in -the bagnio; and at the same time to sprinkle nitre over them; and -to anoint the part with a mixture of wine and oil; then to go into -the bath. If no benefit accrues from these, or if the pustules be of -a larger kind, a lentil must be applied, and when the surface of the -skin is taken off, we must have recourse to lenient medicines. After -the lentil, the epinyctis is to be treated with blood-herb, or green -coriander. - -The ulcers formed from pustules are cured by litharge mixed with -fenugreek seed; and in compounding them, rose oil, or juice of endive, -are used alternately, till the mixture have the consistence of honey. -The proper composition for those pustules, which attack, infants, is of -that stone, which the Greeks call pyrites p. viii. *. with fifty bitter -almonds, and an addition of three cyathi of oil. But the pustules ought -to be first rubbed with ceruss, and then anointed with this. - -[Sidenote: _Of the scabies._] - -The scabies is a hardness of the skin, of a muddy colour, from whence -pustules arise, some of them moist, others dry; from some of them -issues a sanies; and in these there follows a continued itching -ulceration, which in certain cases spreads very fast. In some people -it goes entirely off, in others it returns at a certain season of -the year; the greater its asperity, and the more it itches, the more -difficult it is to cure. And therefore this species of it the Greeks -call agria[FM], that is, cruel. - - [FM] ἀγρία. - -In this also the same diet is necessary, as above prescribed. The -medicine proper for this in its beginning, consists of spodium, -saffron, verdigrease, each p. i. *. white pepper, verjuice, each p. -i. *. cadmia p. viii. *. But where there is already an ulceration, -that, which is composed of sulphur p. i. *. wax p. iv. *. liquid pitch -a hemina, two sextarii of oil. These must be boiled together to the -consistence of honey. There is also another, which is said to have -been invented by Protarchus. It contains a sextarius of lupine meal, -four cyathi of nitre, a hemina of liquid pitch, half a pound of liquid -resin, and three cyathi of vinegar. It is also proper to mix saffron, -lycium, verdigrease, myrrh, ashes, in equal quantities, and boil them -in passum. This heals every kind of scabies. And if there be nothing -else at hand, lees of oil boiled to a third part, or sulphur mixed with -liquid pitch, as I prescribed for cattle, relieve men also labouring -under the scabies. - -[Sidenote: _Of the impetigo._] - -Of the impetigo there are four species. The least malignant is that, -which resembles the scabies. For it is red, hardish, ulcerated, -and corrosive. But it differs widely from that, which is more -ulcerated(90), and has pustules like to vari; and there appear to be -in it somewhat like air bubbles, from which, after a time, something -like scales come off; and this is more certain in its returns. - -The second kind is worse, and is not unlike the papula, but of greater -asperity and a more ruddy colour, having various figures; scales fall -off from the surface of the skin, there is a greater erosion, it -spreads more quickly, and broader, and both comes and goes at more -certain intervals than the former. It is called the red. - -The third kind is still worse. For it is both thicker and harder, -and more swelled; it causes fissures in the surface of the skin, and -corrodes more vehemently. This also is scaly, but black; it spreads -wide(91), and does not stay long at a time; but is less uncertain as -to its periods of coming and going; and is not to be entirely removed. -This has the epithet of the black. - -There is a fourth kind absolutely incurable, very different from the -rest in colour. For it is whitish, and resembling a recent cicatrix; it -has scales of a pale colour, some whitish, others resembling a lentil; -which being taken off, blood sometimes follows. Otherwise the humour of -it is white, the skin is hard and chopped, and it spreads wider. - -All these kinds happen chiefly in the feet and hands; and they also -infest the nails. There is no medicine more efficacious than that I -mentioned for the scabies, which bears the name of Protarchus. Serapion -made use of the following composition, nitre p. ii. *. sulphur p. iv. -*. incorporated with plenty of resin. - -[Sidenote: _Of the papula._] - -There are two species of the papula. One is, where the skin is made -rough by very small pustules, and is both red, and gently corroded; in -the midst of them is a space somewhat smoother; it spreads slowly. And -this disorder is of a round form in its beginning, and proceeds in the -same manner circularly. - -The second, the Greeks call agria: which has a similar appearance, -but the skin is more unequal and ulcerated, and it corrodes more -vehemently, is redder, and sometimes also loosens the hairs. - -That which is less round, heals with greater difficulty; and unless it -be cured, it turns to an impetigo. But a slight papula, if it be rubbed -every day with fasting spittle, will heal. The greater kind is very -well cured by feverfew rubbed over it. But for the compound medicines, -that same prescription abovementioned of Protarchus is so much the more -powerful here, as the distemper is less. There is another of Mico’s for -the same purpose; of red nitre, frankincense, each p. i. *. cantharides -cleansed p. ii. *. crude sulphur a like quantity, liquid turpentine -resin p. xx. *. meal of darnel three sextantes, three cyathi of git, -and one sextans of crude pitch. - -[Sidenote: _Of the vitiligo._] - -The vitiligo also, though of itself not dangerous, yet is both nasty, -and proceeds from a bad habit of body. There are three species of it. -It is called alphos[FN], when it is white; it is commonly a little -rough, and not continued, but appears like drops dispersed here and -there. Sometimes it spreads wider, leaving some, places between free. -The melas[FO] differs from that in colour, being black, and like a -shadow. In other respects it is the same. The leuce[FP] has some -resemblance to the alphos, but is whiter, and penetrates deeper; -and has white downy hairs in it. All these spread; but in some more -quickly, in others slower. The alphos and melas come and go in some -people without any regularity. The leuce does not easily quit a person -it has once seized. - - [FN] ἄλφος. - - [FO] μέλας. - - [FP] λεύκη. - -The two first are not very difficult to cure; the last scarce ever -heals; and though the disorder be in some degree mitigated, yet the -natural colour is never fully restored. Whether any of these be curable -or not, is easily known from an experiment. For the skin should be cut, -or pricked with a needle. If blood issues, which generally happens in -the two former, there is room for a remedy; if a white humour starts, -it will not admit of a cure. And therefore it should not he meddled -with. - -To the curable kinds must be applied lentils mixed with sulphur and -frankincense, the lentils being bruised and dipped in vinegar. Another -composition for the same purpose is that, which goes under the name of -Irenæus. Bastard spunge, nitre, cummin, dry fig-leaves, of each equal -parts, are bruised with the addition of vinegar. With this the part -affected is anointed in the sun; and in a little time, it is washed -off, lest it corrode too much. Some following the practice of Mico, -anoint the alphi with the following medicine; they mix of sulphur p. -ii. *. nitre p. iv. *. dry myrrh powdered an acetabulum; then in the -bath sprinkle upon the vitiligo bean flour, and afterwards put the -other over it. Those which I called melanes, are cured by the following -things beat up together; bastard spunge, frankincense, barley, and -beans; these are sprinkled upon them without oil in the bagnio, before -a sweat comes on, and then that species of vitiligo comes off by -rubbing. - - - - -A. CORNELIUS CELSUS - - OF - - MEDICINE. - - - - -_BOOK VI._ - - - - -CHAP. I. - - -Having done with the disorders, which break out in any part of the body -indifferently, and require the assistance of medicines; I shall now -proceed to those, that are confined to particular parts, beginning with -the head. - -[Sidenote: _Of hairs falling off the head._] - -When the hairs of the head fall off, the principal remedy is frequent -shaving: though labdanum mixed with oil, conduces also towards keeping -them on. I here speak of the hair, which falls off after an illness. -For no remedy whatever can prevent the heads of some people from -becoming bald by age. - - - - -CHAP. II. - -OF A PORRIGO. - - -We call that disorder a porrigo, _scurf_, when certain small scales -arise amongst the hair, and are loosened from the skin; they are -sometimes moist, much more frequently dry. It happens sometimes -without any ulcer, sometimes in a part that is ulcerated, and is -sometimes attended with a bad smell, sometimes with none. It usually -occurs in the hair of the head, more rarely in the beard, sometimes -also in the eye-brows. And as it never comes without some antecedent -disorder in the body, so it is not altogether useless. For when the -head is free from disorders, then it does not appear: when there is -any disorder there, it is more expedient, _in such a case_, that the -surface of the skin should be here and there corrupted, than that the -noxious matter should be turned in upon a more noble part. - -It is more proper then to cleanse it by frequent combing, than to repel -it entirely. But if that method makes it more offensive (which may -happen by the excessive discharge of humour, and more so, if the humour -be fetid) the head is to be shaved often; and treated with some gentle -repellents, such as nitre with vinegar, or labdanum with myrtle oil, -and wine, or myrobalans with wine. If these have little effect, we may -use some of the more powerful ones; but, at the same time, we should be -aware, that this practice is hurtful, when the disorder is recent. - - - - -CHAP. III. - -OF THE SYCOSIS. - - -There is an ulcer, which from its resemblance to a fig, by the Greeks, -is called sycosis[FQ], because flesh sprouts up from it. And this is -the general name. Under it are included two species. The one is a hard -and round ulcer; the other is moist and unequal in its surface. From -the hard one the discharge is very small and glutinous; from the moist, -it is in greater quantity and fetid. Both kinds occur in the parts -covered with hair: but that which is callous and round, most frequently -in the beard; the other, which is moist, chiefly in the hair of the -head. - - [FQ] σύκωσις. - -To both of them it is proper to apply elaterium, or lintseed powdered, -and made into a paste with water, or a fig boiled in water, or the -tetrapharmacum plaister softened with vinegar. Eretrian earth also -liquified with vinegar is proper to lay upon them. - - - - -CHAP. IV. - -OF AREAE. - - -There are two kinds of areae. Both of them agree in this, that the -surface of the skin mortifying, the hairs first decay, and then fall -off; and if the part is wounded, thin and fetid blood is discharged; -and both kinds increase in some people quickly, in others slowly. It is -then worst, when it has rendered the skin thick and fat, and entirely -smooth. That, which is called alopecia[FR], spreads in no certain form. -It is found both in the hair of the head, and in the beard. But that, -which from its likeness to a serpent is called ophiasis[FS], begins at -the hinder part of the head; its breadth not exceeding two fingers; it -creeps with two heads to the ears; in some, even to the forehead, till -the two heads are joined in the fore part. The former species happens -at any age; the latter commonly to infants. The first hardly ever -terminates without medicine; the other often goes away of itself. - - [FR] ἀλωπεκία. - - [FS] ὀφίασις. - -Some scarify these kinds of areae gently with a knife. Others anoint -them with escharotic medicines mixed with oil; and especially burnt -paper. Others apply turpentine resin with thapsia. But nothing is -better than daily shaving with a razor; because, when the cuticula is -gradually cut off, the small roots of the hairs are laid bare. Nor -should this be given over, till it appears, that the hair grows thick. -It is sufficient to rub the part, that is frequently shaved, with -copperas. - - - - -CHAP. V. - -OF VARI, LENTICULAE, AND EPHELIDES. - - -It is almost a folly to cure vari, lenticulae, and ephelides: but -it is impossible to prevent women from being nice in what regards -their beauty. Of these disorders, which I have just mentioned, vari -and lenticulae are universally known; however, that species is more -rare, which the Greeks call phacia[FT], though that is only of a more -ruddy colour, and more unequal surface than the common lenticula. The -ephelis[FU] is unknown to most people; and is nothing else than a -certain ill coloured asperity and hardness. The others are peculiar to -the face; the lenticulae sometimes appear in other parts, of which I -did not think it worth while to treat separately elsewhere. - - [FT] φακία. - - [FU] ἐφηλὶς. - -But vari are well cured by the application of resin mixed with an equal -quantity of scissile alum, and a little honey. Equal quantities of -galbanum and nitre, beat up with vinegar to the consistence of honey, -remove a lenticula. The part is to be rubbed with these, and after an -interval of several hours, washed clean in the morning, and gently -anointed with oil. - -An ephelis is cured by resin, with the addition of a third part of -fossile salt and a little honey. And for all these disorders, and -likewise for giving a proper colour to cicatrices, that composition -is good, which is said to be invented by Tryphon the father. In it -there are equal parts of myrobalans crocomagma, the bluish Cimolian -chalk(92), bitter almonds, flour of barley, and vetches, white -struthium, seed of mellilot: all these are powdered and brought to -a consistence with the bitterest honey, and being rubbed on in the -evening, are always washed off in the morning. - - - - -CHAP. VI. - -OF THE DISORDERS OF THE EYES. - - -The foregoing are indispositions of small account. But our eyes are -exposed to grievous and various maladies. And because they contribute -so large a share both to the conveniency and pleasure of life, they -deserve our utmost care to preserve them. - -Presently after the appearance of a lippitude, there are certain -indications, from which we may form a presage of the event. For, if -a discharge of tears, and a tumour, and a thick gum too(2) have -commenced at once; if that gum is mixed with tears, and the tears are -not hot, also if the gum is white and soft, and the tumour not hard, -there is no danger of the disorder continuing long. But if the tears -are copious, and hot, the gum little in quantity, the tumour small, and -these are confined to one eye; the case will prove tedious, but without -danger. And this species of lippitude is not at all painful; but is -hardly ever removed before the twentieth day; sometimes it continues -for two months, and sometimes not so long. - -If the gum begins to be white and soft, and is mixed with tears, or -both these have attacked the two eyes at once; the lippitude may be -of shorter continuance, but there is a danger of ulcers. Now a dry -and parched gum occasions pain, but terminates sooner; unless it have -produced some ulcer. - -A large tumour, if it be without pain, and dry, is void of all danger; -if it be dry, but attended with pain, it commonly ulcerates; and -sometimes, from this case it happens, that the eye-lid is agglutinated -to the eye. There is room also to fear an ulceration in the eye-lids or -the pupil, when besides great pain, there is a discharge of salt and -hot tears; or even when after the tumour is removed, the tears flow for -a long time mixed with the gum. - -It is worse still, where the gum is pale or livid, the tears are -scalding, or in great quantity, the head hot, and the pain reaches -from the temples to the eyes, also if the person is distressed with -wakefulness in the night; for in such circumstances, generally the eye -bursts, when it were to be wished, it would only ulcerate. A slight -fever is of service to an eye that bursts inwardly. If it breaks and -is protruded externally, the case admits of no remedy. If from a black -colour, some part of it has become whitish, it continues long. But if -it be rough and thick, even after the cure, it leaves some mark. - -Hippocrates, the most ancient author we have, has observed in his -writings, that the eyes are cured by bleeding, by medicines, the bath, -fomentations, and drinking of wine. But he has not explained the proper -time for these, and the reasons for their use; in which the principal -part of medicine consists. There is also much benefit received from -abstinence and clysters. - -They are sometimes seized with an inflammation; in which they are -at once pained and swelled; and there follows a discharge of gum; -sometimes more, sometimes less plentiful, or acrid. In such a case, -the principal remedies are rest and abstinence. Wherefore, for the -first day, the patient ought to lie in a dark place, and even refrain -from speaking; to take no food at all; if he can command himself, not -so much as water; if he cannot do that, at least as little of it as -possible. - -But if the pains are severe, blood must be taken away, and preferably -on the second day; but if the case be urgent, on the first; especially -if the veins in the forehead swell, the patient be strong, and there -is a redundancy of matter: but if the illness be less severe, it calls -for a milder cure. It is not necessary to give a clyster, till the -second or third day. But a small inflammation requires neither of these -remedies; and it is sufficient to rest and fast. - -Nevertheless, long fasting is not proper in lippitudes, lest it render -the gum more fetid and acrid; but on the second day, some of the -gentlest of those things, that generate a thicker phlegm(3), ought -to be given, such as sorbile eggs; if the disorder be but slight, -pulticula, or bread sopped in milk. On the following days, as much -as the inflammation decreases, so much may the quantity of food be -increased; but of the same kind; so that above all, nothing salt, or -acrid, or extenuating be taken; and nothing be used for drink but -water. And with respect to diet, such a regimen is highly necessary. - -Now on the first day of the distemper, it is proper to mix p. i. *. of -saffron, and p. ii. *. of the finest, whitest flour, with the white of -an egg to the consistence of honey; and to spread this upon a piece of -linen, and apply it to the forehead, that by compressing the veins, -it may restrain the violent flux of gum. If saffron cannot be had, -frankincense has the same effect. It makes no difference whether it be -spread upon a bit of linen, or wool. The eyes ought to be anointed with -the following composition: as much saffron as can be held with three -fingers, myrrh, the bigness of a bean, of poppy tears, the bigness of a -lentil, are rubbed down together with passum, and daubed over the eyes -with a probe. Another for the same purpose consists of myrrh, p. i. *. -mandrake juice p. ii. *. poppy tears p. ii. *. rose leaves, hemlock -seed, each p. iii. *. acacia p. iv. *. gum p. viii. *. And these are -applied in the day time; but in the night, for promoting rest, it is -not improper to lay on the crumb of white bread mixed up with wine. For -that both restrains the flux of gum, and if any tears are discharged, -it absorbs them, and does not suffer the eyes to be glued up. - -If the pain of the eyes be so great as to make this application uneasy -and too hard, both the white and yolk of an egg must be dropped into a -cup, and a little mulse added to them, and these mixed with the finger; -when they are incorporated, soft wool combed, ought to be dipped in -it, and saturated with it, and applied over the eyes. This is light, -and by cooling restrains the gum; besides, it does not grow dry, nor -suffer the eye to be glued. Barley-meal also boiled and mixed with a -boiled quince is a proper application. And it is no absurd practice to -use rather a pencillum squeezed out of water, if the disorder be less -severe, if more so, out of vinegar and water. The former applications -are to be bound on with a roller, lest they fall off in the time of -sleep: but it is sufficient to lay the pencillum on the eyes; both -because it can be conveniently replaced by the patient himself, and -because, when it has grown dry, it must be moistened again. If the -disorder is so great as to prevent sleep for a long time, some of -the medicines are to be given, which the Greeks call anodyne: and -for a boy, the bigness of a vetch is a sufficient dose; for a man, -the bigness of a bean. On the first day, it is not fit to inject any -thing into the eye, unless the inflammation be very great: for the -gum is often rather invited than diminished by that means. But on the -second day, even in a severe lippitude, it is proper to relieve by -the injection of medicines, when either the patient has been bled, or -a clyster has been given; or it appears, that neither of these was -necessary. - -There are many collyriums proper for this purpose, invented by -different authors; and new ones may still be made; since lenient and -gently repelling medicines may be easily mixed in various proportions. -I shall mention the most celebrated of them. - -[Sidenote: _Philon’s collyrium._] - -The collyrium of Philon contains of washed ceruss, spodium, gum, each -p. i. *. poppy tears toasted p. i. *. It is fit to know, that all the -ingredients must first be powdered separately, after that mixed and -beat up again, dropping in from time to time, either water or some -other liquid. Gum, as it possesses some other qualities, so has this -peculiar effect upon collyriums, that when they have been long made, -and are grown dry, they continue firmly united, and are not friable. - -[Sidenote: _Dionysius’s._] - -Dionysius’s collyrium: of poppy tears toasted till tender p. i. *. -toasted frankincense, gum, each p. ii. *. spodium p. iv. *. - -[Sidenote: _Cleon’s._] - -Cleon’s is a very famous one: of poppy tears toasted p. i. *. saffron -p. i. *. gum p. *. v. to these, while they are powdered, is added juice -of roses. Another, by the same, stronger; of iron scales, which is -called stomoma[FV] p. i. *. saffron p. ii. *. spodium p. iv. *. lead, -both washed and calcined p. i. *. and the same quantity of gum. There -is still another of the same author’s, chiefly useful where there is -a great flux of gum: of castor p. *. i. aloes p. *. i. myrrh p. *. -ii. prepared cadmia p. viii. *. a like quantity of antimony, juice of -acacia p. xii. *. the mixture may be kept in a small box. But Theodotus -added to this composition toasted poppy tears p. *. i. copper calcined -and washed p. ii. *. date kernels toasted p. x. *. gum p. xii. *. - - [FV] στόμωμα. - -[Sidenote: _The acharistum of Theodotus._] - -But Theodotus’s own, which by some is called acharistum[FW], is thus -made: of castor, Indian nard, each p. i. *. lycium p. *. poppy tears -the same quantity; myrrh p. ii. *. saffron, washed ceruss, aloes, each -p. iii. *. cadmia botryitis washed, calcined copper, each p. viii. *. -gum p. xviii. *. juice of acacia, p. xx. *. antimony the same quantity; -to these is added rain water. - - [FW] ἀχάριστον. - -[Sidenote: _The cythion, or tephrion._] - -Besides these, amongst the most common collyriums is that, which some -call cythion, others from its ash colour, teprion. It contains of -starch, tragacanth, acacia juice, gum, each p. i. *. poppy tears p. ii. -*. washed ceruss p. iv. *. washed litharge p. viii. *. these in the -same manner are beat up with rain water. - -[Sidenote: _The trygodes of Euelpides._] - -Euelpides, who was the greatest oculist in our age, made use of one, -which he had composed himself, and called it trygodes. It contains of -castor p. ii. *. lycium, nard, poppy tears, each p. i. *. saffron, -myrrh, aloes, each p. iv. *. calcined copper p. viii. *. cadmia and -antimony, each p. xii. *. acacia juice p. xxvi. *. gum the same -quantity. - -The more violent any inflammation is, so much the more it requires to -be alleviated by medicines, with the addition either of the white of an -egg, or breast milk. But if neither a physician nor a medicine can be -got, it mitigates the disorder to infuse either of these into the eyes -by a penecillum made for the purpose. But when relief is obtained, and -the flux of gum stops, the slight relics of the disorder, that might -perhaps otherwise continue, are discussed by bathing and drinking wine. -Therefore the patient ought to bathe moderately, being first rubbed -over with old oil, and longer in his legs and thighs than the rest of -his body; and to foment his eyes with plenty of warm water; next to -have warm water first, and afterwards water with the cold just taken -off, poured over his head; after bathing, he must guard against being -exposed to cold, or wind. After this, his diet ought to be somewhat -fuller than formerly(4); but he should abstain from all extenuants -of phlegm: the wine he drinks should be mild, inclining to rough, of -a moderate age; and in this he ought neither to indulge to excess, nor -be too sparing, that the former extreme may not occasion crudity, but -that by a just quantity sleep may be procured, and the acrimony lurking -within may be sheathed. But if a person in the bath has felt more -uneasiness in his eyes than he did before (which usually happens to -those, who have made too much haste to get into it, while the flux of -gum still continued) he ought to come out immediately; to drink no wine -that day; and eat even less than he did the day before. Afterwards, -as soon as the discharge of gum is sufficiently stopt, he must return -again to the use of the bath. - -Nevertheless, it sometimes happens, from some unfavourable circumstance -either in the weather, or habit of the patient, that for several days -neither the pain, nor the inflammation, and least of all, the discharge -of gum ceases. When this is the case, and time itself has brought -the disorder to a full maturity for it, relief is to be sought from -the same remedies, that is, the bath and wine. For though they are -hurtful, while these complaints are recent, because they may irritate -and inflame them; yet in the inveterate, which have not yielded to any -other remedies, they are commonly very efficacious. For in this, as -well as in other cases, when seemingly proper medicines have been tried -in vain, those of a contrary nature give relief. But it is expedient -for the patient, in the first place, to have his hair clipped close -to the skin; next, to foment his head and eyes in the bath, very -plentifully, with warm water; then to wipe both with a penecillum, and -anoint his head with ointment of iris; to lie in bed, till all the -heat acquired in the bath is gone off, and the sweat cease, which was -necessarily collected in his head. Then he should make use of the same -kind of food and wine above recommended, the latter undiluted; and -cover his head, and continue at rest. For after these, either a sound -sleep, or a sweat, or a purging, often puts an end to the discharge -of gum. If the disorder abates (which sometimes does not happen soon) -the same course ought to be pursued for several days, till the cure -be completed. If, on these days, he has no stool, a clyster must be -injected for relieving the superior parts. - -But sometimes a great inflammation arises, and of so violent a nature, -that it propels the eyes from their cavity. The Greeks call this -proptosis[FX], because the eyes fall forward. It is plain such patients -require bleeding, if their strength will admit of it: if that cannot be -done, a clyster is necessary, and long fasting. The mildest medicines -are required _in this case_. Therefore, some use the first of Cleon’s -two collyriums mentioned above. But that of Nileus is the best, and all -authors agree to give it the preference to any other. - - [FX] πρόπτωσις. - -[Sidenote: _Nileus’s collyrium._] - -It is this: Indian nard, poppy tears, of each p. *. gum p. i. *. -saffron p. ii. *. fresh rose leaves, p. iv. *. which are brought to a -consistence, either by rain water, or light wine, inclining to rough. -And it is not improper to boil pomegranate bark, or melilot, in wines, -then to bruise it; or to mix black myrrh with rose leaves; or henbane -leaves boiled with the white of an egg; or meal, with acacia juice, -or passum, or mulse. And if poppy leaves too be added, they will be -somewhat more efficacious. When some one of these is prepared, the eyes -ought to be fomented with a penecillum squeezed out of a warm decoction -of myrtle or rose leaves in water; after that, the medicine is to be -applied. Besides, the skin in the back of the head is to be cut, and a -cupping vessel applied to it. - -If, by these means, the eye is not restored to its place, but -continues prominent as before, we may conclude the eye-sight is gone; -and that the eye will next grow hard, or be converted into pus. If -the suppuration appears in that angle, which is next the temple, an -incision must be made in the eye, that vent being given to the matter, -the inflammation and pain may cease, and the coats _of the eye_ fall -inward, so that the face may be less disfigured afterwards. And then -must be used, either the same collyriums with milk, or an egg; or else -saffron mixed with the white of an egg. But if it has grown hard, and -is mortified, without turning to pus, so much of it must be scooped -out, as to prevent a shocking projection; which must be done thus. The -external coat must be laid hold of with a hook, and below that the -incision made with a knife; then these medicines are to be injected, -till the pain be entirely gone. The same medicines are also necessary -for an eye, that is first protruded, and afterwards bursts in several -places. - -[Sidenote: _Of carbuncles of the eyes._] - -It is not uncommon for carbuncles to proceed from an inflammation, -sometimes in the eyes themselves, sometimes in their lids; and in the -last, they are sometimes in the inside, at other times on the outside. -In this case, a clyster must be given; the quantity of food lessened; -milk allowed for drink; that the offending acrimony may be sheathed. -As to cataplasms and medicines, we must use such as have been proposed -against inflammations. And here also the collyrium of Nileus is the -best. But if the carbuncle be on the external part of the eye-lid, -lintseed boiled in mulse is the most proper for a cataplasm; or if that -is not to be had, wheat meal boiled in the same manner. - -[Sidenote: _Of pustules of the eyes._] - -Sometimes pustules also proceed from inflammations. If this happens in -the beginning of the inflammation, the former directions about bleeding -and rest are even to be more punctually observed; if later than to -admit of bleeding, yet a clyster must be given. If for any reasons that -likewise is impracticable, at least the proper diet must be used. In -this case too, the mild medicines are necessary; such as that of Nileus -or Cleon. - -[Sidenote: _Collyrium of Philes._] - -The collyrium which takes its name from Philes, is also suited to this -disorder. For it contains of myrrh, poppy tears, each p. i. *. washed -lead, Samian earth, which is called after, tragacanth, each p. iv. *. -burnt antimony(5), starch, each p. vi. *. washed spodium, washed -ceruss, each p. viii. *, which are incorporated with rain water. This -collyrium is used mixed either with an egg, or milk. - -From pustules sometimes are generated ulcers; and these, when recent, -are to be dressed with the like lenient medicines, and mostly the same -as I have prescribed above for pustules. There is also a particular -application for them, which is called dialibanou[FY]. It contains of -copper calcined and washed, poppy tears toasted, each p. i. *. spodium -washed, frankincense, antimony calcined and washed, myrrh and gum, each -p. ii. *. - - [FY] διὰ λιβάνου. - -[Sidenote: _Wasting of the eyes._] - -It happens likewise, that the eyes, either one or both, become less -than they ought to be naturally. And this is caused by an acrid flux of -gum in a lippitude, also by continual weeping, and wounds badly cured. -In such cases, the same mild medicines with breast milk are to be used; -and such food as most nourishes and fills the body; and the patient -must carefully avoid whatever occasions weeping, and all the anxiety of -domestic affairs: and if any misfortune happens likely to disturb him, -it must be concealed from his knowledge: acrid medicines and acrid food -hurt by occasioning tears, as much as any other way. - -[Sidenote: _Lice in the eye-lids._] - -There is a peculiar kind of disorder, in which lice are generated -amongst the hair of the eye lids. This the Greeks call phthiriasis[FZ]. -Which arising from a bad habit of body, seldom stops there; but -generally after some time there follows a smart flux of gum; and the -eyes themselves being greatly ulcerated, it even destroys the sight. - - [FZ] φθειρίασις. - -Such patients must be purged by clysters; the hair of their head -clipped close to the skin, and the head rubbed for a long time -every day fasting. They must diligently practise walking, and other -exercises; gargle with a decoction of catmint and a mellow fig in -mulse; foment the head often in the bath with plenty of warm water; -avoid acrid food; use good milk and wine, and also drink more freely -than they eat. Medicines too are to be given internally, of a mild -nature, that they may not generate any acrid gum; and others externally -applied to kill the lice, and prevent the production of more. For this -purpose, of aphronitre p. i. *. sandarach p. i. *. stavesacre p. i. *. -are powdered together, and then equal quantities of old oil and vinegar -are added, till the whole come to the consistence of honey. - -Thus much of those distempers of the eyes, which are cured by mild -medicines. There are besides these, other kinds, which require a -different treatment, commonly proceeding from inflammations, but -continuing even after they - -[Sidenote: _Collyrium of Andreas._] - -are gone. And in the first place, a flux of thin gum continues in -some. To such patients clysters should be given, and their quantity of -food diminished. Neither is it improper to anoint the forehead with -the composition of Andreas: which consists of gum p. i. *. ceruss, -antimony, each p. ii. *. litharge boiled and washed p. iv. *. the -litharge is boiled in rain water; and the dry medicines are rubbed with -the juice of myrtle. These being spread upon the forehead, a cataplasm -of meal is also to be applied over it, made into a paste with cold -water, and with the addition either of acacia juice or cypress. It is -proper also to make an incision on the top of the head, and apply a -cupping vessel there; or to bleed at the temples. The eye ought to be -anointed with that composition, which contains of copper scales, poppy -tears, each p. *. hartshorn calcined and washed, washed lead, gum, each -p. iv. *. frankincense p. xii. *. Now this collyrium, because horn is -one of the ingredients, is called diaceratos[GA]. As often as I do not -subjoin what kind of moisture is to be added, I would be understood to -intend water. - - [GA] διὰ κέρατος. - -[Sidenote: _The memigmenon of Euelpides._] - -For the same purpose is that of Euelpides, which he called -memigmenon[GB]. In it there are poppy tears and white pepper, of -each an ounce, gum a pound, calcined copper p. i. *. During this -course, with some intervals, the bath and wine are serviceable. And as -extenuating food must be avoided by all that labour under a lippitude; -so particularly by those that have for a long time a flux of thin -humour. But if they be surfeited with such food as generates a thicker -phlegm, as is most common in this kind of diet, they must have recourse -to that, which because it binds the belly, constringes the body too. - - [GB] μεμιγμένον. - -But ulcers, that do not go off with the inflammation, generally either -grow fungous, or foul, or at least inveterate. Their excrescences are -best suppressed by the collyrium called memigmenon. The foul ones are -deterged both by the same, and by that, which is called smilion. - -[Sidenote: _Smilion._] - -This contains of verdigrease p. vi. *. gum the same quantity, -ammoniacum, minium from Sinope, each p. xvi. *. these are rubbed down -by some with water, by others, to make them stronger, with vinegar. - -[Sidenote: _Phynon of Euelpides._] - -That of Euelpides, which he called phynon, is also suitable to this -case; of saffron p. i. *. poppy tears, gum, each p. ii. *. copper -calcined and washed, myrrh, each p. iv. *. white pepper p. vi. *. But -the application of this must be preceded by an ointment. - -[Sidenote: _Sphærion of the same author._] - -The collyrium of the same author, to which he gave the name of -sphærion, is of like virtue; of bloodstone washed p. ii. *. pepper six -grains, cadmia washed, myrrh, poppy tears, each p. iii. *. saffron p. -iv. *. gum p. viii. *. which are rubbed down with Aminæan wine. - -[Sidenote: _A liquid medicine by the same._] - -He likewise compounded a liquid medicine for the same purpose, in -which were the following things; of verdigrease p. *. minium calcined, -copperas, cinnamon, each p. iii. *. saffron, nard, poppy tears, each p. -i. *. myrrh p. ii. *. calcined copper p. iii. *. aromatick ashes p. iv. -*. pepper fifteen grains. These are rubbed with a rough wine, and then -boiled with three heminæ of passum, till the whole unites. And this -medicine becomes more efficacious by keeping. - -For filling the cavities of ulcers _of the eyes_, the best of all those -we have mentioned are the sphærion and the collyrium of Philes. The -same sphærion is an excellent medicine for inveterate ulcers, and such -as can scarcely be brought to cicatrize. - -[Sidenote: _Hermon’s._] - -There is also a collyrium, which though it be serviceable in many -cases, yet seems to be most efficacious in these ulcers. It is said to -be invented by Hermon. It contains of long pepper p. i. *. z. *. white -pepper p. *. cinnamon, costus, each p. i. *. copperas, nard, cassia, -castor, each p. ii. *. galls p. v. *. myrrh, saffron, frankincense, -lycium, ceruss, each p. viii. *. poppy tears p. xii. *. aloes, calcined -copper, cadmia, each p. xvi. *. acacia, antimony, gum, each p. xxv. *. - -[Sidenote: _Asclepias._] - -[Sidenote: _Canopite._] - -[Sidenote: _Pyxinum of Euelpides._] - -Cicatrices formed from ulcers are liable to two defects; of being -either concave, or protuberant. If they be concave, they may be filled -by the sphærion collyrium; or that called asclepias. This consists of -poppy tears p. ii. *. sagapenum, opopanax, each p. iii. *. verdigrease -p. iv. *. gum p. viii. *. pepper p. xii. *. cadmia washed, ceruss, each -p. xvi. *. But if the cicatrices are thick, they are rendered thin -by the smilion, or canopite collyrium, which last contains cinnamon, -acacia, of each p. i. *. cadmia washed, saffron, myrrh, poppy tears, -gum, each p. ii. *. white pepper, frankincense, each p. iii. *. -calcined copper p. ix. *. with rain water. Or the pyxinum of Euelpides, -which consists of the following ingredients; of fossile salt p. iv. -*. ammoniacum thymiama p. viii. *. poppy tears p. xiii. *. ceruss p. -xv. *. white pepper, Cilician saffron, each p. lii. gum p. xiii. *. -cadmia washed p. ix. *. Yet the composition, which contains gum p. iii. -*. verdigrease p. i. *. crocomagma p. iv. *. seems to be the best for -removing a cicatrix. - -There is also another kind of inflammation, in which if the patient’s -eyes swell, and are distended with pain, it is necessary to bleed in -the forehead; and to foment the head and eyes plentifully with hot -water; to gargle with lentils, or cream of figs; to anoint with the -acrid medicines mentioned above; particularly that, which is called -sphærion, and which has blood-stone in it. And others are useful too, -which are calculated to lessen the roughness; of which I am going to -speak. - -This commonly follows an inflammation of the eyes; sometimes it is -more violent, at other times more slight. Sometimes too a roughness -occasions a lippitude, and that again increases the roughness, and in -some is short, in others it continues long, and so as to be hardly ever -cured. - -In this kind of disorder some scrape the thick and hard eye-lids -both with a fig-leaf and a specillum asperatum(6), and sometimes -with a knife; and turning them up, they rub them every day with -medicines. Which ought not to be practised, unless in a considerable -and inveterate roughness, nor that often. For the same end is better -obtained by a suitable regimen and proper medicines. Therefore we shall -use exercises and the bath more frequently: and foment the eye-lids -with plenty of warm water. The food must be acrid and extenuating. - -[Sidenote: _Cæsarian._] - -The medicine, which is called Cæsarian, contains of copperas p. i. -*. misy p. *. white pepper p. v. *. poppy tears, gum, each p. ii. *. -cadmia washed p. iii. *. antimony p. vi. *. And this collyrium is -allowed to be a good remedy against every kind of disorder in the eyes, -except those, that are treated by mild medicines. - -[Sidenote: _Hierax’s._] - -That also, which is called Hierax’s, is powerful against a roughness. -It consists of myrrh p. *. ammoniacum thymiama p. ii. *. rasile -verdigrease p. iv. *. with rain water. For the same purpose that -also is proper, which is called canopite, and the smilion, and the -pyxinum, and the sphærion. But if compound medicines are not at hand, a -roughness may be easily enough cured by goat’s gall or the best honey. - -[Sidenote: _Dry lippitude._] - -There is likewise a kind of dry lippitude, which the Greeks call -xerophthalmia[GC]. In this the eyes neither swell, nor run, but are -only red, and heavy with some pain, which is commonly slight, also an -itching, and the eye-lids without any hardness stick together in the -night-time by means of a very troublesome gum: and the less violent in -its degree this species is, so much the longer does it continue. - - [GC] ξηροφθαλμία. - -In this disorder it is necessary to walk much, to take much exercise, -to bathe often, and sweat in the bagnio, to use much friction. The -proper diet is neither such as is filling, nor over acrid, but the -middle kind betwixt these. In the morning, when it is evident that the -concoction is completed, it is not improper to gargle with mustard, and -alter that to rub the head and face a considerable time. - -[Sidenote: _Rhinion._] - -The collyrium best adapted to this case is that called rhinion. Which -contains of myrrh p. i. *. poppy tears, acacia juice, pepper, gum, each -p. i. *. blood-stone, Phrygian stone, lycium, scissile stone, each p. -i. *. calcined copper p. iv. *. The pyxinum also is suitable for the -same purpose. - -[Sidenote: _Basilicon of Euelpides._] - -But if the eyes be scabrous, which mostly happens in the angles, the -rhinion mentioned already may be serviceable. For the same purpose -that may be useful, which contains, of rasile verdigrease, long pepper, -poppy tears each p. ii. *. white pepper, gum, each p. iv. *. cadmia -washed, ceruss, each p. vi. *. However, there is none better than that -of Euelpides, which he called basilicon. It contains of poppy tears, -ceruss, Asian stone, each p. ii. *. gum p. xiii. *. white pepper p. iv. -*. saffron p. vi. *. psoricum(7) p. xiii. *. Now there is no simple, -which by itself is called psoricum; but a certain quantity of chalcitis -and a little more than half its quantity of cadmia are rubbed together -with vinegar; and this being put into an earthen vessel, and covered -over with fig leaves, is deposited under ground for twenty days, and -being taken up again it is powdered, and thus is called psoricum. The -basilicon collyrium too is generally allowed to be proper for all -disorders of the eyes, that are not treated by mild medicines. - -But when compound medicines are not to be had, both honey and wine -mitigates an asperity in the angles. These and a dry lippitude too are -relieved by an application of bread, softened with wine, over the eyes. -For since there is generally a humour, which exasperates sometimes the -eye itself, sometimes the angles, or eyelids; by this application, if -any humour is discharged, it is drawn away, and if it happens to be -lodged near, is repelled. - -[Sidenote: _Of a dimness of the eyes._] - -A dimness comes upon the eyes, sometimes from a lippitude, at other -times even without that, from old age, or weakness. If the disorder -proceeds from the relics of a lippitude, the collyrium called asclepias -is serviceable. Likewise that, which is composed of crocomagma. - -The collyrium which is called diacrocou[GD] is composed peculiarly for -this. It contains of pepper p. i. *. Cilician saffron, poppy tears, -ceruss, each p. ii. *. psoricum, gum, each p. iv. *. - - [GD] διὰ κρόκου. - -But if it arises from old age, or weakness, it may be proper to anoint -with the best honey, and cyprine and old oil. But it is most expedient -to mix together one part of balsam, and two of old, or cyprine oil, -and three parts of the most pungent honey. The medicines prescribed -above for a dimness _from a lippitude_, and those mentioned before for -diminishing cicatrices, are useful in this case too. - -Whoever is troubled with a dimness must walk much, use exercise, -frequent bathing, at which time the whole body must be rubbed, but -principally the head, with iris ointment till it sweat; after that it -must be veiled, and not uncovered, till after he has got home, and -the sweat and heat have ceased. Then he must keep to an acrid and -extenuating diet; and after the interval of some days use a gargarism -of mustard. - -[Sidenote: _Of a cataract._] - -A suffusion also, which the Greeks call hypochysis[GE], sometimes -obstructs the pupil of the eye, where vision is performed. If this -disorder be inveterate, it requires an operation to remove it. At the -beginning sometimes it is discussed by certain methods adapted to the -case. It is expedient to bleed in the forehead, or nose; to cauterize -the veins in the temples; by the use of gargarisms to evacuate phlegm; -to use fumigations; to anoint the eyes with acrid medicines. The best -diet is such as extenuates phlegm. - - [GE] ὑπόχυσις. - -[Sidenote: _A palsy of the eyes._] - -Nor is a palsy of the eyes (which the Greeks call paralysis) to be -cured by any different diet, or different medicines, so that it is -needless to do more than describe the distemper. It happens then -sometimes in one eye, sometimes in both, either from a blow, or from -an epilepsy, or spasms, where the eye itself is strongly convulsed, so -that it can neither be directed to any particular object, nor be kept -fixed; but moves to and fro involuntarily; and therefore cannot see any -thing distinctly. - -[Sidenote: _Of a mydriasis._] - -What the Greeks call a mydriasis[GF] is not very different from this -distemper. The pupil is dilated, the sight grows dull, and almost dim. -This kind of weakness is extremely difficult to remove. Against both -disorders, that is, the palsy and mydriasis, we must use the same -remedies as have been prescribed in the dimness of the eyes, with a few -alterations; thus for the head, to the iris oil must be added sometimes -vinegar, sometimes nitre; it is sufficient to anoint the eyes with -honey. In the latter disorder some have made use of hot waters(8), -and been relieved; others without any apparent cause have suddenly lost -their sight. Some of these, after continuing blind for some time, from -a sudden purging have recovered their sight: whence it seems the less -improper, both when the disorder is recent, and when it is of some -standing, to procure stools by medicines, in order to force all the -noxious matter into the lower parts. - - [GF] μυδρίασις. - -[Sidenote: _A weakness of the eyes._] - -Besides these, there is a kind of weakness of the eyes, in which -patients see well enough in the day-time, but not at all in the night: -which never happens to a woman, when her menstrual discharge is -regular. But persons labouring under this disorder ought to be anointed -with the blood of a liver (particularly the liver of a he-goat; if -that cannot be had, of a she-goat) that drops from it while roasting; -and they ought to eat the liver itself. They may nevertheless not -improperly make use of the same medicines, that extenuate either -cicatrices, or an asperity. Some powder the seed of purslane, and add -honey to it, till the mixture be of such a consistence, as not to -drop off a probe, and anoint with that. They must also use exercises, -bathing, frictions. - -[Sidenote: _Of external hurts in the eyes._] - -These disorders all arise from internal causes. But externally the eye -may be hurt by a blow, so as to become bloodshot. There is nothing -more proper for this case than anointing with the blood of a pigeon, -or ringdove, or swallow. Nor is this practice without reason; since -the sight of these birds being hurt by some accident, in a little time -is restored, and that of the swallow soonest; which gave rise to the -fable, that their parents perform by an herb the cure, which is really -the work of nature. Their blood therefore is a very proper remedy for -our eyes in external hurts, in these different degrees of efficacy; -the blood of a swallow is best, next to that of a ringdove; that of a -pigeon is least medicinal both to itself and us. - -Over an eye that has received a blow, in order to assuage the -inflammation, it is also proper to apply cataplasms. Now sal ammoniac, -or any other, ought to be very finely powdered, oil being dropped in by -degrees, till it acquire the consistence of strigment. Then this is to -be mixed with barley-meal boiled in mulse. Upon a review of all the -cures published, even by physicians, it is easy to see, that there is -hardly one of the abovementioned disorders of the eyes, which may not -be sometimes removed by very simple and obvious remedies. - - - - -CHAP. VII. - -OF THE DISEASES OF THE EARS. - - -Thus far we have recited those disorders of the eyes, in which -medicines are most efficacious; we must now proceed to the ears; the -part, which nature has bestowed upon us next in usefulness to the eyes. -But in these the danger is much greater. For the mischief arising -from the distempers of the eyes is confined to themselves; whereas -inflammations and pains of the ears sometimes occasion madness and -death: which makes it the more necessary to administer speedy relief in -their beginnings, to prevent any greater danger. - -Wherefore, when a person first feels a pain, he ought to fast, and -observe a strict regimen; the day following, if the disorder increases, -to clip the hair of his head, and anoint it all over with ointment of -iris warm, and to cover it. But a violent pain attended with a fever, -and watching, requires also bleeding. If particular circumstances -prevent that, the body must be kept open. Hot cataplasms too, -frequently changed, are serviceable; either of the meal of fenugreek, -or lint-seed, or any other, boiled in mulse. Spunges also squeezed out -of hot water are proper to apply now and then. When the pain is eased, -cerate made either of iris or cyprine oil ought to be put round it. In -some, however, that which is made of oil of roses, succeeds better. If -a violent inflammation prevents sleep entirely, to the cataplasm ought -to be added half its quantity of poppy heads toasted and powdered; and -then these may be boiled together in passum, or mulse. It is proper too -to infuse some medicine into the ear: which ought always to be made -tepid first, and is most conveniently dropped in by a strigil(9). -When the ear is filled, soft wool is to be put into it to keep the -liquor from returning. And these are general remedies. - -Now the medicines _for injection_ are the juice of roses, and the -roots of reeds, and oil, in which worms have been boiled, and the -liquor of bitter almonds, or that, which is pressed from a peach -kernel. The compositions for alleviating the inflammation and pain are -generally these; of castor, poppy tears, equal quantities powdered, -and afterwards mixed with passum. Or equal quantities of poppy -tears, saffron, and myrrh are beat, rose oil and passum being added -alternately. Or the bitter part of an Egyptian bean is powdered, and -rose oil added to it: with which some also mix a little myrrh, or -poppy tears, or frankincense with breast milk, or the juice of bitter -almonds with rose oil. Or castor, myrrh, and poppy tears in equal -quantities, with passum. Or of saffron p. i. *. myrrh, scissile allum, -each p. iii. *. and in powdering these, three cyathi of passum are to -be gradually mixed with them, and less than a cyathus of honey. This is -one of the principal remedies. Or poppy tears with vinegar. We may also -use Themison’s composition, which consists of castor, opopanax, poppy -tears with vinegar, each p. ii. *. aphronitre p. iv. *. which being -powdered are incorporated with passum, till they be of the consistence -of cerate; and so laid by. When they are wanted for use, the medicine -is again rubbed down by a pistil, with the addition of passum. This is -a constant rule, whenever a medicine is too thick for dropping into the -ear, that liquor must be added, with which it ought to be compounded, -till it be sufficiently fluid. - -[Sidenote: _Of pus in the ears._] - -But if there is pus in the ears, it is proper to infuse lycium by -itself; or ointment of iris; or juice of leek, with honey; or juice of -centory with passum; or juice of a pomegranate warmed in its own shell, -with the addition of a small proportion of myrrh. A proper mixture -is also made of the myrrh called stacte p. i. *. the same quantity -of saffron, twenty five bitter almonds, a cyathus and half of honey; -which being rubbed together, are to be warmed in a pomegranate shell, -when they are to be used. Those medicines, which are compounded for an -ulcerated mouth, are equally sanative to ulcers of the ears. If these -be of pretty long standing, and there is a great discharge of sanies, -the proper composition is that generally ascribed to Erasistratus. It -contains of pepper, saffron, each p. i. *. myrrh, misy calcined, each -p. ii. *. calcined copper p. ii. *. These are rubbed down with wine; -when they are grown dry, three heminae of passum are added, and they -are boiled together. When they are to be used, honey and wine are added -to them. There is also a medicine of Ptolemaeus the surgeon; which -contains mastich, galls, of each p. i. *. omphacium p. i. *. juice of -the pomegranate. That of Menophilus is very efficacious, which consists -of the following things; of long pepper p. i. *. castor p. ii. *. -myrrh, saffron, poppy tears, Syrian nard, frankincense, pomegranate -bark, the inner part of an Egyptian bean, bitter almonds, the best -honey, each p. iv. *. When they are powdered, the sharpest vinegar is -added, till the whole be of the consistence of passum. There is also -a composition of Crato’s; of cinnamon, cassia, each p. i. *. nard, -lycium, myrrh, each p. i. *. aloes p. ii. *. honey, three cyathi, wine -a sextarius. Of these the lycium is boiled with the wine; after that -mixed with the other ingredients. But if the quantity of pus be great, -and there is a bad smell; of rasile verdigrease, frankincense, each p. -ii. *. honey, two cyathi, of vinegar four, are boiled all together. -When the composition is to be used, it is mixed with sweet wine. -Or scissile allum, poppy tears, juice of acacia are mixed in equal -quantities, and to these is added juice of henbane less than half the -quantity of any of the other ingredients; and these being powdered are -diluted with wine. The juice of henbane too by itself is pretty good. - -Asclepiades compounded a general remedy against all disorders of the -ears, which is now approved by experience. In it there are of cinnamon, -cassia, each p. i. *. flowers of round cyperus, castor, white pepper, -and long, amomum, myrobalans, each two scruples, male frankincense, -Syrian nard, fat myrrh, saffron, aphronitre, each p. ii. *. Which -being powdered separately, and afterwards mixed, are rubbed down with -vinegar; and being thus preserved are diluted with vinegar when used. -In the same manner, the sphragis of Polybus liquified with sweet wine, -is a general remedy for disorders in the ears; which composition is -contained in the former book. - -But if sanies is discharged, and there is a tumour, it is not improper -to wash it with diluted wine by a syringe; and then to infuse rough -wine mixed with oil of roses, and the addition of a little spodium, or -lycium with milk, or the juice of the blood herb, with oil of roses, or -juice of pomegranate with a very small proportion of myrrh. - -If there are also foul ulcers, it is better to wash them with mulse; -and after that, some one of the compositions mentioned above, that -contains honey, is infused. If the pus flows more plentifully, in -that case, the hair of the head is to be clipped close, and plenty of -warm water poured over it; also gargarisms must be used, and walking -to lassitude, with a sparing diet. If blood likewise appears from the -ulcers, lycium with milk ought to be infused; or a decoction of roses -in water; with the addition of the juice either of blood herb, or -acacia. - -But if a fungus has grown upon the ulcers, which is fetid, and -discharges blood, it ought to be washed with tepid water; and after -that, the composition infused, which is made of frankincense, -verdigrease, vinegar, and honey; or honey boiled with verdigrease. -Copper scales too with sandarach, powdered, is proper to be dropped in -by a pipe. - -[Sidenote: _Of worms in the ears._] - -When worms are generated there, if they be within reach, they must be -drawn out with a specillum oricularium(10), if farther in, they must -be killed by medicines; and means used to prevent the breeding of more. -White hellebore powdered with vinegar, answers both these intentions. -The ear ought to be washed also with a decoction of horehound in wine. -Thus, the worms being killed slide down into the entrance of the ear, -from whence they may be taken out with very great ease. - -[Sidenote: _Obstructions in the ears._] - -If the orifice of the ear be straitened, and a thick sanies is -contained within, the best honey ought to be put into it. If that does -little good, to a cyathus and half of the best honey must be added of -rasile verdigrease p. ii. *. which are to be boiled together, and made -use of. Iris also with honey is good for the same purpose. Likewise of -honey and oil of roses two scruples. Also of galbanum p. ii. *. myrrh -with honey, and ox-gall, each p. ii. *. wine a sufficient quantity to -dilute the myrrh. - -[Sidenote: _Dulness of hearing._] - -When a person grows dull of hearing, (which most commonly happens after -long pains of the head) in the first place, it is proper to inspect the -ear itself. For there will appear either a crust, such as grows upon -ulcers, or a collection of the cerumen. If there is a crust, either -warm oil must be infused, or verdigrease with honey, or juice of leek, -or a little nitre with mulse. And when this crust falls forward, it -must be washed with tepid water, that after it has fairly disengaged -itself it may be the easier pulled out by the specillum oricularium. -If there be cerumen, and this is soft, it must be taken out with the -same instrument. But if it be hard, vinegar, and a little nitre with it -must be injected; and when it is softened, the ear should be washed in -the same manner, and cleansed. And if a heaviness of the head remain, -the hair must be clipped, and the head gently rubbed, but a long time, -with the oil of iris or laurel, and with either of these may be mixed -a little vinegar: then the patient must take a long walk, and after -anointing, foment the head gently with warm water; and make use of -food of the weakest and middle class, and more especially take diluted -drinks; sometimes use gargarisms. Into the ear must be infused castor, -with vinegar and laurel oil, and the juice of radish rind, or the juice -of wild cucumber, with the addition of rose leaves powdered. The juice -also of unripe grapes infused with oil of roses, is pretty good against -a deafness. - -[Sidenote: _Of a noise in the ears._] - -The disorder is of a different nature, where there is a noise within -the ears themselves: and this prevents them from receiving an external -sound. This is slightest, when it proceeds from a gravedo; worse, -when it is occasioned by a distemper or inveterate pains of the head; -worst of all, when it is the harbinger of some violent disease, and -particularly of an epilepsy. If it happens from a gravedo, the ear -ought to be cleansed, and the patient hold in his breath, till some -frothy moisture issue from it. If, from a distemper, or pain of the -head, the same rules _as prescribed in a dulness of hearing_, must -be practised with regard to exercise, friction, pouring on of cold -water, and the use of gargarisms; no food but such as extenuates must -be used; juice of radish, with oil of roses, or with the juice of the -root of wild cucumber, must be infused into the ear, or castor with -vinegar and laurel oil. Hellebore is also rubbed with vinegar, then -incorporated with boiled honey, and being made into a collyrium, is -introduced into the ear. If it has begun without these, and therefore -gives reason to fear the approach of some terrible disease, castor -ought to be infused into the ear with vinegar, or oil, either of iris -or laurel; or together with the last, castor and the juice of bitter -almonds; or myrrh and nitre with oil of roses and vinegar. But a proper -diet is more serviceable in this case too. And the same rules are to -be observed, which I prescribed above, even with greater exactness; -besides which, the patient must refrain from wine, till the noise cease. - -But if, at the same time, there are both a noise and an inflammation, -it is sufficient to inject laurel oil, or that, which is expressed from -bitter almonds; with which, some mix either castor or myrrh. - -[Sidenote: _Of extraneous bodies in the ears._] - -It sometimes happens too, that something falls into the ear, as a -small stone, or some animal. If a flea has got into it, a little wool -must be pressed in; and if it comes upon that, it is drawn out along -with it. If it has not followed it, or it be any other animal, a probe -wrapt in wool must be dipped in the most adhesive resin, particularly -turpentine, and this is to be introduced into the ear, and turned round -there: for it will certainly catch hold of it, and bring it away. But -if it be any lifeless thing, it must be drawn out by the specillum -oricularium, or a blunt hook, but little bent. If these means do not -succeed, it may be drawn out by resin, in the same manner as directed -in the preceding case. Sternutatories also are very proper to force it -out, or water strongly injected by a syringe. _The following method is -also practised in this case_; a board is laid down(11), supported in -the middle, with both ends hanging over, and the patient is tied upon -that, lying on that side, the ear of which is affected, so that he does -not reach over the board; then the end of the board, where his feet -are, must be struck with a hammer, and thus by shaking the ear, what is -within it drops out. - - - - -CHAP. VIII. - -OF THE DISEASES OF THE NOSE. - - -Ulcers in the nostrils must be fomented with the steam of hot water. -This is done both by applying a squeezed sponge, and putting under the -nostrils a narrow-mouthed vessel filled with hot water. After this -fomentation, the ulcers are to be anointed either with dross of lead, -or ceruss, or litharge. When a person powders any of these, he may add, -while they are rubbed, alternately, wine and myrtle oil, till he make -it of the consistence of honey. But if these ulcers be near the mouth, -and have several crusts, and a fetid smell, which kind the Greeks call -ozaena[GG], we may take it for granted, that it is hardly possible to -cure that disease. Nevertheless, the following things may be tried; -to clip the hair of the head close to the skin, and daily to rub it -briskly, and pour plenty of warm water over it; to walk much; to eat -sparingly, and such food as is neither acrid nor of the strongest kind. -Then to put into the nostril honey, with a very little turpentine resin -(which is done by a probe, wrapt up in wool) and let this moisture -be drawn in by the breath, till the taste of it be perceived in the -mouth. For by these means, the crusts are loosened, which ought then -to be discharged by sneezing. The ulcers being thus cleansed must be -fumigated with the vapour of hot water; afterwards should be applied, -either lycium diluted with wine, or the lees of oil, or omphacium, or -juice of mint, or of horehound; or copperas that has been burnt white, -and then powdered; or the pulp of a squill bruised; to any of these -honey may be added, of which in the other mixtures there ought to be -only a very small part; with the copperas so much as to make it liquid; -but with the squill a considerable quantity; then the end of a probe -must be wrapped in wool, and dipped in the medicine; and by that the -ulcers are to be incarned. And further, a piece of lint is to be rolled -up in an oblong form, and dipped in the same medicine, which is to be -introduced into the nostril, and loosely tied at the lower part. This -ought to be done twice a day, in the winter and spring, and thrice in -the summer and autumn. - - [GG] ὄζαινα. - -[Sidenote: _Of fleshy caruncles in the nostrils._] - -Sometimes in the nostrils there grow caruncles resembling womens’ -nipples, and these adhere to its extremities, where it is -cartilaginous. These ought to be treated with escharotic medicines; -by which they are certainly consumed. A polypus[GH] is a caruncle -sometimes white, sometimes inclining to a red colour, which sticks -to the bones of the nostrils; and sometimes spreading towards the -lips, it fills the nostril, at other times reaching backward through -the opening, by which the breath passes from the nose to the fauces, -increases so much, that it may be seen behind the uvula; and almost -suffocates the patient, especially when the south or east wind blows. -It is generally soft, seldom hard; and the latter obstructs the breath -more, dilates the nostrils, and is commonly of the cancerous nature, -and therefore ought not to be touched. The other kind is generally -cured by cutting; sometimes, however, it withers, if by means of lint -or a pencillum, that composition be thrust up into the nose, which -contains of Sinopian minium, chalcitis, lime, sandarach, each p. i. *. -copperas p. ii. *. - - [GH] πολύπους. - - - - -CHAP. IX. - -OF THE TOOTHACH. - - -In the toothach, a disorder, that may justly be ranked even amongst -the greatest torments, the use of wine must be entirely forbid; and at -first a total abstinence from food must be observed; afterwards it may -be taken sparingly, but soft, lest the teeth be irritated by chewing. -Then externally, by means of a sponge, the steam of hot water is to be -applied, and a cerate made of cyprine, or iris oil spread upon wool, -and the head must also be covered. But if the pain be more severe, a -clyster is useful, with hot cataplasms applied to the cheek, as also -some medicinal hot liquor held in the mouth, and frequently changed. -For which purpose is used a decoction of cinquefoil root in diluted -wine; and henbane root, either in vinegar and water, or diluted wine, -with the addition of a little salt to either of them; and poppy heads -not over dry, and mandrake root prepared in the same manner. But in -these three, care must be taken not to swallow what is in the mouth. -The bark of the root of white poplar, boiled in diluted wine, does very -well for this purpose; or hartshorn shavings in vinegar, and catmint -with teda(12), and a mellow fig; also a mellow fig, either in mulse -or in vinegar and honey, and when the fig is dissolved by boiling, -the liquor is strained. A probe also wrapt up in wool is dipped into -hot oil; and used to touch the tooth itself. Moreover, something like -cataplasms are put into the tooth. For which end the inner part of -the shell of an acid and dry pomegranate is powdered, with an equal -quantity of galls and pine bark, and with these is mixed minium; -which being powdered, are brought to a consistence with rain water; -or panaces, poppy tears, hog’s fennel, stavesacre without its seeds, -powdered in equal proportions; or three parts of galbanum, and a fourth -of poppy tears. Whatever is applied to the teeth, a cerate, such as -is directed above, ought, nevertheless, to be kept upon the cheek, -and covered with wool. Some also bruise and spread upon linen, myrrh, -cardamoms, of each p. i. *. saffron, pellitory, figs, pepper, each p. -iv. *. mustard p. viii. *. and apply this to the arm of that side, -where the painful tooth is; if it be in the upper jaw, in the part -next the scapula; if in the lower, on that next the breast; and this -relieves the pain; and when it has given ease, it must be immediately -taken away. - -Now if the tooth be spoilt, we need not be hasty in extracting it, -unless there be a necessity for it; but in such a case, to all the -fomentations directed before, must be added some stronger compositions -to ease the pain. Such as is that, which contains of poppy tears p. -i. *. pepper p. ii. *. sory(13) p. x. *. these are powdered and -mixed up with galbanum, and put round the affected tooth; or that of -Menemachus principally for double teeth, in which are of saffron p. i. -*. cardamoms, soot of frankincense, figs, pepper, pellitory, each p. -iv. *. mustard p. viii. *. Some mix of pellitory, pepper, elaterium, -each p. i. *. scissile allum, poppy tears, stavesacre, crude sulphur, -bitumen, bay-berries, mustard, of each p. ii. *. But if the pain make -it necessary to take it out, a pepper corn stript of its bark, and in -the same manner an ivy berry put into its opening, splits the tooth, -so that it comes away in scales. The prickle of the planus fish also -(which we call pastinaca, the Greeks trygon) is toasted, then powdered, -and mixed with resin, which being put round the tooth loosens it. -Scissile alum likewise put into the opening disposes the tooth to -come away. But it is more expedient to wrap this in a little wool, -and then put it in: because in that way it both preserves the tooth, -and eases the pain. These are the prescriptions of physicians; but -the experience of our peasants has discovered, that for the toothach -the herb horsemint ought to be pulled up by the roots, and put into a -bason, and water infused upon it, and that the patient should sit down -close by it, covered all over with clothes; and then red hot flints are -to be thrown into the bason, so as to be covered with the water, and -the patient with his mouth open must receive the vapour, close wrapt up -as before directed. For both a plentiful sweat follows, and a continued -stream of rheum runs from the mouth, which secures health for a pretty -long time, and frequently for a whole year. - - - - -CHAP. X. - -OF THE DISEASES OF THE TONSILS. - - -If the tonsils swell from an inflammation without an ulcer, the -head must be covered as in the last disorder, and the part fomented -externally with the vapour of hot water; the patient must walk much; -lie in bed with his head raised; and use gargarisms of the repellent -medicines. The liquorice root too bruised, and boiled in passum or -mulse, has the same effect. And it is not amiss to touch them gently -with some medicines, which are made in this manner: the juice is -squeezed from a sweet pomegranate, and a sextarius of this is boiled -over a gentle fire to the consistence of honey; then saffron, myrrh, -scissile alum, of each p. ii. *. are powdered separately, and to these -are added gradually two cyathi of mild wine, of honey one; after that, -they are mixed with the first mentioned juice; and again gently boiled; -or a sextarius of the same juice is boiled in the same way, and the -following things powdered in like manner are added to it; of nard p. -*. omphacium p. i. *. cinnamon, myrrh, cassia, each p. i. *. And these -same compositions are proper both for purulent ears and nostrils. The -food in this disorder also ought to be mild, lest it exasperate the -inflammation. - -But if the inflammation is so great as to obstruct the breath, the -patient must rest in bed, abstain from eating, and take nothing else -but warm water: a clyster must also be given, and a gargarism used -of figs and mulse; and the part touched with honey and omphacium. -Externally the hot vapour must be applied, but for a longer time, till -they suppurate and break of themselves. If pus is contained within, and -the tumours do not break, they must be cut. Afterwards the patient must -gargle with warm mulse. - -But if with an inconsiderable swelling there is an ulceration, for a -gargarism there must be added to the cream of bran a little honey, -and the ulcers are to be anointed with the following medicines: three -cyathi of the sweetest passum are boiled into one; then is added of -frankincense p. i. *. saffron, myrrh, each p. *. and the whole is set -upon the fire again, till it boil. When the ulcers are clean, he must -gargle with the same cream of bran, or with milk. And in this case also -a mild diet is necessary; to which may be added sweet wine. - - - - -CHAP. XI. - -OF ULCERS OF THE MOUTH. - - -Ulcers of the mouth, if they be attended with an inflammation, and -are foul and red, are best treated by the medicines prepared from -pomegranates mentioned before. And a repellent cream, with the addition -of a little honey, is to be held in the mouth often; the patient must -walk, and avoid all acrid food. When the ulcers begin to be clean, -a mild liquor, and sometimes the best water is to be kept in the -mouth: and the use of wine undiluted does service, also a fuller diet, -provided it be not at all acrid. The ulcers ought to be sprinkled with -scissile allum, and a little more than half its quantity of unripe -galls. - -If they are already covered with crusts, such as we find in burns, the -compositions which the Greeks call antherae[GI] are to be applied. -These contain of long cyperus, myrrh, sandarach, allum, equal parts; -or, of saffron, myrrh, each p. ii. *. iris, scissile allum, sandarach, -each p. iv. *. long cyperus p. viii. *. Or, of galls, myrrh, each -p. ii. *. scissile allum p. ii. *. rose leaves, p. iv. *. But some -mix together of saffron p. *. scissile allum, myrrh, each p. i. *. -sandarach p. ii. *. long cyperus p. iv. *. The former are sprinkled on -dry; the last is applied with honey; and not only to these ulcers, but -to the tonsils also. - - [GI] ἀθηραὶι. - -But those ulcers, which the Greek call aphthae, are by far the most -dangerous; that is, in children; for they often kill them: in men -and women there is not the same danger. They begin at the gums, next -possess the palate, and the whole mouth; then descend to the uvula -and fauces. When these are affected, it is not easy for the child -to recover. And the case is more deplorable, if the infant is yet -sucking; because it is more difficult to apply any remedy. But in the -first place the nurse must be obliged to exercise by walking and such -employments as move the superior parts; she must be sent to the bath, -and ordered to pour warm water there over her breasts; next, her food -must be mild, and such as is not easily corrupted; and if the child -have a fever, she must drink water; if not, diluted wine. And if the -nurse is costive, she must have a clyster; if phlegm collects in her -mouth, a vomit. Then _for the infant_, the ulcers must be anointed -with honey, to which is added that kind of rhus(14), which is called -Syrian, or bitter almonds; or with a mixture of dry rose leaves, pine -kernels, and mint incorporated with honey; or that medicine may be -used, which is made up with mulberries; the juice of which is boiled in -the same manner as that of the pomegranate to the consistence of honey; -and in the same way, saffron, myrrh, allum, wine and honey are mixed -with it. Nor is any thing to be given, which may provoke the discharge -of humour. If the child is come to more strength, he ought to gargle -with such mixtures, as have been mentioned before. And if the milder -medicines do but little service here, such are to be used, as by their -caustic quality may cover the ulcers with crusts. The scissile allum is -powerful, or chalcitis, or copperas. Fasting too, in as great a degree -as the patient can bear, does service. The food ought to be mild; -however to cleanse the ulcers, it is proper to give sometimes cheese -spread with honey. - - - - -CHAP. XII. - -OF ULCERS OF THE TONGUE. - - -Ulcers of the tongue require no other medicines than those, that have -been laid down in the former part of the last chapter. But such as -arise upon the side of it continue longest. And it is necessary to -inspect whether some tooth opposite to it is not too sharp, which often -prevents an ulcer in that part from healing, and for that reason must -be filed. - - - - -CHAP. XIII. - -OF PARULIDES AND ULCERS IN THE GUMS. - - -Some painful tubercles also grow sometimes in the gums, near the teeth; -the Greeks call them parulides[GJ]. It is proper at the beginning, to -rub these gently with powdered salt, or with a mixture of fossile salt -calcined, and cypress and catmint; then to wash the mouth with the -cream of lentils, withal holding the mouth open, till the phlegm is -sufficiently discharged. In a greater inflammation the same medicines -are to be used, as were directed before, for ulcers of the mouth; and -a little soft lint is to be rolled up in one of those compositions, -which I said were called antherae, and that must be put betwixt the -tooth and the gum. But if the tumour be too hard to admit of that, the -steam of hot water, by means of a spunge, must be used externally, -and cerate applied. If a suppuration appears, the steam must be used -longer; and a hot decoction of figs in mulse, must also be held in -the mouth. And the tubercle must be cut before it be quite ripe, lest -the pus, by continuing there too long hurt the bone. If the tumour be -pretty large, it is better to cut it out entirely, so that the tooth -may be freed on both sides. When the pus is discharged, if the wound be -slight, it is sufficient to hold warm water in the mouth, and to foment -externally with the same vapour; if it be larger, to make use of the -cream of lentils, and the same medicines, by which other ulcers in the -mouth are cured. - - [GJ] παρουλίδες. - -Other ulcers, likewise, frequently arise in the gums, which are -relieved in the same manner, as those in the other parts of the mouth. -However, it is highly proper to chew privet, and hold the juice of it -in the mouth. It sometimes happens, too, that from an ulcer in the gum, -whether it be a parulis or not, pus is discharged for a long time, when -a tooth is either rotten, or broke, or the bone otherwise spoilt; and -that commonly proceeds from a fistula. When this is the case, the part -must be opened, and the tooth extracted; if there be any exfoliation, -it must be taken out; if any part of it is spoilt, it must be scraped. -After which, the same methods must be taken, as were prescribed before -in the cure of other ulcers. But if the gums leave the teeth, the same -antherae are helpful. It does good also to chew pears or apples not -very ripe, and to keep their juice in the mouth. And mild vinegar held -in the mouth may have the same effect. - - - - -CHAP. XIV. - -OF AN INFLAMMATION OF THE UVULA. - - -A violent inflammation of the uvula may justly excite our fears. -Therefore, in this case, abstinence is necessary, and it is proper -to bleed; and if there is any good reason against that, a clyster is -serviceable. Besides, the head must be covered, and kept pretty high; -next, a decoction of bramble and lentils in water, must be used as a -gargarism; and the uvula itself be touched with honey, mixed either -with omphacium, or galls, or scissile allum. The medicine also, which -is called andronium is suitable to this case. It consists of scissile -allum, scales of red copper, copperas, galls, myrrh, and misy; which -are powdered separately, and being mixed, they are again rubbed with -the addition of rough wine, to the consistence of honey. It does great -service also to apply to the uvula the juice of celandine, by means -of a spoon. When the uvula is moistened with any of these, a great -quantity of phlegm runs out; and when that ceases, the patient must -gargle with hot wine. - -But if the inflammation be slight, it is sufficient to powder laser, -and add to it cold water, and to put this water into a spoon, and -hold it below the uvula. And when it is not much swelled, cold water -alone, used in the same way, constringes it. The patient must also -use a gargarism of water, either with laser, or without it. But the -chirurgical cure for a lengthened uvula I shall describe afterwards. - - - - -CHAP. XV. - -OF A GANGRENE OF THE MOUTH. - - -If a gangrene seizes ulcers of the mouth, it is to be considered in the -first place, whether the body be in a bad habit: if it be, that must -be rectified; and then we may proceed to the cure of the ulcers. But -if that disorder be on the surface, it does well enough to sprinkle -a dry anthera upon the ulcer, if moist: if it be somewhat dry, it -must be laid on with a small portion of honey: if a little deeper, -two parts of burnt paper, and one of orpiment: if the disorder is of -a considerable depth, three parts of burnt paper, and a fourth of -orpiment, or equal parts of salt and iris both toasted; or equal parts -of chalcitis, lime, and orpiment. But it is necessary to dip lint in -rose oil, and apply over that escharotic medicines, to prevent their -hurting the sound contiguous part. Some also throw in so much toasted -salt into a hemina of strong vinegar, till it will dissolve no more; -next, they boil away this vinegar till the remainder be dry; and powder -the salt, and sprinkle it on the ulcers. Now, as often as a medicine is -applied, both before and after, the mouth must be washed, either with -cream of lentils, or a decoction of vetches, or olives, or vervains in -water; and with any of these must be mixed a little honey. Vinegar of -squills, also held in the mouth, has no small efficacy against these -ulcers; and vinegar mixed again with the salt, boiled in vinegar, as -before directed. But when either of these is used, it must be kept in -the mouth a long time together, and be repeated twice or thrice in a -day, as the malady is more or less severe. And if the patient be a -child, a probe must be wrapped in wool, and dipped into a medicine, and -held upon the ulcer; lest for want of thought, he should swallow the -escharotics. But if there be a pain in the gums, and some of the teeth -be loosened, they ought to be pulled out: for they very much obstruct -the cure. If medicines do no service, the ulcers will require to be -cauterized: which, however, is not necessary in the lips, because it is -more convenient to cut them out. And both that which is cauterized, and -that which is cut out, are equally incapable of being filled up without -the manual operation. Now the bones of the gums, which have but little -life in them, when once stripped by burning, continue bare ever after: -for the flesh never grows again there. Upon the burnt places, however, -lentils must be applied, till they recover their soundness, as far as -the case will admit. - - - - -CHAP. XVI. - -OF PAROTID SWELLINGS. - - -These are the disorders in the head, which generally require the help -of medicines, but under the ears, it is common for parotides[GK] to -arise; sometimes in health, when an inflammation commences there; -sometimes after long fevers, when the violence of the disease settles -in that part. This is a kind of abscess: and therefore requires no -peculiar method of cure. This one caution, however, is necessary, that -if the swelling came without any preceding distemper, repellents should -first of all be tried: if the disorder proceeds from any illness, that -method is hurtful; and it is more expedient to have it maturated and -opened as soon as possible. - - [GK] παρωτίδες. - - - - -CHAP. XVII. - -OF A PROMINENT NAVEL. - - -In the case of a prominent navel, to prevent the necessity of any -chirurgical operation, trial must first be made of abstinence, and a -clyster must be given; over the navel may be applied that composition, -which consists of hemlock and soot, each p. i. *. ceruss washed, p. iv. -*. lead washed p. viii. *. with two eggs; to which is likewise added -the juice of night-shade. This ought to lie on for a pretty long time; -and, in the mean while, the patient is to be restrained from motion, -use a spare diet, and avoid every thing flatulent. - - - - -CHAP. XVIII. - -OF THE DISEASES OF THE PRIVATE PARTS. - - -The next disorders we are to treat of, are those of the private parts. -The names of which amongst the Greeks are both more tolerable, and -already established by custom; since they are of common use in almost -every book and discourse of physicians: with us the terms are more -indecent, and have had no sanction from the conversation of modest -men to qualify their coarseness. This makes it difficult to treat of -them so, as at once to preserve a delicacy of expression, and deliver -plainly the precepts of the art. Nevertheless this circumstance ought -not to deter me from writing. In the first place, because it is my -intention to comprehend every thing, that I have learned to be useful; -in the next place, because every body should know how to cure those -disorders, which we are so unwilling to expose to another. - -Therefore, if the penis be swelled from an inflammation, and the -prepuce cannot either be drawn back, or brought forward again, the -part must be fomented plentifully with warm water. And when the glans -is covered, warm water must also be injected by a syringe, betwixt it -and the skin. If the skin, mollified and extenuated by this means, can -be drawn back, the subsequent part of the cure is more easy; if the -swelling prevails _against this remedy_, lentils, or horehound, or -olive leaves boiled in wine must be applied, and to any of these, while -it is rubbed, a little honey is added; and the penis is to be tied up -to the belly; which is necessary in the cure of all its disorders; and -the patient ought to confine himself to a strict regimen, and abstain -from eating, and relieve his thirst by nothing but water. The day -following, the fomentation of water must be applied in the same way, -and trial made, even with some degree of violence, to pull back the -prepuce; if it will not give way, the surface of it must be slightly -cut with a knife. For when the sanies is discharged, the part will be -extenuated, and the prepuce more easily drawn back. - -Whether it has yielded to the latter method, or has never resisted, -ulcers will be found, either in the inner part(15) of the prepuce, or -in the glans, or in the penis beyond that; which must, of necessity, -be either clean and dry, or humid and purulent. If they be dry, they -must be first fomented with hot water; then lycium, with wine applied, -or oil lees boiled with the same, or rose oil with butter. If there is -a thin humour in them, they must be washed with wine; then a little -honey and oil of roses with butter, and a fourth part of turpentine -resin must be used. But if pus is discharged from them, first of all -they ought to be washed with warm mulse; after which is applied of -pepper p. i. *. myrrh p. ii. *. saffron, calcined milsy, each p. ii. -*. which are boiled with a rough wine, to the consistence of honey. -The same composition is also proper for the tonsils, a moist uvula, -and ulcers of the nostrils and mouth. Another for the same purpose: of -pepper p. i. *. myrrh p. i. *. saffron p. ii *. milsy p. i. *. calcined -copper p. ii. *. which are first rubbed down with a rough wine, then -when they have grown dry, they are again rubbed with three cyathi of -passum, and boiled to the consistence of viscum. Verdigrease too, with -boiled honey, and those compositions, which were mentioned before, for -ulcers of the mouth, cure these. But the composition of Erasistratus, -or Crato, is a proper application for purulent ulcers of the parts of -generation. Olive leaves also are boiled in nine cyathi of wine(16), -and to these are added of scissile allum p. iv. *. lycium p. viii. *. -honey a cyathus and half; and if the quantity of pus be pretty great, -this medicine is diluted with honey; if small, with wine. This is a -constant rule; after dressing, while the inflammation continues, to -apply over it such a cataplasm, as before directed, and to dress the -ulcers every day in the same manner. But if pus begins to be discharged -in a great quantity, and is fetid, the _ulcer_ ought to be washed with -cream of lentils, with the addition of a little honey, or a decoction -of olive, or mastich leaves; or a decoction of horehound used in the -like manner with honey. And the same dressings must be applied; or else -omphacium with honey; or that composition for the ears, which is made -of verdigrease and honey; or the composition of Andron; or an anthera, -with the addition of a little honey. Some dress all the ulcers, which -we have yet mentioned, with lycium and wine. - -If the ulcer increases in breadth and deepness, it ought to be washed -in the same manner; and either verdigrease, or omphacium with honey, -applied; or Andron’s composition; or of horehound, myrrh, saffron, -scissile alum calcined, dry rose leaves, galls, each p. i. *. Sinopian -minium, p. ii. *. which are first powdered separately; then mixed and -rubbed together in honey, till they acquire the consistence of liquid -cerate; after which they are boiled in a copper vessel, gently, so as -not to boil over; when the drops of it grow hard, the vessel is taken -off the fire; and this medicine, as occasion requires, is softened, -either with honey or wine. The same composition, by itself, is also -good for fistulas. - -Sometimes too, the ulcer penetrates to the nerves; and there is a -plentiful discharge of humour, and thin sanies and fetid, of no -consistence, but like water, in which recent flesh has been washed; -there are pains and prickings in the parts. Although this be of the -purulent kind, yet it must be cured by mild medicines; such as the -tetrapharmacum plaister, liquified with rose oil, and mixed with a -little frankincense; or that, which is made of butter, rose oil, resin, -and honey, already mentioned. Above all, this ulcer is to be fomented -with abundance of warm water, and covered, and not exposed to the cold. - -Sometimes also, by these ulcers, the penis under the skin is so -consumed, that the glans falls off. In which case, the prepuce itself -must be taken off by circumcision. And it is a general rule, whenever -the glans, or any part of the penis falls off, or is cut off, that the -skin be kept from falling in contact and uniting with the ulcer(17), -so that it cannot be drawn back afterwards, and perhaps may even -obstruct the urinary passage. - -Tubercles likewise, which the Greeks call phymata, arise about the -glans; which are cauterized either by medicines, or the actual cautery; -and when the sloughs cast off, copper scales are sprinkled upon them, -to prevent any thing growing there again. - -[Sidenote: _Of a gangrene._] - -In what we have hitherto described there is still no gangrene; to -which, as in the other parts, so more especially here, ulcers are -liable. It begins with a blackness. If this seizes the prepuce, a -probe must be immediately put under it, and an incision made; then the -extremities are to be laid hold of with a vulsella(18), and whatever -is corrupted must be cut away, and even some of the sound part taken -off, and the place cauterized. Whenever any part is burned, the next -step is to apply lentils; afterwards, when the sloughs have cast off, -the cure is the same with that of common ulcers. - -But if a gangrene has seized the penis itself, some of the escharotic -medicines must be sprinkled upon it, chiefly that, which is composed -of lime, chalcitis, and orpiment. If medicines fail of success, here -also whatever is corrupted is to be cut out with a knife, in such a -manner as that some of the sound part be taken with it. This rule is as -universal as the former, when a gangrened part is cut away, that the -wound must be cauterized. But if either by means of medicines, or the -actual cautery, the sloughs have grown callous, there is great danger, -that when they cast off, a profusion of blood from the penis may -follow. Therefore long rest is necessary, and keeping the body almost -immoveable, till the sloughs be gently loosened from it in proper time. -But if a person either wittingly, or inadvertently, by walking too soon -has separated the sloughs, and there ensues a hæmorrhage, cold water -must be applied. If that does not prevail, recourse must be had to -those medicines, which stop blood. If even these do not relieve, the -part must be cauterized carefully and cautiously; and not afterwards -exposed to the same danger by any motion whatsoever. - -[Sidenote: _Of a phagedaena._] - -Sometimes also in the same place there happens that kind of gangrene, -which the Greeks call phagedæna[GL]. In which no time is to be lost, -but the same remedies must be immediately applied; and if these are not -successful, it must be burnt by the actual cautery. There is likewise -a certain blackness, which gives no pain, but spreads, and if we do -not resist it, it makes its way to the bladder; and cannot be cured -afterwards. But if it be at the end of the glans near the urinary pipe, -a small probe should be introduced into that first, to prevent its -closing; and then the actual cautery must be applied to the ulcer. But -if it has penetrated deep, whatever is tainted must be cut off. For the -rest, it must have the same treatment with other gangrenes. - - [GL] φαγέδαινα. - -[Sidenote: _A callosity or carbuncle._] - -There is likewise sometimes a callous excrescence from the penis, which -is almost void of all sensation, and ought to be cut out. A carbuncle, -as soon as it appears there, must be washed by means of a syringe; then -it must be cauterized too with medicines, particularly chalcitis with -honey, or verdigrease with boiled honey, or sheep’s dung toasted and -powdered with honey. When it falls off, liquid medicines must be used, -which are composed for the lips of ulcers. - -[Sidenote: _Diseases of the testicles._] - -If any inflammation begins in the testicles without a blow, blood must -be taken from the ancle; the patient must abstain from eating; that -composition must be applied, which consists of bean meal boiled in -mulse, then mixed with powdered cummin, and worked up to a consistence -with honey; or powdered cummin with cerate made of rose oil; or -lintseed toasted, powdered, and boiled in mulse; or wheat meal boiled -in mulse with cypress; or lily root bruised. But if the testicles are -grown hard, lint or fenugreek seed, boiled in mulse, should be applied; -or cerate made of cyprine oil; or fine flour rubbed with wine and the -addition of a little saffron. If the hardness be already of pretty long -standing, the root of wild cucumber boiled in mulse and then bruised -does a great deal of service. - -If they are swelled from a blow, it is necessary to let blood, and more -so if they are livid besides; and either of these compositions made -with cummin above mentioned must be applied; or that composition, which -contains of nitre calcined p. i. *. pine resin, cummin, each p. ii. *. -stavesacre without the seeds p. iv. *. honey, a sufficient quantity -to bring them to a consistence. But if from the blow the testicle -ceases to receive nourishment, there is generally a collection of pus -at the same time, and there is no other remedy for it, than by making -an incision in the scrotum, to discharge the pus, and extirpate the -testicle itself. - -[Sidenote: _Diseases of the anus. Rhagadia._] - -The anus too is liable to many and very tedious disorders; and these -are cured by methods not very different from one another. In the first -place it is a common ailment here, that the skin is chopped, and that -in several places: the Greeks call it rhagadia[GM]. When this is -recent, the patient ought to rest, and sit down in hot water. Pigeons -eggs are also to be boiled, and when they are hard, the shells taken -off, after that one of them ought to lie in water well heated, while -the part is fomented with the other warm; and thus each of them must be -used alternately for some time. Then the tetrapharmacum or the rhypodes -must be softened with rose oil; or recent œsypum mixed with liquid -cerate made of rose oil; or to the same liquid cerate must be added -washed lead; or myrrh to turpentine resin; or old oil to litharge: and -the part anointed with any of these. If the part affected be external, -and not concealed within, a piece of lint dipped in the same medicine -ought to be applied to it, and whatever is laid first on, must be -covered with cerate. In this case neither acrid food, nor austere, nor -binding must be used; nothing even dried is good, unless the quantity -be very small. Liquid, mild, fat and glutinous food is better. There is -no reason to refrain from the use of mild wine. - - [GM] ῥαγάδια. - -[Sidenote: _Of condylomata._] - -A condyloma is a tubercle, which commonly proceeds from some -inflammation. When it appears, the directions must be observed, which -were just now given, with regard to rest, meat, and drink. It is -proper to foment this tubercle with eggs, as in the other case. But -the patient should first sit down in a decoction of repellent vervains -in water; then it is fit to apply lentils with a small proportion of -honey, mellilot boiled with wine, and bramble leaves bruised with -cerate made of rose oil; and with the same cerate either a quince -bruised, or the inner part of pomegranate bark boiled in wine; and -chalcitis burnt, and powdered, then mixed with œsypum and rose oil; -and some of that composition, which contains of frankincense p. i. *. -scissile alum p. ii. *. ceruss p. iii. *. litharge p. v. *. to these, -while they are powdered, is instilled alternately oil of roses and -wine. The bandage for that part is a square piece of linen or woollen -cloth, which at two of its corners has two loops, and at the other as -many fillets; and when it is put under the patient, the loops being -turned toward the belly, the two fillets from behind are put through -them, and when drawn tight, the right one must be extended to the left, -and that on the left to the right, and lastly both being brought round -are tied in a knot over the belly. But if the condyloma be inveterate, -and is grown hard, and does not give way to these methods, it may be -cauterized by a medicine, which consists of the following ingredients; -of verdigrease p. ii. *. myrrh p. iv. *. gum p. viii. *. frankincense -p. xii. *. antimony, poppy tears, acacia, each p. xvi. *. with which -medicine some chuse to renew those ulcers of which I was lately -treating. If this has no effect upon the condyloma, even stronger -caustics may be used. When the tumour is consumed, we must change to -the mild applications. - -[Sidenote: _Of the hemorrhoids._] - -The third disease of the anus is when the orifices of the -_hemorrhoidal_ veins grow turgid, and shoot out something like -small heads, which often discharge blood; the Greeks call them the -hæmorrhoides[GN]. And this frequently happens to women in the mouth -of the womb. And it is not safe to stop it in some people, who are -not weakened by the discharge of blood: for this serves for a drain, -and is not a disease. And therefore some that have been cured, as the -blood had no exit, have been seized with sudden and very dangerous -distempers, from the matter settling upon the præcordia and bowels. -But a man that feels bad effects from this discharge, ought to sit -down in a decoction of vervains; and to apply principally pomegranate -bark powdered, with dry rose leaves; and some of those things, which -stop blood. An inflammation sometimes comes on, especially when hard -excrements hurt the part. Then the patient must sit down in pure water, -and foment the part with eggs, and apply the yolks with rose leaves -beat up with passum; and if the disorder be within, this must be put -to it with the finger; if without, it must be applied spread upon a -cloth. Those medicines too, which are calculated for recent fissures, -are suitable here. And the same diet must be used in this, as in the -former cases. If these methods give but little relief, it is usual by -the application of caustic medicines to consume these small heads. But -if they be inveterate, by the direction of Dionysius, sandarach is to -be sprinkled upon them; after that the following composition must be -applied: of copper scales, orpiment, each p. v. *. stone lime p. viii. -*. the next day, they must be punctured with a needle. By cauterizing -these small heads a cicatrix is formed(19), which prevents the -effusion of blood. But whenever this is stopped, to avoid any dangerous -consequence from the suppression, the matter must be dissipated by -much exercise; and besides both men, and such women, whose menstrual -discharge is stopped, ought sometimes to be bled in the arm. - - [GN] αἱμοῤῥοἱδες. - -[Sidenote: _Of a prolapsus of the anus or womb._] - -But if the anus itself, or the mouth of the womb fall down (for that -sometimes happens) it ought to be considered whether the part, which is -protruded, be clean, or covered with a mucous humour. If it be clean, -the patient ought to sit down in salt water, or a decoction of vervains -or of pomegranate bark in water: but if moist, it must be washed with -a rough wine, and rubbed with burnt lees of wine. When it has been -treated in either way, it must be replaced; and an application made of -bruised plantain, or willow leaves boiled in vinegar; over that, linen -and wool: these must be tied on, and the legs bound close together. - -[Sidenote: _Of a fungous ulcer._] - -There sometimes appears an ulcer in the same part resembling a -mushroom. This, if it be the winter-time, must be fomented with water -just warm; if any other season, with cold; afterwards it must be -sprinkled on copper scales, and over that cerate applied made of myrtle -oil, with the addition of a little scales, soot, and lime. If it is -not removed in this method, it must be consumed either by stronger -medicines(20) or the actual cautery. - - - - -CHAP. XIX. - -OF ULCERS IN THE FINGERS. - - -The best cure for ulcers of long standing in the fingers is either -lycium or lees of oil boiled; to either of which wine is added. A -caruncle here also sometimes recedes from the nails with great pain; -the Greeks call it pterygion[GO]. It is proper to dissolve as much -round Melian alum in water, as to make it of the consistence of honey; -then to pour into it the same quantity of honey as there was of alum, -and to stir it with a spatula, till it becomes of a saffron colour, -and rub that over it; some people for the same purpose chuse to mix -equal quantities of dry alum and honey, and boil them together to the -due consistence. If they are not extirpated by this method, they must -be cut off; then the fingers must be fomented with a decoction of -vervains, and a medicine applied over them compounded thus; chalcitis, -pomegranate bark, and copper scales are incorporated with a mellow -fig gently boiled, and honey; or equal quantities of burnt paper, -orpiment, and crude sulphur are mixed with cerate made of myrtle oil; -or of rasile verdigrease p. i. *. copper scales p. ii. *. are brought -to a consistence with a cyathus of honey; or equal parts of stone lime, -chalcitis, and orpiment are mixed together. Which ever of these is -applied, it must be covered with a linen cloth dipped in water. On the -third day, the finger must be opened, and what is dry, must be cut away -as before, and the like dressing applied. If it does not yield to this -method, it must be cleansed with a knife, and burnt with small irons, -and cured like other burns. - - [GO] πτερύγιον. - -But where the nails are scabrous, they ought to be opened round, where -they are joined to the flesh; then some of the following composition -must be applied over them; of sandarach, sulphur, each p. ii. *. nitre, -orpiment, each p. iv. *. liquid resin p. viii. *. And this is to be -taken off on the third day. This medicine causes the spoiled nails to -fall off and better to grow in their place. - - - - -A. CORNELIUS CELSUS - - OF - - MEDICINE. - - - - -_BOOK VII._ - - - - -PREFACE. - - -That surgery makes the third part of medicine, is both universally -known, and has been already observed. This does not indeed discard -medicines, and a proper regimen; but yet the principal part is -accomplished by the hand. And the effect of this is the most evident -of all the parts of medicine. For as fortune contributes a good deal -to the cure of distempers, and the same things are often salutary, -often fruitless; it may be doubted, whether the recovery be owing -to physic, or the constitution. In those diseases also, in which -we chiefly make use of medicines, although their success be pretty -evident, nevertheless it is plain, that health is both sought for -by their means in vain, and often restored without them. As may be -observed with regard to the eyes, which after having long suffered from -the applications of physicians, sometimes recover of themselves. But -in surgery it is manifest that the success, though it may be somewhat -promoted by other means, is chiefly to be ascribed to this. Now this -branch, though it be the most ancient, yet has been more cultivated -by Hippocrates the father of all medicine, than by his predecessors. -Afterwards being separated from the other parts, it began to have its -peculiar professors, and received considerable improvements in Egypt, -as well as elsewhere, principally from Philoxenus, who has treated of -this part fully, and with great accuracy, in several volumes. Gorgias -also, and Sostratus, the two Herons, and the two Apollonii, and -Ammonius Alexandrinus, and many other celebrated men, have each of them -made some discoveries. And at Rome too professors of no small note, -and particularly of late Tryphon the father, and Euelpistus the son of -Phleges, and Meges the most learned of them all, as appears from his -writings, by altering some things for the better have made considerable -additions to this art. - -A surgeon ought to be young, or at most but middle aged, to have a -strong and steady hand, never subject to tremble, and be no less -dexterous with his left than his right hand; to have a quick and clear -sight; to be bold, and so far void of pity, that he may have only in -view the cure of him, whom he has taken in hand, and not in compassion -to cries either make more haste than the case requires, or his cut less -than is necessary; but to do all, as if he was not moved by the shrieks -of his patient. - -Now it may be asked what peculiarly belongs to this branch: because -surgeons assume to themselves the curing of many wounds and ulcers, -which I have treated of elsewhere. I can very well suppose the same -person capable of performing all these: and since they are divided, I -esteem him most, whose skill is most extensive. For my part, I have -left to this branch those cases, in which the physician(1) makes -wound, where he does not find one; and those wounds and ulcers, in -which I believe manual operation to be more useful than medicines; -lastly whatever relates to the bones. Which things I shall consider -in order, and deferring the bones to another book, I shall in this -explain the two former; so treating first of these, which are found -indifferently in every part of the body, I shall proceed to those, that -fall upon particular parts. - - - - -CHAP. I. - -OF CONTUSIONS. - - -Contusions, in whatever part of the body they are, ought as soon as -possible to be treated in this manner; the skin of the part, where the -pain is, must be cut in several places, and the _grumous_ blood issuing -from them must be wiped away with the back of the knife. If it is not -taken in time, and there is a redness, so much of the skin as is red -_must be cut_; if there is a tumour too, wherever that extends, the -same remedy is still the best. Then repellents are to be applied over -it; and particularly sordid wool squeezed out of vinegar and oil. But -if the hurt be more slight, the same applications without an incision -may perform the cure. And if nothing else is at hand, ashes, especially -of burnt twigs; if they are not to be got, any other ashes mixed up -with vinegar, or even with water. - - - - -CHAP. II. - -OF THE OPERATIONS NECESSARY IN SUPPURATED TUMOURS. - - -The foregoing case is easily managed. But there is more trouble -with those tumours, that come from an internal cause, and tend to -suppuration. That all these are kinds of abscesses, I have elsewhere -shewn, and treated of the medicines proper for them: it now remains, -that I mention the manual operations necessary for their cure. -Wherefore it is requisite, before they grow hard, to cut the skin, -and apply a cupping vessel to evacuate any bad and corrupted matter -which may have been collected there: and this may be repeated a second -and third time, till all the symptoms of an inflammation be gone. -Nevertheless, it is not right to trust(2) entirely to the cupping -vessel. - -Sometimes also it happens, though rarely, that a collection of pus -is inclosed in a covering of its own: the ancients called this a -coat. Meges, because every coat is nervous, affirmed a nerve was not -generated in a disorder, which destroyed the flesh, but that the pus -being lodged below for a long time, was surrounded with a callosity. -This however has not the least relation to the method of cure; because -the same course, that ought to be pursued if it be a coat, is also -necessary if it be a callosity. And though it should be a callosity, -yet as it invelops something, there is no reason against calling it -a coat. And then again, it is not uncommon for this to be found even -before the suppuration is formed(3), and therefore what is below it -cannot be extracted by a cupping vessel. But this is easily discovered, -when the application of that instrument has made no change. Therefore, -where-ever that happens, or when there is already a hardness, nothing -is to be expected from this remedy: but as I have directed elsewhere, -either the afflux of matter to the part must be diverted, or it must -be discussed, or brought to a perfect suppuration. If either of the -former has taken place, nothing further is necessary. If the pus has -been maturated, in the armpits and groin an incision is rarely to be -made: likewise where-ever the abscess is but small; also where-ever -the malady is in the surface of the skin, or even in the flesh; unless -the weakness of the patient obliges us to lose no time. And it is -sufficient by cataplasms to assist the pus to make its own way. For -the part, that has not been touched by an instrument, is generally -free from a scar. If the malady lies deeper, it ought to be considered -whether the part be nervous or not. For if it be nervous, it should -be opened by the actual cautery; the reason of which is, that a small -wound may keep open longer for evacuating the pus, and the cicatrix -afterwards may be small. But if there be nerves near it, the actual -cautery is improper, lest convulsions follow, which may debilitate(4) -the limb; yet the assistance of the knife is necessary. The others may -be opened before they be quite mature: but amongst tendons the utmost -ripeness is to be waited for, that the skin may be thin, and the pus -brought close to it, that it may be the sooner found. And some again -require a wound(5) in a straight direction, as those in the flesh: -but others render the skin extremely thin; and in such the whole -surface of it above the pus must be cut away. Now in all cases where -the knife is used, care must be taken, that the wounds be as small -and as few in number as possible: with this caution, however, that we -do all the case requires, both with regard to size and number: for -larger cavities require broader incisions; sometimes even in two or -three different directions. And we must endeavour that the deepest -part of the sinus shall have a free discharge, lest any of the humour -settle within, which by corroding the contiguous parts yet sound, may -make sinuses there. Cases also sometimes occur, in which the skin -must be taken off to a more considerable breadth. For when after long -distempers, the habit of the whole body has been vitiated, and the -sinus is enlarged to a great compass, and the skin is pale; we may -take it for granted that it is already mortified, and will be useless: -therefore it is more proper to cut it off: and especially if this -happen about the larger joints, and the patient has been troubled with -a purging while he was confined to his bed, and he gains no flesh by -the nourishment he takes. But the excision should be made in the form -of a myrtle leaf, that it may heal the more easily. And this rule must -constantly be observed, whenever a physician upon any account cuts away -the skin. After the pus is discharged, in the armpits and groin there -is no need of lint, but a sponge squeezed out of wine must be laid on. -In the other parts, if lint is equally needless, a little honey must -be infused to cleanse it; then agglutinants are to be applied: if lint -be necessary, over it also in like manner ought to be laid a sponge -squeezed out of wine in the same way. When lint is necessary, and when -not, has been determined elsewhere. The other directions are to be -observed when the suppurated tumour is cut, which I gave for one, that -has been broke by medicines. - - - - -CHAP. III. - -OF THE GOOD OR BAD SYMPTOMS OF SUPPURATIONS. - - -It is soon known from the nature of the symptoms, how a cure advances, -and what event is to be hoped or feared: and these are commonly the -same with what have been laid down in wounds. For they are good signs -to sleep, to breathe easily, not to be troubled with thirst, not to -loathe food, if there has been a slight fever, to be free of it: -also that the pus be white, smooth, and not fetid. The bad signs are -wakefulness, difficulty in breathing, thirst, loathing of food, a -fever, and the pus black, or feculent, and fetid: also a hemorrhage -in the process of the cure; or if before the cavity is filled up -with flesh, the lips become callous, and the flesh there be dull of -sensation, and spongy. But for a person to faint either in the dressing -or afterwards, is worst of all. Moreover, if the fever cease suddenly, -before the suppuration is begun, or if it continue after the discharge -of the pus, these are just grounds for fear. There is room to fear -also, if the wound is not sensible of corrosive medicines. But whatever -symptoms shall happen to arise, it is the part of a physician to -endeavour the recovery of his patient. Therefore, as often as he shall -open a wound, he ought to wash it, if it seems necessary to repel the -humour, with a mixture of wine and rain water, or with a decoction of -lentils in water: if it needs cleansing, with mulse; and to apply the -same dressings again. When the humour shall appear to be stopt, and the -ulcer clean, it will be convenient to promote the growth of the flesh, -and dress the ulcer with equal parts of wine and honey, and apply a -sponge dipt in wine and oil of roses, which things are incarning. A -proper regimen however, as I have observed elsewhere, is more effectual -for this purpose: that is, when the fever is removed, and the appetite -restored, bathing now and then, daily but mild gestation, and such -kinds of food and drink as are of the most nourishing nature. All which -rules also hold with regard to an abscess, that has been broken by -medicines. But because it is hardly possible to cure a large tumour -without the knife, the mention of these has been reserved to this place. - - - - -CHAP. IV. - -OF FISTULAS. - - -With regard to fistulas, if they penetrate pretty deep, so that a -collyrium cannot reach the bottom of them, if they are tortuous, or -consist of several sinuses, operations are more useful than medicines; -and those, that run in a transverse direction below the skin, give less -trouble than such as go directly inward. Therefore, if the fistula -be transverse under the skin, a probe ought to be introduced, and an -incision made upon that. If it be tortuous, its windings are to be -followed by the probe and knife. And the same course must be taken, if -several of them appear like rivulets _uniting their streams_. When we -have reached to the end of the fistula, all the callosity must be cut -out, and fibulae applied to it with medicines to agglutinate. But if it -points directly inward, when its direction is found by a probe, that -sinus must be cut out: then a fibula put upon the lips of the skin, -and agglutinating medicines laid over it; or if the ulcer be very foul -(which sometimes happens from a carious bone) when that also is cured, -medicines to promote a digestion. - -[Sidenote: _Of fistulas amongst the ribs._] - -It is common for fistulas to extend beneath the ribs. When this case -occurs, the rib in that part must be cut through on both sides, and -taken out, lest any thing corrupt be left within. It is usual for them -also, when they have got through the ribs, to penetrate the transverse -septum, that divides the intestines from the superior viscera. Which -circumstance may be known, both from the situation, and from the -violence of the pain, and because sometimes the air comes out with the -matter, as it were bubbling, and particularly when the patient keeps -in his breath. For this case there is no remedy. In the other kinds -about the ribs, which are curable, greasy medicines are hurtful, and -_therefore_ we should use such as are adapted to wounds: but the best -application is dry lint, or if any thing requires to be cleansed, the -same dipped in honey. - -[Sidenote: _Of fistulas in the belly._] - -There is no bone within the skin of the belly; but fistulas in that -part are extremely dangerous; insomuch that Sostratus believed them -incurable. That they are not always so, experience has shewn. And -indeed, which may seem very wonderful, a fistula opposite to the -liver and spleen, and stomach, is more safe than one opposite to the -intestines: not that the thing is of its own nature more pernicious -there, but because it exposes to a danger of another kind. The reason -of which fact some authors have but little understood, though their -experience convinced them of this difficulty. For the belly itself is -often wounded by a weapon, and the intestines, that have fallen out, -are replaced, and the wound united by sutures: the manner of doing -which I shall point out presently. Therefore, when a small fistula -has even penetrated the abdomen, it may be cut out, and the lips of -it joined by a suture. But if the fistula spreads wider within, upon -its being cut out, it must necessarily leave a pretty large vacuity, -which cannot be sewed up without great violence; especially on the -internal side, where there is a kind of membrane, which the Greeks call -peritonaeum, that surrounds the abdomen. Therefore, as soon as a person -begins to walk or move, the suture breaks, and the intestines are let -loose, so that the patient must perish. But the case is not always -desperate; and therefore, we must attempt the cure of smaller fistulas -there. - -[Sidenote: _Of fistulas in the anus._] - -Fistulas in the anus require a particular treatment. A probe being -put into them, an incision must be made in the skin at its further -end: then the probe must be drawn out at the new orifice with a thread -following it, which was put through an eye made in the other end for -the purpose. There the thread must be taken hold of, and tied to the -other end, that it may gently take hold of the skin above the fistula: -and the thread should be made of crude lint(6), double or triple, -and so twisted as to make one string. In the mean time the patient -may go about his business, walk, bathe, and eat, just as if he were -in the most perfect health. Only loosing this knot(7) twice a day, -the string must be drawn in such a manner, that the part, which was -above, may then be within the fistula. And the thread must not be -suffered to rot, but every third day, the knot must be untied, and at -its one end must be fixed a fresh ligature, which when the old one is -drawn out, must be left in the fistula with a like knot. For thus it -gradually cuts the skin that is above the fistula: and, at the same -time, the part that has been eat through by the thread, heals; whilst -the remainder, which is pinched by the thread, continues to be cut by -it. This method of cure is long, but is attended with no pain. - -Those, that are for making quick dispatch, ought to tie the skin -tight with the string, that it may be the sooner cut; and at night to -introduce some small slips of a penecillum, that the skin may be made -thin by the same means that it is distended; however this occasions -pain. The dispatch, as well as the pain, is increased, if both the -string and the penecillum be turned with some one of those medicines, -which I mentioned, for consuming a callosity. It may happen, however, -that the use of the knife may be necessary, even in this part, if the -fistula points inward, or consists of several sinuses. Wherefore in -these kinds, the probe must be introduced, and the skin must be cut -in two lines, so that betwixt them a very small habenula may be cut -out(8), to prevent the lips from uniting presently; and that room -may be left for pledgits of lint, as few of which as possible ought -to be laid on; and the same course must be pursued as was directed in -abscesses. But if, from one orifice, there shall be several sinuses, -that sinus, that runs straight, must be opened with a knife, and the -others, that branch from it, which will then appear, must be tied with -a ligature. If any one penetrate so deeply, that an instrument cannot -be safely used, a collyrium must be put in. - -The food, in all these cases, whether the treatment be by an operation, -or by medicines, ought to be moist; the quantity of drink pretty -liberal, and for a long time water. And when the flesh begins to sprout -up, then indeed the bath may be used, but sparingly, and such food as -plumps the body. - - - - -CHAP. V. - -OF EXTRACTING WEAPONS OUT OF THE BODY. - - -Weapons, that lodge in the body, are very often troublesome to extract. -For there are some difficulties, which arise from their different -forms; others from the situation of the parts, into which they have -penetrated. Now every weapon is extracted, either on that side, where -it entered, or on that, to which it points. In the first case it -returns by the way itself made: in the other, it receives one from the -knife; for the flesh is cut directly upon the point of the weapon. -If the weapon does not lie deep, but is in the surface of the flesh, -or at least has not past through large veins and nervous parts, the -best method is to pull it out by the way it entered. But if the space, -through which the weapon must return, be greater than that, which is to -be laid open, and it has already past through veins and nerves, it is -more expedient to open what remains, and extract it that way; for it is -both nearer at hand, and is drawn out with more safety. And in one of -the larger limbs, if the point of the weapon has past beyond the middle -of it, it will heal the more readily for being open quite through, as -the remedies will act at both extremities of the wound. But if the -weapon is to be brought back the same way, the wound must be enlarged, -that it may move the more easily, and occasion the less inflammation; -which will be considerable, if the body be lacerated by the weapon as -it returns. And in like manner, if an opening be made on the opposite -part, it ought to be so large, as not to be increased afterwards by -the weapon passing through it. In either case, the greatest caution -must be used not to cut a tendon, or a large vein, or an artery. When -any of these are exposed, it must be laid hold of with a blunt hook, -and drawn aside from the knife. When an incision is made large enough, -the weapon must be taken out: then also the same method, and the same -precaution are to be used, lest any of the abovementioned parts should -be injured, which lie under the weapon, that is to be extracted. - -[Sidenote: _Of arrows._] - -The foregoing directions are general: besides which, there are some -particular rules for the several kinds of weapons, which I shall -immediately subjoin. Nothing is so easily lodged in the body as an -arrow, and it goes to the greatest depth. The reasons are, both that it -moves with great force, and because it is small. Therefore, it must be -extracted more frequently on the opposite part, than on that by which -it entered, and especially because it is generally surrounded with -beards, which lacerate more, if they be drawn backward than forward. -But an orifice being made on the opposite part, the flesh ought to -be opened by an instrument made in the form of the Greek letter ν; -and when the point appears, if the shaft adheres to it, it must be -pushed forward, till it can be taken hold of at the opposite part, and -extracted. If that is already broke off, and only the iron head is -within, the point must be taken hold of by the fingers, or a forceps, -and thus pulled out. And there is no other method of extracting it, -when it is thought adviseable to pull it out by the orifice it entered -at: for after the wound is enlarged, either the shaft, if that be -lodged within, must be pulled out; or if that be not there, the iron -itself. But if the beards are visible, and they are short and small, -they ought to be broke off with a forceps, and the weapon, when freed -of them, to be brought out; if they are larger and stronger, they must -be covered with writing reeds split, to prevent their lacerating any -part, and thus pulled out. This is the method observed in extracting -arrows. - -[Sidenote: _Of broad weapons._] - -But if a person has a broad weapon lodged within his flesh, it is not -proper to draw it out at the opposite part, lest we add another great -wound to the large one already made. It must therefore be pulled out -with a certain kind of iron instrument, which the Greeks call the -graphiscus of Diocles[GP], because it was invented by Diocles, whom I -have already taken notice of among the ancient and greatest physicians. -This is a plate of iron, or sometimes of copper, at the one end, -having two claws turned downwards on each side; the other perforated -and folded back on each side; bent a little at that extremity, which -has the claws; and likewise on the other, which is perforated. This -is introduced transversely, hard by the weapon; and then, when it -has reached its point, it is turned a little, that it may receive -the weapon into the perforation. When the point is in the hole, the -operator, clapping two of his fingers to the claws at the other end, -draws out at once his instrument and the weapon. - - [GP] γραφίσκος Διοκλέους. - -[Sidenote: _Of leaden bullets, &c._] - -A third kind of weapon, which requires sometimes to be pulled out, is -a leaden bullet, or a stone, or some such thing, which having broke -through the skin, is entirely lodged within. In all these cases, the -wound must be enlarged, and what is within must be extracted by a -forceps the way it entered. - -But there is an additional difficulty attending every wound, where the -weapon is either fixed in a bone, or has sunk into an articulation -between two bones. If, in a bone, the weapon must be moved to and fro, -till the part, which gripes the point, gives way, and then the weapon -must be extracted, either with the hand, or a forceps. Which is also -the method of extracting the teeth. And it is very rare that the weapon -does not follow in this way. But if it still remains, it may be forced -out with some kind of instrument. The last resource, when it is not -extracted, is to make a perforation near it by a terebra, and from that -opening, to cut the bone in the form of the letter v, opposite to the -weapon, in such a manner, that the opening of the lines be directed -towards the weapon; when this is done, it must necessarily give way, -and be easily taken out. - -If it has made its way into an articulation between two bones, the two -limbs must be bound up with rollers and straps, and by means of these -drawn contrary ways, to stretch the tendons: which being extended, -will leave a larger space between the bones, so that the weapon may -be extracted without difficulty. Care must be taken, as I observed -in other cases, in its extraction, that no nerve, vein, or artery be -wounded by the weapon, whilst it is extracting, _which is to be guarded -against_ by the method mentioned before. - -[Sidenote: _Of poisonous weapons._] - -But if a person be wounded by a poisoned weapon, all that is above -mentioned being, if possible, still more expeditiously executed, he -must also be treated in the method prescribed for one that has drunk -poison, or been bit by a serpent. The treatment of the wound itself, -after the extraction of the weapon, is the same as if nothing had been -lodged there; of which I have said enough elsewhere. - - - - -CHAP. VI. - -OF A GANGLION, MELICERIS, ATHEROMA, STEATOMA, AND OTHER TUBERCLES OF -THE HEAD. - - -These are cases that occur in any part of the body indifferently: the -rest have certain seats, which I am going to speak of, beginning with -those in the head. In this a great number and variety of tubercles -rise, called ganglia[GQ] melicerides[GR], atheromata[GS]; there are -some other kinds, to which authors give different names; to which I -shall also add steatomata[GT]: which though they often arise in the -neck, and in the armpits, and sides, I have not mentioned separately; -since all of them differ but little, and neither are threatening, nor -require any different treatment from each other. Now all these rise -from a very small beginning, and increase gradually for a long time, -and are inclosed each in a coat of its own. Some of them are hard, and -resist pressure, others are soft and yielding; some of them are bald -in a part, others remain covered with hair, and are commonly without -pain. What their contents are, though it may be pretty well guessed -at, yet cannot be certainly known, till they be taken out. However, -generally in these that resist, there are found either some stony -substance, or a number of hairs concreted together: but in those that -yield, something resembling honey, or thin pulticula, or the scrapings -of cartilage, or insensible or bloody flesh; and these are commonly -of different colours. And for the most part ganglia are elastic: the -atheroma contains a liquor like thin pulticula: the meliceris a more -liquid one, which therefore fluctuates upon being pressed: there is -a fat substance in the steatoma, and that generally has the largest -circumference, and so relaxes the whole surface of the skin above it, -as to make it slide backward and forward; whereas, in the rest, it is -more bound. It is proper first to shave them all if they be covered -with hair, and then to cut them through the middle, that whatever was -collected within may be evacuated. But the coat of the steatoma must -also be cut; because it is not easily separated from the skin and -subjacent flesh. In the others the coat is to be preserved entire: and -immediately, when it appears white and tense, it must be separated by -the handle of the knife from the skin and flesh, and taken out together -with its contents. If, however, it should happen, that the lower side -of the coat adheres to a muscle, lest that be wounded, the upper side -must be taken away, and the lower left in its place. When the whole -is extracted, the lips must be brought together, and a fibula put -upon them, and over that an agglutinating medicine. When either the -whole coat, or any part of it is left behind, medicines to promote a -digestion must be applied. - - [GQ] γάγγλια. - - [GR] μελικηρίδες. - - [GS] ἀθερώματα. - - [GT] στεατώματα. - - - - -CHAP. VII. - -OF THE DISEASES OF THE EYES, WHICH ARE CURED BY MANUAL OPERATIONS. - - -But as the foregoing disorders do not differ much either in their -nature, or method of cure, so these in the eyes, which require manual -operations, are both different in their kinds, and require different -methods of cure. - -[Sidenote: _Of vesicles in the upper eye-lids._] - -In the upper eye-lids then it is common for fat and heavy vesicles to -rise, which scarcely allow the eye to be raised, and occasion gentle, -but constant fluxes of gum in the eyes. And they commonly happen to -children. _In this case_, it is necessary to compress the eye with -two fingers, and thus stretching the skin, to cut with the knife in a -transverse line, with a very light hand, in such a manner as not to -wound the vesicle, and so that it may pass out when a way is made for -it; then to catch hold of it with the fingers, and pull it out: for it -easily separates. After this the part ought to be anointed over with -any of these collyriums, that are used in lippitudes; by which means it -is covered with a cicatrix in a very few days. It is more troublesome, -when the vesicle is cut: for it discharges its humour, and cannot be -laid hold of after, because of its smallness. If that accident should -happen, one of the medicines that promotes a digestion, may be laid on. - -[Sidenote: _Of a crithe._] - -In the eye-lid, likewise, above the lashes, there grows a small -tubercle, which from its resemblance to a barley-corn, is, by the -Greeks, called crithe[GU]. It is contained in a coat, and seldom -maturates. Upon this should be applied hot bread, or wax heated now and -then, provided the degree of heat be no more, than the part can easily -bear: for by this method it is often discussed, sometimes maturated. If -pus appear, it ought to be divided by a knife, and the contained humour -squeezed out: and to be afterwards treated with the same warmth, and -anointed, till it recover a sound state. - - [GU] κριθὴ. - -[Sidenote: _Of chalazia._] - -Other tubercles not unlike this, grow in the eye-lids; but however not -of the same form, and also moveable, when they are impelled this way or -that by the finger: which because of their resemblance to hail-stones, -the Greeks call chalazia[GV]. These ought to be cut on the external -side, if they be immediately under the skin; on the internal, if they -lie below the cartilage; after that, they must be separated by the -handle of the knife from the sound parts. And if the wound be on the -internal side, it must be anointed at first with mild, and afterwards -more acrid medicines; if, on the external, an agglutinating plaister -must be applied over it. - - [GV] χαλάζια. - -[Sidenote: _Of the unguis._] - -The unguis, called by the Greeks, pterygium[GW], is a small nervous -membrane, which arising from the angle of the eye, sometimes reaches to -the pupil, and obstructs the sight. It oftener begins from the angle, -near the nose, sometimes too from that towards the temples. It is no -difficult matter to discuss this, when recent, by the medicines, which -lessen cicatrices in the eyes. If it be of long standing, and has -acquired some thickness, it ought to be cut out. After an abstinence -of one day, the patient must be placed in a seat, either with his -face opposite to the physician, or with his back to him, in such a -manner, that he may recline his head upon his breast. Some, if the -disease be in the left eye, chuse to have him set with his face to -the physician; if in the right, in the reclined posture. One eye-lid -ought to be opened by an assistant, and the other by the physician. -If the physician face him, he must take hold of the lower one; if he -be reclined, the upper one. Then the physician is to fix under the -extremity of the unguis, a small sharp hook, with its point turned a -little inward; and to let go the eye-lid, which is then to be held -by an assistant, and taking hold of the hook, he is to lift up the -unguis, and pass a needle through, drawing a thread after it; then to -lay aside the needle, and take hold of the ends of the thread, and by -them raising up the unguis, if it adheres any where to the eye, to -separate it by the handle of the knife, till he come to the angle; then -alternately sometimes to slacken, sometimes to draw it, that so both -its origin and the extremity of the angle may be found. For there is a -double danger attends it; either lest some part of the unguis be left, -which being ulcerated is hardly ever cured, or lest the caruncle be -cut away from the angle; for if the unguis be drawn away with too much -force, that also follows, and comes away. If it is torn off, an orifice -is opened, through which afterwards a humour always descends, which -the Greeks call rhyas[GX]. The true termination then of the angle must -be found out. When that plainly appears, the knife is to be used, the -unguis not being too straight drawn; and then this small membrane is -to be cut out in such a manner, that no part of the angle be wounded. -Afterwards lint covered with honey must be laid on, and over that a -linen cloth, and either spunge, or sordid wool. The following days the -eye must be opened daily, lest the eye-lids be agglutinated together by -a cicatrix (for that is also a third danger) and lint be put on in the -same way: lastly, it must be anointed with a collyrium, that cicatrizes -ulcers. - - [GW] πτερύγιον. - - [GX] ῥυὰς. - -But this operation should be performed in the spring, or at least -before winter. Which circumstance, though it belongs to several places, -it will be sufficient to mention once for all. For there are two kinds -of cures; one, in which we are not at liberty to chuse a time, but that -must be laid hold of, that offers, as in wounds and fistulas; another, -in which we are not pressed for time; but it is quite safe and easy to -wait the most convenient season; as is the case in these disorders, -which both increase slowly, and are not extremely painful. In such, we -must defer it till spring; or if there is any urgent circumstance, the -autumn however, is better than the winter or summer; and of that the -middle, when the excessive heats are gone, and the colds not yet set -in. Now the more necessary the part is, whose cure shall be undertaken, -the greater will the danger be it is exposed to. And often by how much -larger the wound is to be made, so much the more must the season of the -year be regarded. - -[Sidenote: _Of an encanthis._] - -From the operation for the unguis, as I observed, disorders arise, -which may also sometimes proceed from other causes. For sometimes after -the imperfect excision of an unguis, or upon some other occasion, a -tubercle grows in the angle, which hinders the entire opening of the -eye-lids; the Greek name for it is encanthis[GY]. It ought to be laid -hold of with a hook, and cut round; and here also the operator must be -cautious not to cut away any thing from the angle itself. Then a small -piece of lint must be sprinkled either with cadmia, or copperas; and -the eye-lids being opened it must be introduced into that angle, and -bound over in the same manner as the former; and for some following -days must be dressed in like manner, first bathing it with water, just -warm, or even cold water. - - [GY] ἐγκανθὶς. - -[Sidenote: _Of the ancyloblepharon._] - -Sometimes the eye-lids grow together, and the eye cannot be opened. -Which is often attended with this disorder besides, that the eye-lids -adhere to the white of the eye; that is when an ulcer in either of -them has been negligently cured. For as it heals, what might, and -ought to have been separated, will be agglutinated; both species of -the distemper is called by the Greeks ancyloblepharon[GZ]. When the -eye-lids only cohere, they are separated without difficulty; but -sometimes to no purpose: for they are agglutinated again. However trial -ought to be made; because the case often turns out well. Therefore -the broad end of the probe must be introduced betwixt them, and the -eye-lids separated by that; then small penecilla are to be put between -them, till the ulceration of the part be cured. But when the eye-lid -adheres to the white of the eye itself, Heraclides the Tarentine -advises to cut under it gently with a knife with great caution, lest -any thing be cut away either from the eye, or the eye-lid; and if -that cannot be entirely avoided, rather to take something from the -eye-lid. After these let the eye be anointed with such medicines as -cure an asperity; and the eye-lid be inverted every day, not only that -the medicine may be applied to the ulcer, but also to prevent its -adhesion: the patient himself must also be charged to raise it often -with two fingers. I do not remember an instance of one person cured -by this method. Meges too tells us he tried many ways, and never was -successful; for the eye-lid always adhered again to the eye. - - [GZ] ἀγκυλοβλέθαρον. - -[Sidenote: _Of the aegilops._] - -Again in that angle, that is next the nose, from some disorder, a kind -of small fistula is opened, through which gum(9) perpetually distils; -the Greeks call it ægilops[HA]. And this gives constant uneasiness -to the eye; sometimes also eating through the bone, it penetrates to -the nostrils. This sometimes is of a cancerous nature; when the veins -are tense and crooked, the colour of it is pale, the skin hard, and -irritated by a slight touch, and it raises an inflammation in the -contiguous parts. It is dangerous to attempt the cure of those, that -are cancerous: for it even hastens death. And it is needless to meddle -with such as reach to the nostrils: for neither do they heal. But the -cure of these in the angle may be attempted; though it should be known -however that it is difficult; and the nearer to the angle the opening -is, so much the more difficult, because there is a very little room -for the management of the hand; yet it is easier to cure the disorder -when recent. The top of the opening must be taken hold of with a small -hook; and then all the cavity as I directed in fistulas, must be cut -out to the bone; and the eye and other contiguous parts being well -covered, the bone must be strongly cauterized with a hot iron. But if -it be already affected with a caries, that a thicker scale may cast -off, some apply caustic medicines; as copperas, or chalcitis, or rasile -verdigrease: which method is both slower, and not so effectual. When -the bone is cauterized, the remaining part of the cure is the same as -in other burns. - - [HA] αἰγίλωψ. - -[Sidenote: _Of hairs in the eye lashes irritating the eye._] - -The hairs of the eye-lids sometimes irritate the eye; and that from -two causes. For sometimes the skin of the eye-lid is relaxed, and -falls down; whence it happens, that the lashes are turned in upon -the eye itself, because the cartilage is not also relaxed; at other -times, beside the natural row of hairs, another grows under it, which -point directly inward upon the eye. The methods of cure are these. If -preternatural hairs have grown, an iron needle thin and broad, like a -spatha(10), must be put into the fire, and when it is red-hot, the -eye-lid being lift up in such a manner, that the offending lashes are -in the view of the operator, it must be passed from the angle close to -the roots of the hair, till it move over the third part of the eye-lid; -then it must be applied a second and third time, as far as the other -angle. The consequence of which is, that all the roots of the hairs -being burnt, die away. Then a medicine to prevent an inflammation must -be applied: and when the eschars have cast off, it must be brought to -cicatrize. This kind heals very easily. Some alledge that it is proper -to pierce the external part of the eye-lid near the eye-lashes with a -needle, which must be passed through with a woman’s hair doubled for a -thread; and when the needle has gone through, that the offending hair -must be taken up into the loop of the woman’s hair, and by that drawn -upward to the superior part of the eye-lid, and there to be glued down -to the flesh, and a medicine applied to close up the orifice thus made: -for that this will cause the eye-lash to point afterwards externally. -This in the first place cannot be practised, but upon a pretty long -hair; whereas they generally grow short there. And then if there be -several hairs, the patient must suffer a long torture, and the needle -passing so often through will raise a great inflammation. Lastly, when -any humour is settled there, the eye being irritated both before by the -hairs, and afterwards by the perforations of the eye-lids, it is hardly -possible to prevent the glutinous matter, which fastens the hair, from -being dissolved: and thus of course the hair returns to the place, from -whence it was drawn away. - -The method of cure for a relaxed eye-lid, which is universally -practised, never fails of success. For the eye being closed, one must -take hold of the middle part of the skin of the eye-lid, whether it be -the upper or the lower, with his fingers, and raise it; then consider -how much must be taken away, to reduce it to its natural condition. -For there are two dangers attending this case; lest if too much be cut -off, the eye cannot be covered; if too little, the end be not obtained, -and the patient have suffered to no purpose. The part, which it shall -be thought needful to cut, must be marked by two lines with ink in -such a manner, that betwixt the range of hairs and the line nearest -to it, some space may be left for the needle to lay hold of. These -things being determined, the knife is to be used: and if it be the -upper eye-lid, the incision next the eye-lashes must be made first; -if the inferior one, last: and it must begin in the left eye, at the -angle next the temple; in the right, at the angle next the nose; and -what lies between the two lines must be cut out. Then the lips of the -wound are to be joined together by a single stitch, and the eye must -be covered; and if the eye-lid does not descend far enough, it must -be relaxed; if too much, it must be either straiter drawn, or a small -habenula again cut off from that lip of the wound, which is farthest -from the eye-lashes. When it is cut off, other stitches must be added, -not above three. Moreover a scarification must be made in the upper -eye-lid, under the roots of the eye-lashes, that being raised from the -inferior part they may point upwards: and this alone will be sufficient -for the cure, if they are but little turned in. The lower eyelid does -not need this process. When these are done, a spunge squeezed out -of cold water must be bound on: the day following an agglutinating -plaister should be applied. On the fourth, the stitches must be -taken away, and the wound anointed with a collyrium, to prevent an -inflammation. - -[Sidenote: _Of the lagophthalmus._] - -Sometimes from this operation, when too much of the skin is cut away, -it happens, that the eye cannot be covered. And this sometimes proceeds -from another cause. The Greeks call the disorder lagophthalmos[HB]. -When too much of the eye-lid is wanting, there is no remedy for it; -if but a small part, it may be cured. An arched incision must be made -in the skin a little below the eye-brow, with its horns pointing -downward. The wound ought to go as deep as the cartilage, but without -injuring it: for if that be cut, the eye-lid falls down, and cannot -afterwards be raised. Let the skin then be only divided, so as to -allow it to descend a little in the lower part of the eye; which will -be the consequence of the wound’s gaping above. Let lint be put into -it to prevent the union of the divided skin, and to generate a little -flesh in the middle: and when this has filled up the part, the eye is -afterwards properly covered _by the eye-lid_. - - [HB] λαγώφθαλμος, or hare’s eye, outward. - -[Sidenote: _Of an ectropium._] - -As it is a disorder of the upper eye-lid not to descend far enough to -cover the eye, so there is a disease of the lower, in which it is not -raised high enough, but hangs down, and cannot be brought close to the -other. And this also sometimes proceeds from a similar fault in the -cure, sometimes even from old age. The Greeks call it ectropium[HC]. -If it happens from a faulty cure, the treatment is the same as in the -foregoing case: only the horns of the wound are turned towards the -cheeks, and not to the eye. If it proceed from old age, the whole of it -must be cauterized externally with a thin plate of iron; then anointed -with honey; and from the fourth day fomented with hot water, and -anointed with medicines to bring on a cicatrix. - - [HC] ἐκτρόπιον, from turning. - -[Sidenote: _Of the staphyloma._] - -These then are the general disorders, that commonly occur in the parts -about the eye, the angles, and eye-lids. In the eye itself the external -coat is sometimes raised, either from the rupture or relaxation of some -of the internal membranes; and it resembles a raisin stone in its form, -whence the Greeks call it a staphyloma[HD]. There are two methods of -cure for it. One is to pass through the middle, at the root of it, a -needle with a double thread; then to tie tight the ends of one of the -threads above, and of the other below; which by cutting it gradually -may bring it off. The other is, to cut out from its surface about the -bigness of a lentil; then to rub in spodium or cadmia. When either -of these is done, the white of an egg must be spread upon wool and -applied; and afterwards the eye must be fomented with the steam of hot -water, and anointed with mild medicines. - - [HD] σταφύλωμα. - -[Sidenote: _Of clavi._] - -Callous tubercles in the white of the eye are called clavi; which name -is given them from their figure. The best method is to pierce them at -their very roots with a needle; and below that to cut them off, and -then to anoint with mild medicines. - -[Sidenote: _Description of the eye._] - -I have already elsewhere mentioned a cataract, because when recent, -it is often removed by medicines. But when it is of long standing, it -requires a manual operation, and one, which may be reckoned amongst the -nicest. Before I treat of this, I shall give a short account of the -nature of the eye; the knowledge of which, as it is of importance in -several other parts, so it is peculiarly necessary here. The eye then -has two external coats; the exterior of which by the Greeks is called -ceratoides[HE]; and this, where it is white, is pretty thick, but -before the pupil is thinner. The interior coat is joined to this, in -the middle where the pupil is, and is concave, with a small aperture; -round the pupil it is thin, but at a distance from it, something -thicker; and by the Greeks is called chorioides[HF]. As these two coats -surround the internal part of the eye, they again join behind it, and -becoming finer, and uniting together, pass through the opening, which -is between the bones, to the membrane of the brain, and are fixed to -it. Under these, in the part where the pupil is, there is a void space; -then again below, is an exceeding fine coat, which Herophilus called -arachnoides[HG], the middle part of which subsides, and in that cavity -is contained somewhat, which from its resemblance to glass the Greeks -call hyaloides[HH]. This is neither liquid, nor dry; but seems to be a -concreted humour; from the colour of which, that of the pupil is either -black, or grey, though the external coat be white. This is inclosed -by a small membrane, which proceeds from the internal part of the -eye. Under these is a drop of humour resembling the white of an egg, -from which proceeds the faculty of vision. By the Greeks it is called -chrystalloides. - - [HE] κερατοειδὴς. - - [HF] χοριοειδὴς. - - [HG] ἀραχνοειδὴς. - - [HH] ὑαλοειδὴς. - -[Sidenote: _Of a cataract._] - -Now a humour concretes under the twoὑαλοειδὴς. coats, where I mentioned -the void space to be, either from a disease, or a blow; and being -gradually indurated, it obstructs the interior faculty _of vision_. -There are several species of this malady, some of which are curable, -and others not. For if the cataract be small, immoveable, of the colour -of sea-water, or burnished iron, and leaves some sense of light on its -sides, there remains hope. If it is large, if the black part of the -eye, losing its natural appearance, is changed into some other, if the -cataract be of the colour of wax(11), or gold; if it slides and moves -to and fro, it is scarcely ever cured. And for the most part, the more -severe the disease, or the greater the pains of the head, or the more -violent the blow has been, which gave rise to it, so much the worse it -is. Neither is old age a proper time of life for a cure; which without -an additional disease causes a dimness of sight: nor even childhood; -but the middle age betwixt these. Neither is a very small eye, nor one, -that is hollow, fit for this operation. And there is also a certain -maturity of the cataract itself: wherefore we must wait till it seems -to be no longer fluid, but to have concreted with a certain degree of -hardness. - -Before the operation, the patient must use a spare diet, drink water -for three days, the day immediately preceding take nothing at all. -After this preparation he must be set in a light place, in a seat -facing the light, and the physician must sit opposite to the patient -on a seat a little higher; an assistant behind taking hold of the -patient’s head, and keeping it immoveable; for the sight may be lost -for ever by a slight motion. Moreover the eye itself, that is to be -cured, must be rendered more fixed by laying wool upon the other, and -tying it on. The operation must be performed on the left eye by the -right hand, and on the right by the left hand. Then the needle sharp -pointed(12), but by no means too slender, is to be applied, and must -be thrust in, but in a straight direction, through the two coats, in -the middle part betwixt the black of the eye and the external angle -opposite to the middle of the cataract, care being taken to wound -no vein. And it must not be introduced with timidity(13) neither, -because it comes into a void space. A person of very moderate skill -cannot but know when it arrives there; for there is no resistance -to the needle: when we reach it, the needle must be turned upon the -cataract, and gently moved up and down there, and by degrees work the -cataract downward below the pupil; when it has past the pupil, it must -be prest down with a considerable force, that it may settle in the -inferior part. If it remain there, the operation is compleated. If it -rises again, it must be more cut with the same needle, and divided into -several pieces; which when separate, are both more easily lodged, and -give less obstruction. After this the needle must be brought out in a -straight direction, and the white of an egg spread upon wool must be -applied, and over that something to prevent an inflammation, and then -_the eye_ be bound up. - -Afterwards there is a necessity for rest, abstinence, mild unctuous -medicines, and food (which it is soon enough to give on the day -following) at first liquid, that the jaws may not be too much employed, -then when the inflammation is gone, such as was directed in wounds. To -which we must add this rule, that the patient’s drink be water for a -pretty long time. - -[Sidenote: _Of a flux of gum._] - -I have already treated of a flux of thin gum, which infests the eyes, -so far as the cure depends upon medicines. I now come to these cases, -that require manual operation. Now we observe that some people’s eyes -never grow dry, but are always moistened with a thin humour; which -circumstance occasions a constant asperity, and from slight causes -excites inflammations, and lippitudes, and in fine renders a person -uneasy all his life. And this disorder in some no remedy can relieve; -in others it is curable. Which difference ought first of all to be -known, that we may relieve the one, and not meddle with the other. - -And in the first place, it is in vain to attempt the operation in -those, who have this disorder from their infancy, because it will -certainly continue to their dying day. Secondly, it is needless, where -the discharge is not great, but acrid; because they are not assisted -by a manual operation, but are brought to a sound state by medicines, -and a proper diet for generating a thicker phlegm. Broad heads also are -hardly susceptible of the remedy. Then it makes a difference whether -the gum be discharged by the veins, that lye between the skull and the -skin, or by those between the membrane of the brain and the skull: -for the former moisten the eyes by the temples; the others by the way -of those membranes, that go from the eyes to the brain. Now a remedy -may be applied to those veins, that discharge above the bone, but not -to those below the bone(14). Neither can relief be given, where the -discharge comes from both places; because when one part is relieved, -nevertheless the other remains disordered. - -The source of the disorder is discovered by this method. After shaving -the head, such medicines, as stop the gum in a lippitude, ought to -be laid on from the eye-brows as far as the top of the head: if the -eyes begin to be dry, it appears that they are moistened by those -veins, which are under the skin: if the moisture is not diminished, -it is manifest it descends from below the bone: if a humour still -flows(15), but in less quantity, the disorder is from both. In most -patients however the complaint is found to be derived from the superior -veins; and therefore the greater number may be relieved. And this is -very well known, not only in Greece, but amongst other nations too: so -that no part of medicine has been more clearly explained in any country. - -Some _practitioners_ in Greece cut the skin of the head in nine lines; -two straight ones in the occiput, one transverse above these; then two -above the ears, one also transverse betwixt them; and lastly three -straight ones between the top of the head and the forehead. Others drew -these incisions in a straight direction from the top of the head to -the temples; and discovering from the motion of the jaws the origins -of the muscles, made gentle incisions in the skin above these, and -separating their lips by means of blunt hooks, they inserted lint in -such a manner, as to prevent the edges of the skin from uniting, and to -cause flesh to sprout up in the middle, which might bind those veins, -from whence the humour passes to the eyes. Others again have drawn a -line with ink from the middle of one ear to the middle of the other, -and another line from the nose to the crown of the head; and where -these lines met, made an incision with a knife; and after the effusion -of blood, cauterized the bone in that part. And notwithstanding this, -they also applied the actual cautery to the rising veins both in the -temples, and betwixt the forehead and crown of the head. - -It is a common method of cure to cauterize the veins in the temples, -which indeed are generally turgid in this kind of disorder; but that -they may be more inflated and show themselves better, the neck must -first be tied pretty strait. And the veins must be cauterized with -small and blunt irons; till the flux of gum upon the eyes stop: for -that is a sign the passages are blocked up, by which the humour was -conveyed. - -However it is a more effectual method, when the veins are small and -lie deep, and therefore cannot be separated(16), to make a ligature -about the neck in the same manner, and the patient keeping in his -breath, that the veins may rise the more, to mark with ink these in -the temples, and between the crown of the head and the forehead; -then loosing the neck, to cut the veins, where these marks are, and -discharge blood; when a sufficient quantity has flowed, to cauterize -them with small irons: in the temples indeed with caution; lest the -muscles lying below, which secure the jaws, be hurt; but betwixt the -forehead and the crown so strongly, that a scale may cast off from the -bone. - -But the method of the Africans is still more efficacious, who cauterize -the crown of the head to the bone, so as to make it cast off a scale. -But nothing is better than what is done in Gallia Comata, where they -separate the veins in the temples, and the upper part of the head. -The manner of treating cauterized parts I have already explained. At -present I shall add this one direction; that when veins are cauterized, -we should not endeavour to hasten the separation of the eschars, nor -the filling up of the ulcers; lest either an hemorrhage ensue, or the -pus be quickly suppressed; since it is fit these parts be dried by the -latter, and it is not proper they should be exhausted by the former. If -however an hemorrhage should at any time happen, medicines for stopping -blood must be rubbed in, but not such as will prove caustic. Now the -method of separating veins, and what is to be done, when they are -separated, I shall explain, when I come to the varices of the legs. - - - - -CHAP. VIII. - -OF THE OPERATIONS REQUISITE IN THE EARS. - - -But as the eyes require many operations, so in the ears there are very -few disorders, which come under this branch of medicine. However it -sometimes happens, either immediately from the birth, or some time -after, when there has been an ulceration, and the ear has been filled -by a cicatrix, that there is no opening in it, and there it is deprived -of the faculty of hearing. When this happens, trial must be made with -a probe whether it be filled up to any depth, or be only agglutinated -in the surface. For if it be deep, it does not yield to the pressure; -if superficial, it presently receives the probe. The first ought not to -be touched, lest a convulsion follow without any hopes of success, and -from that there may be a danger of death; the other is easily cured. -For where the foramen ought to be, either some caustic medicine must -be applied, or it must be opened by the actual cautery, or even cut -with a knife. And when that is opened, and the ulcer is clean, a quill -must be introduced there, armed with a cicatrizing medicine; and round -something must be applied, to promote the healing of the skin about the -quill; the effect of which is, that after it is removed, the patient -has the faculty of hearing. - -But where the ears have been bored and give offence, it is sufficient -to pass a hot needle through the cavity very quick, that its lips may -be slightly ulcerated; or even to ulcerate it with a caustic medicine; -then afterwards to apply something to deterge it; next somewhat to -fill up the part, and bring on a cicatrix. But if this opening be -large, as it generally is in those who have worn heavy ear-rings, it is -proper to cut through what remains,(17) to its extremity; then above -that to scarify the edges _of the foramen_ with a knife, and afterwards -to stitch them, and apply an agglutinating medicine. The third case -consists in giving a supply to any part, that is deficient; which as it -may also be done in the lips and nose, and the method is the same, it -will be best to treat of it once for all. - - - - -CHAP. IX. - -THE OPERATION NECESSARY IN A WANT OF SUBSTANCE IN THE EARS, LIPS, AND -NOSE. - - -Defects in these three parts, if they be small(18), may be cured: if -considerable, they either do not admit of a cure, or by the cure itself -are so deformed, that they were less offensive before. And in the ear -indeed, and the nose, deformity is the only thing to be feared: but in -the lips, if they are too much contracted, there is also a disadvantage -in respect of their use; because the food is taken, and the speech is -articulated with more difficulty. For flesh is not generated there; but -is brought from the adjacent part. Which though in a slight mutilation -it may both cause no defect, and escape observation, in a great one -cannot. Now an old person is not a proper subject for this operation, -nor one in a bad habit of body, nor one in whom ulcers heal with -difficulty; because there is no part, where a gangrene more quickly -seizes, or is harder to remove. - -The method of cure is this; to reduce that, which is mutilated, into a -square; from its interior angles to cut in transverse lines, so as to -divide the part, that lies within these lines, from that beyond them; -then to draw together the parts we have thus opened: if they do not -fully meet, then beyond the lines we made before, to cut in two places -in a lunated form, with the horns turned towards the wound, so as only -to separate the surface of the skin: for by this means what we draw -together will be more at liberty to follow; which is not to be forced -by violence, but gently drawn, so as it may easily follow, and when let -go, not recede far. - -Sometimes however, the skin not being altogether brought from one side, -renders the part, which it has left, deformed(19). In such a place an -incision must be made only on one side, and the other kept untouched. -Therefore we must not attempt to draw any thing either from the lower -part of the ears, or the middle of the nose, or the lower parts of the -nostrils, or from the angles of the lips. We may draw on both sides, -where there is any defect in the upper parts of the ear, or the lower -parts or the middle of the nostrils, or the middle of the lips: which -however are sometimes mutilated in two places; but the method of cure -is the same. If a cartilage projects in the part where the incision is -made, it must be cut off; for it neither unites again, nor is safely -pierced by the needle. Neither must much of it be cut away, lest -between the two extremities of the skin freed from it on both sides, -there should be a collection of pus. Then the lips of the wound being -brought into contact, must be stitched together, the skin being taken -up on both sides; and where the lines above mentioned are, there also -the suture must be used. In dry parts, as the nostrils, the application -of litharge does very well. Into the interior and lunated incisions -lint must be put; that granulations of flesh may fill up the wound. And -that the part thus sewed must be attended to with the greatest care, -may appear from what I said before of a gangrene. Therefore every third -day, it must be fomented with the steam of hot water, and the same -medicine applied again, which commonly on the seventh day unites it. -Then the stitches ought to be taken out, and the ulcer healed up. - - - - -CHAP. X. - -OF THE EXTIRPATION OF A POLYPUS IN THE NOSE. - - -I have elsewhere said that the knife is the principal cure for a -polypus growing in the nostrils. Wherefore it is necessary to separate -this from the bone with a sharp iron instrument made in the form of -a spatha: care being taken not to hurt the cartilage below, which is -difficult to cure. When it is cut off, it must be extracted with an -iron hook. Then a piece of lint twisted, or some part of a penecillum -must be sprinkled with a styptick medicine, and the nostrils be gently -filled with it. The blood being stopped, the ulcer must be deterged -with lint. When it is clean, a quill armed with a cicatrizing medicine -must be introduced within, in the same manner as was directed in the -ear, till it be entirely sound. - - - - -CHAP. XI. - -OF THE CHIRURGICAL CURE OF AN OZÆNA. - - -I do not find in the eminent surgeons any operation for the cure of -that disorder, which the Greeks call ozæna, when it does not yield to -medicines. I suppose because the operation seldom works a cure, and is -nevertheless attended with great pain. By some however it is directed -to introduce either a small cannula, or writing reed into the nostril, -till it reach up to the bone; then through this to pass a small hot -iron to the very bone; next to deterge the cauterized part with -verdigrease and honey; and when clean, to heal it up with lycium: Or -that an incision be made in the nostril from its extremity to the bone, -that the part may be seen, and the hot iron may be more easily applied; -then that the nostril be stitched; and the cauterized ulcer cured as in -the former method; and litharge or some other agglutinant laid upon the -suture. - - - - -CHAP. XII. - -OF THE OPERATIONS REQUISITE IN THE MOUTH. - - -[Sidenote: _Of the teeth._] - -In the mouth also some disorders are cured by manual operation. Here in -the first place the teeth are sometimes loosened, either by reason of -the weakness of their roots, or from the gums decaying. It is proper in -both cases to apply a hot iron to the gums, so as to touch them gently, -but not to make a deep impression. The gums when cauterized must be -rubbed with honey, and washed with mulse. When the ulcers begin to be -clean, some dry repellent medicines must be sprinkled upon them. - -But if a tooth occasions pain, and it seems proper to extract it, -because medicines give no relief, it ought to be scraped all round, -that the gum may be loosened from it; then it is to be shook; which -must be continued till it move easily: for the extraction of a fast -tooth is attended with the greatest danger, and sometimes the jaw-bone -is dislocated. It is attended with more danger still in the upper -teeth; because it may give a shock to the temples or eyes. After these -precautions, the tooth is to be taken out, if possible, by the hand, if -not, by a forceps. - -But if it be corrupted before, its cavity must be filled up either with -lint, or lead well adapted to it, lest it break under the forceps. The -forceps must be drawn out straight, lest the thin bone, to which the -tooth adheres, be fractured in some part by its bended roots. Neither -is this without danger; especially in the short teeth, which generally -have longer roots; for often, when the forceps cannot lay hold of the -tooth, or does it without success, it takes hold of the jaw-bone, and -breaks that. - -One may immediately be sure, when there is a large effusion of blood, -that something is broken off from the bone. Therefore the scale, -that has come off, must be sought for by a probe, and taken out with -a vulsella. If it does not come away, the gum ought to be cut, till -the scale loosened from the bone can be taken out. And if it be not -entirely broken, but the external part of the jaw swells, so that the -mouth cannot open, on the outside must be applied a warm cataplasm of -meal and figs, till it bring on a suppuration there; then an incision -must be made in the gum. A copious discharge of pus is also a sign of a -fractured bone: so that even then it is proper to extract it. Sometimes -too, when it is injured, there is a fissure, which ought to be scraped. - -A rough tooth ought to be scraped, where it is black, and rubbed with -the powder of rose leaves, with an addition of one-fourth part of -galls, and another of myrrh; and pure wine must be held in the mouth -frequently. And in this case the head must be covered, the patient must -walk much, make use of friction to his head, and a diet not acrid. - -But if either, from a blow, or some other misfortune, some of the teeth -are loosened, they must be tied with gold to those that are firm; -and restringents must be held in the mouth, such as wine, in which -pomegranate bark has been boiled, or in which hot galls have been -infused. And if one tooth should happen to grow in children, before the -former has fallen out, that, which should have dropped, must be scraped -round and pulled out; that which is growing in the place of the former, -must be pushed into its proper place, with the finger, every day, till -it come to its just size. Whenever a tooth is extracted, and its root -has been left, that also must be immediately taken out by a forceps -made for that purpose, which the Greeks call rizagra. - -[Sidenote: _Of indurated tonsils._] - -Tonsils, that are indurated, after an inflammation, called antiades[HI] -by the Greeks, when they are covered by a slight coat, should be -disengaged all round by the finger, and pulled out. If they are not -separated by this method, it is necessary to take hold of them with a -small hook, and cut them out with a knife; then to wash the ulcer with -vinegar, and rub the wound with a styptic medicine. - - [HI] ἀντιάδες. - -[Sidenote: _Of the uvula._] - -The uvula, if it is inflamed, and falls down, and is painful, and of a -ruddy colour, cannot be cut without danger; for there is commonly a -great effusion of blood: therefore it is better to make use of those -remedies I have mentioned elsewhere. But if there be no inflammation, -and nevertheless it is relaxed to a great length by a humour, and is -small, sharp, and white, a portion of it ought to be cut off: and -likewise, if the extremity of it be livid and thick, and the superior -part small. There is no better method than to take hold of it with a -vulsella (_a kind of forceps_), and under that, to cut off what we -think fit: for there is no danger, that either too much or too little -be cut off; as we have it in our power to leave no more below the -vulsella, than appears to be useless, and to cut off so much as shall -reduce the uvula to its natural magnitude. After the operation, the -same applications are proper, which were prescribed above for the -tonsils. - -[Sidenote: _Of the tongue._] - -The tongue, in some people, is joined with the part below it from their -birth; who are by that means deprived of speech. The end of their -tongue must be taken hold of with a vulsella, and the membrane below it -cut; great care being taken, that the contiguous veins be not wounded, -and the patient hurt by an effusion of blood. The remaining part of the -cure of the wound is already directed in the preceding cases. And most -people speak, as soon as it is healed. But I have known an instance, -where a person after the cutting of his tongue, though he could thrust -it far enough beyond his teeth, did not attain the faculty of speaking. -Thus it happens in the practice of physic, that what is always right to -do, is not always attended with success. - -[Sidenote: _An abscess under the tongue._] - -An abscess also sometimes gathers under the tongue; which is generally -included in a coat, and excites violent pains. If this be small, it is -sufficient to make one incision into it: if larger, the surface of the -skin must also be cut off to the coat, then the lips of it are to be -laid hold of on both sides with small hooks, and the membrane must be -freed from its connections all round; great care being taken in this -operation not to wound any large vein. - -[Sidenote: _Of chopped lips._] - -The lips are frequently chopped; which besides the pain, is attended -with this inconvenience, that it hinders our speaking, as that action -by opening the fissures causes them to bleed, and to give pain. If -these be only in the surface, it is better to treat them by those -medicines, which are composed for ulcers of the mouth: if they are -deeper, it is necessary to cauterize them with a thin iron; which being -made in the form of a spatha, ought to slide over them as it were, and -not press upon them. Afterwards, the same method must be followed, as -was laid down in cauterized ulcers of the nostrils. - - - - -CHAP. XIII. - -OF THE BRONCHOCELE. - - -In the neck, between the skin and the wind-pipe, a tumour rises, -which the Greeks call bronchocele[HJ], in which there is contained -sometimes insensible flesh, at other times a humour like honey or -water; sometimes also hairs mixed with small bones. Whatever that be, -which is contained in the coat, it may be cured by caustic medicines, -which burn the surface of the skin, together with the coat below it. -When this is done, if it be a humour, it runs out; if it be any thing -substantial, it is taken out by the fingers; then the ulcer is healed -by lint. But the cure by the knife is more expeditious. An incision is -made in one line in the middle of the tumour down to the coat; after -which, the morbid body is separated by the finger from the sound parts, -and is taken out entire with its coat: then it is washed with vinegar, -to which either salt or nitre has been added; and the lips are joined -by one stitch. The other applications are the same as in other sutures; -afterwards it must be bound up gently, lest it press the fauces. If -it should happen that the coat cannot be taken out, we must sprinkle -escharotics into it, and dress it with lint and other digestives. - - [HJ] βρογχοκήλη. - - - - -CHAP. XIV. - -OF THE OPERATIONS PERFORMED AT THE NAVEL. - - -There are several disorders about the navel, concerning which, because -they are very uncommon, authors are not agreed. Now it is probable, -that each one omitted what he had not met with, and that none of them -feigned a disease he had not seen. An indecent prominence of the navel -is common to them all. The question is, what are its causes? Meges has -assigned three; that sometimes the intestine makes its way into that -part, sometimes the omentum, at other times a humour. Sostratus has -not mentioned the omentum. To the other two he has added, that flesh -sometimes grows there; which is sometimes sound, at other times of a -cancerous nature. Gorgias also has omitted the omentum, but allowing -the other three causes, says, that air too sometimes is forced into -this part. Heron has mentioned all these four, and the omentum too; and -that species also, in which there is both the omentum and the intestine. - -The following symptoms discover what species it is. When the intestine -is protruded, the tumour is neither hard nor soft; is lessened by -cold, increases not only by heat, but even by keeping in the breath; -sometimes it sounds; and when a person lies on his back, the intestine -returns of itself, and the swelling subsides. When it is the omentum, -the other symptoms are similar, but the tumour is softer, and from its -base, tapers towards the top; and if one takes hold of it, it slips -away. Where both these are together, the symptoms are also complicated, -and the degree of softness is between both. But flesh is harder, and -there is a swelling always, though the patient lies on his back; it -does not yield to pressure, whereas the former easily does. If it be -corrupted, it has the same appearances which I described in a cancer. -A humour, if it be pressed, fluctuates. Air gives way to pressure, but -quickly returns; and when the body is in a supine posture, the tumour -retains the same figure. - -Of these species, that which proceeds from air, does not admit of -a cure. It is dangerous also to meddle with flesh that resembles a -cancer; and therefore it must be let alone. Where it is sound, it ought -to be cut out, and the wound dressed with lint. Some discharge the -humour by making an incision in the top of the tumour, and cure that -also by lint. With regard to the others, the opinions are various. -However, the circumstances themselves make it plain, that the body -must be laid in a supine posture; that whether it be the intestine or -the omentum, it may fall back into the abdomen. Then the cavity of -the navel being empty, by some is laid hold of by two regulae(20), -and their ends being tied tight, the part mortifies: by others it is -pierced to the bottom with a needle, followed by two threads, and is -tied on the one side and the other by the two ends of each of these -threads (as is done in the staphyloma of the eye) for by this means -the part above the ligature mortifies. Others added this process to -the operation: before tying, they made a single incision on the top, -that, by introducing a finger, they might push back the protruded -part, and then made the ligature. But it is sufficient to order the -patient to hold in his breath, that the tumour may show itself in its -full magnitude; then to mark the base of it with ink; and laying the -person on his back, to press down the tumour, that if any part has -not returned, it may be forced in by the hand; this done, to draw up -the navel, and where the mark of the ink is, to tie it strongly with -a thread; then to cauterize the part above the ligature, either with -medicines, or the actual cautery, till it be mortified; and to dress -the ulcer like other burns. This method is very successful not only -when the intestine, or the omentum, or both are contained in it, but -even where it is a tumour. - -But some circumstances are to be considered, before proceeding to the -operation, that no danger may arise from the ligature. For neither -an infant, nor an adult, nor an old man are proper subjects for this -method of cure; but generally such as are from seven to fourteen -years old. Next, that person is in a fit condition for it, whose body -is sound; but one, who is in a bad habit, and labours under papulæ, -impetigoes, and the like disorders, is not a proper subject. Slight -tumours also are easily removed; but there is danger in attempting -to cure those that are too large. The autumnal and winter season of -the year must be avoided. Spring is most suitable: and the beginning -of summer is not amiss. Besides these precautions, it is necessary to -fast the day before. Nor is that sufficient; for a clyster must also be -given, that all the protruded parts may the more easily subside within -the abdomen. - - - - -CHAP. XV. - -THE METHOD OF DISCHARGING THE WATER IN HYDROPICK PEOPLE. - - -I have elsewhere observed, that it is necessary to discharge the water -in dropsical patients. I must now describe the manner of performing it. -Some do it below the navel, about four fingers breadth to the left: -some by perforating the navel itself. Others first cauterize the skin, -and then make an incision through the interior teguments, because what -is divided by the actual cautery unites less quickly. The instrument -is to be introduced with great care not to wound any vein. It ought to -be of such a form, that the breadth of its point should be about the -third part of a finger; and it must be introduced so as to pass through -the membrane also, which separates the flesh from the internal part; -then a leaden or copper pipe must be introduced into it, its lips being -either spread outward, or surrounded with some check to prevent its -slipping through. The part that goes within ought to be a little longer -than that without, that it may reach beyond the internal membrane. By -this the water must be evacuated, and when the greater part of it is -discharged, the pipe must be stopped with a bit of linen, and left in -the wound, if it was not cauterized. Then on the following days, about -a hemina must be let out every day, till no water appears to remain. -Some even take out the pipe, though the skin has not been cauterized, -and tie over the wound a spunge squeezed out of cold water, or vinegar, -and the day following introduce the pipe again (which the recent wound, -by being a little stretched open, will admit of) that so, if any -humour remains, it may be evacuated; and this they recommend to be done -only twice. - - - - -CHAP. XVI. - -OF WOUNDS OF THE BELLY AND INTESTINES. - - -Sometimes the belly is perforated by a wound; upon which the intestines -roll out. When this happens, it must be first of all considered, -whether they be unhurt; and then whether they retain their natural -colour. If the smaller intestine be perforated, I have already -observed, that there is no cure for it. The large intestine may be -sewed; not that there is any reliance on the cure, but because a -doubtful hope is preferable to certain despair: for it sometimes -reunites. However, if either the intestine be livid, or pale, or black, -which symptoms also are necessarily attended with a want of sensation, -all remedies are vain. But if they yet retain their proper colour, -they must be treated with great expedition; for they are changed in -a moment, when exposed to the external air, to which they are not -accustomed. The patient must be laid on his back, with his hips raised -pretty high; and if the wound be so narrow, that the intestines cannot -be conveniently reduced, a sufficient opening must be made by incision. -And if the intestines are already become too dry, they must be washed -with water mixed with a little oil. Then the assistant ought gently to -separate the lips of the wound with his hands, or even with two hooks -passed through the peritonaeum, and the physician must insert those -intestines first that came out last, in such a manner as to preserve -the order of their several convolutions. When they are all replaced, -the patient must be shook gently, which causes all the intestines to -return to their proper places, and settle there. These being lodged, -the omentum must also be considered; and if any part of that be already -black or mortified, it must be cut off by the scissars; if any of it is -sound, it must be reduced upon the intestines. Now, neither a suture of -the skin alone, nor of the interior membrane is sufficient, but both of -them together. And that must be performed with two threads, and sewed -closer than in other places; because it may both be more easily broken -by the motion of the belly, and this part is not so liable to violent -inflammations. Therefore, threads are to be put into two needles, and -these held in both hands; the interior membrane must be sewed first, -beginning at the extremity of the wound, in such a manner, that the -needle may pass from the internal towards the external part, the left -hand carrying it through the right lip, and the right hand through the -left, by which means, the points of the needles are always farthest -from the intestines, and the blunt part next to them. When each side -is pierced once, the needles must be changed in the hands, that the -needle, which was in the left hand, may be in the right, and that come -into the left, which the right held before: and in the same manner they -must pass through the lips again; and also a third and fourth time, -and so on, the hands each time interchanging the needles, and thus the -wound must be closed. Then the same threads and needles must be brought -to the skin, and in like manner both sutures be performed on that part -too; the needles always passing from the internal part, and from the -one hand to the other. Afterwards agglutinants must be applied: to -which it is needless to repeat, from time to time, that it is necessary -to add either spunge or sordid wool squeezed out of vinegar. When these -are applied, a gentle bandage ought to be passed round the belly. - - - - -CHAP. XVII. - -OF A RUPTURE OF THE PERITONAEUM. - - -Sometimes either from a blow, or keeping in the breath too long, or -by the pressure of a heavy load, the internal membrane of the abdomen -breaks, when the skin above is whole: which also frequently happens -to women from pregnancy; and it generally occurs about the ilia. The -consequence is, that the flesh above being soft, does not bind the -intestines strongly enough, and the skin distended by them forms an -indecent tumour. And this disease is cured in different ways. For some -passing a needle with two threads into the base _of the tumour_, tie -it on both sides in the same manner described in the cases of the -navel and the staphyloma, that whatever is above the ligature may -mortify. Others cut out the middle of it in the form of a myrtle leaf -(according to the rule before laid down for all cases of a like nature) -and then join the lips by a suture. However, the best method is to -lay the patient on his back, and try by the hand, in what part the -tumour yields most, because the membrane must necessarily be ruptured -there, and resist more, where it is sound: then, where it appears to be -ruptured, incisions are to be made in two lines(21) by a knife, that -the part betwixt them being cut out, the internal membrane may have a -recent wound on both sides; because what has been long disunited does -not unite by a suture. The place being laid open, if the membrane in -any part should appear not to be fresh wounded, a small slip must be -cut off, only to ulcerate its edges. What else relates to the suture, -and the remaining part of the cure, has been above directed. - -[Sidenote: _Of varices in the belly._] - -Besides these, some people have varices in their bellies; but as the -method of cure here does not differ from that which is practised in the -legs, and being about to describe it by and by, I shall refer it to -that place. - - - - -CHAP. XVIII. - -A DESCRIPTION OF THE TESTICLES, AND THEIR DISEASES. - - -I now come to those diseases which arise in the private parts about the -testicles: which, that I may the more easily explain, I shall first -give a short account of the nature of the part. The testicles then have -something resembling small glands(22): for they do not discharge -blood, and are void of all sensation; the coats, however(23), which -contain them, are pained in wounds and inflammations. Now each of them -hangs from the groin by a nerve (_the vas deferens_) which the Greeks -call cremaster[HK]: and with each descends both a vein and an artery. -And these are covered with a membrane, thin, nervous, not sanguineous, -and white, which by the Greeks is called elytroides[HL]. Over that is a -firmer coat, which adheres strongly in the lowest part to the interior -one. The Greeks call it dartos[HM]. Besides, there are many small -membranes, which inclose the veins and arteries, and those nerves; and -betwixt the two coats in the superior part they are thin and open. Thus -far then the coats and vessels are peculiar to each testicle. But there -is a sinus common to both, and to all the internal part, which is also -exposed to our view. The Greeks call it oscheum[HN]; in our language it -is scrotum. And this in the lower part is slightly connected with the -middle coats, above only envelopes them. - - [HK] κρεμαστὴρ. - - [HL] λυτροειδὴς. - - [HM] δαρτὸς. - - [HN] ὀσχεὸν. - -Under this then several disorders occur: which happen sometimes -when these coats, which I said had their origin from the groin, are -ruptured; at other times, when they are entire: for sometimes the coat, -which ought to separate the intestines from the inferior parts, is -either first inflamed from a distemper, and afterwards burst by the -weight, or ruptured at once by some wound. Then either the omentum -alone, or that and the intestine together, fall down into it by their -own weight. And finding a way there, they bear down gradually from the -groin upon the inferior parts, and by and by divide the nervous coats, -which, for the reason I gave before, are open. The Greeks call these -enterocele[HO] and epiplocele[HP]: with us an indecent, but common name -for them is hernia. - - [HO] ἐντεροκήλη. - - [HP] ἐπιπλοκήλη. - -Now if the omentum descends, the tumour in the scrotum is never removed -either by fasting, turning the body one way or another, or placing it -in any particular posture; and if the breath be kept in, it is not much -increased, is unequal to the touch, and soft and slippery. - -But if the intestine also descends, the tumour without any inflammation -sometimes lessens, at other times increases, and it is generally free -from pain, and when a person is at rest, or lies down, it sometimes -entirely subsides, at other times it is so diminished, that a very -small part of it remains in the scrotum; but upon vociferation, or -repletion, and a violent exertion of force in bearing a great weight, -it increases: by cold it is contracted, by heat dilated; and at that -time the scrotum is both round and smooth to the touch, and what lies -within is slippery; if it be pressed, it returns to the groin; and -being let go, it rolls down again with a murmuring kind of noise, and -this happens in the lesser degrees of this malady. But sometimes from -the reception of excrements, the swelling is vastly enlarged, and -cannot be reduced; and occasions pain at such times to the scrotum and -groin, and abdomen. Sometimes too the stomach is affected, and throws -up first reddish coloured bile, then green, and in some even black. - -Sometimes the membranes being entire, a fluid distends this part: and -there are also two species of this. For it either collects between the -coats, or in the membranes, which surround the veins and arteries in -that part, when they are oppressed, and have grown callous. Neither -has that fluid betwixt the coats one certain seat: for sometimes -it lodges between the external and middle, sometimes betwixt the -middle and internal coat. The Greeks call this by the general name of -hydrocele[HQ], of whatever species it be. Our countrymen, not being -acquainted with any distinctions, include this also under the same name -as the former disorders. - - [HQ] ὑδροκήλη. - -Now in these there are some symptoms, that belong to all, and others, -that are peculiar to each particular species. The general are such as -indicate the collection of a fluid; the particular, its seat. We know a -fluid is contained within, if there be a tumour, that never disappears -entirely, but is sometimes lessened by fasting, or a slight fever, and -chiefly in children. And this is soft, if there is not a very great -quantity of fluid within; but if it has greatly increased, it resists -like a bottle filled, and tightly tied; the veins in the scrotum also -are inflated; if we press upon it with our finger, the fluid yields, -and fluctuating raises the part that is not pressed; and it appears -through the scrotum, as if it were in a glass or a horn; and in itself -is attended with no pain. The seat of it is thus known: If the water be -betwixt the external and middle coat, when we press with two fingers, -it gradually returns between them; the scrotum is somewhat lax and -whitish; if it is stroked, it stretches little or nothing; the testicle -can neither be seen nor felt in that part. But if it is within the -middle coat, the scrotum is more stretched and raised higher, so that -the penis above it is concealed under the swelling. - -Besides these, when the coats are equally entire, a ramex grows there. -The Greeks call it cirsocele[HR], when the veins swell. These being -sometimes twisted, and rolled up toward the superior part, fill either -the scrotum, or the middle coat, or the innermost one; sometimes they -grow even within the innermost coat about the testicle itself and its -nerve. Those that are in the scrotum itself are exposed to view; and -those which lie upon the middle or innermost coat, as being deeper, are -not indeed equally discernible, but yet are visible; besides that there -is both some swelling, according to the size and capacity of the veins, -and it also resists pressure more, and is unequal by reason of the -varicous dilatations of the veins; and on that side where it is, the -testicle is more dependent than it should be. But when this malady has -grown upon the testicle itself and its nerve, the testicle hangs down -much lower, and becomes less than the other, as being deprived of its -nutriment. - - [HR] κιρσοκήλη. - -Sometimes, though seldom, flesh grows between the coats. The Greeks -call that sarcocele[HS]. - - [HS] σαρκοκήλη. - -Sometimes too the testicle itself swells from an inflammation, and -also brings on fevers; and unless the inflammation has quickly ceased, -the pain reaches to the groin and ilia; and these parts swell, and the -nerve, by which the testicle hangs, is enlarged, and grows hard at the -same time. - -Besides the foregoing, the groin is also sometimes filled with ramices; -which case they call bubonocele[HT]. - - [HT] βουβωνοκήλη. - - - - -CHAP. XIX. - -GENERAL DIRECTIONS FOR OPERATIONS IN THE FOREGOING DISEASES ABOUT THE -TESTICLES. - - -These disorders being known, we must proceed to treat of their cure: in -which some things are common to them all, some proper to the particular -kinds. I shall first speak of the general: and now treat of those, -which require the knife. For those, that are either incurable, or ought -to be treated in a different manner, I shall take notice of, when I -come to the particular species. Now the incision is made sometimes in -the groin, sometimes in the scrotum. In either method it is necessary -for the patient to drink water for three days before; and the preceding -day even to fast: on the day of the operation, he must be laid on his -back; and if the incision is to be in the groin, and that is covered -with hair, it must first be shaved; then the scrotum being extended to -render the skin tense, the incision must be made at the bottom of the -belly, where the inferior coats are joined to the abdomen. It must be -opened boldly, till the external coat, which is the scrotum itself, be -cut, and the middle one come in view. When the wound is made, there -is an opening toward the inferior parts. Into that the fore finger of -the left hand must be introduced, that by separating the intervening -membranes it may enlarge the sinus. And an assistant taking hold of the -scrotum with his left hand, must extend it upward, drawing it away as -much as possible from the groin; at first with the testicle, while the -physician cuts away by the knife, if he cannot separate them by his -finger, all the small membranes, that are above the middle coat; after -this, letting go the testicle, that it may slip down, and come near to -the wound, and be brought out thence by the finger, and laid upon the -belly with its two coats. And if any part of it is corrupted, it must -be cut off. And as several veins are dispersed upon it, the small ones -may be cut at once, but the larger should be first tied with a pretty -long thread, to prevent a dangerous hemorrhage from them. - -But if the middle coat be affected, or the disease lies below it, it -must be cut out in such manner, that in the higher part close to the -groin it should be clean cut off: but the whole must not be taken away -below; for what is strongly connected at the base of the testicle with -the innermost coat, cannot be cut off without the greatest danger, and -for that reason must be left there. - -The same method is to be taken in the innermost coat too, if that be -injured. But it must be cut off, not at the top of the wound in the -groin, but a little below that; lest it bring on inflammations by -wounding the membrane of the abdomen. Neither on the contrary must -too much of it be left; lest afterwards it form a sinus, and afford a -receptacle to the same distemper. - -The testicle being thus cleansed must be gently let down through the -wound, with the veins, and arteries and its nerve; and care must be -taken, that no blood fall into the scrotum, and that it does not remain -coagulated in any part: which will be prevented, if the physician has -been careful to tie the veins. The threads, by which their ends are -secured, must hang without the wound: and when a suppuration comes on, -they will fall off without any pain. Upon the wound itself must be put -two fibulæ; and over them an agglutinating medicine. - -It is sometimes necessary to cut off something from one of the lips, -that the cicatrix may be larger and broader. When this is the case, -the lint must not be pressed down upon it, but only laid on lightly; -and over it some medicines to repel an inflammation, such as sordid -wool, or spunge squeezed out of vinegar; every thing else must be used -as when a suppuration ought to be excited. But when it is necessary -to make the incision beneath, the patient being laid on his back, the -left hand must be put below the scrotum; and a strong hold must be -taken of it, and the incision made; if the seat of the disorder be -small, the incision must be moderately sized, so as to leave a third -part _of the scrotum_ below entire, in order to support the testicle; -if it be larger, the wound may be greater, a little at the bottom -only being left entire, upon which the testicle may rest. But the -knife at first should be held in a straight direction, with a very -light hand, till it divide the scrotum itself; then the point of it -must be turned aside a little, to cut the transverse membranes, that -are between the external and middle coats. But the middle coat ought -not to be touched, if the disease lie above it; but if it lies below -the middle coat, that must be cut too; as likewise the third, if that -cover the malady. Wherever the disorder is found, the assistant should -squeeze the scrotum gently at the lower part; and the physician having -separated the inferior part by his finger, or the handle of the knife, -should bring the coat out of the wound, and make such an incision with -an instrument, which from its figure is called corvus, that he may -introduce his fore and middle fingers: when this is done, the remaining -part of the coat must be cut, and the knife must pass between the -two fingers, and whatever is noxious must either be taken out, or be -allowed to run out. - -Whatever coat is injured in the operation must be cut off; and the -middle one, as I observed before, as high as possible at the groin; the -innermost one a little lower. But before they are cut off, the vessels -ought to be tied very carefully by a thread; and the ends of this -thread must be left without the wound, which must be done also in other -veins, where the ligature is requisite. - -When that is done, the testicle must be returned into its place: and -the lips of the scrotum joined together by a suture: and the stitches -must not be too few, lest they be not agglutinated, and the cure prove -tedious; nor yet too many, lest they increase the inflammation. And in -this case too we must be cautious, that no blood remain in the scrotum: -afterwards agglutinants must be applied. - -If however blood has made its way into the scrotum, or any coagulated -blood has fallen down into it, an incision should be made below it; -and after cleansing it, a spunge moistened with sharp vinegar must be -applied round it. A wound that has been made for these reasons, after -it is tied up, if there be no pain, must not be opened for the first -five days; but either the wool or spunge, that lies over it, must be -sprinkled twice a day with vinegar alone; if there be pain, it must -be opened on the third day; and where there are fibulæ, they must be -cut; and where lint, that must be changed; and what is put on, must be -wet with oil of roses and wine. If the inflammation increases, to the -foregoing applications must be added a cataplasm of lentils and honey, -of pomegranate bark boiled in a rough wine, or a mixture of these. -If the inflammation does not give way to them, after the fifth day, -the wound must be fomented with plenty of hot water, till the scrotum -itself be both extenuated, and become more wrinkled; then a cataplasm -must be applied of wheat meal, with an addition of pine resin; which, -if the patient be a robust man, must be boiled up with vinegar; if more -delicate, with honey. And whatever the disorder has been, if there be -a great inflammation, without doubt medicines to promote a suppuration -must be applied. - -But if pus is generated within the scrotum, a small incision ought to -be made to give a vent; and so much lint is to be applied as to cover -the orifice. When the inflammation is removed, upon account of the -nerves, the last-mentioned cataplasm, and then cerate must be used. -This is the peculiar treatment of wounds of this kind. All other things -both in regard to the manner of dressing, and the diet, should be -conformable to the directions we have given about other wounds. - - - - -CHAP. XX. - -OF THE CURE OF A RUPTURE OF THE INTESTINE INTO THE SCROTUM. - - -These things being premised, we must descend to the particular species. -And if the intestine comes down in a young child, a bandage must be -made trial of before the knife: for this purpose a roller is sewed, to -which in one part a bolster is used made of cloths, which is applied -under the intestine to repel it; and then the rest of the roller is -bound tight about him: by means of which, the intestine is often forced -in, and the coats are agglutinated together. Again if the patient be -advanced in years, and from the largeness of the tumour it appears, -that much of the intestine has fallen down, and the case is attended -with pains and vomiting (which generally proceeds from the excrements -getting down into that part by a crudity) it is plain that the knife -cannot be used without fatal consequences; the complaint is therefore -only to be alleviated; and the intestine evacuated by other methods. - -The patient ought to be bled in the arm: and then if his strength will -admit, abstinence must be enjoined for three days; if he cannot bear -that, at least as long as his strength will allow. At the same time -must be kept upon it a cataplasm of lintseed boiled in mulse. After -these both barley meal with resin must be applied, and the patient put -into a bath of warm water mixed with oil; and some light and hot food -must be given. Some even administer clysters. These may carry something -into the scrotum, but cannot evacuate any thing from thence. The -disease being mitigated by the methods above prescribed, if the pain -returns at any time, the same course must be pursued. - -If a great portion of the intestine has fallen down without pain, it is -also needless to make an incision; not but that it may be removed from -the scrotum (unless an inflammation prevent) but because when repelled -thence, it stops at the groin, and raises a tumour there; and thus -there is not a termination, but a change of the malady. - -But where the use of the knife is proper, as soon as the wound made in -the groin shall reach to the second coat, that must be taken hold of -near the lips with two small hooks, while the physician disengages it -by taking out all the small membranes: for that, which is to be cut, -cannot be injured without danger, as the intestine must lie below it. -When it shall be separated, an incision must be made from the groin to -the testicle, care being taken not to wound the last; then it must be -cut out. For the most part however this operation is _only_ practicable -in children, and in a moderate degree of the malady. - -But if it be a robust man, and the disorder be more considerable, the -testicle ought not to be taken out, but to remain in its place. The -operation is performed in this manner. The groin is opened in the -same way by a knife, as far as the middle coat; and this coat in like -manner is taken hold of with two hooks, and the testicle is held by an -assistant(24), so as to prevent its coming out at the wound; then an -incision must be made downward in this coat with a knife; and below -it the fore finger of the left hand is introduced to the bottom of the -testicle, which it forces up to the wound: then the thumb and fore -finger of the right hand separate the vein and artery, and their nerve, -and coat from the external coat. And if any small membranes obstruct -this, they are divided by the knife, till the coat be wholly exposed to -view. When all is cut out, that requires excision, and the testicle is -replaced, a pretty broad habenula is to be taken from the lip of the -wound in the groin, that the wound may be the larger, and generate the -more flesh. - - - - -CHAP. XXI. - -OF THE CURE OF A RUPTURE OF THE OMENTUM INTO THE SCROTUM. - - -But if the omentum descends, the groin must be opened, and the coats -separated in the same manner as directed before. And it must be -considered whether it be a large or small part of it. For when it is -very small, it must be forced back over the groin into the abdomen by -a finger or the broad end of a probe: if it is large, whatever has -fallen out of the abdomen must be allowed to remain there; and it must -have escharotic medicines laid on it, till it mortify and fall off. -Some in this case pass through it a needle with two threads, and tie -the two ends of each contrary ways; by which it mortifies with equal -certainty, but not so soon. The effect is accomplished sooner, if the -part of the omentum above the ligature be rubbed with eating medicines, -but not corrosive; they are called septica by the Greeks. There have -been others, who have cut off the omentum with scissars: which is not -necessary, where the quantity is small; and if large, it may occasion -an hemorrhage; for the omentum is also connected by veins, and some of -them large. Neither can this practice be justified by an example drawn -from the cases of the belly opened by a wound, where the part of the -omentum, which falls out, is cut away by the scissars: since in this -case, it is both mortified, and cannot be taken off in any other way -more safely. If the omentum be reduced, the wound ought to be stitched; -or if it has been large and has mortified externally, the lips must be -cut off, as proposed before. - -[Sidenote: _Of a hydrocele._] - -If there be a fluid within _the membranes_, an incision must be made, -in boys upon the groin, unless too large a quantity of fluid forbid the -operation in that place; but in men, and where-ever there is a large -quantity, the scrotum must be opened. Then if the incision be made in -the groin, the coats must be drawn out at that part, and the humour -evacuated; if at the scrotum, and the disease be immediately below that -coat, there is no more required but to evacuate the humour, and cut -away any of the membranes, that happen to contain it; then it must be -washed with water, and an addition either of salt, or nitre: if the -disease lie within the middle or innermost coat, they must be taken -entirely out of the scrotum and cut off. - - - - -CHAP. XXII. - -OF A RAMEX IN THE SCROTUM. - - -A ramex situated upon the scrotum must be cauterized with small and -sharp irons run into the veins themselves, provided they burn nothing -else: it is peculiarly necessary to apply the cautery where they are -twisted and rolled together; afterwards meal mixed up with cold water -must be laid on; and the bandage must be applied, which I recommended -for the anus; on the third day lentils with honey must be put to it: -after the separation of the eschars, the ulcers must be deterged with -honey, embrocated with rose oil, and brought to cicatrize by dry lint. -Where the veins above the middle coat swell, the groin must be cut, and -the coat brought without the orifice; after which the veins are to be -separated from it by the finger, or the handle of the knife, and where -they adhere, tied both above and below by a thread; then they must be -cut through close to the ligatures, and the testicle replaced. But if -the ramex be situated upon the innermost coat, it is necessary to cut -out the middle one. And then if two or three veins swell, so that some -part be affected, but the greater part be from the disease, the same -method must be pursued as directed above; that is, the veins being -tied both at the groin and testicle, may be cut off, and the testicle -reduced to its place. But if the ramex have seized upon the whole of -it, the fore finger must be introduced through the wound, and put under -the veins, so as to draw them out gradually and uniformly, till the one -testicle be equal to the other; then fibulæ are to be put in the lips -in such a manner, as to lay hold of these veins likewise. It is done -thus. A needle passes through the lip from the external part, and then -is directed not through the vein itself, but its membrane, and from -thence is forced into the other lip. The veins ought not to be wounded, -lest they discharge blood. There is always a membrane between these -veins, which occasions no danger, and holds them fast enough, when -taken up by the thread: and therefore two fibulæ are sufficient. After -this, whatever veins have been brought out, should be returned into the -groin with the broad end of the probe. The time for loosing the fibulæ -is, when the inflammation is gone, and the ulcer deterged; that the -cicatrix may at once bind up both the lips and the veins. - -When the ramex has grown between the innermost coat, and the testicle -itself and its nerve, the only cure is to cut off the whole testicle: -for it does not in the least contribute to generation, and hangs down -in all indecently, in some even with pain. But in this case too, an -incision is to be made in the groin, and the middle coat must be drawn -out and cut away; the innermost one is to be treated in the same -manner; and the nerve, by which the testicle depends, to be cut off. -After this, the veins and arteries must be tied by a thread at the -groin, and cut off below the ligature. - - - - -CHAP. XXIII. - -OF A SARCOCELE. - - -If flesh happen to grow between the coats, it must certainly be taken -out; and the most convenient way of doing it is by an incision in the -scrotum. - -But if the nerve be indurated, the disorder cannot be cured either -by the hand or medicines. For the patients are oppressed with ardent -fevers, and either green, or black vomitings, besides these a violent -thirst, and roughness of the tongue; and generally about the third -day, frothy bile is discharged by stool, which excoriates the parts; -and food can neither be easily taken or retained; not long after, -the extremities grow cold, a tumour comes on, the hands are expanded -involuntarily; then comes on a cold sweat in the forehead, which is -followed by death. - - - - -CHAP. XXIV. - -OF A RAMEX IN THE GROIN. - - -When there is a ramex in the groin, if the swelling be small, a single -incision ought to be made; if it be larger, it ought to be done in two -lines, that what lies between may be cut out; and then without taking -away the testicle, as I have above shewn to be sometimes practised in a -rupture of the intestines, the veins must be taken up, and tied, where -they adhere to the coats, and cut off below these knots. The cure of -this wound is no way different from others. - - - - -CHAP. XXV. - -THE OPERATIONS REQUISITE IN THE DISORDERS OF THE PENIS. - - -From those we are to proceed to the operations upon the penis. If the -glans be bare, and a person chuses for the sake of decency to have -it covered, that may be done; but more easily in a boy than a man; -and more easily in one, to whom it is natural, than in another, who -according to the custom of some nations has been circumcised; better -where the glans is small, and the skin about it pretty large, and the -penis itself short, than where there is quite the reverse of these -circumstances. The cure of these, in whom it is natural, is performed -in this manner. The skin about the glans is laid hold of, and extended -till it cover it, and tied there; then near the pubes a circular -incision is made on the skin of the penis, till it be laid bare; and -great caution is used not to cut either the urinary pipe, or the -veins in that part. When this is done, the skin is drawn towards the -ligature, so that a part near the pubes is laid bare resembling a hoop; -then over it is applied lint, that the flesh may grow and fill it up, -and the breadth of the wound may afford a sufficient covering to the -glans. But the ligature must be continued till a cicatrix be formed, -leaving only in the middle a small passage for the urine. But in a -person, that has been circumcised, under the circle of the glans, the -skin ought to be separated by a knife from the inner part of the penis. -This is not very painful, because the extremity being loosened, it may -be drawn backwards by the hand, as far as the pubes; and no hemorrhage -follows upon it. The skin being disengaged, is extended again over the -glans; then it is bathed with plenty of cold water, and a plaister put -round it of efficacy in repelling an inflammation. For the following -days the patient is to fast, till he be almost overcome with hunger, -lest a full diet should perhaps cause an erection of that part. When -the inflammation is gone, it ought to be bound up from the pubercles to -the circle of the glans; and a plaister being first laid on the glans, -the skin ought to be brought over it; for thus it will happen, that the -inferior part may be united, and the superior heal so as not to adhere. - -On the contrary, if the glans be covered, so that it cannot be denuded -(which malady the Greeks call phymosis) it must be opened: which is -done in this manner. An incision is made in the prepuce below its -extremity, in a right line to the frænum; and the upper part being -thus relaxed, may be drawn back. But if this be not effectual, either -upon account of the straitness or hardness of the prepuce, a piece of -skin must be immediately cut out in the lower part in the form of a -triangle, with its vertex at the frænum, and the base at the extremity -of the prepuce. Then lint is to be applied over it, and other medicines -to heal it. And it is necessary to continue at rest till it be -cicatrized; for walking, by the attrition it causes, renders the ulcer -foul. - -[Sidenote: _Of infibulating boys._] - -Some have made a practice of infibulating boys, sometimes upon account -of their health(25): the method of doing it is this. The skin that -covers the glans is extended, and marked on both sides with ink, where -it may be perforated, and then is let go. If these marks return upon -the glans, too much has been taken up, and it ought to be marked nearer -the extremity: if the glans is not reached by them, that part is proper -for the fibula. Then where the marks are, the skin is pierced by a -needle followed by a thread, and the two ends of this thread are tied -together, and moved every day, till small cicatrices be formed about -the orifice. When these are confirmed, the thread is taken out, and a -fibula put in, which, the lighter it is, is so much the better. But -this operation however is more frequently needless than necessary. - - - - -CHAP. XXVI. - -OF THE OPERATION NECESSARY IN A SUPPRESSION OF URINE, AND LITHOTOMY. - - -Sometimes when no urine is made, an operation is necessary to discharge -it, either because the passage is collapsed from old age, or because a -stone, or some other concretion from blood has obstructed it within; -and a moderate inflammation also often prevents it from being evacuated -in a natural way. And this is requisite not only in men, but in women -too sometimes. For this purpose are made copper pipes; and that these -may serve for all bodies larger and smaller, a physician must have by -him three for men, and two for women. Of the male kind, the largest is -fifteen fingers breadth long, the middle size twelve, the least nine; -for the females, the greater is nine, and the lesser six. They ought -to be curved, but more especially the male kind, and very smooth; and -their diameter neither too large, nor too small. - -The patient then is to be laid on his back, in the same manner as is -described in the operation for the stone, either on a couch or bed. The -physician standing on the right side, ought with his left hand to take -hold of the penis if it be a man, and with his right to introduce the -pipe into the urinary passage; and when it comes to the neck of the -bladder, by an inclination of the pipe and the penis at once, to force -it into the bladder, and when the urine is evacuated, to take it out -again. In a woman, the urethra is both shorter, and straighter, and -resembles a caruncle, being situated between the labia pudenda above -the vagina; and they as frequently require assistance, but it is not -attended with so much difficulty. - -Sometimes a stone sliding into the urethra, sticks, where that grows -narrower(26), not far from the end; if possible it ought to be -drawn out either by a specillum oricularium, or the instrument, with -which the stone is extracted in cutting for that distemper. If that -has proved impracticable, the prepuce must be drawn out as much as -possible, and the glans being covered, must be tied by a thread; then -on one side a longitudinal incision must be made into the penis, and -the stone extracted; after this the prepuce is let go; for by this -means the sound part of the skin covers the incision in the penis, and -the urine will be discharged in the natural way. - -Since I have made mention of the bladder and stone, the place itself -seems to require me to subjoin the _chirurgical_ cure for calculous -patients, when they can be relieved no other way. But since that is -a very dangerous method, it is by no means proper to undertake it -precipitately. Nor is it to be attempted in every season, nor at all -times of life, nor in every degree of the disease; but only in the -spring, and upon a patient, whose age exceeds nine years, and not -fourteen; also if the disease has arisen to such a height that it can -neither be overcome by medicines, nor protracted, but that in some time -it must kill. Not but that now and then even a rash attempt succeeds; -however it more frequently fails in this case, because there are more -kinds and seasons of danger, all which I shall mention together with -the operation itself. - -Therefore when it is resolved to try the last remedy, for some -days before, the body must be prepared by diet, that is, by taking -moderately wholesome food, no way glutinous, and drinking water. In the -mean time the patient must exercise by walking, to cause the stone to -descend towards the neck of the bladder. Whether this has happened may -be known by introducing the fingers, as I shall shew in the operation. -When that is certain, the boy must first fast for a day; and then the -operation must be performed in a warm place; which is conducted in this -manner. - -A strong and skilful man sits down upon a high seat, and laying the -boy, whose back is towards him, in a supine posture, setting his hips -upon his knees, takes hold of him, and drawing up his legs, orders the -boy to put down his hands to his hams, and pull them toward his body -with all his might, and at the same time he holds them in that posture. -But if the patient be pretty strong, two able men must sit behind him -on two contiguous seats, and both their seats, and their legs next each -other must be tied together, to prevent their giving way. Then he is -placed upon both their knees in the same manner, and the one according -as he sits, lays hold of his left leg, and the other of his right; and -at the same time he himself draws up his hams. Whether he be held by -one or two, they lie forward with their breasts upon his shoulders. -Whence it happens, that the sinus above the pubes, between the ilia, is -extended without any wrinkles, and the bladder being compressed into a -small compass, the stone may be the more easily laid hold of. Besides, -two strong men are placed one at each side, who stand by, and do not -suffer either the one or two, that hold the boy, to give way. - -Then the physician, having carefully pared his nails, introduces his -fore and middle fingers of the left hand together, being first slightly -anointed with oil(27), into the anus of the patient, and lays the -fingers of his right hand lightly upon the lowest part of his abdomen; -lest if his fingers on both sides at once should press strongly upon -the calculus, it might hurt the bladder. And this must not be done -hastily, as in most cases; but so as may be safest: for hurting the -bladder brings on convulsions, with a danger of death. And first of all -the stone is sought for about the neck: where if it be found, it is -expelled with less trouble; and therefore I said the operation was not -to be attempted, unless this were known by its proper signs. If either -it was not there, or has gone backward, the fingers are applied to the -end of the bladder; and the right hand being removed also beyond it, it -is brought gradually down. - -And when the stone is found (as it must necessarily fall between the -surgeon’s hands) it is drawn down with the greater caution by how much -it is smaller and smoother, lest it escape, that is, lest there be a -necessity to harass the bladder again and again. Therefore the right -hand is always kept before the stone; and the fingers of the left force -it downwards, till it come to the neck. Into which part, if it be -oblong, it must be forced so as to come out prone(28); if flat, so as -to be transverse; if square, that it may rest upon two angles; if it be -larger at one end, so that the smallest may pass first. In a round one, -from the figure itself it is plain, there is no difference, save that -if it be smoother in one part than another, that should come out first. - -When it is brought to rest upon the neck of the bladder, a lunated -incision must be made in the skin, near the anus, as far as the neck of -the bladder, with the horns pointing a little towards the ischia; then -in that part where the bottom of the wound is straiter, again under the -skin(29), another transverse wound must be made, by which the neck -may be cut; till the urinary passage be open in such a manner, that the -wound is something larger than the stone. For those, who through fear -of a fistula (which in that part the Greeks call ouroruas[HU]) make but -a small opening, are reduced to the same inconvenience with greater -danger; because the stone, when it is brought away by force, makes a -passage, if it does not find one. And this is even more pernicious, if -the shape or asperity of the stone contribute any thing to it: whence -both an hemorrhage and convulsion may ensue. But though a person escape -these, the fistula will be much larger, when the neck is lacerated, -than it would have been if cut. - - [HU] Οὐρορυὰς: this word, as far as I can find, occurs no where else. - It is variously written in the different editions. The sense seems to - determine it to what I have expressed in the translation, with which - the etymology of it agrees. - -When the opening is made, the stone comes into view; the size of which -makes a material difference _with respect to its management_. Therefore -if it be small, it may be pushed forward on one side, and drawn out -on the other by the fingers. If larger, a crotchet(30) made for the -purpose must be put over the upper part of it. This at its extremity is -thin, beat out into the form of a semicircle, broad and blunt; on the -external part smooth(31), where it comes in contact with the wound; -on the inside rough, where it touches the stone. And it ought to be -pretty long; for one too short has not force enough to extract it. When -it is fixed, it ought to be inclined to each side, that the stone may -appear, and be held fast, because if it be laid hold of, it also gives -way to it. And the necessity for this is, lest when the crotchet begins -to be drawn, the stone may fly inward, and the crotchet fall upon the -edge of the wound, and lacerate it, the danger of which I have already -shewn. - -When it appears that the stone is securely held, a triple motion -must be made, almost at the same instant, to both sides, and then -externally; but this must be done gently, and the stone must be first -drawn a little forward; after this, the end of the crotchet must be -raised upward, that it may be farther within the bladder, and bring it -out the more easily. But if the stone cannot be conveniently held at -the superior part, its side must be taken hold of. This is the most -simple method. - -But a variety of circumstances requires some particular observations. -For there are some stones not only rough, but also full of sharp -points, which falling of themselves into the neck of the bladder, are -extracted without any danger. But if they are within the bladder, it -is neither safe to seek them, nor draw them forward; because when they -wound it, they bring on convulsions and death; and more especially if -any point is fixed in the bladder, and causes it to fall into folds, -as it is brought down _towards the neck_. Now a stone is discovered to -be in the neck, when the urine is made with greater difficulty than -ordinary; and to be pointed, when it comes away bloody; and this is -particularly to be tried by the fingers, and the operation is not to -be attempted unless we are sure it is there. And even then the fingers -must be introduced, and opposed to it behind tenderly, lest they -wound by pushing it with violence; then the incision must be made. -And in this case also many have made use of the knife. Meges (because -the knife being weak might fall on some prominence of the stone, and -after having cut the flesh above it, would not divide where there is -a hollow, but leave what will require a second incision) made an iron -straight instrument, with a broad back on its upper part, and its -lower part semicircular and sharp. This being taken between his fore -and middle fingers, and his thumb laid upon it, he prest it so, that -together with the flesh, he might cut any part of the stone that was -prominent: by which he gained this advantage, that he made a sufficient -opening at once. Now in whatever method the incision in the neck is -made, a rough stone ought to be extracted gently; no violence being -used for the sake of expedition. - -But a sandy stone is easily discovered both before the operation, -from the discharge of sandy urine, and in the operation; because it -makes but a faint resistance to the fingers, and that not equally, -and besides is apt to slide away. Also urine, that brings off with -it something like scales, discovers the stones to be soft, and that -they are composed of several small ones not firmly united together. -All these it is proper to bring away gently, changing alternately the -fingers in such a manner, that they may not hurt the bladder, and -no broken relics stay behind, which may afterwards render the cure -difficult. Any of these, that come into view, must be extracted either -by the fingers or crotchet. - -But if there are several stones, they must every one be taken out; -but if any very small one remain, it may rather be left: for it is -difficult to find it in the bladder; and when found, it quickly -escapes. Thus by long search the bladder is hurt, and mortal -inflammations are brought on; in so much that some, though they were -not cut, when the bladder has been long, and to no purpose, roughly -handled, by the fingers, have died. Besides all which, a small stone -being brought to the wound afterwards by the urine, drops out. - -In case the stone appears so large, that it cannot be extracted without -lacerating the neck, it must be split. The author of this contrivance -was Ammonius, who upon that account was called Lithotomus[HV] (_the -stone-cutter_.) It is done in this manner. A crotchet is fixed upon the -stone with so sure a hold as to prevent it from recoiling inward: then -an iron instrument of moderate thickness, with a thin edge, but not -sharp, is made use of. This is applied to the stone, and being struck -on the other side, cleaves it; great care being taken, that neither the -instrument come to the bladder, nor any thing fall in by the breaking -of the stone. - - [HV] λιθοτόμος. - -These operations are performed upon females much in the same manner, -concerning whom a very few peculiarities must be mentioned. For in -them, where the stone is very small, cutting is unnecessary; because it -is forced by the urine into the neck, which is both shorter, and laxer -than in men: therefore it often drops out of itself, and if it sticks -in the urinary passage, which is narrower, it is however extracted -without any harm by the abovementioned crotchet. But in larger stones -the same method is necessary. However, in a virgin, the fingers should -be introduced _into the rectum_ as in a man, in a married woman by -the vagina. Again, in a virgin, the incision must be made below the -left lip of the pudendum; but in a married woman, between the urinary -passage, and the bone of the pubes; the wound also must be transverse -in both places, and we need not be alarmed if the hæmorrhage be -considerable from a female body. - -When a stone is extracted, if the patient be strong, and not greatly -spent, we may let the blood flow to lessen the inflammation. And it is -not amiss for the patient to walk a little, that if any grumous blood -remain within, it may drop out. But if it does not cease of itself, it -must be stopped, lest the strength be entirely exhausted; and this is -to be done immediately after the operation in weak patients. For as a -person is in danger of a convulsion, whilst the bladder is fatigued, so -there is another fear, when the applications are removed, lest there be -such an hæmorrhage as to prove mortal: to prevent which, the patient -ought to sit down in sharp vinegar with the addition of a little salt; -by which means both the blood commonly stops, and the bladder is -contracted, and therefore is less inflamed. But if that does little -service, a cupping vessel must be applied, both in the knees(32) and -hips, and above the pubes too. - -When either a sufficient quantity of blood has been evacuated, or the -hæmorrhage stopped, the patient must be laid upon his back, with his -head low, and his hips a little raised; and over the wound must be -applied a double or triple linen cloth wet with vinegar. Then after an -interval of two hours, he must be let down in a supine posture into -a bath of hot water, so that he may be under water from the knees -to the navel, the other parts being covered with clothes, only with -his hands and feet bare, that he may be both less exhausted, and be -able to continue there the longer. This commonly produces a plentiful -sweat; which in the face is to be now and then wiped off by a spunge. -And the rule for the continuance of this bathing is, till it hurts by -weakening. After that the patient must be anointed plentifully with -oil, and a handful of soft wool saturated with warm oil, must be laid -on, so as to cover the pubes and hips, and groin, and the wound itself, -which must still remain covered with the linen beforementioned; and -this is to be moistened now and then with warm oil; that it may both -prevent the admission of cold to the bladder, and gently mollify the -nerves. Some make use of healing cataplasms. These do more hurt by -their weight, which by pressing upon the bladder(33) irritates the -wound, than service by their heat: and for that reason, not so much as -any kind of bandage is necessary. - -On the day following, if there be a difficulty in breathing, if the -urine is not evacuated, or if the part above the pubes has immediately -swelled, we may be assured, that grumous blood has staid within the -bladder. Therefore the fingers being introduced in the same manner as -above, the bladder must be handled gently, and whatever has happened -to be coagulated there dispersed; by which means it is afterwards -discharged from the bladder through the wound. Neither is it improper -to inject through the wound into the bladder by a syringe, a mixture -of vinegar and nitre; for if there be any bloody concretions, they are -discussed in that way. And these may be done even the first day, if -we are afraid of any thing being within; especially when weakness has -prevented the evacuation of it by walking. The other methods laid down -for the preceding day, the putting him into the bath, applying the -cloth, and wool in the manner above described, are to be continued. - -But a boy is neither to be put so often into the warm water, nor kept -there so long _at a time_, as a youth; the weak, as the strong; one -affected with a slight inflammation, as another, in whom it is more -violent; one whose body is disposed to evacuations, as he that is -bound. But in the mean time, if the patient sleep, and his breathing -be equal, his tongue moist, his thirst tolerable, his lower belly not -at all swelled, and the pain and fever moderate, we may take it for -granted that the cure goes on well. - -But in such patients the inflammation ceases commonly about the fifth -or seventh day: when that is abated, the bath is needless. Only the -wound, as the patient lies in a supine posture, must be fomented with -hot water, that if the urine corrodes, it may be washed away. Digestive -medicines must be laid on; and if the ulcer appears to want deterging, -honey may be applied. If that corrodes, it must be tempered with rose -oil. The enneapharmacum plaister seems fittest for this intention, for -it both contains suet to promote digestion, and honey to deterge the -ulcer, marrow also, and especially that of veal, which is particularly -efficacious in preventing a fistula from remaining. And at that time -lint is not necessary over the ulcer; but is properly laid above the -medicine to keep that on. But when the ulcer is cleansed, it must be -brought to cicatrize by lint alone. - -At this time, however, if the cure has not proceeded happily, various -dangers arise: which one may quickly prognosticate, if there be a -continual watching, or a difficulty of breathing, if the tongue be -dry, if there be a violent thirst, if the bottom of the belly swells, -if the wound gapes, if the urine that makes its way through it, does -not corrode it; in like manner, if before the third day some livid -stuff drops out; if the patient makes no answers to questions, or very -slowly; if there are vehement pains; if after the fifth day violent -fevers come on, and a nausea continues; if lying upon the belly is the -most agreeable posture. However nothing is worse than a convulsion, -and a bilious vomiting before the ninth day. But there being reason to -fear an inflammation, it must be obviated by abstinence, and moderate -food seasonably administered; and by applying, at the same time, -fomentations, and the other means above prescribed. - - - - -CHAP. XXVII. - -OF A GANGRENE AFTER CUTTING FOR THE STONE. - - -The next danger is that of a gangrene. This is known by a discharge of -fetid sanies both by the wound and the penis, and together with that, -something not very different from grumous blood, and little films like -small locks of wool; it is also known by the lips of the wound being -dry, by a pain in the groin, by the continuance of the fever, and its -increase at night, and by the accession of irregular shudderings. Now -it must be considered to what part the gangrene spreads. If to the -penis, that part grows hard and red, and is painful to the touch, and -the testicles swell, if to the bladder, a pain of the anus follows, -the hips swell, the legs cannot be easily extended; but if to one side, -it is apparent to the sight, and has these same symptoms on either -side, but not so violent. - -The first circumstance of importance is, that the body lie in a proper -posture, that the part into which the disease is propagated be always -laid highest. Thus if it tends to the penis, the patient should lie -supine; if to the bladder, upon his belly; if to one side, upon the -other, which is sound. Then as to the means of cure, the patient must -be put into a bath made of a decoction of horehound, or cypress, or -myrtle, and the same liquor must be injected into the wound by a -syringe; then a mixture of lentils and pomegranate bark both boiled in -wine must be laid on; or bramble, or olive leaves boiled in the same -manner, or other medicines, which we have prescribed for restraining -and cleansing gangrenes. And if any of these shall be in a dry form, -they must be blown in through a writing reed. - -When the gangrene begins to stop, the ulcer should be washed with -mulse. And at this time cerate must be avoided, which softens the -flesh, and prepares it for receiving the infection. Rather let washed -lead with wine be laid on; over which shall be applied the same spread -upon a linen cloth: by which a cure may be accomplished. Nevertheless -we should not be ignorant, that when a gangrene has begun, the stomach, -which has a certain sympathy with the bladder, is often affected; -whence it happens, that the food can neither be retained, nor if any is -retained, can it be concocted, nor the body nourished; and therefore -the wound can neither be deterged nor incarned: which must of necessity -soon bring on death. - -But as it is not possible, by any means, to save patients under these -circumstances, from the first day however, the method of cure must be -_regularly_ observed. In _the conduct of_ which some caution is also -necessary with regard to the food and drink: for at the beginning, -none but moist food ought to be given; when the ulcer is deterged, of -the middle kind; greens and salt fish are always hurtful. A moderate -quantity of drink is required: for if too little is drunk, the wound -is inflamed, the patient labours under a want of sleep, and the -strength of the body is diminished: if too much be taken, the bladder -is frequently filled, and by that means irritated. It is too plain to -require a frequent repetition, that the drink must be nothing but water. - -It generally happens from a diet of this kind, that the belly is bound. -A clyster must be given of a decoction of fenugreek or mallows in -water. The same liquor mixed with rose oil, must be injected into the -wound by a syringe, when the urine corrodes it, and prevents it from -being cleansed. For the most part, at first, the urine is discharged -by the wound; whilst it is healing, it is divided, and part begins to -be discharged by the penis, till the wound be entirely closed: which -happens sometimes in the third month, sometimes not before the sixth, -at other times after a whole year. - -And we should not despair of a solid agglutination of the wound, unless -where the neck has been greatly lacerated, or many and large caruncles, -and at the same time some nervous substances have come away by a -gangrene. But the greatest precaution must be used, that no fistula, or -at least a very small one, be left there. Therefore, where the wound -tends to cicatrize, the patient should lie with his thighs and legs -extended: unless the stones have been soft or sandy; for in that case -the bladder is not so soon cleansed: and, therefore, it is necessary -for the wound to be longer open; and never to be brought to cicatrize -till nothing more of that nature be discharged. - -But if the lips have united before the bladder was cleansed, and the -pain and inflammation have returned, the wound must be separated by the -fingers, or the broad end of a probe, to allow a passage to what causes -the pain: which being evacuated, and the urine having come away pure -for a pretty while, cicatrizing medicines must at length be laid on, -and the feet extended, as I directed before, as close to one another as -possible. - -But if from those causes, which I mentioned, there appears to be danger -of a fistula, to close it the more easily, or at least to contract it, -a leaden pipe must be introduced into the anus(34); and the legs -being extended, the thighs and ancles must be tied together, till there -be a cicatrix as good as we can obtain. - - - - -CHAP. XXVIII. - -OF THE OPERATIONS REQUIRED WHEN A MEMBRANE, OR FLESH OBSTRUCTS THE -VAGINA IN WOMEN. - - -The foregoing diseases may happen both to men and women. But some are -peculiar to women; as in the first place, where the vagina, by its lips -being joined, does not admit of coition. And this happens sometimes in -the womb of the mother; at other times, from an ulcer in those parts, -and the lips, in healing, having by bad management been united. If it -be from the birth, a membrane obstructs the vagina: if from an ulcer, -it is filled up with flesh. - -In the membrane an incision must be made in two lines crossing each -other, in the form of the letter X, great care being taken not to -wound the urinary passage; and then the membrane is to be cut out. But -if flesh has grown there, it is necessary to open it in a straight -line; then taking hold of it with a vulsella or hook, to cut off a -small habenula, as it were, from the orifice of the vagina, after -which must be introduced a piece of lint rolled in a long form (by the -Greeks called lemniscus) dipped in vinegar; and over this sordid wool -moistened with vinegar is to be bound on; the third day, these are to -be removed, and the part dressed like other wounds. And when it begins -to heal, it is proper to introduce into the part a leaden pipe armed -with a cicatrizing medicine; and over that to apply the same medicine, -till the wound be cicatrized. - - - - -CHAP. XXIX. - -THE METHOD OF EXTRACTING A DEAD FOETUS OUT OF THE WOMB. - - -When a woman conceives, if the foetus dies in the womb, near the time -of delivery, and cannot come away of itself, an operation is necessary. -This may be reckoned amongst the most difficult: for it both requires -the highest prudence and tenderness, and is attended with the greatest -danger. But above all, the wonderful nature of the womb, as in other -cases, so in this also, is easily discovered. - -In the first place, it is proper to lay the woman on her back, across a -bed, in such a posture, that her ilia may be compressed by her thighs: -whence it happens, that both the bottom of her belly is presented to -the view of the physician, and the child is forced to the mouth of the -womb; which is close shut, when the foetus is dead, but at intervals -opens a little. The physician, making use of this opportunity, having -his hand anointed, ought to introduce, at first, the fore-finger, -and keep it there till the mouth be opened again, and then he must -introduce another finger, and the rest upon the like opportunities -offering, till his whole hand be within it. Both the capacity of the -womb, and the strength of its nerves, and the habit of the whole body, -and even the fortitude of the mind conduce much to the facility of -doing this: especially, as in some cases, it is necessary to have both -hands within the womb. - -It is of importance, that both the bottom of the belly, and the -extremities of the body be as warm as possible; and that an -inflammation be not begun, but that help be administered instantly, -while the case is recent. For if the body be already swelled, the hand -can neither be introduced, nor the fœtus brought away without the -greatest difficulty; and together with a vomiting and tremor, there -generally follow mortal convulsions. When the hand is introduced upon -the dead fœtus, it immediately discovers its posture: for it is either -turned upon the head, or the feet, or lies transverse but commonly in -such a manner; that either its hand or foot is near. - -The intention of the physician is, by his hand, to turn the child, -either upon its head, or even upon its feet, if it happened to be in -a different posture. And if there is no other hinderance, taking hold -of the hand or foot puts the body in a better posture: for the hand -_being laid hold of_, will turn it upon the head, and the foot upon its -feet. Then if the head is nearest, a crotchet should be introduced, -in every part smooth, with a short point, which is properly fixed, -either in the eye, or the ear, or the mouth, sometimes even in the -forehead; and then being drawn outwards, brings away the child. Yet it -is not to be extracted at any moment of time indifferently: for should -it be attempted, when the mouth of the womb is shut, there being no -exit for the child, it breaks to pieces, and the point of the crotchet -slips upon the mouth of the womb itself, and there ensue convulsions, -and extreme danger of death. Therefore, it is necessary to forbear, -when the womb is shut; and when it opens, to draw gently; and every -such opportunity to extract it gradually. The right hand must draw the -crotchet, the left being kept within, must pull the child, and at the -same time direct it. - -It sometimes happens, that the child is distended with water, and there -is a fœtid sanies discharged from it. If this be the case, the body -must be perforated with the fore-finger, that its bulk may be lessened -by the discharge of the humour: then it must be taken out gently by the -hands only: for the crotchet being fixed in a putrid body, easily loses -its hold. The danger attending which, I have already pointed out. - -But a child being turned upon its feet, is not difficult to extract: -for these being taken hold of, it is easily brought away by the hands -alone. - -If it be transverse, and cannot be got into a proper direction, a -crotchet must be fixed in the armpit, and gradually pulled: in this -case, the neck is generally doubled, and the head turns back upon the -body. The remedy is, to cut through the neck, that the two parts may be -brought away separately. This is done by a crotchet, which resembles -the former, save that it is sharp all along the internal part. Then -we must endeavour to bring away the head first, after that, the rest -of the body: because generally, when the largest part is extracted, -the head slips back into the womb, and cannot be extracted without the -greatest danger. - -However, if this has happened, a double cloth must be laid upon the -belly of the woman, and a strong and skilful man ought to stand at her -left side, and put both his hands upon the lower part of her belly, and -press with one upon another: by which means the head is forced into the -mouth of the womb, and may then be extracted by the crotchet, in the -manner above described. - -But if one foot be found at the mouth of the womb, and the other is -behind, with the body, whatever is protruded, must be gradually cut -away. And if the buttocks begin to press upon the mouth of the womb, -they must be thrust back again, and the other foot sought for and -brought forward. There are also some other difficulties, which make it -necessary to cut the child into pieces, when it cannot be brought away -entire. - -Whenever a fœtus is brought away, it must be delivered to an assistant; -who must take it in his hands, and then the physician ought to draw the -umbilical cord gently with his left hand, but not to break it, and with -the right to follow it, as far as what they call the secundines, which -were the covering of the fœtus within the womb; and taking hold of the -extremities of these, to separate all the small veins and membranes in -the same manner, by his hand, from the womb, and to extract the whole -of it, and any concreted blood that remains within. Then the woman’s -thighs must be laid close together, and she placed in a room moderately -warm, without any thorough air. To the bottom of her belly must be -applied sordid wool dipped in vinegar and rose-oil. The remaining part -of the cure ought to be the same, as is used in inflammations, and such -wounds as are in nervous parts. - - - - -CHAP. XXX. - -THE OPERATIONS REQUIRED IN DISEASES OF THE ANUS. - - -Diseases of the anus also, when they are not removed by medicines, -require the assistance of the hand. Therefore, if any fissures, in -that part, by long continuance, have become indurated, and are already -callous, it is most proper to give a clyster; then to apply a hot -spunge, in order to relax them, and bring them to the external part, -when they are in view, to cut off each of them with a knife, and renew -the ulcers; then to lay on soft lint, and over it honey spread upon a -linen cloth; and to fill up the part with soft wool, and thus bind it -up; on the next and following days, to dress with mild medicines, which -I have elsewhere prescribed for the same disorders when recent; and in -the first days to diet the patient with gruels, after that gradually -to add to the food, but something of that kind, which I have directed -in the same place. If at any time, from an inflammation, pus arises -in them, as soon as that appears, an incision must be made to prevent -the anus itself from suppurating. But we must not be in a hurry to -do it before; for if it be cut while crude, the inflammation is much -increased, and a greater quantity of pus is generated. In these wounds -too, there is a necessity for mild food, and the same kind of medicines. - -But the tubercles called condylomata, when they have grown hard, are -cured in this manner. First of all, a clyster must be given. Then the -tubercle being laid hold of by a vulsella, must be cut out near its -roots. When this is done, the same course must be followed, that I -prescribed after the preceding operation; only if there is any fungus, -it must be kept under by copper scales. - -The mouths of the hæmorrhoidal veins, discharging blood, are taken -off thus. When there is a discharge of sanies besides blood, an acrid -clyster must be administered, that the mouths of the veins may be -pushed the farther outward; which causes all the vessels to appear like -small heads. Then if a head be very little, and have a small base, it -must be tied with a thread a little above the point, where it joins -the anus; and a spunge squeezed out of hot water must be laid over it, -till it grow livid; then above the knot it must be scarified either by -the nail or the knife. If this is not done, violent pains ensue, and a -difficulty in making water. If it be pretty big, and the base broad, it -must be taken hold of with a small hook or two, and an incision made -round the tumour, a little above the base; and neither any part of the -head must be left, nor any thing taken off the anus: which a person -may accomplish, if he neither draws the hooks too much nor too little. -Where the incision has been made, a needle should be put in, and below -that the head tied with a thread. If there be two or three of them, the -inmost must be cured first; if more than that number, not all at once, -lest there be(35) sore places all round the part at the same time. If -there is a discharge of blood, it must be received in a spunge; then -lint must be applied; the thighs, groin, and what lies contiguous to -the ulcer, be anointed, and cerate laid over it, and the part filled -with warm barley meal, and thus bound up. The day following, the -patient ought to sit down in warm water, and be dressed with the same -cataplasm. And twice in the day, both before and after the dressing, -the ischia and thighs must be anointed with liquid cerate, and the -patient kept in a warm place. After an interval of five or six days, -the lint is to be taken out with a specillum oricularium; and if these -heads have not dropped off at the same time, they must be pushed off -by the finger. Afterwards, the ulcer must be brought to heal by mild -medicines, such as I have prescribed before. The proper treatment, when -the disease is cured, I have already mentioned elsewhere. - - - - -CHAP. XXXI. - -OF VARICES IN THE LEGS. - - -From these disorders we go on to the legs. Varices in these are not -difficult to remove. To this place I have deferred the cure of those -small veins, which hurt in the head, as also the varices in the -belly, because it is the same in them all. Therefore any vein that -is troublesome, either is cauterized, and so decays, or is cut out. -If it be straight, or though transverse, yet simple, it is better to -cauterize it. If it be crooked, and as it were twisted into orbs, or -several of them are involved within each other, it is more convenient -to cut them out. - -The method of cauterizing is this. An incision is made in the skin over -it; then the vein being laid bare, is moderately pressed by a small and -blunt iron instrument red hot: and we must avoid burning the lips of -the wound itself, which it is easy to draw back with small hooks. This -is repeated over the whole varix, at the distance of about four fingers -breadth; and after that a medicine for healing burns is laid on. - -But it is cut out in this manner. An incision being made in the same -way in the skin over the vein, the lips are taken up with a small hook; -and the vein is separated all round from the flesh by a knife, but in -this great care is taken not to wound the vein itself; and a blunt hook -is put under it; and generally, at the same distance mentioned before, -in the same vein, the same operation is repeated. The course of it is -easily discovered by extending it with the hook. - -When this has been done, as far as the varices go, the vein, being -brought forward in one part by the hook, is cut through, then where -the next hook is, it is drawn up and pulled away, and is cut off -there again. And in this manner the leg being entirely freed from the -varices, the lips of the wounds are then brought together, and an -agglutinating plaister is laid over them. - - - - -CHAP. XXXII. - -OPERATIONS REQUIRED IN COHERING AND CROOKED FINGERS. - - -If the fingers, either from the birth, or by an ulceration in their -opposite sides, have afterwards adhered together, they are separated by -the knife; round each of them a plaister, not greasy, is put on, and -thus they heal separately. - -But if there has been an ulcer in a finger, and afterwards a cicatrix -injudiciously brought on, has rendered it crooked; in the first place -a malagma must be tried. If that does no good (which generally happens -both in an old cicatrix, and where the tendons are hurt) then we -ought to see whether the fault be in the tendon or the skin. If in -the tendon, it ought not to be touched, for it is not curable: if in -the skin, the whole cicatrix must be cut off, which being generally -callous, prevents the fingers from being extended. Then being kept -extended, it must be brought to cicatrize afresh. - - - - -CHAP. XXXIII. - -OF THE OPERATION REQUIRED IN A GANGRENE. - - -I have elsewhere observed, that a gangrene comes about the nails, -armpits or groin; and that if it does not yield to medicines, the -member ought to be cut off. - -But even this is attended with very great danger: for the patients -often die in the operation, either by a hæmorrhage, or faintings. But -in this, as well as other cases, it is not to be considered, whether -the remedy is very safe, which is the only one we have. Between the -sound and corrupted part then, an incision must be made with a knife in -the flesh, as far as the bone. But this must not be done over a joint; -and some of the sound part must rather be cut off, than any of the -corrupt left. When we come to the bone, the sound flesh must be drawn -back from it, and cut below round the bone, that some part of the bone -may also be laid bare under it; then the bone must be cut off with a -saw, as close as we can to the sound flesh, that still adheres to it; -and then the fore part of the bone, that has been roughened with the -saw, must be smoothed, and the skin brought over it; which in a cure -of this kind ought to be lax, that it may cover the bone as much as -possible all round. The part, which the skin does not reach, must be -covered with lint, and above that a spunge squeezed out of vinegar must -be tied on the place. The remaining part of the cure must be the same, -as I have directed in wounds which are brought to digestion(36). - - - - -A. CORNELIUS CELSUS - - OF - - MEDICINE. - - - - -_BOOK VIII._ - - - - -CHAP. I. - -OF THE SITUATION AND FIGURE OF THE BONES OF THE HUMAN BODY. - - -It now remains, that I speak of what relates to the bones: for the -easier understanding of which, I shall first describe their situations -and forms. The first then is the skull, which is concave on the -internal side, externally gibbous, and on each side smooth, both where -it covers the membrane of the brain, and where itself is covered by -the skin, from which the hair grows. In the occiput and temples it -is simple; but double from the forehead to the vertex. And the bones -of it in their external part are hard; on the inside, where they are -connected with each other, softer. And veins are distributed between -them, which probably supply them with nourishment. - -Now the skull is rarely entire without sutures; but in hot countries it -is more frequently found so. And such a head is strongest, and the most -safe from pain; of others, the fewer sutures there are, so much the -freer is the head from complaints; for their number is not certain, nor -indeed their situation. However, for the most part two above the ears -divide the temples from the upper part of the head; the third running -to each side through the vertex, separates the occiput from the top -of the head; the fourth goes from the vertex along the middle of the -head to the forehead; and this ends in some at the point, to which the -hair extends, in others between the eye-brows, dividing the forehead -itself(1). The other sutures are exactly fitted to each other upon -the same level. But the transverse ones above the ears, grow gradually -thinner to their edges; and thus the inferior bones slightly overtop -the superior ones. The bone behind the ear is the thickest in the -head; for which reason, probably hair does not grow there. Over these -muscles too(2), that cover the temples, a bone is situated in the -middle, which is inclined to the external part. But the face has the -largest suture; which beginning from the one temple runs transversely -through the middle of the eyes, and the nose, to the other temple; from -which two short ones point downward under the internal angles. The -cheek-bones also have each of them a transverse suture in the upper -part. And from the middle of the nose, or the sockets of the upper -teeth, proceeds one through the middle of the palate; and another also -divides the palate transversely. These then are the sutures found in -most people. - -The largest foramina of the head are those of the eyes; next the -foramina of the nose; then those we have at the ears. The foramina of -the eyes run straight and undivided to the brain. Two foramina are -observed in the nose, divided by a bone in the middle: for these about -the eye-brows and angles of the eyes begin osseous, and so proceed -near the third part of the way; then turning cartilaginous, the nearer -they approach to the mouth, so much the softer and more fleshy they -become. But these foramina, which from the beginning of the nostrils -to the internal part are simple, are there again divided each into two -courses; the branches opening into the fauces both emit and receive -the breath; the others go to the brain; in the end they are branched -into many small openings, which afford the sense of smelling. In the -ear too the passage at first is straight, and simple, but farther in, -it becomes winding; the part next the brain is separated into many and -small openings, from which we have the faculty of hearing. Near these -there are as it were two small sinuses; and above them, that bone -terminates, which going in a transverse direction from the cheeks is -sustained by the inferior bones. It may be called jugale from the same -resemblance, which gave it the Greek name of Zygodes[HW]. The maxilla -is a soft bone(3), and only one in number: the middle and lowest -part of which compose the chin; from whence it proceeds on both sides -to the temples; and this only moves: for the malæ with the whole bone, -that contains the upper teeth, are immoveable: but the extremities of -the maxilla shoot as it were into two horns. One of these processes is -broader below(4), and is narrowed at the vertex, and being extended -forward enters below the os jugale, and over that is tied down by the -muscles of the temples. The other is shorter and rounder, and is lodged -like a hinge in that cavity, which is near the foramina of the ear; -and there turning itself different ways, gives the maxilla a power of -moving. - - [HW] ζυγὼδες. - -The teeth are harder than bone; part of them are fixed in the lower -jaw-bone, and part in the upper. The four first from their cutting -are by the Greeks called tomici[HX]. On each side of these _above and -below_ stand the four canine teeth; beyond which there are commonly -five maxillary teeth, except in those, in whom the genuine (_dentes -sapientiae_) which generally grow late, have not come out. The fore -teeth adhere each by one root, the maxillary by two at least, some by -three or four. And a longer root commonly emits a shorter tooth; and -the root of a straight tooth is straight, that of a crooked one bent. -From this root in children, a new tooth springs, which most frequently -forces out the former; sometimes however it appears above or below it. - - [HX] τομικοὶ. - -Next to the head is the spine, which consists of twenty-four Vertebræ. -There are seven in the neck, twelve by the ribs, and the other five are -below the ribs. These are round and short, and send out two processes -on each side; in the middle they are perforated, where the spinal -marrow, connected with the brain, descends. The sides also between -the two processes are perforated by small holes, through which, from -the membrane of the brain similar small membranes proceed. And all -the Vertebræ(5) (except the three uppermost) at the superior part -in the processes themselves have small depressions; at the lower, on -the contrary, they send out processes pointing downwards. The first -then immediately sustains the head, by receiving small processes of it -into two depressions; which is the reason that the surface of the head -below is rendered unequal by two prominences. The second is inserted -into the under part of the first, and the superior part of the second -is round and narrow (_processus dentatus_) in order to admit of a -circular motion, so that the first surrounding the second allows the -head to move towards each side. The third receives the second in the -same manner; whence the neck has great facility of motion. And indeed -it would not be able to sustain the head, if straight and strong nerves -on each side did not secure the neck; these the Greeks call Carotæ. -For one of them in every flexure, being always stretched, prevents the -upper parts from slipping further. The third Vertebra has prominences, -which are inserted into that below it. All the rest are inserted -each into its inferior one by processes pointing downwards; and by -depressions, which they have on each side, they receive the superior, -and are secured by many ligaments, and a great quantity of cartilage. -And thus one moderate flexure forward being allowed, a man both stands -erect for some kinds of employment, and at other times bends himself as -the actions he is engaged in require. - -Below the neck, the first rib is situated opposite to the shoulders. -After that the six inferior ones(6) reach the bottom of the breast: -and these at their origin being round, and furnished with something -like small heads, are fixed to the transverse processes of the -vertebræ, which are in that part a little depressed; then they grow -broader, and bending outward, degenerate gradually into cartilage; -and in that part being again turned gently inward, are joined to the -pectoral bone: which begins strong and hard at the fauces, being -excavated on each side, and terminates at the præcordia, where it is -softened into a cartilage. And under the superior ribs there are five, -which the Greeks call Nothæ (_spurious_) shorter, and thinner, which -also gradually turn to cartilage, and adhere to the external parts of -the abdomen; the lowest of these in the greatest part of it is nothing -else but a cartilage. - -From the neck two broad bones, one on either side, go to the shoulders, -by us called scutula operta, by the Greeks Omoplatæ. These have -cavities at their vertices; from the vertices they become triangular, -and growing gradually broader tend to the spine; and the broader they -are in any part, so much the duller is their sensation. These too at -their extremity are cartilaginous, and in their back part lie as it -were loose, because, unless at the top, they are fixed to no bone, but -are there tied down by strong muscles and nerves. - -But at the first rib(7) a little within the middle of it, a bone -grows out, in that part indeed slender; but going forward, the nearer -it comes to the broad bone of the scapula, it becomes thicker, and -broader, bending a little inwards, which being a little enlarged at its -other vertex, sustains the clavicle. This bone is crooked, and is to be -reckoned amongst the hardest bones; the one end of it is joined to the -bone I just mentioned before, and by the other it is fixed in a small -depression of the pectoral bone, and is moved a little in the motion of -the arm; and its lower head is connected by ligaments and a cartilage -with the broad bone of the shoulders. - -Here the humerus begins, which at both its ends is enlarged, soft, -without marrow, and cartilaginous; in the middle round and hard, and -containing marrow; is a little concave(8) in its fore and internal -part; and convex in its posterior and external part. Now the fore part -is next the breast; the posterior is toward the scapulæ; the internal -next the side; and the external at the greatest distance from the side: -which distinctions will afterwards appear applicable to all joints in -the extremities. The upper end of the humerus is rounder than the other -bones, which I have yet mentioned, and _a small part of it_ is inserted -into the vertex of the broad bone of the shoulder; the greatest part, -standing out of it, is secured by ligaments. But the inferior head -has two processes; the intermediate space between which, is even more -depressed than its extremities. - -This affords a reception to the fore-arm; which consists of two bones. -The Radius, which the Greeks call cercis[HY], is the superior one and -shorter, and at first being more slender, with its ends round, and -a little concave, receives the small tubercle of the humerus, which -is secured there by ligaments and a cartilage. The cubitus is the -inferior and longer; it is at first larger in its upper end, and by -two vertices, as it were, standing out, fixes itself into the sinus -of the humerus, which I mentioned, betwixt its two processes. The two -bones of the fore arm at first(9) are close together, then separate -by degrees, and meet again at the hand, their former proportions being -reversed: for there the radius is pretty large, and the cubitus very -small. After that the radius rising to a cartilaginous head is inserted -into its neck. The cubitus is round at its extremity, and projects a -little on one part. And to save frequent repetition, this ought to be -known, that most bones end in a cartilage, and that every articulation -is thus terminated: for it could neither be moved, unless it pressed -upon something smooth, nor be joined with flesh and ligaments, unless -these were connected by some matter of a middle nature. - - [HY] κερκὶς. - -In the hand, the first part of the palm consists of many and small -bones, the number of which is uncertain. But all of them are oblong and -triangular, and connected together by a peculiar kind of structure, -the plain of each one being higher than another alternately; whence it -happens, that the whole makes up the appearance of one bone a little -concave on the internal part. But from the hand two small processes -are lodged in the cavity of the radius. Then at the other end five -straight bones going to the fingers, compleat the palm; from which -the fingers themselves have their origin. These consist each of three -bones. The conformation of them all is the same. The more internal -bone has a depression in its vertex, and receives the small tubercle -of the external, and these are secured by ligaments. From them arise -the nails, which grow hard: and thus they adhere by their roots, not -to bone, but rather to flesh. This then is the construction of the -superior parts. - -But the lower part of the spine ends in the hip-bone, which is -transverse, and far the strongest, and defends the womb, bladder, and -intestine Rectum. And this in the external part is convex; at the spine -inclined backward; on the sides, that is, at the hips themselves, -it has round cavities; from whence arises the bone, which is called -pecten; and that being situated transversely over the intestines under -the pubes, strengthens the belly; it is straighter in men, but in women -more bent externally, that it may not prevent the birth. - -From these proceed the thigh bones; the heads of which are still -rounder than those of the humeri; though the latter have more -rotundity, than is found in any of the rest. A little lower they have -two processes on the fore and posterior part. From that they descend -hard and full of marrow, externally convex, and are again enlarged at -the inferior heads. The superior ones are inserted into the cavities of -the hip-bone, as the humeri into the bones of the scapulæ; then, lower -down, they slope gently inward, that they may more equally sustain the -superior parts. And their inferior heads have also depressions between -them, that they may be the more easily received by the bones of the -leg: which articulation is covered by a small, soft, and cartilaginous -bone, which is called Patella. This floating above, and not being fixed -to any bone, but bound down by flesh and tendons, and a little more -inclined to the thigh bone, defends the joint in all flexures of the -legs. - -The leg consists of two bones; for in every thing the thigh resembles -the arm, and the leg the fore-arm; so that the shape and elegance of -the one may be known from the other; which beginning with the bones, -answers also in the flesh. One of these bones is situated on the -external part of the calf of the leg, and from that properly enough -takes the name of Sura(10). This is shorter and more slender above, -but is enlarged at the ancles. The other, which is placed in the fore -part, and has the name of Tibia, is longer and larger in the upper -part, and is alone connected with the lower end of the thigh-bone, as -the cubitus is with the humerus: and these bones too, being joined both -below and above, separate in the middle, as those of the fore arm. - -The leg bones are received below by a transverse bone in the ancle; -and that is situated above the heel bone; which in one part has a -depression and in another prominences, and it both receives the -processes from the ancle-bone, and is inserted into its cavity. And -this is hard, without marrow, and projecting more to the posterior part -makes a round figure there. The other bones of the foot are constructed -in a similar manner to those of the hand. The soles answer to the -palms, the toes to the fingers, and the nails to the nails. - - - - -CHAP. II. - -GENERAL DIVISION OF DISORDERS IN THE BONES. OF A BLACKNESS AND CARIES, -AND THEIR TREATMENT. - - -Whenever a bone is injured, it is either corrupted, or fissured, or -fractured, or perforated, or contused, or dislocated. A corrupted bone -generally turns first oily, and afterwards either black or carious. -These cases happen from large ulcers, or fistulas over them, when they -have either grown antient, or have been seized with a gangrene. First -of all it is necessary to lay bare the bone, cutting out the ulcer, and -if the disorder extends farther than the ulcer was, to pare away the -flesh below, till the sound part of the bone be exposed all round; then -it is sufficient to cauterize the part that is oily, once or twice, -by the application of an iron instrument, that so a scale may cast -off; or to scrape it, till some blood appear, which is the mark of a -sound bone: for whatever is vitiated must necessarily be dry. The same -method must also be pursued in a cartilage that is injured; for that -too must be scraped by a knife, till what remains be sound. And then -what is thus scraped, whether bone or cartilage, must be sprinkled with -nitre well powdered. And nothing else is to be done, where a caries or -blackness is in the surface of the bone: for in that case, the cautery -or the scraping must only be continued a little longer. A person, -that scrapes these, ought to press the instrument boldly, that he may -both do it effectually, and have the sooner done. The operation is -finished, when we come to the white or firm bone. It is evident, that -when the defect is a blackness, it ends in the white, and that where -there is a certain degree of solidity, there the caries terminates. We -have already observed, that there is also some blood in a sound bone: -But when either of these happen to go in pretty deep, it is uncertain -where they end. - -It is easy to form a judgment in a caries, if a small probe is -introduced into the foramina, which by penetrating more or less, shews -that the caries is either in the surface, or of greater depth. The -same may be collected(11) even from the pain and fever; for when -these are moderate, it cannot have penetrated deep. A greater certainty -is obtained however by the application of the perforator: for the -disease ends, where the dust of the bone ceases to be black. Therefore -if the caries has gone deep, several holes must be made in it by the -perforator, as deep as the disease goes; then into these holes must be -put hot irons, till the bone become entirely dry. For the consequences -of this operation will be, that whatever is spoilt will be separated -from the bone below; and the cavity will be filled up with flesh; -and afterwards either no humour at all, or a small quantity will be -discharged. - -But if the blackness goes through(12) to the other side of the -bone, it ought to be cut out. The same may be done also in a caries, -that penetrates to the other side of the bone. But where the whole is -spoilt, the whole must be taken away. If the inferior part is sound, -so far as is corrupted, ought to be cut out. Likewise if the skull or -pectoral bone, or a rib be carious, the actual cautery is needless, but -there is a necessity for excision. Neither does the opinion of these -people deserve our attention, who defer the excision to the third day -after the bone is laid bare, before they cut it out; for in all cases -it is safer to perform an operation, before an inflammation come on. -Therefore both the skin is to be cut, and the bone laid bare, and freed -from every fault, as far as possible, in the same moment. Now a disease -in the pectoral bone is far the most pernicious of any; because though -the operation have succeeded well, it hardly ever restores a perfect -soundness. - - - - -CHAP. III. - -OF THE USE OF THE MODIOLUS AND PERFORATOR, AND OTHER INSTRUMENTS, -ESPECIALLY FOR THE BONES OF THE HEAD. - - -There are two ways of cutting out a bone; if the part injured be very -small, by a modiolus, which the Greeks call chœnicion[HZ], if larger -by terebræ. I shall explain the method of each. The modiolus is a -concave and round iron instrument with serrated edges in its lowest -extremity; through the middle of which is put a pin, surrounded also -by an interior circle. Of perforators there are two kinds: one of them -resembling that, which carpenters use; the other with a longer head, -which begins from a sharp point, and then turns quickly broader; and -again from another beginning goes upward with thickness pretty near -equal. - - [HZ] χοινίκιον. This was the name of a measure among the Greeks, and - from its resemblance in shape, they have probably used the same word - for this chirurgical instrument; for the same reason, I suppose the - Romans have named it _modiolus_. Though I have chosen to retain our - author’s term, yet the reader will see the difference is not material - betwixt that, and the trepan of our surgeons; the terebra comes so - near to the perforator, that I have used the modern term for it. - -If the disease be confined to a small space, so that the modiolus can -cover it, that must be used preferably. But if a caries appear below, -the pin in the middle is put into the opening. If there be a blackness, -a small hole is made by the angle of a chisel(13) to receive the -pin, that the modiolus resting upon that, by being turned round may -not slip, and then it is turned like the perforator by a strap. And -there is a certain degree of pressure required, that both a perforation -may be made, and it may go round; because if it be lightly impressed, -it does not produce the effect; if too much, it has no motion. And it -is not improper to drop in a little rose oil or milk, the smoothness -of which may make it turn with the greater ease; yet too much of the -liquid blunts the edge of the instrument. But when the modiolus has -marked out a way for itself, the middle pin is taken out, and it is -worked about by itself. And then, when the soundness of the inferior -part is discovered by the dust, the modiolus is taken away. - -But if the disease is more extended than to be covered by that, we must -make use of the perforator. By this a hole is made in the limit, that -divides the injured from the sound part of the bone; and not far from -that a second, and a third, till the part, that is to be cut out, be -surrounded with these holes. And in this case too the dust indicates -how deep the perforator is to go. Then a chisel being drove by a mallet -from one hole to another, cuts out the intermediate space between them; -and thus a circumference is formed like to that, which is imprinted in -a smaller circle by the modiolus. In whichever way the circle has been -made, let the same chisel, laid flat on the corrupted bone, smooth each -superior lamina, till the bone be left entirely sound. - -A blackness hardly ever goes quite through a bone, but a caries does, -especially where the skull is faulty. There also the disorder is -discovered by the probe, which being introduced into the hole, that -terminates at the sound part of the bone, both finds some resistance, -and comes out moist. If it prove pervious, the probe going in deeper -between the bone and the membrane, meets with no resistance, and comes -out dry: not because there is no corrupt sanies within, but because it -is there diffused, as being in a larger cavity. - -Now whether a blackness, which the perforator has discovered, or a -caries, which the probe has shewn, pass through the bone, the use of -the modiolus is generally fruitless: because, where the disease has -penetrated so deep, it must also necessarily be largely extended in -breadth. Here then we must use the second kind of perforator above -described; and to prevent its growing too hot, it must be dipped now -and then in cold water. But then we must proceed with greater caution, -when we have perforated either half through in a simple bone, or the -superior lamina in a double one. The space itself guides us in the -first case; and in the other, the blood. Therefore at that time the -strap must be drawn slower, the left hand should press more gently, and -be taken off pretty frequently: also the depth of the perforation is -to be considered, that we may be sensible whenever the bone is broke -through, and run no risque of wounding the membrane of the brain by its -point, from which proceed violent inflammations, with danger of death. - -When the holes are made, the intermediate spaces must be cut out in -the same manner, but with much more circumspection; lest the angle of -the chisel chance to wound the same membrane; till a passage be made, -through which the instrument to protect the membrane may be introduced. -The Greeks call it meningo-phylax[IA]. It is a copper plate, firm, -bent a little upward towards the end, and externally smooth: which -being introduced in such a manner, that its external surface be next -the brain, is put under that part, which is to be separated by the -chisel; and if it receives its angles, it stops its progress; and upon -this account the physician repeats his strokes upon the chisel both -more boldly, and more safely, till the bone being cut out all round is -raised by this plate, and may be taken away without any hurt to the -brain. When the whole bone is taken out, the edges must be scraped -round and smoothed, and if any dust has fallen upon the membrane, it -must be gathered up. When the superior part is taken away, and the -inferior left, not only the edges, but the whole bone must be smoothed, -that the skin may afterwards generate upon it without being hurt, which -growing upon a rough bone, does not immediately become sound, but -produces new pains. - - [IA] Μηνιγγοφύλαξ: the etymology of this word answers exactly to its - use: it is delineated by Scultet. tab. 2. fig. 9. - -The steps to be taken after the brain is uncovered, I shall mention, -when I come to fractured bones. If any base is preserved, medicines -not greasy, that are calculated for recent wounds, must be applied, -and over them must be laid sordid wool moistened with oil and vinegar. -In process of time flesh grows from the bone itself, which fills up -the cavity made by the operation. And when any bone is cauterized, -it separates from the sound part, and granulations sprout up between -the sound and mortified part, which expel what has separated. And -this, because it is a thin and small lamina, by the Greeks is called -lepis[IB], that is, a scale. - - [IB] λεπὶς. - -It may happen too, that from a blow, a bone may be neither fissured, -nor broke through, but the surface of it only contused, and rendered -rough. When this occurs, it is sufficient to scrape and smooth it. -Though these methods are most commonly practised in the head, yet they -are common to the other bones too; so that wherever the like case -shall occur, the same remedy must be used. But as they are fractured, -fissured, perforated, and contused, they require some particular -methods of cure in each kind, and in most of them, some general ones -also. Of these I shall proceed to treat, beginning with the head. - - - - -CHAP. IV. - -OF FRACTURES OF THE SKULL. - - -When a blow has been received upon the skull, we must immediately -enquire, whether the person has vomited bile; whether he have lost -his sight, or his speech; whether blood has issued by his nostrils, -or ears; whether he has immediately fallen down; whether he has lain -insensible, as if asleep: for these do not happen without a fracture of -the bone. And when they occur, we may be assured, that an operation is -necessary, but of uncertain success. If besides, a torpor has come on; -if he is delirious, if either a palsy, or a convulsion has followed, it -is probable that the membrane of the brane too is wounded; and of such -patients there is still less hope. But if none of these have ensued, -and it may be doubted, whether the bone be fractured, it is first to be -considered, whether the blow was given by a stone or a stick, or iron, -or any other weapon, and whether _the instrument_ was smooth, or rough, -small or large, whether struck with force, or more lightly; because -the more gentle the stroke was, so much the more easily we may suppose -the bone to have resisted it. But it is best to examine that by a more -certain mark. Therefore a probe ought to be introduced where the wound -is, neither too small nor sharp, lest if it should light upon any of -the natural sinuses, it mislead us into an opinion of a fracture, -where there is none; and not too thick, lest small fissures escape it. -When the probe comes to the bone, if nothing but what is smooth and -slippery occur, one may judge it to be sound; if there is an asperity, -especially where there are no sutures, that is an evidence the bone is -fractured. - -Hippocrates has recorded, that he was himself deceived by the sutures. -This is the custom of great men, who have a just consciousness of their -own superior abilities: for little minds, because they are deficient -in every thing, never allow themselves to be deficient in any. An -ingenuous confession of an error is worthy of a great genius, who will -have enough besides to entitle him to esteem; and it is especially -_laudable_ in a practical art, which is handed down to posterity for -their benefit; that they may not be deceived in the same way another -was deceived before them. A regard to the memory of a professor, in -other respects so great a man, led us into this digression. - -Now a suture may deceive for this reason, because it is equal in -asperity to the other; so that though there be a fissure, one may -readily take it for a suture, in a place, where it is likely one lies -below. Therefore it is not fit to be thus deceived; but the safest -method is to lay bare the bone: for, as I observed before, the place -of the sutures is not certain; and the same part may both have this -natural junction, and be fissured by a blow, or may have some fissure -near it. Nay sometimes, when the blow has been violent, though nothing -be found by the probe, yet it is better to open it. And if even then -the fissure is not manifest, writing ink must be drawn over the bone, -and then scraped off with a chisel, for if there be any fissure it -retains the blackness. - -Sometimes it even happens, that the blow has been given on one side, -and the bone fissured on the other. For that reason, if upon receiving -a violent blow, bad symptoms have followed, and no fissure be found in -that part, where the skin is lacerated; it is not improper to consider, -whether any part on the opposite side be softer, and swelled; and to -open that; for there a fissure in the bone will be found. Nor is -it very troublesome to heal the skin again, though nothing has been -discovered by the incision. A fractured bone, unless help be seasonably -administered, brings on violent inflammations, and is treated with more -difficulty afterwards. - -Rarely, but sometimes it happens, that the whole bone remains sound; -but from the blow some internal vein in the membrane of the brain is -broke, and discharges blood, which being coagulated there, raises -violent pains, and deprives some people of their sight. But there is -generally a pain in the part that covers it, and an incision being made -in the skin there, the bone is found pale; and therefore this must also -be cut out. Upon whatever account this operation is necessary, if the -opening of the skin is too small, it must be enlarged, till all the -injured part be in view. In this great care must be taken to leave upon -the bone no part of that fine membrane that covers the skull below the -skin; because when this is lacerated by the chisel, or perforators, it -excites violent fevers with inflammations. Therefore it is better to -separate it entirely from the bone. If the external wound be made by -the blow, we cannot alter the form of it. If we are to make one, the -best is that made by two transverse lines in the shape of the letter -X, that afterwards the skin may be cut below, beginning at each of the -prominent angles. - -If blood is discharged in the time of doing this, it must be frequently -restrained by a spunge dipped in vinegar, and taken up by lint applied -upon it, and the head raised high. This accident is attended with no -danger except among the muscles, which secure the temples; but even in -that place there is no safer method. - -In almost every fissure, or fracture of the bone, the ancient -physicians had immediate recourse to instruments to cut it. But it -is far the best method, first to try plaisters that are composed for -the skull. Some one of these, it is proper to soften with vinegar, -and apply alone upon the fissured or fractured bone; then over that, -somewhat broader than the wound, a piece of linen spread with the same -medicine, and besides that, sordid wool dipped in vinegar; then to bind -up the wound, and open it again every day; and dress it in this manner -for five days; from the sixth, to foment it also with the vapour of -hot water by a spunge, continuing all the former treatment. And if -granulations begin to grow, if the febricula is either gone, or abated, -if the appetite has returned, and the patient gets sufficient sleep, we -must continue the same dressings. Some time after, the plaister must be -softened, with the addition of a cerate made of rose oil, to promote -the growth of flesh: for, by itself, it has a repellent quality. By -this method often the fissures are filled with a kind of callus, which -is as it were a cicatrix in a bone. And in large fractures, if the -bones do not cohere together in any part, they are united by the same -callus; and this is a far better covering to the brain, than the flesh -that grows, when the bone is cut out. If, under the first treatment, -the fever increases, the sleeps are short and disturbed by dreams, the -ulcer is moist and does not fill, small glandular swellings rise in the -neck; the pains are violent; and with all these the loathing of food -increases; then, and only in that case, recourse must be had to the -hand and the chisel. - -There are two dangers attending a blow upon the skull; that it be -either split, or depressed in the middle. If it is fissured, the lips -of it may be compressed; either because one of them rises above the -other, or even because they have run together again with force: whence -it happens, that a humour descends upon the membrane, and has no vent, -and thus irritates it, and brings on violent inflammations. - -When the bone is depressed in the middle, it presses upon that same -membrane of the brain; and sometimes also some sharp points from the -fracture, prick it. In the cure of these cases as little as possible -must be taken off the bone. Therefore, if one edge rests upon the -other, it is sufficient to cut off the prominence with a plain chisel. -After that is removed, if the fissure gapes a little, it is enough for -the cure. But if the edges are compressed together, an opening must be -made with the perforator, at a finger’s breadth distance on one side, -and from that the chisel must be carried in two lines, to the fissure, -in the form of the letter Λ: so that the vertex of it may be at the -opening, and the base at the fissure. - -But if the fissure extends to a great length, it will be proper to -repeat the operation from another foramen; and thus nothing that is -broke off can be concealed under the bone, and a large opening is -procured for whatever is hurtful within. Nor is it necessary to cut -out the whole of a fractured bone, though it be depressed; but if it -be either entirely broke through, and has separated wholly from the -cranium, or if it adhere to _the surrounding skull_ in a small part, -it must be divided from the sound bone by the chisel. Then in the -depressed bone, near the fissure we have made, holes must be bored; -if the injured part be small, two; if larger, three; and the spaces -betwixt these must be cut out; and then the chisel must be drove on -both sides to the fissure, in such a manner as to make a semicircular -cavity, and let the middle part be toward the fracture, and the horns -point to the sound bone. Then if any pieces be loose, and can be -easily taken away, they must be removed by the forceps, which is made -for that purpose, especially those sharp pieces, which irritate the -membrane. If this cannot be easily done, the plate, which I called -meningo-phylax, must be put below it; and above that whatever is -prickly, and stands inward, must be cut off; and whatever is depressed -inward must be raised by the same plate. The effect of such treatment -is, that the fractured bones, if they adhere together in any part, may -be consolidated; and wherever they are broke away, in time they may be -separated by medicines without any pain; and at the same time a space -may be left sufficiently large between them, to evacuate the sanies; -and the brain may have a better protection from the bone than it would -have had, if that were cut out. - -After these things are done, the membrane must be sprinkled with -sharp vinegar; that, if there be a discharge of blood from it, it may -be restrained, or if any blood remain coagulated within, it may be -discussed; then the same medicine must be applied, softened in the -manner above prescribed, to the membrane itself; the other directions, -which relate to the linen spread, and the sordid wool, must be observed -in the same manner, and the patient must be kept in a warm place, and -the wound dressed every day; and in summer even twice. - -But if, by reason of an inflammation, the membrane has swelled, warm -rose oil must be infused upon it. If it shall swell to such a height -as to rise above the bones, it will be restrained by lentils well -powdered, or vine leaves powdered, and mixed with either fresh butter, -or recent goose fat; and the neck will require to be mollified by -liquid cerate made of iris ointment. But if the membrane shall appear -not to be clean, equal quantities of the plaister and honey must be -mixed; which must be infused upon it; and to keep that on, a piece of -lint or two must be clapped on, and that again covered with a linen -cloth spread with a plaister. When the membrane is sufficiently clean, -cerate must be added in the same manner to the plaister to promote the -growth of flesh. - -As to abstinence, and the food, and drink, in the first and more -advanced stages of the cure, the same rules must be observed which I -prescribed in wounds, and with the greater exactness, by how much a -hurt in this part is more dangerous. Nay even when it shall be fit to -allow such a quantity of food as not barely to sustain the patient, but -to nourish him, yet every thing that requires chewing must be avoided; -also smoke, and whatever excites sneezing. The membrane being moveable, -and of its natural colour, granulations of ruddy flesh, and an easy -motion of the lower jaw and neck, afford certain hopes of recovery. The -bad signs are, the membrane immoveable, black, livid, or of any other -vitiated colour; a delirium, acrid vomiting, a palsy, or convulsion, -livid flesh, or rigor of the jaws and neck. The other symptoms that -relate to sleep, appetite, fever, and the colour of the pus, are either -salutary or mortal, as in other wounds. - -When the case succeeds well, the growth of flesh begins from the -membrane itself; or if the bone in that part be double, it sprouts from -thence too, and fills up the void space between the bones; sometimes -it even rises higher than the surface of the skull. If that happens, -copper scales must be sprinkled on to keep it down; and medicines -applied to bring a cicatrix over it, which is easily obtained in every -place, except the part of the forehead, which is a little above the -space that lies between the eyebrows (_sinus frontalis_): for there, an -ulceration for the whole life after, can hardly be prevented; this must -be covered with a linen cloth spread with a medicine. And the following -directions must be always observed in a fractured skull, that till the -cicatrix be strong, the sun, wind, frequent bathing, and excess in wine -be avoided. - - - - -CHAP. V. - -OF FRACTURES OF THE NOSE. - - -In the nose, both the bone and the cartilage are liable to be -fractured; and that sometimes happens in the fore part, sometimes on -one side. If either both, or one of them be fractured in the fore part, -the nostrils fall in, and the breath is drawn with difficulty. If the -bone is fractured on one side, that part is hollow; if the cartilage, -the nostrils are turned to the opposite side. - -Any part of the cartilage, that has given way, must be gently raised, -either by a probe put under it, or two fingers compressing it on both -sides; then lint platted of a due length, sewed up in soft leather, -must be put within; or some part of a dry penecillum composed in the -same manner; or a large quill dipped in gum or joiner’s glue, and -covered with soft leather, which prevent the cartilage from sinking -in. But if the fracture be in the fore part, both nostrils are to be -equally filled. If on one side, what is put in ought to be thicker -in that part where the nose falls in, and smaller on the other; and -externally, a soft strap must be carried round, the middle of which is -spread with fine flour and soot of frankincense mixed together; and -this must be drawn beyond the ears, and the two ends being crossed -there and returned, are to be glued to the forehead: for it sticks to -the skin like glue, and when it has grown hard, it keeps the nostrils -firm. But if what is put within gives pain, which happens chiefly where -the interior part of the cartilage is broke through, the nostrils being -raised in the same(14) manner, must be only held firm by the strap -abovementioned; then, after fourteen days, that must be removed; it is -to be separated by hot water, with which also the swelled part(15) -must be fomented every day. - -But if the bone be fractured, that must also be reduced into its -place by the fingers; and when the fracture is in the fore part, both -nostrils must be filled; when on the side, that to which the bone has -been forced; cerate also must be applied, and it is to be bound down a -little more tightly; because in that part, there not only grows callus -enough to make it sound, but even to form an eminence. From the third -day, it must be fomented with hot water, and the more so, the nearer -it may be expected to approach a sound state. And if there be several -small pieces in the fracture, nevertheless each of them _that are beat -in_, must be forced into its place by the fingers: also the strap must -be applied externally, as before directed; and over that a cerate, -without any other bandage. - -But if any fragment be separated all round, and will not be united with -the rest, as may be known from the humour, which will be discharged in -great quantity from the wound, it must be extracted by a vulsella; and -when the inflammation is gone, some one of those medicines that are -gently repellent, must be applied. The case is worse, when besides a -fracture of the bone, or cartilage, there is also a wound in the skin. -This very seldom occurs. When it does happen, they must nevertheless -be raised to their place in the same manner; and upon the skin must be -laid some one of these plaisters, that are adapted to recent wounds: -but no bandage must be applied over it. - - - - -CHAP. VI. - -OF FRACTURES OF THE EARS. - - -Sometimes the cartilage of the ear is broke. When this happens, an -agglutinating medicine must be applied, before a suppuration begins; -for that often prevents it, and heals the ear. Both here and in the -nose, it should be understood, that the cartilage itself is not -re-united, but that the flesh growing round it consolidates the part; -and therefore, if, together with the skin the cartilage is broke, -the skin is sewed on both sides; but I now speak of the cartilage -fractured, when the skin is entire. If pus then is already formed, the -skin must be opened on one side, and over against the incision, the -cartilage itself must be cut in a lunated form; then a gentle styptic -must be used; such as lycium diluted with water, till the bleeding be -stopped; after that a plaister that is not greasy, spread upon linen, -must be laid on, and soft wool put behind the ear, to fill up the -space between that and the head; then it must be fastened by a gentle -bandage; and from the third day fomented with warm water, as I directed -for the nostrils; and in these kinds of accidents, at first abstinence -is necessary, till the inflammation be gone. - - - - -CHAP. VII. - -OF A FRACTURED MAXILLA, TOGETHER WITH SOME GENERAL OBSERVATIONS -RELATING TO FRACTURES. - - -As I am to proceed from these parts to the lower jaw, I think it proper -to insert some observations relating to all the bones in general, to -prevent a frequent repetition of them. Every bone then is sometimes -split longitudinally, like wood, sometimes is fractured transversely, -sometimes obliquely; and in this last species the ends are sometimes -blunt, sometimes acute, which last is of the worst kind; because they -are not easily united, where they do not rest upon something obtuse, -then they also wound the flesh, and sometimes a nerve or a muscle: -moreover, one fragment sometimes happens to be divided into several. In -fractures of the other bones, one end often recedes entirely from the -other; but the broken ends of a jaw-bone remain always in contact in -some one part. - -Therefore, first the bones are to be forced into their place, by two -fingers pressing on each side, both within the mouth and upon the -chin; then if the fracture of the jaw-bone be transverse, (in which -case one tooth generally stands out beyond that next to it) when it is -reduced, the two contiguous teeth, or if they are loose, those next to -them, must be tied together by a horse-hair. In a different kind of -fracture this is needless. All the other steps are the same _as in the -above-described fractures_; for a double linen cloth dipped in wine and -oil must be laid upon it, and with that fine flour, and the soot of -frankincense; then a roller or soft strap, with a longitudinal opening -in the middle, that it may take in the chin both above and below; and -lastly, the ends of it must be brought over the head and tied there. - -With regard to the bones in general, it may further be remarked once -for all, that fasting at first is necessary; then from the third day -moist food; when the inflammation is removed a little fuller diet and -such as promotes the growth of flesh; wine is hurtful through the whole -time. On the third day, they ought to be opened, and fomented with the -vapour of hot water by a spunge, and the same dressings, as at first, -are to be put on; this to be repeated on the fifth day, and so on, -till the inflammation is gone, which ceases, either on the ninth day, -or generally on the seventh: when that is removed, the bones must be -examined again, that if any fragment is not in its place, it may be -reduced, and the bandage must not be taken away, till two thirds of the -time have elapsed, in which the several bones unite. - -Now, generally between the fourteenth and twenty-first day, the -following bones heal: the lower jaw, cheek-bone, clavicle, breast-bone, -scapula, ribs, the spine at the hips, the ancle-bone, heel, hand, and -foot; between the twentieth and thirtieth, the bones of the leg and -fore arm; between the twenty-seventh and fortieth, the arm and thigh -bones. - -But concerning the lower jaw-bone I must add, that the case requires -the long use of a liquid diet. Also far a considerable time pancakes -and such like must be continued, and nothing be chewed, till the callus -has perfectly restored the strength of the bone: and for some days, at -first, the patient must not speak at all. - - - - -CHAP. VIII. - -OF A FRACTURED CLAVICLE. - - -The clavicle, if it be fractured transversely, sometimes unites very -well of itself, and if it be not moved, may do well without a bandage; -but sometimes, and especially when it is moved, it slides away; and -generally the part next the breast lies over, and behind that next the -humerus. The reason of which is, that it does not move by itself; -but complies with the motion of the humerus: therefore, this standing -still, the humerus is moved upon it. That part of the clavicle, next -the breast, very seldom lies on the forepart; insomuch that men of -great character in the profession have told us they never met with it; -but the authority of Hippocrates is sufficient to put the fact beyond -dispute. - -However, as these cases are dissimilar, so each requires a treatment -somewhat different from the other. When the clavicle flies back -towards the scapulæ, the humerus must be pushed backward by the palm -of the right hand, and at the same time the clavicle itself be brought -forward. When turned to the breast, this must be forced backward, and -the humerus brought forward; and if the humerus fall below the other, -that part of the bone next the breast must not be depressed, because it -is immoveable; but the humerus itself must be raised; but if it rise -higher, the part next the breast must be filled with wool, and the arm -bound down to the breast. If there be sharp pieces in the fracture, an -incision must be made in the skin over it; and any parts of the bone, -that wound the flesh, must be cut off; then the blunted bones must be -brought together; and if there be a prominence any where, it must be -kept down by a linen cloth, three times folded, dipped in wine and oil: -if there be several fragments, they are to be covered with a splint, -the inside of which is to be smeared with wax, lest the roller should -slip on one side. The roller must be bound over the clavicle, when -reduced, rather often than tight: and this rule holds in all fractures. -In a fracture of the right clavicle, the bandage ought to pass from -it to the left arm-pit; if, of the left _clavicle_, to the right; -and again under the arm-pit of the affected bone: this done, if the -clavicle be inclined toward the scapula, the fore-arm must be tied to -the side; if forward, to the neck; and the patient laid on his back. -All the other directions given before must be observed. - -Now there are several bones that have very little motion, and are -either hard, or cartilaginous, which are liable to be fractured, or -pierced, or bruised, or fissured, as the malae, the breast-bone, -scapula, ribs, spine of the hips, ancle-bone, heel, hand, and foot. -The method of cure is the same in all these. If there is an external -wound, that must be dressed with the medicines proper for it. While -the wound is healing, a callus also fills up the fissures of the bone, -or any vacuity that may be in it. If the skin is entire, and from the -pain we infer that the bone is injured, there is nothing else to do but -rest; and cerate must be applied, and tied on gently, till the pain is -removed by the bone becoming sound. - - - - -CHAP. IX. - -OF FRACTURES OF THE RIBS AND SPINE. - - -But there are some peculiarities to be observed relating to the ribs; -because they are near the viscera, and that part is exposed to great -dangers. A rib then is sometimes fissured in such a manner, that not -the exterior surface of the bone, but the interior part of it, which is -thin, is hurt; sometimes it is broke entirely through. If the whole is -not fractured, there rarely follows either a spitting of blood, or a -febricula, or any suppuration; and the pain is not great; however the -place is slightly pained upon being touched. But this case requires no -more than to do what is above directed; and in binding it up to begin -at the middle of the roller (_a double-headed roller_) lest it draw the -skin to either side. After the twenty-first day, when the bone ought to -be united, we must endeavour, by a more plentiful diet, to render the -body as plump as possible, that it may cover the bone the better; which -being yet tender is in that part exposed to injuries under a thin skin. -And through the whole time of the cure, vociferation must be avoided, -and even speaking, hurrying, anger, all violence of motion, smoke, -dust, and whatever excites either coughing or sneezing; and it is not -even proper to hold in the breath much. - -But if a rib be entirely broke through, the case is more troublesome: -for both violent inflammations, and a fever and suppuration, and often -a danger of death ensue; and a spitting of blood. Therefore, if the -strength admits, blood must be taken from the arm of the same side -with the rib; if it does not allow this, a clyster must be given, -but without any thing acrid; and the patient must fast a considerable -time. He must not eat bread before the seventh day, but live upon -gruel alone; and upon the part must be applied cerate made of lycium, -with an addition of boiled resin; or the malagma of Polyarchus; or -cloths squeezed out of wine, rose oil, and common oil; and over these -soft sordid wool, and two double-headed rollers, but not tight. What -I mentioned before as hurtful, are in this case to be avoided with -greater caution; so that even the breath must not be too often fetched. -But if a cough be troublesome, a potion must be taken for it, either -of germander, or rue, or the herb staechas, or of cummin and pepper. -When there are severe pains, it is proper to lay on a cataplasm either -of darnel or barley, with an addition of a third part of mellow figs. -And this must lie on in the day time; but in the night, either cerate, -or a malagma, or cloths; because the cataplasm may drop off. Therefore -it must be opened every day, till such time as we may be content with -the cerate or malagma. And for ten days the body must be reduced by -fasting; from the eleventh we must begin to nourish it; and therefore -the bandage about it must be more lax than at first; and generally this -method is continued to the fortieth day. - -In the course of which, if there be any fear of a suppuration, -the malagma will be more effectual to discuss it than cerate. If, -notwithstanding, the suppuration take place, and cannot be discussed -by the medicines prescribed before, no time must be lost, lest the -bone below be affected; but in the part where it shall swell most, -a hot iron must be introduced, till it reach the pus, which must be -evacuated. If a tumour does not appear any where, we may discover where -the pus is principally lodged in this manner. We must rub all the part -with Cimolian chalk, and suffer it to dry; and wherever the moisture -shall penetrate deepest, there the pus is nearest to the skin; and here -the actual cautery is to be used. If there shall be a pretty large -abscess, it will require two or three perforations; and lint to be put -into them, or some part of a penecillum; which may be tied by a thread -at the top, that it may be easily drawn out. What remains to be done is -the same as in other burns. When the ulcer shall be clean, the body -must be nourished, lest a consumption follow, which would be fatal. -Sometimes too, when the bone is more slightly affected, and neglected -at first, not pus, but a certain humour like mucus is collected within, -and the skin over it grows soft; in which case, we must use the cautery -in the same manner. - -[Sidenote: _Fracture of the spine._] - -There is also something peculiar to be noted in the spine: for if any -part has separated from a vertebra, or is any way broken(16), the -part becomes hollow; prickings are felt there, because these fragments -must necessarily be jagged: whence it happens, that the patient now and -then leans forward. These are indications of the case; and the same -medicines are necessary, which have been mentioned in the first part of -this chapter. - - - - -CHAP. X. - -OF FRACTURES OF THE HUMERUS, FORE-ARM, THIGH, LEG, FINGERS, AND TOES. - - -The cases which occur in the arms and thighs, and their methods of -cure, are in a great measure similar. There are also some general -things that belong equally to the arms, fore-arms, thighs, legs, -fingers, and toes; for a fracture in the middle of these is least -dangerous; but the nearer the fracture is, either to the superior or -inferior head, so much the worse: for it both creates greater pain, -and is more difficult to cure. Of fractures, the most innocent is a -simple transverse one; worse, where it is oblique, and where there are -fragments; worst of all, when these are sharp. Sometimes the bones -in these parts being fractured, continue in their places: but they -much more frequently give way, and one part lies over the other. This -circumstance ought to be first of all considered; and there are certain -marks for knowing it. If they are displaced, they are bent, and cause -the sensation of pricking, and are unequal to the touch. But if they -meet one another, not directly, but obliquely (which happens, when they -are not in their place) that limb is shorter than the other, and the -muscles of it swell. - -Therefore, if this is found to be the case, it is proper to extend the -limb immediately: for the tendons and muscles being _in a natural state -kept_ stretched by the bones, are _in this case_ contracted; neither do -they return to their place, unless they be extended by force. Again, -if that is neglected for some days at first, an inflammation comes on, -during which, it is both difficult and dangerous to use violence to the -tendons; for there follows a convulsion or gangrene; or at least, which -is the mildest of the bad consequences, a suppuration; therefore, if -the bones have not been replaced before _the inflammation_, they must -not be reduced till after it is gone. Now one person alone may extend a -finger, also any other member, if it be of a child, by taking hold of -one part with his right hand, and the other with his left. A stronger -limb requires two to pull different ways. If the tendons are very firm, -as is the case in robust men, and chiefly in their thighs and legs, the -ends of the joints on both sides must be tied with straps, or linen -rollers, and pulled contrary ways by several persons; and when this -force has stretched the limb a little beyond its natural length, then -the bones must be pressed by the hands into their place; and the sign -of a bone’s being reduced, is the removal of the pain. The limb being -made equal with the other, must be wrapt up in cloths two or three -times doubled, dipped in wine and oil; for which purpose linen is best. - -Six bandages are generally required. The first to be applied is the -shortest; which should be rolled about the fracture(17), and ascend -spirally like a screw; and it is sufficient for it to go round in this -manner thrice. The second is one half longer than this; which, if -the bone project in any part, must begin there; if it be every where -equal, it may begin any where upon the fracture, and go in an opposite -direction to the former, tending downwards, and returning again to -the fracture, end in the upper part beyond the former bandage. Over -these must be laid cerate, upon a broad piece of linen, to keep them -on. And if the bone is prominent in any part, a cloth, three times -doubled, moistened in the wine and oil before mentioned, must be laid -upon it. These are to be secured by a third and a fourth bandage, in -such a manner, that the following move always in a contrary direction -to the former, the third alone must end in the lower part, and the -other three in the superior; because it is better to make several -convolutions, than to bind it tight; for a strict bandage disorders -a part, and makes it liable to a gangrene. We ought to bind an -articulation as little as possible; but if the fracture of the bone is -near the joint, there is a necessity for it. - -When the limb is bound up, it must be kept so to the third day, and -the bandage should be such, as on the first day not to hurt _by its -stricture_, and yet not to seem lax; on the second it should be a -little laxer; the third almost loosened. Therefore, the limb must then -be bound up again, and a fifth roller must be added to the former; -after which it must be again opened on the fifth day, and then secured -by six rollers, in such a manner, that the third and fifth may end -below, and the rest above. As often as the limb is opened, it must be -fomented with hot water. But if the fracture be near a joint, wine, -with the addition of a small proportion of oil, must be dropped upon -it for a long time, and all the other directions observed, till the -inflammation leave it, or the limb become smaller than ordinary: which, -if it does not happen on the seventh day, will certainly be effected by -the ninth. Then the bones are handled with great ease. - -Therefore, if they are not well joined to each other, they must be set -again; and if any fragments rise above the rest, they must be reduced -into their places, and then the limb must be rolled up in the same -manner, and splints be fitted round it, to keep the bones in their -places. And on that side, to which the fracture inclines, a broader -and stronger splint must be applied. About a joint all these should -turn outward, that they may not hurt it, and be bound no tighter than -is necessary to secure the bone: as they grow laxer in time, they must -be a little tightened every third day by their straps; and if there -be no itching nor pain, continue so, till two-thirds of the time be -compleated, in which each of these bones unites; afterwards, it is to -be bathed more gently with hot water; for at first it is necessary to -dissipate the humours, and afterwards to make them transpire. Therefore -it must also be anointed lightly with liquid cerate, and the surface of -the skin rubbed; and the fracture be bound up more loosely. It must be -opened every third day, and all the applications be repeated, except -the hot water; only one of the rollers, as often as it is loosed, must -be withdrawn. - -[Sidenote: _Of a fractured humerus._] - -The foregoing rules are general; the following peculiar to each -bone. If the humerus be fractured, the extension must not be made as -in another limb; but the patient is placed in a high seat, and the -physician in a lower one opposite to him. Then the patient’s fore-arm -is to be supported by a bandage passed round it, and fastened behind -the neck. _This done_, a second bandage, _with two heads_, is to be -rolled round the upper part of the humerus, and have its two ends -tied into a knot above the head. Lastly, a third bandage of the like -kind is to be fastened to the lower part of the humerus, and carried -downwards, its two ends being also tied together. Then, from behind -the patient’s head, an assistant stretching his own arm _through the -loop of_ the second mentioned roller, his right, if the right humerus -is to be extended, his left, if the left _humerus_, takes hold of a -stick placed between the patient’s thighs; the physician also sets his -right foot, if he be to operate upon the left humerus, his left, if -upon the right, on the third of these rollers; and at the same time the -assistant raises the one roller, and the physician depresses the other; -by which means, the humerus is gently extended. If the fracture be in -the middle or lower part of the bone, shorter rollers are required; if -in the superior, longer; so that they may be extended from thence over -the breast, under the other arm-pit to the shoulders. In binding it -up, the fore-arm must be so inclined, and the affected part put into -such a position by the bandages, that the suspending of the forearm -afterwards, do not turn the humerus any other way, than when it was -bound up. And the fore-arm being hung, the humerus is to be also gently -tied down to the side; by which means it will be prevented from moving, -and therefore the bones continue as they have been set. When we come to -the application of splints, these ought to be longest on the external -side, shorter on the fore-part, but shortest of all under the arm-pit. -And when the humerus is fractured near the cubitus, they must be pretty -often removed, lest the tendons there grow rigid, and the fore-arm be -rendered useless. Whenever they are removed, the fracture must be held -in the hand; and the cubitus fomented with hot water, and rubbed over -with soft cerate; and splints must either not be put upon the processes -of the cubitus at all, or they must be somewhat shorter _than the -others_. - -[Sidenote: _Of a fracture of the fore-arm._] - -But if there is a fracture in the fore-arm, it must be first of all -considered, whether one bone or both be broken: not that there is any -different method of cure to be used; but first that the extension may -be the stronger, if both bones be fractured, because the tendons must -necessarily be less contracted, when one of the bones is entire, and -keeps them upon the stretch; in the next place, that every thing which -relates to securing the bones, may be done with the greater accuracy, -if one of them does not help the other: for where one is unhurt, it -helps more than rollers and splints. The fore-arm ought to be tied -up with the thumb turned a little toward the breast; for that is the -most natural posture of the fore-arm: and after the bandages are put -on, it is best held in a scarf, the full breadth of which is under the -fore-arm, with its ends, which are very narrow, fixed over the neck; -thus the arm is conveniently suspended from the neck, and ought to hang -a little higher than the other elbow. - -But if any part of the top of the cubitus be fractured, it is improper -to secure it by bandages, because the fore-arm becomes immoveable. And -if means only are found(18) to remove the pain, it remains as useful -as before. - -[Sidenote: _Fractures of the thighs and legs._] - -It is of equal importance in the leg for one of the bones to continue -entire. Both in this and the thigh it is fit after binding it up to -put it in a box. This box ought to have holes below, through which any -humour that is discharged, may descend; and at the foot a prop, which -may both sustain, and not suffer it to slip; and holes in the sides, -through which straps being past, some bars[IC] may keep the leg and -thigh in their position. If it be a fracture of the leg, this ought to -reach from the foot to the ham; if of the thigh, as far as the hip; -if near the head of the thigh-bone, so as that the hip likewise may -be within it. We ought not to be ignorant, however, that a fractured -thigh becomes shorter, because it never entirely returns to its former -state; and that the person ever after supports himself upon his toes in -that foot, which occasions great weakness; however it is much worse, -where the misfortune has been encreased by neglect. - - [IC] morae. - -[Sidenote: _Fractures of the fingers._] - -It is sufficient to bind a finger to one small twig, after the -inflammation is gone. - -[Sidenote: _General rules._] - -The foregoing directions are confined to the cases relating to -particular limbs; the following are general: fasting for some days -at first; then when the callus is growing, a pretty full diet; long -abstinence from wine; plentiful fomentations of hot water, while -the inflammation continues; when that has ceased, they must be more -sparing; lastly, a pretty long but gentle rubbing of liquid cerate -into the more remote parts. Nor must the limb be immediately put upon -exercise, but by degrees returned to its former motions. - -The case is a good deal worse, when, besides the fracture of the bone, -there is also a wound in the flesh; and particularly if that happen in -the muscles of the thigh or arm: for the inflammations there are much -greater, and they are more liable to gangrenes. And generally, where -the bones of the thigh have slipped past each other, it is necessary -to cut it off. The arm is also endangered in the same circumstances, -but is more easily preserved. And these dangers are still more to be -apprehended, if the fracture be near the joints: therefore, such a case -must be treated with more care, and the muscle must be cut through -transversely over the middle of the wound; and if the hæmorrhage has -been but small, the patient must be bled, and extenuated by fasting -for ten days. And though the other limbs may be extended slowly, and -the bones reduced gently to their place; yet in these it is not quite -expedient either to extend the tendons, or handle the bones. And the -patient must be allowed to keep them in the position that is easiest -to him. To all such wounds must be applied, at first, lint dipped in -wine, with an addition of a very little rose oil: the other management -is the same as above recommended. They are to be bound up with rollers -broader(19) than the wound; which must be applied looser, than if -there was not a wound there; and as the wound is more liable to -corruption and a gangrene, we are by a number of rollers to manage it -so, that though they are slack, they may keep the bones firm. - -This method may be followed in the thigh or arm, provided the bones -have chanced to return to their proper place; but if they be in any -different situation, they must only have such a bandage, as will keep -on the medicine that is applied. The other directions I gave before -must be observed: except that neither splints nor boxes be used, with -which the wound cannot heal; but only more and broader rollers are -necessary; and both hot oil and wine must be poured upon them now and -then; more frequently the latter. At the beginning the patient must -fast; the wound must be bathed with hot water; he must avoid the cold; -and recourse must be had to medicines for promoting digestion of the -wound, and more care must be taken of the wound than the bone: for that -reason it must be opened every day and dressed. - -In the mean time, should any small fragment of the bone project, if -it be blunt, it must be reduced into its place; if sharp, its point, -when long, must first be cut off, when short, filed, and in either case -smoothed with a chisel; and then it must be returned in again. And if -that cannot be done by the hand, a vulsella, such as workmen make use -of, must be applied with that part(20) which turns inward to the -sharp point of the bone, that by its convex part the prominent bone -may be thrust into its place. If it be too large, and covered by small -membranes, we should allow these to be dissolved by medicines, and when -the bone is laid bare, cut it off; which is to be done pretty early, -and afterwards, in this method we may let the bone unite and the wound -heal; the first in its proper time, and the other as the circumstances -admit. - -Sometimes too it happens in a large wound, that some fragments as it -were mortify, and do not unite with the rest. This may be discovered -from the quantity of discharge; which makes it necessary to open the -ulcer oftener than it is dressed; and the consequence generally is, -that this bone, after some days, of itself falls off; otherwise, though -the condition of the wound is miserable enough before, that often -encreases it, and makes it more tedious of cure. The bone too is often -broken away, when the skin is entire, and immediately an itching and -pain come on. Wherefore, if that happens it is proper to open it the -sooner, and bathe it in the summer time with cold water; and in the -winter with water just warm; and then apply myrtle cerate. - -Sometimes, the fracture, by some points like prickles, irritates -the flesh: which being discovered by the itching and prickings, the -physician must open it, and cut off these points. The other part of the -cure is the same in both these cases as in a recent wound. When the -ulcer is clean, nourishing food must be taken. If the limb is still too -short, and the bones are not in their places, a wedge of the smallest -and smoothest kind must be put in between them with its head standing -out a little, and the thick part of it must be driven farther in every -day, till that limb be equal to the other. Then the wedge must be taken -out, and the wound healed up. When a cicatrix is brought on, it must be -bathed with a decoction of myrtle, ivy, and other like vervains, cold, -and a drying medicine applied upon it; and in this case, there is a -greater necessity for rest, till the limb recover its strength. - -When the bones happen not to unite, because they have been often -opened, and often moved, the method of cure is obvious; for they may -unite. If the fracture be of long standing, the limb must be extended, -to create a fresh injury; the bones must be separated from one another -by the hand, that their surfaces may be roughened by rubbing against -each other, and if there be any fat substance, it may be abraded, and -the whole of it become as it were recent: great care, however, must -be taken not to wound tendons or muscles. Then it must be bathed with -a decoction of pomegranate bark in wine; and the same mixed with the -white of eggs, must be applied to it; on the third day it must be -opened, and bathed with a decoction of the vervains abovementioned: -which must be repeated on the fifth day, and splints put round it; -the other steps, both before and after, which I directed already, -must be taken in the same manner. However, sometimes the bones unite -obliquely(21); and thus the limb becomes both shorter and deformed, -and if the ends are pretty sharp, continual prickings are felt: for -this reason the bones ought to be fractured again, and put in a proper -direction. It is done in this manner. The limb is fomented with plenty -of hot water, and rubbed over with liquid cerate and extended; in the -mean time, the physician handling the bones, the callus being yet -tended, separates them by his hands, and forces the part that projects, -into its place: and if that is not effectual, on that side, to which -the bone inclines, he puts a regula wrapped up in wool; and by thus -binding it up brings it to a habit of lodging in its former place. - -Sometimes also, though the bones have united as they should do, too -large a callus grows upon them; and therefore the part is swelled. When -this happens, the limb must be rubbed gently for a long time, with oil, -salt and nitre, and bathed with plenty of salt water; a discutient -malagma must be applied; and a tight bandage put on; and the patient -must eat herbage, and take vomits; by which course, the callus is -reduced together with the flesh. Some good is done by an application -of mustard and a fig upon another limb, till it corrode a little, and -derive the matter to that part. When the tumour is lessened by these -means, the person may return to his ordinary course of life. - - - - -CHAP. XI. - -OF LUXATIONS. - - -Thus far then we have treated of fractures. Now the bones are -dislocated in two ways. For sometimes those that are joined together, -separate from each other, as when the broad bone of the scapula -recedes from the humerus(22), and in the fore-arm the radius from -the cubitus, and in the leg, the tibia from the fibula, and sometimes -in leaping the heel-bone from the ancle; which last, however, seldom -happens. Sometimes the articulations are displaced. I shall speak first -of the former. - -When such an accident happens, the part is immediately hollow, and -by pressing upon it with the finger one feels a cavity. After that, -a violent inflammation comes on; and particularly in the ancle; for -generally it occasions fevers and gangrenes, and either convulsions, or -contractions, which draw the head down upon the shoulders. To avoid -which, the same method must be followed here, as in injuries of the -moveable bones. And whenever it happens, the medicines prescribed -before must be laid on these parts to remove the pain and tumour: for -bones once separated in this manner never come together again; and -though some degree of comeliness be attainable in the part, yet it is -of no use(23). - -But the lower jaw and the vertebræ, and all the joints, though they be -secured by strong ligaments, are luxated by the force of a blow, or -when the ligaments are either ruptured, or some way weakened; and more -easily in children or lads, than in those that are more robust. And -they slip out forward and backward, and inward and outward; some of -them in all these ways, others in particular ways. And there are some -general signs belonging to all, others peculiar to each one: for there -is always a tumour in that part, to which the bone is propelled, and a -cavity in that from whence it recedes. Now these marks are common to -them all; the others peculiar to the several bones will be mentioned, -when I speak of each case distinctly. - -But though all the articulations may be dislocated, they cannot be -all replaced; for the head is never reduced, nor a vertebra in the -spine, nor a jaw-bone, which being out on both sides, has raised an -inflammation before it could be returned. Again, those that slip out -from the fault of the ligaments, when they are forced into their -places, give way again. And those that have been dislocated in -childhood, and have not been reduced, grow less than the rest: and the -flesh of all these that are not in their place, is decayed, and more so -in the member nearest to it, than in one beyond it. For instance, if -the humerus is not in its place, the arm wastes more than the fore-arm, -and that more than the hand. Then according to the situations, and the -nature of the accidents, there is left either more or less use of the -limb; and the more use remains of it, the less it is wasted. - -Now whatever is dislocated should be reduced before an inflammation -begin. If that has already seized it, till it cease, it must not be -meddled with; after its removal, trial must be made in such limbs -as are reducible. A great deal depends upon the habit both of the -body and the ligaments: for if the body be slender, or humid, or if -the ligaments be weak, the bone is more quickly reduced; but it is -both more liable to dislocation, and is less firmly held after it -is reduced(24). Bodies of the contrary qualities hold it faster -in its place; but when once forced out, admit of its return with -difficulty. It is proper to alleviate the inflammation by applying -sordid wool squeezed out of vinegar; and if the misfortune be in a -strong articulation, to abstain from food for three, and sometimes even -five days; to drink warm water till the thirst be gone; to observe -these rules more strictly in luxations of those bones, that are held -by strong large muscles; and much more so if a fever has ensued; on -the fifth day to foment with hot water; and taking away the wool, to -apply cerate made of Cyprine oil, with the addition of nitre, till the -inflammation be entirely removed. Then it is proper to use friction -to the limb; to take food of good juices, wine in moderate quantity; -and by this time, to make some use of the limb: because motion, as it -is extremely hurtful in pain, so it is very salutary when the pain -is removed. These observations are general; I shall now treat of the -particular cases. - - - - -CHAP. XII. - -OF A LUXATED MAXILLA. - - -In a dislocation of the lower jaw it is pushed forward, but sometimes -on one side, sometimes on both. If on one side, it inclines together -with the chin to the contrary side, the teeth do not answer to each -other, but the canine teeth below are opposite to the incisores: if -on both sides, the chin leaves its place, and is protruded to the -external part; and the lower teeth come farther out than the upper; -and the muscles of the temples appear tense. The patient, as soon as -possible, must be placed in a seat in such a manner, that an assistant -may secure his head behind; or he may be seated near a wall, putting a -hard leather cushion between the wall and his head, and let his head -be pressed upon the cushion by an assistant, that it may be kept the -steadier; then the thumbs of the physician being wrapped up with linen -cloths, or rollers, that they may not slip, must be introduced into -his mouth; and the fingers must be applied externally. When the maxilla -is firmly grasped, if the luxation be on one side, the chin must be -shaken, and brought towards the throat; then at the same time his head -must be held, and the chin being raised, the maxilla forced into its -place, and the mouth shut; and all this must be done almost in the same -instant. But if the luxation be on both sides, the same method must -be taken; but the jaw-bone must be forced back equally on both sides. -When the bone is replaced, if the case was attended with a pain of the -eyes and neck, blood must be taken from the arm. And as liquid food at -first is proper for all persons, whose bones have been dislocated, so -particularly in this circumstance; where even frequent speaking, by the -motion of the mouth, hurts the nerves of the temples(25). - - - - -CHAP. XIII. - -OF A LUXATION OF THE HEAD. - - -In the first part of this book, I have already observed, that the head -is secured upon the neck by two processes received into two depressions -of the upper vertebra. These processes are sometimes dislocated toward -the posterior part; the consequence of which is, that the nerves below -the occiput are extended, the chin is fixed upon the breast, and the -patient can neither drink, nor speak, and sometimes discharges his -semen involuntarily. Such patients die very quickly. I judged it -necessary to mention this case, not because there is any cure for -it; but that it might be known by its symptoms, and if any should -lose a friend in this way, they might not think it was for want of a -physician. - - - - -CHAP. XIV. - -OF A LUXATION IN THE SPINE. - - -The same misfortune attends those, whose vertebræ of the spine are -luxated. For this cannot happen, unless both the medulla, which passes -through the middle, and the two membranes, that go through the two -processes on the sides, as also the ligaments, that secure them, be -ruptured. They are dislocated both backward, and forward; both above -and below the transverse septum. As they slip the one way or the -other, there will be either a swelling or a cavity behind. If this -happens above the septum, the hands become paralytick, a vomiting -or convulsions follow, the breath is oppressed, and a violent pain -and deafness ensue. If below the septum, the thighs are paralytick, -the urine is suppressed, and sometimes it even flows involuntarily. -Though a person does not in such cases die so quickly as where the -head is luxated, yet it commonly happens within three days; for what -Hippocrates has directed in a vertebra luxated externally, that the -patient must be laid prone, and extended, and then a person ought -to stand upon him with his heel and force it in, must be understood -of those, that are but partially displaced, not of these, that are -entirely luxated; for sometimes a weakness of the ligaments causes a -vertebra to protuberate forwards, though it be not dislocated: this is -not mortal. But it is not possible to force it back from the internal -part. If any vertebra be reduced from the external side, it generally -returns again, unless, which is very rare, the tone of the nerves be -restored(26). - - - - -CHAP. XV. - -OF A LUXATION OF THE HUMERUS. - - -The humerus slips sometimes into the axilla, sometimes forward. If it -has fallen into the arm-pit, the cubitus recedes from the body, and -cannot be brought upward with the humerus to the ear of the same side; -also that arm is longer than the other: if forward, the upper part of -the fore-arm is extended, but not to its full length; and the cubitus -is moved with more difficulty forward than backward. - -Therefore if the humerus has fallen into the arm-pit, and the patient -be young, or of a lax habit, so that the ligaments are weak, it is -sufficient to place him in a seat; and to order one assistant to draw -back gently the head of the broad bone of the scapula, and another to -extend the fore-arm; while the physician himself sitting behind, with -his knee under the patient’s arm-pit, forces the humerus upwards, and -at the same time presses the scapula with one hand, while he pushes the -cubit to the side with the other. - -But if the patient be of a large stature, or the ligaments more robust, -a wooden spatha is necessary of the thickness of two fingers, and so -long as to reach from the arm-pit to the fingers. In the top of it, is -a small round head a little hollowed; that it may receive some part of -the head of the humerus; and in three places at due distances there -are two holes made for the admission of soft straps. This spatha being -wrapt up in a roller, that it may hurt the less, is applied from the -fore-arm to the arm pit, in such a manner, that the head of it is put -under the axilla; then it is tied to the arm by its straps, in one -place a little below the head of the humerus, another a little above -the elbow, and the third above the hand; to which purpose the distances -of the holes are then also to be adapted. The arm being thus tied up -is put over a step of a ladder, so high, that the patient cannot stand -upon the ground; and at the same time his body is suffered to sink on -one side, and his arm kept extended on the other; the effect is, that -the head of the humerus, being impelled by the head of the spatha, is -forced into its place, sometimes with a crack, sometimes without it. It -appears from Hippocrates alone, that there are many other methods; but -none of them has been more approved by experience than this. - -But if the humerus is luxated forward, the patient must be laid on his -back, and a roller, or strap put round the middle of the arm-pit, and -the ends of it delivered to one assistant behind the patient’s head, -and his fore-arm to another; then the first must be ordered to extend -the strap, and the other the fore-arm; and the physician must thrust -back the patient’s head with his left hand, and with his right raise -the cubitus together with the humerus, and force the bone into its -place; which in this case is more easily reduced than in the former. - -When the humerus is replaced, wool must be put under the arm-pit; that -if the bone was in the interior part, it may prevent its returning; if -forward, that it may however be more conveniently rolled up. Then the -roller being first carried under the arm-pit, ought to surround the -head of the bone, and passing over the breast to the other arm-pit, and -from that to the scapulæ, and back again to the head of the _luxated_ -humerus, it must be carried round in this manner several times, till -the head of the humerus be well secured. The humerus being thus bound -up is better fixed, if it be drawn close to the side, and tied down to -it with a roller. - - - - -CHAP. XVI. - -OF A LUXATION OF THE CUBITUS. - - -From what has been said in the first part of this book, it may be -understood, that three bones meet together at the elbow, the humerus, -radius, and cubitus. If the cubitus, which is fixed to the humerus, -separates from it, the radius, which is contiguous to it, is sometimes -dislocated, and sometimes remains firm. Now the cubitus may be luxated -in all the four different ways. If it be displaced forward, the -fore-arm is extended, and cannot be bent; if backward, the fore-arm is -bent, cannot be extended, and is shorter than the other; sometimes it -brings on a fever and bilious vomiting; if externally, or internally, -the fore-arm is stretched, but is a little bent to that part, from -whence the bone has receded. - -Whatever species it be, the method of reduction is the same (and not -only in the cubitus, but in all the larger limbs, which are joined in -the articulation by a long process) to extend both limbs different -ways, till there be a void space between the bones; and then to thrust -the luxated bone from that side, into which it has prolapsed, to the -contrary. However the methods of extension are various according to the -strength of the ligaments, and the position of the luxated bones. And -sometimes the hands alone are used, sometimes other means. - -Therefore if the cubitus is displaced forward, it is sufficient for -it to be extended by two hands, sometimes assisted by two straps; -then some round body must be put into the bend of the elbow, and upon -that, the cubitus is to be suddenly forced towards the humerus. But in -the other cases the best method is so extend the fore-arm in the same -manner, as was directed in a fractured humerus, and then to reduce the -bones. - -The remaining part of the cure is the same as in the other luxations; -only this must be sooner, and more frequently opened, also more -plentifully fomented with hot water, and rubbed longer with oil, and -nitre, and salt. For the cubitus, whether it remain displaced, or be -reduced, is more quickly surrounded by a callus than another joint, and -if this grows, while the arm is at rest, it afterwards prevents its -flexure. - - - - -CHAP. XVII. - -OF A LUXATED HAND. - - -The hand too may be displaced in all the four directions. If it slips -backward, the fingers cannot be extended; if forward, they cannot be -bent; if on either side, the hand is turned to the opposite, that is, -either toward the thumb, or the little finger, and may be replaced -without much difficulty. The hand and fore-arm should be extended on -something, that is hard and will not give way, the hand being prone, -if the luxation was to the posterior part; and supine, if forward; if -internally, or externally, it should be laid on one side. When the -ligaments are sufficiently stretched, if the luxation was lateral, it -must be repelled to the contrary side by the hands: but where it was -forward, or backward, some hard body is to be put upon it, and pressed -upon the prominent bone by the hand, which additional force pushes it -more easily into its place. - - - - -CHAP. XVIII. - -OF LUXATIONS IN THE PALM. - - -The bones also in the palm are sometimes dislocated, and that either -forward, or backward. For they cannot be luxated laterally by reason -of the resistance from the parallel bones on each side. There is only -one indication of it, which is common to them all: a tumour in that -part, to which the bone comes, and a cavity in the other, from which it -recedes. But the bone being well pressed by a finger, returns without -extension to its place. - - - - -CHAP. XIX. - -OF LUXATED FINGERS. - - -In the fingers there are as many different cases, and the same signs, -as in the hands. But an equal degree of force is not necessary in their -extension; because the _several_ bones are shorter, and the ligaments -less strong. They ought only to be extended upon a table, when the -luxation is forward or backward; and then compressed with the palm of -the hand that thus the finger may be(27) restored to the place from -whence it slipped. - - - - -CHAP. XX. - -OF A LUXATION OF THE FEMUR. - - -Having treated of the humerus(28), what I said there may seem to -suffice for the lower extremities; for there is some similitude in this -case between the femur, and humerus, the tibia, and cubitus, the foot -and hand. However something must be said in particular about these. - -The femur is protruded in all the four ways; most frequently to the -internal part, next externally, very rarely forward, or backward. If it -be luxated internally, the leg is longer and turned round externally -more than the other; for the toes point outward. If to the external -part, it is shorter and bowed inward, and the foot turns the same way; -the heel in walking does not touch the ground, but the person rests -upon the extremity of the sole of the foot; and in this case, the leg -sustains the superior part of the body better than in the former, and -less needs the help of a staff. If forward, the leg cannot be bent, and -being extended is as long at the heel as the other: but the toes are -turned less inward; also the pain is most violent in this case; and the -urine very liable to be suppressed: when the inflammation together with -the pain have ceased, such patients walk pretty well, and their foot is -straight. If the luxation be backward, the leg cannot be extended; and -is shorter; also in standing, the heel does not reach the ground. - -But there is a great danger attending the femur, that it be either -difficult to reduce, or slip out again after it is replaced: some -affirm it always comes out again; but Hippocrates, and Diocles, -and Philotimus, and Nileus, and Heraclides the Tarentine, very -celebrated authors, have affirmed, that they have made a perfect cure. -Neither would Hippocrates, Andreas, Nileus, Nymphodorus, Protarchus, -Heraclides, and a certain artificer too, have contrived so great a -variety of machines for extending the femur in this case, if it were to -no purpose. But as this is a false opinion, so on the other hand it is -true, that the ligaments and muscles there being very strong, if they -retain their natural firmness, they will hardly admit of a reduction; -if they do not, they do not hold it fast, when reduced. - -Therefore trial must be made, and if the limb be but tender, it is -sufficient to make an extension by one strap at the groin, and another -at the knee; if it be muscular, the extension will be better made by -tying these straps to strong sticks; and then putting the lower ends -of the sticks against a fulcrum, and pulling the upper ends with both -hands. The extension of the limb is still more strong upon a bench, -that has axes at both ends, to which these straps are tied; which being -turned as in a wine-press, by persevering, they will not only extend, -but even break the ligaments and muscles. Now the patient must be laid -upon this bench, either prone or supine, or on one side, so that the -part, into which the bone has slipped, be always uppermost, and that, -from which it has receded, lowermost. When the ligaments are extended, -if the bone is luxated forward, some round body must be put upon the -groin; and the knee must suddenly be drawn towards the body, in the -same manner, and for the same reason, as is done in the arm; and if the -femur gives way to the flexion, it is reduced. - -But in the other cases, where the bones have receded a little from -each other, the physician ought to force back the prominent part; and -an assistant to push the hip in a contrary direction. When the bone is -reduced, there is nothing different required in the treatment, except -confining the patient longer to his bed; lest if the femur be moved, -while the ligaments are too lax, it may slip out again. However it may -be secured by keeping the middle or upper part of the joint in some -canaliculus(29). - - - - -CHAP. XXI. - -OF A LUXATION OF THE KNEE. - - -It is very well known, that the knee slips inward, outward, and -backward. Most authors have written, that it is not displaced forward. -And that may appear very probable; as in that place the patella is -opposed to it, and likewise keeps in the head of the tibia. But Meges -has given an instance of a person cured by him, where the luxation was -forward. - -In these cases the ligaments may be extended by the same means, which -I recited in the femur. And where the bone is luxated backward, it is -reduced in the same manner, by some round body applied to the ham, and -drawing up the leg. In the other cases the hands are only to be used, -and then the bones are at the same time forced different ways. - - - - -CHAP. XXII. - -OF A LUXATED ANCLE. - - -The ancle is luxated in all directions. When it is inward, the sole of -the foot is turned outward. When the contrary case to this happens, -there is also the contrary symptom. But if it be luxated forward, the -broad tendon behind is hard, and tense; and the foot turns downward. If -backward, the heel is almost hid, and the sole of the foot is enlarged. -This luxation is reduced by the hands; the foot and leg being first -extended different ways. And in this case also the patient must be kept -longer in bed; lest the ancle, which sustains the whole body, yield -beneath its load, and be forced out again before the ligaments have -recovered their strength. And at first low shoes must be used, lest the -binding hurt the ancle. - - - - -CHAP. XXIII. - -OF LUXATIONS IN THE SOLES OF THE FEET. - - -The bones in the soles of the feet are luxated in the same manner as -those in the hands; and are reduced by the same methods; only it is -necessary to put a roller round the heel; lest as the middle part and -extremity of the sole require to be bound, the ancle being left free, -may receive the redundant matter, and thus come to suppuration. - - - - -CHAP. XXIV. - -OF LUXATED TOES. - - -In the toes there is nothing else required, than what has been directed -before in the fingers. - - - - -CHAP. XXV. - -OF LUXATIONS ATTENDED WITH A WOUND. - - -These are the methods to be taken, when the bones have been displaced -without a wound; but they are often dislocated, and the part wounded at -the same time; and here the danger is great, and so much the greater, -as the limb is larger, and the ligaments, or muscles that hold it, -stronger; and therefore, from the arm and thigh bones there is danger -of death: and if the bones are reduced, there is no hope; and yet when -they are not replaced, there is also some danger. In both, the event -is the more to be feared, the nearer the wound is to the articulation. -For Hippocrates has asserted, that no bone could in this case be -safely reduced, except the fingers and toes, and the bones of the feet -and hands; and that even here great caution must be used, lest it -suddenly destroy the patient. Some have reduced both arms and legs; -and to prevent gangrenes and convulsions (which in such cases often -terminate in speedy death) they let blood from the arm. But not even a -finger (where, as the malady, so also the danger is least) ought to be -reduced, either while there is an inflammation, or afterwards, when the -bones have continued long luxated. And farther, if after the reduction -of the bone, convulsions come on, it must be immediately put out again. - -Now every member that is at once wounded and dislocated, and continues -unreduced, ought to lie in the posture easiest to the patient; provided -it neither be moved nor hang down. In every case of this kind the cure -is much promoted by long fasting; and then the use of those methods -prescribed before. In fractured bones, where there is a wound, if the -naked bone project, it will always prevent its healing; therefore, the -prominent part must be cut away, and dry lint applied, and medicines -not greasy; till the greatest degree of soundness attainable in such a -case be restored; for it both leaves a weakness behind it, and the part -is covered with a thin cicatrix, which must of necessity be ever after -greatly exposed to injuries. - - - - -NOTES - -TO - -BOOK I. - - -1. _Their gods._ Though Æsculapius lived so near to the time of the -Trojan war, yet the Greeks knew very little about him. The superstition -of those times gave him a place among the gods: and as he was adored -under the character of the genius of physick, it came at last to be -doubted whether he was ever a mortal. This blind devotion, however, -produced one happy consequence: his priests were obliged, for their -own interest, to make themselves masters of all the physic that was -known in that country, that they might be qualified to give advice to -the people, who applied to them. Their prescriptions passed for the -suggestions of the god; their cures for miraculous. But both diseases -and remedies were carefully recorded.----Strabo tells us, that from -these registers in the temple of Æsculapius at Cos, Hippocrates formed -his plan for a proper diet.----_Strabon. Geograph. lib. 14. p. 657. -Edit. Casaub._ - -2. _Immortal gods._) That this was really the opinion of the -ancients, may be seen by many passages in Homer’s poems, where he -mentions Jupiter punishing wicked nations by diseases, as well as -famine, wars, and other calamities. - -3. _Principles._) Some of the ancient philosophers maintained, that -the human body, as well as the whole material system, was composed of -four principles or elements, viz. fire, air, earth, and water. - -4. _Vessels_, in the original, _vena_; which is used by our author -as a general term for arteries and veins. In this place it is evident -he means arteries; for mentioning the same opinion again, page 16, he -says, _At si sanguis in arterias transfusus_; and he often speaks of -the motion of the veins, where, it is plain, he intends the pulsation -of the arteries. _Arteria_ he uses to signify the wind-pipe, and -likewise the sanguiferous arteries, as in chap. 1. of book 4. _Circa -guttur venae grandes, quae sphagitides nominantur; item arteriæ, quas -carotidas vocant._ - -5. _Distribution of the same._) The word in the original is _digero_, -which, by the modern physicians, is generally applied to the digestion -of the aliment in the stomach. But that is what our author never -intends by it. _Digero_ he uses in three different senses; 1st, for the -distribution of the aliment from the stomach (after its concoction) -to all the other parts of the body, which appears to be his meaning -here: 2dly, for any evacuation made by the pores of the skin, as -_sudore digerit_ in the end of the ninth chapter of this book: 3dly, -for discussing any collection of humour, so as to prevent its coming to -suppuration; _vel avertenda concurrens eo materia_, _vel digerenda_, -_vel ad maturitatem perducenda est: si priora contigerunt_, _nihil -praeterea necessarium est_. Lib. vii. c. 2. ad fin. p. 408. Unless we -restrain the meaning of this last passage to discussing by the skin, -which would bring it under the second sense. - -6. _Asperity._) Ten of the most ancient editions mentioned by -Morgagni[ID] read _contactum_; but as that seems to convey no -convenient sense, others prefer _contractum_, which is found in one -of the manuscripts, and suppose it to mean asperity, a sense which -it is not found to bear elsewhere; and therefore, Constantine boldly -enough substitutes _confractum_, which he thinks agreeable to this -interpretation. The same reason may, perhaps, have led him to that -alteration, as induced the others to explain _contractum_ by asperity, -that it might stand in opposition to smoothness. For my own part, -though _confractus_ is not found in any other classic, yet I have given -this translation, because I can find no other sense of the place, as it -now stands. If I durst offer my own conjecture, ἀπόζυμος γαστὴρI would -rather chuse to read _anfractum_, which, I think, is applicable to the -windings of some of the internal parts. - - [ID] Ep. iii. p. 53. - -7. _Lippitudo_ is used by Celsus, and the more ancient Latins in the -same sense as the Greek term _Ophthalmia_. - -8. _Abdomen._) The word in the original is _uterus_, which our author -generally uses for the cavity of the abdomen. - -9. _Indeed may be opened._) The text in Almeloveen and Linden runs -thus, _Nam ne uterum quidem ut nihilominus aerem contineat_, &c. The -particle _ne_ is not in the older copies or the MS. of Morgagni[IE], -and as it spoils the sense, I have omitted it. The same older copies -read _qui minus ad rem pertineat_, instead of _ut nihilominus aerem -contineat_; but as the first can bear no sense at all in this place, -and the other has not the elegance of Celsus, I have taken no notice -of either; and as the connection is perfect without any addition, I -suspect both to have crept in from the margin. - - [IE] Ep. vii. p. 187. - -10. _Praecordia._) This word frequently occurs in Celsus; and he -seems to use it in two senses: 1st, For the cavity of the thorax, -as lib. 4. c. 1. _At sub corde atque pulmone transversum ex valida -membrana est septum, quod è praecordiis uterum diducit._ 2dly, For -the hypochondria; for which see several passages in the first eight -chapters of the second book, where he considers the symptoms of -distempers from the external appearance of the præcordia; by which -word, in those passages, he translates the Greek term ὑποχονδρίον in -Hippocrates; the derivation of which demonstrates it to be below the -Cartilago Xiphoides. - -11. _Quantity of flesh._) I shall not trouble the reader with several -various and opposite opinions of this case, by different commentators; -it will be sufficient to recite the opinion of Morgagni[IF] (which -appears the only probable one) and the reasons with which he supports -it. In his anatomical lectures he explained it as an inverted uterus, -which he says resembles nothing more than flesh, and is quickly seized -with a gangrene, for the reasons given by Ruysch. Observ. Anat. Chir. -10. and thus[IG] Celsus, in the description of a gangrene, mentions -_siccam et aridam carnem_; and Boerhaave says, an inverted uterus is -seized with a gangrene in three hours after its inversion, which agrees -with _intra paueas horas_ in this place.----The ingenious author, -first mentioned, confirms this explanation by a case that occurred to -a surgeon, who, struck with the novelty of it, came immediately to ask -his opinion: upon his shewing the surgeon Ruysch’s delineation of an -inverted uterus, he confessed it to be perfectly similar.----Morgagni -advised him to run back and replace it immediately, which he did in an -hour after its inversion, and the lady was cured. - - [IF] Ep. iv. p. 89. - - [IG] Lib. 5. c. 26. p. 301. - -12. _Nervus._) Though it might be doubted, whether the ancients -comprehended under this word, what is now properly called a nerve, -yet, it is certain they used it for a tendon, or ligament; which so -evidently appears in many passages of Celsus, particularly the eighth -book, that it is quite superfluous to instance any single example. -And this is agreeable to the signification of the Greek word νευ̃ρον, -a chord or string; and thus Hippocrates says, “The nerves are dry -and void of any cavity, and grow to the bone, and have most of their -nourishment from thence; they are nourished also from the flesh, and -their colour and strength is in a middle degree between bone and -flesh.” Hippocrat. Opera, sect. 4: lib. de loc. in homin. p. 409. -ad finem. That I might not seem to determine, what may be thought -doubtful, I have generally retained the author’s term _nerve_, and -left the application to the reader’s judgment; but in some places, -particularly in the eighth book, where the meaning was very evident, -and the word νευ̃ρον_nerve_ would have been harsh to an English reader, -I have rendered it tendon, or ligament, as the connection appeared to -require. - -13. _Another loose._) The word in the original is _fluens_, that is a -disorder attended with some discharge. - -14. Our author means here the ἀχμὴ of a disease, after which it -increases no more. - -15. _A dinner also._) Mercurialis conjectures that the custom among -the Romans of making but one set meal in the day, arose from their -spending so much time in cleaning their bodies, and going through the -several processes at the baths, that they had hardly time left even for -one meal; considering that besides all these operations, they had each -his own private business to transact, and their bathing was too sacred -to be omitted. Hieron. Mercurial. de Art. Gymnast. lib. i. cap. 11. - -16. _Iatroalipta._) This is a Greek word, and signifies _a physician -that anoints_. There was always one or more of these attending a -gymnasium, to whose province belonged every thing that related to -unction. To their care was committed the strength and complexion of -the body; thus Cicero in an epistle to Lentulus, says, _Sed vellem non -solum salutis meae, quemadmodum medici, sed etiam ut aliptae, virium -et coloris rationem babere voluissent_. It is probable, that at their -first institution, they were acquainted with the nature and effects of -their operations on human bodies; and according to Plato, de Legibus, -lib. xi. they were either physicians, or in many things equal to them. -But Galen complains, that in his time they were ignorant. For a more -particular account, see Mercurial. de Art. Gymnast. lib. i. cap. 12. - -17. _Sometimes the warm bath_, &c.) No practice was ever more -universally followed, than that of bathing among the ancients. The -first design of it was certainly the preservation of health; but, as -riches and luxury increased among both Greeks and Romans, the edifices -for this purpose grew proportionably more elegant and sumptuous. The -construction of baths and their several appurtenances must have been -so well known, when in use, that it is not to be wondered we have so -imperfect accounts of them transmitted to us. Without entering into -any of the disputes about the form or use of several of their parts, -I shall subjoin what seems to be generally agreed to by all, and may -serve to explain any passages in our author which have relation to them. - -In the baths there were five apartments--One, called _Tepidarium_, -was a room close all round, and rendered tepid by dry vapours from a -fire. Persons staid here so long as to rarify their humours, that they -might not go unprepared into the hotter rooms. The _Calidarium_, or -_Laconicum_, was in all things similar to the foregoing, only the heat -was greater. Some affirm, that in both these apartments there were -vessels of water, of the same temperature with their air. Next followed -the _Solium_, where was the hot bath. People sat here, sometimes, -without going into the bath, and had water poured over them, as Celsus -in several places prescribes. The _Baptisterium_, or _Piscina_, was -the receptacle for cold water, for bathing and swimming in. There was -also an apartment called _Frigidarium_, concerning which there is a -dispute, whether it contained water or not; Mercurialis says, ‘Some -have imagined there was water here for those who were fond of swimming; -but there is no mention of water in authors.’--He adds, ‘that it was -contrived for those that came immediately from the _Tepidarium_ and -_Calidarium_, and wanted to enjoy a cool air.’ Pliny[IH] the younger -mentions a _Frigidarium_ in a bath at his villa, where there was water -for swimming in; but this may have been a new mode, and not known in -Celsus’s time. Whether this apartment contained water or not, I shall -not determine; but it would appear from authors, that either the air or -water here was of a mild temperature, not quite cold, nor yet so warm -as the _Tepidarium_. To[II] these several parts were subservient; the -_Aquarium_, in which a large reservoir was built for holding water -brought from the aqueducts and elsewhere.--The _Vasarium_, where the -necessary vessels were placed, and where the water was heated; this -stood above the _Hypocaustum_, or stove. - - [IH] Plin. epist. 6. lib. v. - - [II] Vitruv. lib. v. c. 10. - -Seneca[IJ] has shown us of how great importance the Romans esteemed the -baths in the time of the republic, when he observes, ‘What pleasure -there would be in going into the baths, which a person knew to be -tempered by the hand of Cato in his edileship, or Fabius Maximus, or -one of the Cornelii--for, says he, this function the most noble ediles -performed, of inspecting those places frequented by the people, and -requiring cleanliness and a convenient and salutary temperature; not -such as has been lately brought into use, in which the heat is so -violent, that one would imagine a slave convicted of some crime were -condemned to that punishment.’ - - [IJ] Senec. epist. lxxxvi. - -These several parts of the baths were variously used, according to -the case of the person, and the intention pursued. Where no epithet -is added to the bath in the text, it will appear from the connection, -generally, that the hot bath is to be understood. For any further -particulars relating to the baths, see Mercurial. de Art. Gymnast. lib. -i. c. 10. - -18. _Gravedoes._) I have here retained the original word, because -we have no one English term which will answer to it. See its symptoms -enumerated, lib. iv. c. 4. - -19. _In one that has laboured little._) According to the reading -of Almeloveen and Linden, which is, _In eo, qui minus laboravit, et -bene concoxit, remissior: in eo, qui assuetus est, et minus concoxit, -amplior_, Celsus gives a precept contrary to what he had directed -before, p. 22. l. 2. _Qui parum concoxit, quiescere debet._ In justice, -therefore, to our author, I restore with Morgagni[IK] the old reading, -_In eo, qui minus laboravit, et bene concoxit, amplior: in eo, qui -fatigatus est, et minus concoxit, remissior_. - - [IK] Ep. 6. p. 148. - -20. _Salt fish, salsamentum._) By this is generally understood fish -salted and dried (resembling our dried ling), for in several ancient -authors it is ordered to be macerated before boiling; and it is often -mentioned as made of fish: but it would appear from Strabo[IL], that -the same name was also given to flesh cured in like manner; for he -mentions a ταρχεία, or _salsamentum_, made of pork, amongst the -Sequani, which was brought to the Roman market. - - [IL] Strabon. lib. iv. p. 192. See Athenæus--A. Terent. in Adelph. - -21. _Sexes._) Our author here proposes the difference arising from -the sexes, as one of the subjects to be treated of, but no notice is -taken of it in the subsequent part of the chapter: so that this word -must either have been interpolated, or, as Constantine observes, Celsus -must have forgot it, (which is not probable,) or his observations upon -that article may be lost, by the carelessness of transcribers. - -22. _Frequent yawning._) As this whole paragraph relates to -people that are fatigued, it renders the old reading more probable, -_fatigatio_, instead of _oscitatio_, especially as it follows, that a -change of labour relieves from fatigue; unless we reckon yawning as -one of the symptoms of lassitude; Morgagni[IM] prefers _fatigatio_: -but as the difference is of small importance, I have not departed from -Almeloveen. - - [IM] Ep. 6. p. 133. - -23. _Warm water._) It appears a little doubtful, why our author -should mention this, as he adds _the bath_ immediately after: unless -by _balneum_ he means all the processes at the bath; and by the other, -bathing in warm water alone. - -24. _Mulse_ was made of two parts of wine, and one of honey. Dios. -lib. v. cap. 790. But from Celsus, it would appear that the -proportions were arbitrary: for he says, Mulse is more nourishing the -more honey it contains. Lib. ii. cap. 18. - -25. _Hyssop._) Hippocrates thus prescribes it for a vomit to -corpulent men; let about a gill of powdered hyssop be given to drink -in a gallon of water, adding a little vinegar and salt, to make it as -pleasant as possible; and let this be drunk at first gradually, and -afterwards more quickly. Lib. de Salub. Vict. Rat. p. 338. Edit. Gen. -1657. - -26. _Lotus._) There are several species of this mentioned by ancient -authors; but the particular kind intended here seems to be the lotus -Ægyptius, growing in the water, with a stalk resembling the _cyamus_. -It has a root like a quince, and is eaten both raw and boiled, and in -the last way, in quality, it is like the white of an egg. The Egyptians -make bread of its head, which resembles poppy.--See Dioscorid. lib. iv. -cap. 696. and Plin. Hist. Nat. lib. xiii. cap. 17 and 18. - -27. _The body is rendered humid._) Lommius asserts the copies to be -every one corrupted in this place. From the moisteners he strikes out -the following,--_continuing awake_, _long and brisk walking_, _morning -exercise without eating after it_,--as unworthy of our author. And -for the same reason, in the list of dryers, inserts _watching and -unction, without bathing in cold water_. This I thought proper to -mention in a note, but did not chuse to take so great liberties with -the text against the authority of all the other copies, but leave it -to the judgment of the learned reader, though I rather incline to the -alteration proposed. Vide Lomm. Comment. de Sanitat. tuend. p. 218 and -219. - -28. _Apples_, _Poma_.) Under this Celsus includes all the apple-kind; -and he elsewhere comprehends in this genus, cherries, mulberries, &c. -so that he seems to take in all the pulpy fruits, whether they have -stones or not. Wherever he intends what we particularly call apples, he -makes a distinction, as _Quæque propriè poma nominantur_, lib. ii. cap. -18. - -29. _Salt wine._) “Wines are prepared with sea water in different -ways; for some, immediately after gleaning the grapes, mix sea-water -with them; others expose them to the sun, and thus tread them, adding -sea-water. Others again, make the grapes into raisins, and macerate -them in vessels with sea-water, and thus tread and press them. Wine -made in this way is sweet: but there are others prepared of a more -austere taste[IN].” - - [IN] Dioscorid. lib. v. c. 801. - -Pliny tells us, That the properties of this wine were first -accidentally discovered by a servant stealing some wine, and filling up -the vessel with sea-water[IO]. - - [IO] Nat. Hist. lib. xiv. c. 8. - -30. _Defrutum_ is sweet must, boiled to one half its quantity, done -to imitate honey. Plin. lib. xiv. cap. 9. Columella says to one-third, -which Pliny calls sapa. Ibid. - - - - -NOTES - -TO - -BOOK II. - - -1. _Not but in any weather._) Morgagni observes, that in the -original, it should be read, _Non quod non omni tempore, omni -tempestatum genere_; so that the translation should run, _Not but in -any season, and in any weather_. What renders this correction more -probable is, that a few lines before, Celsus had said, _Quæ tempora -anni, quæ tempestatum genera_.--These two words, though omitted -by Juntas and Cæsar, and after them by Linden and Almeloveen, are -nevertheless extant in the MS. and the other editions he perused. Ep. -6. p. 142. - -2. _To be most apprehended in the spring._) The words in the original -are, _Vere tamen maxime_, &c.--As there is no opposition -between this observation and any going before, if the reading be right, -there must be a chasm in the text.--But I suspect _tamen_ ought to be -_quam_, and have rendered it accordingly. - -3. _Dropsical disorders._ _Aqua inter cutem._) This is a term used -by our author, to signify a slight species of the _leucophlegmatia_, -or the first appearances of a dropsy. See the beginning of the 21st -chapter of lib. iii. - -4. _Braces a sound body._ _Spissat sanum corpus._) Literally, it -thickens, or compacts a sound body.--The interpretation here given is -confirmed by opposite effects of the south wind, a few lines after, -_Corpus efficit hebes_, _humidum_, _languidum_. - -5. _If the temples be strait bound._) This happens, when there is no -perspiration from them. - -6. _And pubes be full._) Linden and Almeloveen here have _plana_--But -I chose rather with Constantine to read _plena_; both because the -appearance is then exactly opposed to what follows in the IV. chapter, -as a bad symptom in those parts, and because it corresponds better with -Hippocrat. aphor. 35. sect. 2. - -7. _At the end of a distemper._) Celsus takes this from Coac. Prænot. -601. which if he had translated literally, he would have said, instead -of _Sub fine morbi, ad crisim_; which shows his great care to avoid the -Greek terms of art, and render the knowledge of medicine as easy as -possible to his countrymen. - -8. _Betwixt the fourth hour._) The Romans divided the day from -sun-rise to sun-set into twelve equal parts, or hours; the measure of -which therefore differed in proportion to the length of the day. The -sixth hour was our twelve; it is easy to reckon all the rest by their -distance from that middle point. When they mention hours as a general -measure of time, they mean equinoctial hours, as Plin. lib. xviii. cap. -25. - -9. _Strigments_, _Strigmenta_.) I find the moderns differ about -the signification of this word; some taking it for the sordes -absterged from the skin at the baths or palestræ, other for abraded -fibres from the guts. It is agreed on all hands, that Celsus by this -word translates ξύσματα in Hippocrates, and so it is rendered by -Foesius.--Though ξύσμα will bear either of these interpretations, yet -it seems to favour the first, that not only Erotianus explains it -so in his lexicon to Hippocrates; but Celsus himself, in the sixth -book, c. 6. orders a composition to be brought to the consistence of -_strigmentum_. - -10. _Many ways._) Instead of _pluribus modis_, most editions have -_pluribus morbis_. However, either of them will agree with what goes -before and follows. - -11. _And if there is not a discharge of blood from the nose, &c._) -In Almeloveen and Linden the reading is thus, _Ac si inter ipsa initia -sanguis è naribus non fluit, circa aures erumpit_.--Morgagni[IP] here -observes, that this does not agree with the prænotion, no. 6. whence -this whole context is taken; and also that these words, _Sanguis è -naribus_, are not in the margin, nor in any of his editions; and that -Constantine and Ronsseus have in the margin _Initia aut viscera_, while -all of them write in the text _Ipsa ulcera_, some _Non fluit_, others -_Non fuit_; which the most ancient editions and the MS. have, and -besides _viscera_.--So that, upon the whole, he would incline to read -_Ac si inter ipsa viscera non fit, circa aures erumpit_, viz. And if it -is not formed amongst the viscera, it breaks out about the ears. - - [IP] Ep. 7. p. 172. - -12. _If it grow less._) I have chosen to follow the older reading, -which omits the negative particle, because it seems plain, that our -author is here speaking not of the body, but the belly, in this and -the two preceding articles; the sense determines itself.--If the -belly yields to purging medicines or spontaneously discharges soft -and figured excrements, and the effect of one or both appears in the -diminution of its bulk. - -13. _Is hysteric._) The original is, _Quæ locis laborat_; which -by itself is pretty obscure, but the sense here given appears just, -from comparing it with aphorism 35. sect. 5: Γυναικὶ ὑπὸ ὑστερικω̃ν -ἐνοχλουμένη, ἢ δυστοκούση, πταρμὸς ἐπιγινόμενος ἀγαθόν.--_Mulieri uteri -strangulatu vexatæ, aut difficultate partus laboranti, sternutatio -succedens bono est._ - -14. _Of that kind that breaks outward._) The text in this place -in Almeloveen and Linden appears to be corrupt, who read, _At ex -suppurationibus hæ pessimæ sunt, quæ intus tendunt, sic ut exteriorem -quoque cutem decolorent: ex his deinde, quæ in exteriorem partem -prorumpit; tum quæ maximæ, quæque planissimæ sunt_. I own I could make -no sense of it, that I thought tolerable. The plural number is used -both in the first and last members of the period; and the nature of -the distributor seems to require the same number to be used here. For -this reason I have made but two members, and read the latter thus: _Ex -his deinde quæ in exteriorem partem prorumpunt, quæ maximæ, quæque -planissimæ sunt._ By which small alteration we have an observation -worthy of our author, and consonant to the parallel place in Hippocrat. -Coac. Prænot. no. 281. where Foesius quotes this passage as here -proposed. - -15. _In the middle of the body._) An ascites. - -16. _Puffed up as it were by fermentation, &c._) Foesius observes -in a note upon lib. ii. prædictor. 31. from whence this context is -closely copied, that ἀπόζυμος γαστὴρ, _fermentatus venter_, is an -unusual kind of expression, which makes him suspect the reading should -be ὑποξήρους, which he thinks is supported by Galen in his Exegesis, -who says that ὑποξήρους περὶ γαστέρων signifies ταπεινοτέρας _aut_ -προεσταλμένας, that is _dried up_, _extenuated_, _contracted_. Foesius -thinks too, that Celsus by mistake has read λιπαράς for ῥυπαρὰς, _fat_ -for _sordid_. But as this is only conjecture, it is much more natural -to suppose, that λιπαρὰς was the true reading, and that ῥυπαρὰς had -crept in since the time of Celsus. - -17. _Therefore an intermission_, &c.) In Almeloveen the reading is -thus, _Expectanda ergo intermissio est: si non decedit, cum crescere -desiit: si neque remissio speratur, tunc quoque_, &c.--[IQ] Morgagni -observed this reading to be suspicious, as it was not probable our -author would have mentioned its stop before its remission; and upon -examining his editions, he found this reading in them all, _Expectanda -ergo remissio est_. _Si non decrescit; sed crescere desiit, tunc -quoque_, &c. i. e. therefore a remission is to be waited for. If it -does not remit, but has ceased to increase, in that case the only, &c. - - [IQ] Ep. 5. p. 139. - -18. _Already hurt._) I have here rejected the word _quam_ upon the -authority of the marginal reading; because it appears to me to spoil -the sense, which without it is very proper. - -19. _Penecillum._) [IR] Fabricius ab Aquapendente makes _penecillum_ -a tent made of scraped lint. I think he is right as to its form -and materials; but it often occurs in Celsus, where it is used as -a pledgit, and not introduced into any cavity, as in this place. -Notwithstanding, in other places, it exactly corresponds to a tent, -as lib. vii. cap. 4. when used to a fistula.--For this reason I have -chosen to retain the original word. - - [IR] Lib. II. de Vulnerib. cap. 8. - -20. _Scales of copper._) These are scales that fly off in hammering -red-hot copper. They were washed and rubbed in a mortar, to free them -from any adhering sordes, and when cleaned and dried, put by for use. -Dioscorid. lib. v. cap. 863. - -Celsus added here, called by the Greeks λεπὶς χαλκου̃, which he had -literally translated by _squama æris_. - -21. _Sea spurge_, _Lactuca marina_.) Our author elsewhere says, that -this herb by the Greeks is called tithymalus--of which Dioscorides -enumerates seven species, all similar in their virtues, amongst which -is the παράλιος or maritime kind here mentioned. Dioscorid. lib. iv. -cap. 747. - -22. _Hydromel_ was made of two parts of water to one of honey. -Dioscorid. lib. v. cap. 791. - -23. _Ptisan_ was made by steeping barley in water, till it swelled; -then drying it in the sun; afterwards beating it, till the husk came -off; then grinding it; the meal was boiled in water, dried in the sun, -and then set by. When used, it was boiled up again with water; and this -was what they called the _cremor_ or _succus ptisanæ_. - -24. _A decoction of vervains._) What herbs our author means by -_vervains_, he shows in chapter 33d of this book. - -25. _Concerning friction_, &c.) In the text, _De frictione et -gestatione adeo multa Asclepiades_, &c. which, though it be the reading -in most copies, must necessarily appear erroneous by considering what -follows; and therefore I have taken no notice of these words _et -gestatione_. - -26. _Digestion._) See note at lib. i. p. 6. - -27. _A prop is to be put under one foot_, &c.) In Linden and -Almeloveen the reading is, _At certe uni pedi lecti fulcimentum -subjiciendum est_.--But all the editions in the possession of -Morgagni[IS] and the MS. have _Funiculus subjiciendus est_. A cord is -to be put under one foot, &c. And in this way Mercurialis reads it, -when he quotes this passage de Art. Gymnast. lib. iii. cap. 12. - - [IS] Ep. 5. p. 132. - -28. _Clibanum_ was the name of a particular kind of oven among the -Romans. As it is here mentioned, beside the laconicum or hot-room at -the bath, he probably intends by it a stove placed in a common room so -as to heat it. - -29. _Fever._) Our author here means, either an acute continued fever, -or the paroxysm of an intermitting one; as will appear by the following -paragraph. - -30. _Bottles filled with hot oil_, _Utriculi_.) Their bottles were -made of leather. The nearest to this kind of practice among the moderns -are the tin cases made in different shapes, and adapted to the abdomen, -breast, or joints, filled with hot water. - -31. Lentils. - -32. _The Cetus._) Cetus is generally translated _whale_ in English; -but it cannot be understood of what we call a whale, but is a general -name for all the larger fishes that are viviparous. - -33. _Particular kind of bread_, _Opus pistorium_.) The English reader -will perceive, by the ingredients mentioned, that there is no such -bread in modern use, and consequently no proper name for it. Pliny -mentions the same composition. lib. xviii. cap. 11. - -34. _Phœnicopter._) This signifies a bird with purple wings; its -tongue was of a delicious taste. Plin. lib. x. cap. 48. - -35. _Snails._) Cochlea, without distinction, is used to signify a -snail and periwinkle, which last is only the marine snail. The Romans -were at prodigious expence and trouble, to feed their snails to an -almost incredible size. - -36. _Conchylia_, according to Pliny, in different places, a delicate -shell-fish, the greatest plenty of which came from the river Indus, of -the same nature and properties with the purple fish. - -37. _Siligo_ was a kind of wheat, very delicious to the taste, -extremely white, growing best in moist ground. Plin. lib. xviii. cap. -8.--The same author says it never grows so ripe as the other kinds; for -when it is suffered to stand too long, it drops its grains, Id. ibid. -cap. 10. Columella says that all wheat in a watery soil, after the -third sowing, turns into siligo. Lib. ii. cap. 9. - -38. _Than the mealy_, _Fragilia_.) Which translation appears to be -just, from its opposition to _succosa_. - -39. _Thrush_, _Turdus_.) The Romans included several birds under this -name. - -40. _Salsamenta_, which are salted and dried. Vide note at chap. 2. -book i. - -41. _Lacertus et aurata._) I have chosen rather to retain the Latin -appellations of these fish, and several more, than to follow the -conjectures of the moderns, where they are not agreed. _Aurata_ is -taken for the _gilt-head_, _corvus_, _a cabot_, _oculata_, _eye-fish_, -resembling a lizard, _plani_, _flat_ _fish_, or _the turbot kind, -lupus_ some will have _the pike_, others _sturgeon_. _Mullus_, -_barbett_, or _mullet_.--See Pliny who describes them. - -42. _Four footed animal._) I have here rejected the particle _vel_, -according to the older reading; because our author would never say, _A -quadruped or any animal that is sucking_, &c. since no other sucking -animals are used for food but quadrupeds. - -43. _Soft or sorbile._) The first by Dioscorides is called ἀπαλὸν, -and the second ῥοφητὸν. Humelbergius in his notes upon Apicius de re -Coquinar. takes the first to be eggs boiled soft without their shell, -by us called poached eggs. - -44. _Alica_ is reckoned among the vernal seeds. It is a species of -wheat which degenerates after being sown in soils not proper for it, -as in Africa, where it has the name of zea. It is ground to meal, and -the husks taken from it, and then chalk is added to it, which renders -it exceedingly white and soft. The best chalk for this purpose is found -between Puteoli and Naples. A common way of counterfeiting it is to -take the largest and whitest grains of wheat, and after parboiling -these, and drying them in the sun, to sprinkle them, and after drying -a second time, to grind them. Plin. lib. xviii. cap. 7. and 11. The -same author says, this is an invention of the Romans, and not very old, -unknown to the Greeks, otherwise they would not have bestowed so many -encomiums upon their ptisan; because it was not mentioned by any of the -followers of Asclepiades, he believed it was not used in the time of -Pompey the Great. Id. lib. xxii. cap. 25. - -45. _Pulse._) Pulticula is a diminutive of puls, which was a very -ancient kind of food, made of meal, water, honey, or with cheese and -eggs boiled, which, according to Pliny, the Romans used for many years, -before they knew bread. - -46. _Passum._) Columella’s method of making passum (from Mago) is -this--Gather the early grapes thoroughly ripe, and throw away what -stones are either dry or rotten. Expose them to the sun in the daytime, -and cover them at night from the dew. When they are dried, take out the -stones--then put them into a cask, and add as much of the best must -as to cover them; when the grapes are macerated and filled, on the -sixth day take them out and press them, and thus draw off the passum. -Columell. lib. xii. cap. 39. This resembles nothing in modern use so -much as raisin wine. Other inferior kinds were also prepared, for which -see Columella in the same chapter, and Pliny, lib. xiv. cap. 9. - -47. _Starch_, _amylum_, so called from its being prepared without a -mill. Though the process among the ancients differed a little from the -present, yet the effect of the operation is the same.--See Dioscorid. -lib. ii. cap. 311. - -48. _Tragum_ was made from wheat in the same manner as ptisan from -barley. Plin. lib. xviii. cap. 7. - -49. _Wombs of hogs._) This amongst the ancients was accounted a -delicate dish; it is now entirely disused. The butchers give that part -the name of the bearing bag. - -50. _Garum_ was a liquor made of the intestines of fish macerated -with salt. So that it was a kind of sanies of them in their putrescent -state. It was formerly made of the fish, which the Greeks called garos; -afterwards it was prepared from a great many more, so that the kinds of -it are almost infinite. It bore a higher price than any thing, except -unguents. One kind was of the colour of old mulse, and so sweet and -thin, that it might be drunk. Plin. lib. xxxi, cap. 7 and 8. - -51. _Bulbusses._) The ancients had several kinds of bulbusses. -[IT]Dioscorides mentions the _bulbus esculentus_, which he says is -known to every body; it is good for the stomach and belly, of a reddish -colour, and brought from Africa. But the bitter and squillaceous kind -is fitter for the stomach, and helps concoction. All of them are acrid -and heating. Pliny, lib. xix. cap. 5. reckons up many species. Most -naturalists agree that they are not known now. - - [IT] Lib. ii. cap. 389. - -52. _Pancake_, _Laganum_.) This differed a little from our pancake, -as they added to it cheese, pepper, saffron, cinnamon, &c. - -53. _Those called crustumina_, &c.) Pliny observes that such fruits -as these have taken their names, either from their planters, countries, -or the persons whose taste they pleased. All these pears and apples are -reckoned among the best kinds by him, lib. xv. cap. 14. and 15. as also -by Columella, lib. v. cap. 10. - -54. _Wormwood._) In Linden and Almeloveen the word _absinthium_ is -followed by _murices_, _purpuræ_, _cochleæ_, which are omitted in all -[IU]Morgagni’s editions, except Ruellius and the MS. And as they appear -redundant here, the same words occurring a few lines after, I have -taken no notice of them. - - [IU] Ep. 6. p. 145. - -55. _Resinated._) This is made in different countries. It was very -common in Gaul, where the grapes not thoroughly ripening by reason of -the cold, the wines turned sharp, unless mixed with resin. The resin, -together with the bark of the tree, was either cut small, or powdered, -and mixed with the wine. Some separated the resin from it by straining, -others let it stand. Such wines become sweet by age. Vide Plin. Nat. -Hist. lib. xiv. cap. 20. Columella, lib. xii. cap. 23. et Dioscorid. -lib. v. cap. 817. - -56. _Pecten_ was a name for shell fish striated like cockles. - -57. _Murex and purpura._) These fishes afforded the purple dye, and -their difference was not considerable according to ancient authors, but -they are not known now. - -58. _Sweet bread mentioned before_, viz. chap. 18. - -59. _Scarus_, taken for the _scar_ or _char_, _lolligo calamary_, or -_sleeve-fish_, _locustus lobster_, _polypus pourcountrel_. - -60. _Pelorides._) This was a sort of shell fish, so called from -Pelorus, a promontory in Sicily, supposed by some to be cockles. - -61. _Soft water_, &c.) The reading in Linden is _Aqua, omnia tenera, -tepida_, &c. but it is not probable our author would have expressed -himself so loosely as to say _aqua_, without any epithet. By making a -small change in the order of the words, we find this properly opposed -to _aqua dura_, said in chap. XXX. to bind the belly; I have therefore -read with Constantine, Cæsar, Stephens, and several others, _Aqua -tenera, omnia tepida, dulcia_. - -62. _Torminalia._) These, says Pliny, are the fourth species of the -service fruit, and probably called so from being used as a remedy; that -is, for the dysentery, as appears by the name. Lib. xv. c. 21. - -63. _Sordid wool_, _Lana succida_, by Dioscorides called εἰρίον -οἰσυπηρὸν. The more oily sordes it contained, it was reckoned so -much the better and more emollient, upon account of its œsypum, the -preparation of which will be mentioned in its proper place. The wool -about the neck and inside of the thighs was most esteemed. Dioscorid. -lib. ii. cap. 720. - -64. _Cimolian chalk._) This had its name from Cimolus an island -in the Cretan sea. There are two kinds of it, one white, and the -other inclining to purple. The first by Dale, is thought to resemble -tobacco-pipe-clay; and the second fullers earth. Vide Plin. lib. xxxv. -cap. 17. et Dioscorid. lib. v. cap. 950. - -65. _Tarras_, _gypsum_, is a-kin to lime; for it is procured by -burning a stone, which ought to resemble the alabaster, or marble. The -best kind is made from lapis specularis. Plin. lib. xxxvi. cap. 24. -Amongst the moderns some take this to be the calx of alabaster, others -of Muscovy glass, others of the selenites. - -66. _Oil of quinces._) _Oleum vel unguentum melinum_, according to -Dioscorides, was prepared by infusing and boiling some aromatics in -oil, and afterwards macerating quinces in it, and thus letting them -stand till the oil had imbibed the strength of the quinces. Others made -it with quinces alone. Dioscorid. lib. i. cap. 56. - -67. _Or myrtles._) This is prepared by bruising and pressing the -tender leaves of the black myrtle, and mixing their juice with an equal -quantity of the oil of unripe olives, then boiling them together, and -taking off whatever swims upon the top. Some thicken the oil first with -pomegranate bark, cypress, &c. Dioscorid. lib. i. cap. 49. - -68. _Of roses._) This is made by boiling the juncus odoratus with -water and oil, and after straining, fresh roses are infused in the -oil: they are stirred frequently with the hands rubbed with honey, and -squeezed. When they have stood for a night, they are pressed out. A -second and third kind of rose oil is prepared, by infusing the same -roses in fresh quantities of oil. Dioscorid. lib. i. cap. 54. - -69. _Bitter oil._) This has probably been prepared from the wild -olive; for Pliny says, such is thin, and much more bitter than what is -made from the olive. Lib. xv. cap. 7. - -70. _Made of far._) Far is a species of wheat.--Columella reckons -four kinds of it. Pliny says it is the hardest of all, and firmest -against winter. It was called also _semen adoreum_. It was the first -grain the Romans used. Pliny, lib. xvii. cap. 8, et Columella, lib. ii. -cap. 6. - -71. _Cyprine oil_ was made from the tree called _cyprus_ in Egypt, -according to Pliny--And in his time some conjectured it to be the same -with the _ligustrum_ of Italy. Plin. Nat. Hist. lib. xii. c. 24. - -72. _Oil of iris._) The oil is first inspissated by boiling it with -water, and the involucrum of the fruit of the palm tree (called by -Dioscorides, spatha). When this is done, an equal quantity of bruised -iris is infused with this inspissated and aromatized oil, which stands -for two days and two nights, and then is strongly expressed. A more -fragrant kind is prepared by inspissating the oil with balsam-wood and -calamus. After expression, a fresh quantity of iris may be added, if it -be desired stronger. Dioscorid. lib. i. cap. 67. - -73. _Nitre._) So much has been said by modern authors concerning -the nitre of the ancients, that it would be impertinent to give a -particular account of it here. The greatest plenty was produced in -Egypt, in the lands which the Nile had overflowed. Most naturalists -believe it to have been a native alkaline salt. Pliny says, it was -adulterated in Egypt by lime, but that trick was easily discovered by -putting it in water, when the true nitre would dissolve, and the lime -not. Plin. lib. xxxi. cap. 10. where a long account of it may be seen. - - - - -NOTES - -TO - -BOOK III. - - -1. _Those things_, &c.) See book ii. chap. 2. - -2. _Digested._) See note lib. i. p. 6. - -3. _From the inguen._) Almeloveen would rather read _ingluvie_, or -_sanguine_, than _inguine_. But these cannot be reckoned among the -external causes. There is no reason to question the authority of the -text, if we remember what Hippocrates has said, aph. 55. sect. 4. ‘All -fevers proceeding from buboes are bad, except a diary.’ - -4. _For these reasons others defer it._) The translation is agreeable -to the reading of Linden and Almeloveen. But Morgagni[IV] informs -us, that all the editions in his possession, and the MS. too, read -thus: _Ob hæc ad mediam noctem decurro, id est, finito jam gravissimo -tempore, eodemque longissime distante, secuturis vero antelucanis -horis, quibus onmes fere maxime dormiunt, deinde matutino tempore, quod -sua natura levissima est._ That is, ‘for these reasons I defer it till -midnight, that is, when the most severe time is over, and the return -of it is at the greatest distance, this being succeeded by the hours -before day-light, when every body generally sleeps most quietly, and -these followed by the morning, which is naturally the easiest period -of all.’--He adds, beside the impropriety of the prescription, as it -now stands in Almeloveen, when Celsus meant quite otherwise; the place -is the more worthy of notice, that it shews Celsus, although not for -common, yet to have practised medicine. - - [IV] Ep. 6. p. 157. - -5. _Apply his hand to his wrist, ejus_ carpo _manum admovere_.) The -word _carpus_ appears suspicious, as it no where else occurs in Celsus. -On the contrary, in describing this part he says, _In manu vero, prima -palmæ[IW] pars_, &c. and Morgagni[IX] observes the old reading was -_corpori_, and _carpo_ only Constantine’s explication. - - [IW] Lib. viii. cap. i. - - [IX] Ep. 5. p. 115. - -6. _Intrita._) We have no particular description of this food in -any of the ancients, as far as I remember. By comparing their several -applications of this word, I take it to be a general term for several -species of compositions, the ingredients of which were rubbed small in -a mortar, or softer materials macerated in liquids, as bread in wine, -mentioned by Pliny, _Intrita panis e vino_, lib. ix. cap. 8.--By our -author’s use of it here, it plainly appears to be something light, -soft, and simple, probably very like, if not the same with our panada. - -7. _But if one in such a fever coughs gently_, &c.) _Siquis autem in -hujus modi febre leniter tussit, is neque vehmenti siti conflictari, -neque bibere aquam frigidam debet; sed eo modo curandus -est, quo in cæteris febribus præcipitur._--All this is omitted -in Morgagni’s MS.--Ronsseus suspected it to be interpolated, and -it is not to be found in the Pinzian edition, nor the Juntine, nor -Florentine.--Ronsseus’s suspicion arose from considering aph. 54. sect. -4.--‘Those that are troubled with dry and gentle coughs in ardent -fevers, are not very thirsty.’ Morgagni, Ep. 5. p. 140.--But perhaps -this objection might be removed by only reading _conflictatur_, instead -of _conflictari_. - -8. _To twenty-four hours._) Linden and after him Almeloveen have -followed Constantine in rejecting the preposition _inter_. But the old -reading seems preferable, which was this,--_Inter horas viginti quatuor -et triginta sex_: that is, _The fit takes up between twenty-four hours -and thirty-six_. - -9. _Cleanse his belly_, _vomendo ventrem purgaret_.) It is probable -by _venter_ here our author means the stomach. - -10. _And apply that_, _et id ingerere._) I cannot help agreeing -with Scaliger, that these words are interpolated. For supposing them -to mean the application of the medicine here mentioned, yet that is -particularly directed a few lines after. Besides I do not remember any -instance of _ingero_ bearing a sense that would answer in this place. - -11. _Greeks call zesis._ _Et jactationem, fervoremque corporis, quem -ζέσιν Græci vocant._)--All Morgagni’s[IY] editions and his MS. agree -in reading thus, _Fætoremque quendam odoris, quem ὄζην Græci vocant_. -Which word from this single passage of Celsus has a place in Stephens’s -Thesaur. Ling. Græc. But as the sense, according to this last reading, -is not near so proper, and as Linden, no doubt, had some authority for -his reading, I have abode by it. - - [IY] Ep. 5. p. 139. - -12. _Former regimen strictly._) After the words, to which these -answer in the original, there follows in Linden and Almeloveen, _Et -aqua tantummodo calida, si sitis est, uti: ac tum ita nono die balneo -frigus prævenire, et_. Which must appear manifestly corrupt; for this -would be making the paroxysm of a quartan fever return after one day’s -interval: so that though the other words were retained, yet _nono_ -should be undoubtedly changed into _decimo_. But I have chosen rather -to follow the reading of Pinzi and Junta, which is perfectly consonant -with the context. _Septimo die balneo frigus prævenire, abstinere, -continere se debet; si febris redierit, ducere alvum; ubi ex eo corpus -conquieverit, inunctione vehementer perfricari, eodem modo sumere cibum -et vinum, biduo proximo se abstinere, frictione servata. Decimo die -rursus balneum experiri, &c._ This makes the directions which follow -_nono die_, to belong to the _seventh_; and _decimo die_ for _decimo -tertio die_ still preserves the regular succession of the fits. This -reading is confirmed by what our author adds in the next paragraph, -where he prescribes a new method to be pursued, if the fever should -return upon the thirteenth day. ‘Wherefore, if the distemper shall -continue upon the thirteenth day, the bath must neither be tried before -the fever nor after it, &c.’ For if we allow the reading of Linden, &c. -_decimo tertio die_, in the first paragraph, he orders bathing on this -day; and in the next he absolutely forbids it. - -13. _Laser._) This was the juice or gum of a plant like the _ferula_, -by the Latins called _laserpitium_, by the Greeks _silphium_. That -kind, which was most esteemed, came from Cyrene, where it seems it was -worn out in Pliny’s time, for he tells us only one stalk was found in -his memory, which was sent to Nero; he adds, that for a long time they -had no other imported to them, but what came from Persia, Media, and -Armenia, where it grew in abundance, but much inferior to the Cyrenean, -and adulterated with gum, sagapenum, or bean-meal.--See Plin. Nat. -Hist. lib. xix. cap. 3.--Some of the moderns take this for assa-fœtida; -others, among whom is Dr Lister, think it a different thing, and -absolutely unknown now. I have therefore chosen to retain the original -word.--See the description of it Dioscorid. lib. iii. cap. 500. - -14. _Happened in the beginning._) _Cum id initio inciderit_; thus -Linden and Almeloveen read it; some older editions have _vitio_, _when -that has happened by some mismanagement_; which agrees with what -our author says in the end of the 15th chapter. Perhaps it might be -_Initio, cum id inciderit_, that is, upon its first appearance, &c. - -15. _That cannot be assigned._ _Certis partibus assignari possunt._) -Constantine, and after him Linden and Almeloveen, have thought fit to -omit _non_, which will appear to any, who considers the sense to be -manifestly wrong. Our author himself determines it in the beginning of -the fourth book, where with reference to this part of his work he says, -_Hactenus reperiuntur ea genera morborum, quæ in totis corporibus ita -sunt, ut iis certæ sedes assignari non possint_. See Morgagni, Ep. 1. -p. 25. - -16. _There may be the same reason_, &c. _Nec minus dubitari potest, -an alvus ducenda sit._) The connection of this sentence with the -context has an obscurity very uncommon in our author. We must observe -that he is here maintaining the necessity of taking blood in phrenitic -cases against Asclepiades: and after general reasons drawn from the -nature of the disease, he adds an argument from the practice of that -physician. He prescribed clysters in this distemper, though, as Cælius -Aurelianus[IZ] observes, that was directly contrary to a principle of -his own. Celsus therefore insists, that there is no reason against -bleeding, that is not equally strong against clysters, which are -however approved by Asclepiades. According to the exact method every -where observed by our author, this argument would naturally have -followed what he said of friction ordered by Asclepiades: and as it now -stands after the conclusion drawn, it seems to be an after-thought. If -this explication be thought unnatural, it may be otherwise paraphrased, -and connected with the following paragraph thus: _The doubt is the same -with regard to clysters, as to the letting of blood, and the resolution -is also the same. But after either of these, intermitting a day_, &c. - - [IZ] De Acut. Morb. lib. i, cap. 15. - -17. _Ointment of saffron._) In preparing this they first inspissated -the oil by boiling it with calamus and myrrh, and then infusing saffron -in it for five days, and stirring it frequently; and on the sixth the -oil was poured off clear. Others added the myrrh in powder, after the -oil was poured off the other ingredients. - -18. _Ajax or Orestes._) These cases are best illustrated by the -tragedies of Sophocles and Euripides, which our author seems to have -had in view. Ajax enraged to see Ulysses preferred to him in the -competition for the arms of Achilles, falls into madness. He resolved -to revenge this affront upon the whole army. And in the night ran into -the fields, where their flocks and herds were grazing, murdered the -shepherds and laid about him among the cattle, taking them for men; -slew numbers of them, which he imagined to be Agamemnon, Menelaus, -and others, that were accessary to his dishonour. Then bound and led -prisoners to his tent many more oxen and sheep to be reserved for -tortures, and flogged unmercifully a great ram for his adversary -Ulysses, before he put him to death. Orestes was affected in the same -manner. After the murder of his mother, he fancied himself haunted by -the furies, and her amongst them. He is represented as terrified by -their frightful looks, sometimes reasoning, sometimes beseeching, and -at other times drawing his sword to fight them. In one of these fits, -like Ajax, he falls upon the cattle. See Sophocl. Ajax flagell. et -Euripid. Orest. et Iphigen. in Taur. Such are the figures presented to -the imagination in this species of madness. - -19. _Purged in the inferior parts._) The whole sentence, which runs -thus, _Ubi ab inferiore parte purgandus aliquis est, ventrem ejus ante -solvendum esse: ubi à superiore, comprimendum esse_, is taken from -aph. 66. sect. 7. And after comparing them together, I conceive our -author’s meaning to be, that when the intention is to purge, the belly -should first be moistened by diluent liquors taken inwardly, or perhaps -a laxative clyster administered to facilitate the operation. On the -contrary, when a vomit is intended, the belly should be bound. - -20. _Polenta_ is made from barley in several ways. The Greeks pour -warm water upon the grain, dry it for one night, and the day following, -toast it, and then grind it. Others toast it more, and sprinkle it -again with a little water, and dry it before they grind it. Others -again shaking out the recent barley from the green ears, bruise it, -while moist, in a mortar, and wash it in baskets, dry it in the sun, -beat it again, and after it is cleansed, grind it. In whatever way it -is prepared, they first of all toast three pounds of lintseed, and half -a pound of coriander, with an acetabulum of salt, and mix it in the -mill, with twenty pounds of barley. Those that have a mind to preserve -it for a longer time, put it into earthen vessels with its own flour -and bran. In Italy it is ground fine after toasting, without pouring -any water upon it, and mixed up with the ingredients abovenamed and -millet. Plin. b. xviii. cap. 7. - -21. _Vomit spontaneously._ _Sponte vomere._) That is, vomit without -any emetic medicine being given. - -22. _Bulbous roots._) Aretæus mentions nothing of rubbing these -over the whole body; but he recommends the small red kind, crude with -pepper, and the powdered lees of vinegar, as the best cataplasm for the -feet in this disorder. To which he adds this caution, that they must -be frequently removed, for fear of ulcerating the parts. Lib. ii. de -Curat. Acut. Morb. cap. 3. - -23. _Inject by way of clyster._) Celsus here shews that he knew -it was possible to nourish by clysters, and that it was sometimes -practised--Cælius Aurelianus mentions the use of clysters in this -disorder, particularly acrid ones, as prescribed by the followers of -Serapion, Heraclides, and Herophilus, and also by Asclepiades and -Themison. But he does not give the least hint, as if any of these -authors directed an injection with a view to nourishment, but only -to make a derivation of the humour from the skin to the belly. Cæl. -Aurelian. de Acut. Morb. lib. ii. cap. 38. - -24. _Malagmas._) These cannot according to the present division of -compositions admit of a literal translation, and therefore the original -word is retained. By turning to the fifth book, chap. 17. and 18. will -be seen their difference from plaisters, &c. and that they consist of -various ingredients, but compounded without any heat. - -25. _Catapotia._) Most of the moderns translate this word _pills_. -But our author does not limit their consistence nor form; for we find -him sometimes ordering them to be diluted, sometimes of the consistence -of sordes, and sometimes swallowed about the bigness of a bean, and -at other times dry powders given in some kind of liquor. See lib. v. -cap. 25.--Scribonius Largus defines a catapotium as a medicine, that is -swallowed without being diluted, cap. 22. comp. 87. Upon which Rhodius -will have them to be much the same with the bolusses now in use. - -26. _Attempt that by diet._) The reading in Almeloveen and Linden -is _Alvum moliri cibo melius est_, &c. But as there was no mention of -the belly before, and no proper sense can be assigned to _molior_, as -it there stands, I have followed the old reading, _Sed id ipsum moliri -cibo melius est_, and the rather, as Celsus immediately subjoins proper -medicines for that purpose. This reading is approved by Morgagni, Ep. -6. p. 149. - -27. _Nard._) It is generally agreed, that what we now have under the -name of nard, is not the ancient kind. Dioscorides says, it resembles -the cyperus in its smell, has a small head, is bitter to the taste, -and drying to the tongue, retaining its fragrancy for a long time. -There were two species of it, one called Indian, and the other Syrian. -Dioscorid. lib. i. cap. 6. - -28. _Balsam._) Our author does not distinguish what part of the -balsam-tree he intends. The ancients called the juice opobalsam, the -wood xylobalsam, and the fruit carpobalsam; which distinction Celsus -himself elsewhere uses. Dioscorid. lib. i. cap. 18. - -29. _Panaces_, or _panax_.) Dioscorides mentions three kinds of -this, which are still retained by modern botanists. Considering the -virtues he ascribes to each, I think it probable our author intends the -_panax Heracleum_, or Hercules’s all heal, from whence the opopanax is -produced. Though it is to be observed, that Pliny affirms the opopanax -to be obtained from the panax Asdepium. Lib. xxv. cap. 4. P. Ægineta -from the Heracleum lib. vii. - -30. _Cardamom._) It neither appears from Celsus nor Dioscorides, -that the seed was in use among the ancients. Some affirm it to be the -same with the modern greater cardamom. Dioscorides[JA] says, the best -comes from Comagene, Armenia and Bosphorus. It grows also in Arabia -and India. The best is firm, large, compact, and pungent to the smell, -acrid and bitterish to the taste; it has a heating quality. By this it -would seem they made use of the root. - - [JA] Dioscorid. lib. i. cap. 5. - -31. _Acorum_ according to Dioscorides has leaves likes the iris, but -narrower, and roots not unlike to it, not growing straight, but oblique -and creeping on the surface of the earth, whitish, divided by joints, -acrid to the taste, and smelling not unpleasant. Lib. i. cap. 2. - -32. _The flower of long and round cyperus._) In the original _Juncus -quadratus et juncus rotundus_. I shall not determine, whether what we -now call _cyperus longus, et rotundus_, are the same as here mentioned. -However, they certainly belong to the same class, and the virtues -ascribed to the present, agree pretty nearly with those attributed to -the ancient by Dioscorid. lib. i. cap. 4. and 16.--See also Dale and -Schroder. - -33. _Bound upon the skin._) This seems a very odd way of using -squils; the old reading appears much more just. _Utiliter etiam scilla -cocta delinitur cutis._ _It does good also to rub boiled squils -over the skin._ The same variety recurs at the end of the following -paragraph, _Sicut supra dixi delinitur_, instead of _Simul super -ventrem deligatur_. - -34. _Frequent pimples._) That is the smoothness or continuity of the -skin is interrupted by pimples and ulcers. - -35. _Takes its rise from the head._) From a catarrh, which the -ancients imagined to be a discharge from the brain through the os -ethmoides. - -36. _Mild as gruel._) I have here departed from Linden and -Almeloveen, who have it thus, _Deinde lenis sorbitio_, &c. _Afterwards -mild gruel_, because the more ancient reading, _Dein lenis, ut -sorbitio_, besides being more elegant, is confirmed by the following -words of our author. - -37. _And especially brains._) I have taken no notice of the words _ex -prima_ in the reading of Linden and Almeloveen, which manifestly spoil -the sense, otherwise complete without them. [JB]Morgagni observes, -that all the other editions read, either _ex pruna_, or _ex aprugna_; -but this last is not probable, because he said, that a boar was of the -strongest class of food, lib. ii. but the whole head of a lamb or kid -in the middle kind; and the former seems to be superfluous. - - [JB] Ep. 7. p. 180. - -38. _Comitial_, so called from the comitia or assemblies of the -people being adjourned, when any person was taken with one of these -fits. - -39. _Arquatus._) The obscurity of this name gives room to the -conjectures of critics. Some tell us it was so called, because the -colour in the jaundice resembles the greenness of the rainbow; others -because it bends the bodies of those afflicted with it like a bow. - -40. _Suppurations._) Ronsseus think this paragraph wrong placed here, -as having no connection with what goes before; and suspects its proper -place to be at the end of the twenty second chapter of this same book; -because the author there treats of consumptive people, and suppurations -of the lungs. Morgagni also believes it to be improperly placed, Ep. 1. -p. 32. - - - - -NOTES - -TO - -BOOK IV. - - -1. Sometimes _like a small tongue_, viz. the epiglottis. - -2. _Below the last ribs_, &c.) I have here translated, according to -an emendation proposed by Morgagni[JC], who would read, _Qui lumbis sub -imis costis inhærent, a parte earum rotundi, ab altera resimi_. Where -a small alteration renders the description just: whereas in the way -it stands in all the editions, _Qui lumbis sub imis coxis inhærent, a -parte earum resimi, ab altera rotundi_, it plainly contradicts truth, -as will be very obvious to any person the least conversant in anatomy. - - [JC] Ep. 1. p. 32. - -3. _They are stocked with vessels, and covered with coats._) -In Almeloveen, _Et venosi sunt, et tunicis super conteguntur_. -Morgagni[JD] informs us, that after the three first words, all his -editions agree in inserting _Et ventriculos habent_, _and they have -ventricles_; and it is not probable our author would take no notice of -these; and to the same purpose speaks Hippocrates de Ossium Natur. no. -8. - - [JD] Ep. 6. p. 144. - -4. _Relaxation of the nerves._) _Resolutio nervorum_ he commonly uses -for a palsy, yet he cannot intend that here, but a langour or slight -relaxation of the solids. - -5. _Cervicalia._) Cervicale was used in a double sense by the Romans, -either for a bolster, or a piece of dress resembling the neckcloth. - -6. _And venery_, _A venere_.) It is probable that Almeloveen is wrong -in omitting after this _a vino_, which is in Morgagni’s[JE] MS and all -his editions especially as a few lines after, our author mentions the -condition of allowing wine. - - [JE] Ep. 6. p. 149. - -7. _Nostrils are more open._) In Almeloveen _magis pallent_. Though -the MS and Cæsar and Ruellius read thus, yet it is plain from the text -itself that the other editions are right, which have it _magis patent_; -for our author presently adds, in a worse state of the disorder, the -contrary symptom: _Si nares æque clausæ videntur._ Morgagni, Ep, 6. p. -140. - -8. _Aminean wine._) This, says Pliny, has the preference of all other -wines, upon account of its strength, and its growing better by age. -Plin. Nat. Hist. lib. xiv. cap. 2. And thus Virgil says, Georg. 2. -line 97.--_Sunt et Amineæ vites, fortissima vina._ - -9. _Liquid cerate_, says Ægineta, such as is used for fractures, is -prepared from two parts of oil and one of wax. Lib. vii. cap. 17. - -10. _Syrian oil._) I suppose our author must here mean what was -called from its sweetness _elæomeli_--which Pliny says is produced -spontaneously in the maritime parts of Syria. It flows from the trees, -fat, thicker than honey, thinner than resin, of a sweet flavour, and -is used by the physicians. Plin. Nat. Hist. lib. xv. cap. 7.--And -to the same purpose Dioscorid. lib i. cap. 37.--To this account P. -Ægineta adds, that about two cyathi of this taken in a hemina of water -discharge crude and bilious humours by stool; but that this draught is -apt to stupefy a person, which, however, is not dangerous, but he would -require to be excited. P. Æginet. lib. vii. cap. 3. - -11. _Synanche_, or _Cynanche_.) According to Aretæus, the latter of -these names was given to the distemper, either because it was common to -dogs, or because these animals, even in health, hang out their tongues. -Lib. i. de Caus. et Sign. Morb. Acut. cap. 7. - -12. _His belly must be opened._ _Si non febrit, venter solvendus -est._) This I take to be the general direction; if he has no fever, -the intestinal discharge must be promoted--_Liquenda alvus_, by which -I understand the accomplishment of this by diet or medicines, and -_Interdum etiam ducenda_, the use of clysters. - -13. _Lycium_ or puxacantha, _box-thorn_, a tree of the thorn-kind. -The branches, with the leaves, are bruised and macerated for some days -in water, then boiled, and after straining it, is boiled again to the -consistence of honey. The best lycium is what will burn. It has an -astringent quality. They adulterate it by mixing lees of oil, or the -inspissated juice of wormwood or ox-gall in the boiling. Dioscorid. -lib. i. cap. 133. - -14. _Frankincense, thus._) It is generally allowed, that what the -ancients called _thus_, goes now under the name of olibanum. - -15. _Stomach._) When our author mentions the gullet and stomach -together, as in the first chapter of this book, he calls the former -_stomachus_, and the latter _ventriculus_; but he often comprehends -both under the name of _stomachus_, as in this place, which appears by -the disorders mentioned. - -16. _A powder with oil._) This word is _pulvis_--Our author does not -say what powder. He had mentioned rose-oil just before: can he intend -the powder of rose-leaves? or any of those powders he prescribes in the -cardiac disorder, the last of which is _quilibet ex via pulvis_, any -common dust? Or has the word, denoting the kind, been omitted by the -copiers? - -17. _Sulphurated wool._) I suppose he means wool impregnated with the -fumes of sulphur. - -18. _Cutiliæ, &c._) The waters of Cutiliæ in the country of the -Sabines, Pliny says, are extremely cold, and by a kind of suction -excite a sensation in the body like a bite; they are very useful to the -stomach, nerves, and the whole body. Lib. xxxi. cap. 2. Our industrious -critics and collectors have not been able hitherto to find any such -place as _Subruinæ_ or _Sumbruinæ_, and therefore to cut the knot they -cannot loose, propose to read here, as well as in the forecited place -of Pliny, _Subcutiliæ_. - -19. _Rhetic or Allobrogic._) These wines, whose qualities are here -described, had their names from the countries where they were produced; -the first was the Grisons, and the latter Savoy. - -20. _Signine._) This wine by reason of its great austerity was used -as an astringent medicine in fluxes. It had its name from the town of -Signia in Latium. Plin. Nat. Hist. lib. xiv. cap. 6. - -21. _Sesanum._) Dioscorides gives no description of this, but says, -it is bad for the stomach, and produces a bad smell in the mouth. Lib. -ii. cap. 369. Pliny tells us it is brought from India, and the colour -of it is white, and it resembles the _erysimum_ or hedge mustard in -Greece and Asia. Lib. xviii. cap. 10. The moderns give this name to the -oily purging grain. - -22. _Over it._) That is, through the teguments, so as to bring the -part affected into view. I have here followed the old reading _contra -id_, which Constantine upon the authority of an ancient MS. changed -into _ultra id_; which I think does not afford so good a sense, though -followed by Linden. - -23. _Cytisus_ is a shrub, all white like the buckthorn, sending out -branches of a cubit’s length or more, about which are the leaves, -resembling fenugreek; which being rubbed between the fingers smell like -rocket. Dioscorid. lib. iv. cap. 695. - -24. _Acorns._) Dioscorides calls this βάλανος μυρεψική. It is the -fruit of a tree like the myrica.--It resembles the Pontic nut: upon -being squeezed like bitter almonds, it emits a moisture, which is used -for ointments instead of oil.--It grows in Ethiopia, Egypt, and Arabia. -Lib, iv. cap. 742. - -25. _Ferula_ answered to _narthex_ among the Greeks, and was a -general name for several herbs of the same genus, from whence some -of the fetid gums are obtained, as sagapenum, and galbanum.--The -ancients made use of the stalks of these herbs, in the same manner as -paste-boards are now used for fractures, as will be seen in the eighth -book. - -26. _Refreshing to nature._) I have given a sense of the phrase -_secundum naturam_ (which is the reading of Linden and Almeloveen) very -near to that, in which the philosophers use it, because I can find -no other.--Pinzius, Junta, and the Manutii read _vel mentha secundum -naturam est_. As the books vary, and none of them make the meaning -quite clear, it might perhaps be plainer, if it be read, _vel quod -secundum eam naturam est_, that is, _Or mint, or something of the same -nature_. - -27. _Regimen for such patients I have already mentioned._) Vid. book -i. chap. 7. - -28. _Minium._) Pliny complains that _minium_, which was used by the -painters, was of a poisonous nature, and through ignorance often given -in medicine instead of the _Indian cinnabar_. This last, he says, is -believed to be the gore of a dragon crushed by the weight of a dying -elephant, with the mixture of the blood of these animals. _Minium_ was -found in the silver mines in both the Spains, but hard and sandy; also -at Colchos in a certain inaccessible rock, but this was a spurious -kind: the best was got near Ephesus.----_Minium_ some of the Greeks -call _cinnabar_, others _miltos_. Plin. lib. xxix. c. i. & lib. xxxiii. -c. 7. _Cinnabar_, says Dioscorides, some mistake for what is called -_ammion_: for this last is prepared from a certain stone mixed with the -silver sand in Spain, and no where else. In the melting pot it changes -into a very florid and flame colour: it has a suffocating steam in the -mines: the painters make use of it. But _cinnabar_ is brought from -Libya, and sold at a great price, in so much that painters can hardly -have it for their use: the colour of it is deep, whence some have -imagined it to be the blood of a dragon: it has the same virtues as the -hæmatites stone. Lib. v. c. 883.--_Miltos Sinopica_, the best is solid -and heavy, of a liver colour, not stony, very thin when melted. It is -gathered in Cappadocia in certain caves; it is strained and brought -to Sinope, and sold there, whence its name. It possesses a drying -quality, and agglutinating, for which reason it is mixed with vulnerary -plaisters, and drying and styptick troches. It binds the belly if taken -with an egg, and is given in clysters to hepatick patients, Lib. v. c. -885.----Our author elsewhere prescribes _minium_ from _Sinope_, which -makes it probable, that he intended the _miltos_ of Dioscorides. But -upon comparing these several descriptions, which it is needless to -enlarge upon, the learned reader may determine for himself. - -29. _Tetrapharmacum_, or compounded of four medicines. Vid. lib. v. -c. 19. - -30. _Myrrhapia._) So called, according to Pliny, from the likeness of -their flavour to that of myrrh. Lib. xxv. c. 15. - -31. _If the hardness continue._) _Si durities manet._ This appears -suspicious, as our author had mentioned no hardness before. In this -chapter he first describes hysterick fits, then prescribes the proper -treatment both during the paroxysms, and after they are over. We have -very great reason to believe the whole chapter to be corrupted, for -reasons which will be mentioned in a following note. With regard to -this particular place, my opinion is, that after Celsus had finished -what he had to say concerning hysterick fits, he next proceeded to -treat of a hardness of the uterus; and after directing some remedies, -in case of their failing, and the hardness continuing, he orders other -medicines to be tried.--What renders this conjecture the more probable, -is, that Aretæus, amongst the chronick diseases of the uterus, mentions -σκληριη, _a hardness_. “There is,” says he, “another species of -cancer, where there is no ulcer, but a hard and resisting tumour. The -whole uterus is stretched, violent pains distress, and all the other -symptoms are the same as in a cancerous ulcer of this part.” Lib. ii. -de caus. et sig. morb. chron. c. 2. - -32. _Restringents must be used._) _Si maligna purgatio est, -subjicienda sunt coërcentia_: thus Linden and Almeloveen.--Morgagni -observes, that the MS. copy of Alex. Paduan, after the words -_subjicienda sunt_, not only has a great vacuity to the end of the -page, but in the beginning of the next _coëuntia_, and in the margin -opposite to this chasm are written these words, _Desunt in vetustissimo -exemplari duo folia_. _Two leaves are wanting in the oldest copy._ In -this also, where the indexes were prefixed to each book, he found the -following in the fourth--Vulva exulcerata est--De vesica--De calculis -in vesica--In omni dolore vesicæ. And in the margin of the book, -he found, _Vulva ulcerata est_, written opposite to _Si vero vulva -exulcerata est_. Then should have followed the two other--And the last, -namely, _In omni dolore vesicæ_, was set over against _Præter hæc in -omni dolore vesicæ_, and not _vulvae_, as Linden and Almeloveen read it. - -In the MS. in the library of St Anthony at Venice, he found the -preceding chasm much larger, 42 large pages, the same observation -in the margin, and the correspondent numbers in the contents of the -book.--Morgagn. ep. ii. p. 45.--ep. iii. p. 50. So that it is probable -our author had first finished the diseases of the uterus, as being -peculiar to women, and then proceeded to those of the urinary bladder, -as common to both sexes. - -33. _And especially rue with vinegar, &c._) Almeloveen and Linden -read, _praecipueque ex aceto; vitare autem oportet rutam, et ne supinus -dormiat_. This is making Celsus condemn what all physicians almost -have approved, and therefore with Constantine and Ronsseus, I read -_praecipueque ex aceto rutam: vitare etiam oportet ne supinus dormiat_: -which Morgagni prefers. Ep. i. p. 27. - -34. _At such seasons as it returns._) I have here followed the -correction offered by Morgagni _his_ for _hi_ which last would -manifestly destroy our author’s meaning, as may appear from the general -sense of the whole sentence--Instead of the present translation it -would be, _by those upon whom it returns_. - -35. _Sarcophagus_, or _flesh-eating_.) This is found at Assos, a city -of Troas. Dead bodies interred in it are said to be consumed in forty -days, bones and every thing, except the teeth. Plin. l. xxxvi. c. 17. - -36. _Asian stone._) Dioscorides says this ought to be of the colour -of the pumice, spongy, light, and easily friable. Lib. v. c. 916. - -37. _Acopon_, according to the derivation of the word, signifies -something that relieves lassitude, which was rubbed upon the -joints.--Our author exhibits some forms of them lib. v. cap. 24. where -their consistence varies.--P. Ægineta for _acopa_ orders four parts of -oil to one of wax, lib. vii. cap. 17.--In later ages the word was used -in a more extensive sense, for compositions of the consistence of oil, -or as a liniment even when the intention was not to relieve fatigue. - -38. _Most agreeable to his humour._) That is, Celsus supposes a man -in good health, who is his own master, to be confined to no laws, lib. -i. cap. i. but upon account of a preceding illness he must return to -that gradually. - - - - -NOTES - -TO - -BOOK V. - - -1. _Chalcitis._) Pliny lib. xxxiv. cap. 2. says, this was an ore of -copper, and found in Cyprus. Dioscorides describes the best chalcitis -as resembling copper, easily friable, having shining veins. Lib. v. -cap. 889. - -2. _Gum_, when mentioned alone in any of the ancient authors, is -understood to be the same with what now bears the name of gum Arabic. - -3. _Calcined lead. Plumbum combustum._) The process of this is -mentioned by Dioscorides under the correspondent Greek name--It was -prepared by putting very thin laminæ of lead, with sulphur strewed -upon each of them, into an earthen pot, and keeping them on the fire, -stirred with an iron rod, till the lead was converted into ashes. It -was afterwards rubbed in a mortar, and washed by repeated affusions of -water, till no dross swam at top. Dioscorid. lib. cap. 870. - -4. _Misy._) This hath the same virtues as the chalcitis, and they -only differ in the degree of strength. The best comes from Cyprus, of a -gold colour, hard, and when broken, shining and stellated. Dioscorid. -lib. v. cap. 891. - -5. _Allum._) There are several kinds of this mentioned by the -ancients. Dioscorides says, the scissile, round and liquid, were -applied to medicinal purposes, and that the scissile was the best. Lib. -v. cap. 897. - -(6) _Melinum._) As our author in this place mentions only simples, he -cannot intend by this word, oil of quinces; so that it must either be -a kind of colour that came from Melos, or else the Melian allum; in -which last sense the comma ought to be expunged betwixt _alumen_, and -_Melinum_.--But it is necessary to observe, that our author mentioning -this species of allum in the sixth book, calls it _Alumen Melium_, -which in other editions is _Alumen Melinum_. - -7. _Iron scales_ are reckoned to have the same virtue as its rust, -but not so efficacious. - -8. _White vine._) Paul Ægineta mentions the _Ampelos leuce_, or -_white vine_, which he said was also called _bryonia_. Lib. vii. - -9. _Propolis_ is a gluey matter, of a fetid smell, found in the -honey-combs, which Pliny says serves to keep out the cold.--Dale calls -it bee-bread.--Others call it bee-glue. - -10. _Soot of frankincense._) Dioscorides orders it to be made -thus,--“With a pair of small tongs light a bit of thus at a lamp, -and put it into a new hollow earthen vessel, which is covered with a -concave copper one, with an opening in the middle, and carefully anoint -it over; on one side or both, put small stones to the height of four -fingers, to show if it burns, and that there may be room to put in -other bits, before the first be entirely extinguished; and continue -this, till you observe a sufficient quantity of soot collected; always -wetting the external side of the copper with a sponge dipped in cold -water. For thus all the soot will be fixed, when this is not too much -heated: otherwise it would fly off again by reason of its lightness, -and be mixed with the ashes of the thus.” Lib. i. cap. 85. - -11. _Sandarach._) This is the mineral sandarach, or red arsenic. - -12. _Gnidian berry._) Modern botanists are not agreed, what this -berry of the ancients was; some taking it for the mezereon, or spurge -olive, others for the spurge flax. - -13. _Omphacium._) Of this there were two kinds, the one the juice of -unripe olives, and the other the juice of unripe grapes. Plin. lib. -xii. cap. 27. - -14. _Copper-scales._) This must be an interpolation, as in this same -chapter, which mentions only the class of cleansers, it occurred before. - -15. _Calcined copper._) The metal was calcined by being put -into a pot, _stratum super stratum_, with sulphur and salt.--Or -else the copper was kept for several days in the fire in a pot by -itself.--Others again added allum to it, or sulphur alone, which last -gave it a sooty colour.--It was washed in a mortar, and the water -changed four times a day, till no froth arose in it. Dioscorid. lib. v. -cap. 861. - -16. _Apronitre._) The spume or froth of nitre was of a purplish -colour, and the lighter the better. It had the same virtues with -nitre.--Id. lib. v. cap. 905. - -17. _Chrysocolla._) I have here retained the original word, because -naturalists are not agreed, that it was the modern borax. Dioscorides -says the Armenian is the best, and in colour it resembles leeks.--What -is full of earth and stones is to be rejected. Lib. v. c. 878. - -18. _Cyprus ashes._ _Cinis Cyprius._) I do not remember that this is -mentioned by any other ancient author; but it has probably been the -ashes of the tree or plant of this name, or perhaps some particular -kind of ashes brought from the island of Cyprus. - -19. _Cadmia._) The best is the Cyprian, called botryitis, solid, -moderately heavy, being clustered like a bunch of grapes, of the colour -of spodium, and being broken it appears cineritious and eruginous -within. There are other kinds of it inferior, known by the names -onychitis, zonitis, and ostracitis. For burning cadmia it is hid in -live coals, till it grows diaphanous, and runs into bubbles like the -scoria of iron; afterwards it is extinguished in Aminæan wine. Some -burn it thus three times, till it be perfectly converted into ashes; -and then they use it instead of spodium. It is washed in a mortar, and -the water changed, till no dross appears on the top. Dioscorid. lib. v. -cap. 858.--I have here mentioned particularly the burning and washing -of cadmia, because it may serve to shew the nature of this process in -other minerals, when our author prescribes such; and Dioscorides in -mentioning them often refers to cadmia as the general example. - -20. _Hypocistis_ grows near the roots of cistus. The juice of it is -inspissated like the acacia; and it has the same qualities. Dioscorid. -lib. i. cap. 128. - -21. _Diphryges._) This is not known in medicine at present. -Dioscorides says ‘there are three species of it. One of the metallic -kind found only in Cyprus, which is first dried in the sun, and then -burnt by laying sticks all round it. Whence its name from being twice -torrified. A second kind is found at the bottom of the copper furnaces -after smelting. The third is the pyrites stone calcined for several -days in a furnace, till it have the colour of cinnabar. The taste of -diphryges is eruginous, astringent, and vehemently drying upon the -tongue.’ Lib. v. cap. 894. - -22. _Salamander._) Our author here intends the animal so called, and -Dioscorides ascribes to it this virtue. It was burnt and the ashes made -use of. Lib. ii. cap. 255. - -23. _Flower of copper._) _Flos æris_ is obtained, when the melted -copper runs from the furnace, by pouring cold water upon it to -refrigerate it. For by the sudden check, this substance is as it were -spued out, and concretes into flowers. Id. lib. v. cap. 862. - -24. _Spodium_ was scraped off the walls of furnaces mixed with -sparks, and sometimes coals; that, which was generated in the gold -furnaces, was reckoned best for the eyes. Plin. lib. xxxiv. cap. 13. - -25. _Phrygian._) This was made use of by the dyers in Phrygia, whence -its name. The best is pale-coloured and moderately ponderous, not firm -in its concretions, and having white veins. Diosc. lib. v. cap. 915. - -26. _Scissile._) This is produced in the western Iberia. The best -is of a saffron colour; easily broken and split; in its contexture it -resembles the sal ammoniac. Dioscorid. lib. v. cap. 919. - -27. _Vinegar_ is superfluous, because mentioned before in the same -chapter. - -28. _Burned paper._) It must be observed the paper of the ancients -was made from the papyrus or paper-reed. - -29. _Sansucus._) Dioscorides says this is the same with the amaracus, -or sweet marjoram, which is the name given to _sansucus_ by the -Sicilians and people of Cyzicum. Lib. iii. cap. 452. - -30. _Asteriace._) I do not find that this word occurs any where else. - -31. _Eretrian earth_ is very white, or of an ash-colour: this last, -and the soft is best. Dioscorid. lib. v. cap. 945. - -32. _Poppy-tears._) Dioscorides after describing the _papaver -sativum_ and its virtues, says, ‘It is not improper to subjoin the -method in which the _opos_ or _juice_ of it is collected. Some then -cutting the poppy heads with the leaves, squeeze them through a press, -and rubbing them in a mortar, form them into troches. This is called -_meconium_, and is weaker than the _opos_. But whoever desires to -gather the juice, must proceed thus. After the heads are moistened with -dew, let him cut round the asterisk with a knife, but not penetrate -through them, and from the sides, cut straight lines in the surface, -and draw off the tear that flows, with his finger, into a shell; and -come again not long after, for it will be found standing upon it; and -the day following, it will be found in the same manner. It is proper -to rub it in a mortar, and forming it up, to set it by.’ Dioscorid. -lib. iv. cap. 647.--Pliny says, that the meconium is prepared from a -decoction of the heads and leaves; but is much weaker than opion. Lib. -xx. cap. 18. - -From this account it seems plain, that our author means the genuine -tear, or the opos of Dioscorides. - -33. _Antimony._ _Stimmi_, and in other places of our author -_stibium_.) Dioscorides’s description of this shews it to be the modern -antimony, lib. v. cap. 873. - -34. _Dross of lead._) This is glassy, and has the same virtues as -calcined lead. If is washed in a mortar like other minerals. Dioscorid. -lib. v. cap. 878. - -35. _Matter._ _Materia._) This is not meant here of pus, as will -appear by what the author immediately adds; but any humour, that is the -proximate cause of a disease. - -36. _Struthium._) This was an herb used by dyers. Dioscorides says -it was well known. The wool-washers make use of it for cleansing wool: -the root of it is pungent and diuretic, and relieves in disorders of -the liver, &c. Lib. ii. cap. 381.--This herb is not known now, at -least by the same name. Some take it for the luteola, others for the -imperatoria, others for red valerian, others for saponaria. - -37. _Nard ointment._) For making this, oil is inspissated with -cyperus, and for the fragrancy is added costus, amomum, nard, myrrh, -balsam. Dioscorid. lib. i. cap. 76. - -38. _Cachrys_ is the fruit of the _libanotis fructifera_, which is by -some called zea or campsanema, and has leaves like fennel, but thicker -and broader, roundish, and creeping on the ground; the stalk, about a -cubit or more in length; the fruit has a heating quality, very drying, -whence it is good mixed with ointments against rheums of the eyes. -Dioscorid. lib. iii. cap. 492. et 93. - -39. _Viscum_, bird-lime. - -40. _Ammoniacum thymiama._) According to Constantine, this is nothing -else than gum ammoniac. I forbear to mention the conjectures of others, -that seem to be not well founded. Paulus Ægineta says, it is an opos, -or juice, endued with such an emollient virtue as to discuss schirri -and tophi. Lib. vii. - -41. _Crocomagma._) This was the refuse left after the expression of -the oil in making the crocine ointment; which, besides retaining some -of the virtues of saffron, would also be in some measure impregnated, -with the aromatics used in the composition of that ointment. Vide Plin. -lib. xxi. cap. 20. et Dioscorid. lib. i. cap. 26. - -42. _Thapsia._) According to Dioscorides’s description and account -of its virtues, it seems to be the modern thapsia, or turpethum -garganicum, deadly carrot. Vide Dioscorid. lib. iv. cap. 739. - -43. _Washed lead_ was thus prepared.--Put water into a leaden mortar, -and rub it with a lead pestle, till the water becomes black and -feculent; then strain it through a linen cloth, pouring water upon it, -that all that is dissolved may be strained; and repeat this till you -have a sufficient quantity. Then suffer it to settle, pouring water -upon it several times, till no more blackness stand upon the top; then -work it up into a troches and set it by. Dioscorid. lib. v. cap. 869. - -44. _Cedria_ is what distils from the cedar-tree; the best is thick, -pellucid, and of a strong smell, and not diffusing itself when poured -out. Dioscorid. lib. i. cap. 106. - -45. _Laurel oil._) This was made in different ways. One method was -boiling the berries in water when they fall off the tree, which causes -them to emit their oil, which is separated by the hands into _shells_. -Others impregnate the oil of unripe olives with cyperus, calamus, -and afterwards putting in the tender leaves of the laurel, boil -them together. Others add to these bay-berries, till the oil smell -sufficiently of them. Others mix with it storax and myrrh. Dioscorides, -lib. i. cap. 50. - -46. _Rasile verdigrease_ is made by suspending a copper vessel, or -plate, over the steam of vinegar for ten days; then the verdigrease -produced is scraped off. Or else by putting one or more lumps or plates -of copper into husks of grapes grown sour. Dioscorid. lib. v. cap. 865. - -47. _Oesypum_ is the oily part collected from sordid wool thus: the -wool was washed in warm water, and all its sordes expressed, the fat -swimmed a-top, with a froth, and upon throwing in some sea water, it -subsided to the bottom, and when all the œsypum was obtained from it in -this manner, it was purified by repeated affusions of water. When pure -it has no sharp taste, but is in some degree astringent, and appears -white. It has a heating quality, fills up ulcers, and is emollient. -Dioscorid. lib. ii. cap. 272. - -48. _Boiled copperas._) Dioscorides mentions a species prepared -in Spain that had the name of χάλκανθον ἑφθὸν--_atramentum sutorium -coctum_. Lib. v. cap. 888. - -49. _Cicine._) A proper quantity of κροτωνὼν, _of the Ricinus_, is -dried in the sun, till their exterior coat break and fall off. Then the -pulp is collected, put into a mortar, and pounded well, and afterwards -removed into a tinned kettle containing water, and boiled over a fire. -When all the juice is obtained from them, remove the vessel from the -fire, and take up the oil that swims a-top, and set it by. In Egypt, -where great use is made of this oil, they obtain it by first grinding -the seed, and then pressing it. Dioscorid. lib. i. cap. 38. - -50. _Burnt ceruss._) Put powdered ceruss into a deep vessel; set -it on the fire, stirring it with a ferula, till it has the colour -of sandaracha, (red arsenick). Dioscorides also mentions a toasted -or roasted ceruss, but the process is of the same nature, and only -stopped, when the ceruss acquires a lemon colour. Dioscorid. lib. v. c. -877. - -51. _Polybus._) I have chosen to read this name with the older -editions, because our author afterwards mentions the sphragis of -Polybus, which can have no other place to refer to but this. - -52. _Cauneæ._) Mentioned by Cicero, De Divinatione, lib. 2. - -53. _Susine ointment._) For making this, oil was first boiled with -wine, calamus, and myrrh, and after being strained, cardamom was -infused in it, til it gave a proper flavour, After this, to three and -an half pound of this oil were added the leaves of a thousand lilies, -and the whole was stirred with hands anointed with honey. After -standing a day and a night, the lilies were squeezed out. Dioscorid. -lib. i. c. 63. - -54. _If a woman does not conceive._) _Si non comprehendit._ This -sentence has, in some copies, been joined with the former, _si -concidere vitio locorum, &c._ as if _comprehendit_ related to the -consistence of the pessus obtained by the honey. There are several -other explanations offered, but none of them with any appearance of -truth. I thought it capable of no other sense than what I have given -in the translation; and was pleased to find this supported by the -opinion of Morgagni, Ep. i. p. 18. - -55. _Sprinkled on dry._) The words as they stand in the text, -seem capable of no proper sense. _Misy quoque et galla, si paribus -portionibus misceantur, corpus consumunt: eaque vel arida inspergere -licet, vel excepta cadmia, illinere._ I have therefore taken the -liberty to transpose _cadmia_, and place it after _galla_ for the -cadmia is as dry as the other two, and therefore could not serve to -bring them to any consistence; but still there seems to be a word -wanting after _excepta_, to denote the substance for uniting them. - -56. _Marmor coctum._) I suppose this to be burnt marble; for -Dioscorides mentions a lapis alabastrites, which was burnt, and mixed -with resin or pitch, and thus used to discuss hardnesses. Lib. v. c. -927. - -57. _Ignis sacer._) Some, among whom is Heister[JF], believes, -that Celsus calls an erysipelas _ignis sacer_, whereas he has -erysipelas under its own name, cap. 26. of this book.--Fabricius[JG] -ab Aquapendente, and Wiseman[JH], by his _ignis sacer_ understand the -miliary herpes. See our author’s description of it, cap. 28. - - [JF] Chirurg. p. i. lib. iv. cap. 6. - - [JG] Oper. Chirurg. lib. i. cap. 18. - - [JH] Book i. chap. 17. - -58. _Malabathrum._) It is a question, whether the modern malabathrum, -or Indian leaf, is the same with the ancient. Dioscorides says, some -will have it to be the leaf of Indian nard being deceived by the -similarity of its smell. But that is not true; for it is a vegetable of -a peculiar nature, growing in the fens of India, without any root, the -leaves swimming on the surface of the water. Lib. i. cap. 11. - -59. _Black cassia_ is the second species mentioned by Dioscorides, -who says it is preferable to the first, and fittest for medicinal use; -the natives of Arabia call it zigir; it is thick, and smells like -roses. Lib. i. cap. 12. - -60. _Myrrh called stacte_ was the oily part expressed from particular -kinds of myrrh, and was very fragrant. Dioscorid. lib. i. c. 78. - -61. _Pontic root._) Dale, with Alpinus, believes the rhapontic of the -ancients to be the same with the true rhapontic of the moderns. - -62. See note at chap. 24. book iv. - -63. _Sil._) Rhodius, together with Constantine and Ronsseus, are for -reading _seselis_ instead of _silis_, for sil is a species of ochre; -and they take it for the _seseli Creticum_, or _tordylium_, _hartwort -of Candy_. - -63a. _Between the fingers. Vel inter digitos._) Morgagni observes, -that, instead of these words, his MS. and all his editions read _In -articulis_ which the reader, he says, cannot wonder at, if he considers -what follows concerning the difficulty of curing wounds in the joints, -p. 297. of the original. Ep. 6. p. 144. - -64. _Fibulæ._) The word _fibula_, in other classical authors is -translated by a _buckle_; which from its connection in such places -appears very proper. But upon comparing the several passages in our -author, where the use of them is directed, it seems very difficult to -give any account of them. The variety of opinions may very well be -reduced to two, those of Guido de Cauliaco and Fallopius. The first -believed them to be hooks, whose size was adapted to that of the -wounded member, curved at both ends in the form of the letter S, that -they might be fixed to both lips of the wound. According to Fallopius -the _fibula_ was nothing else but the interrupted suture now commonly -used in wounds. - -Fabricius was at first of opinion, that the fibula was not made of -thread, but copper or iron, not hard, as Guido would have it, but -softer and flexible, that it might be fixed through the lips of the -wound and then twisted. But after mature consideration, he says he -found Fallopius’s opinion to be most agreeable to truth. - -Rhodius in his treatise _de Acia_, where his design is only to clear up -_the fibula and acia of Celsus_, has been at immense pains to collect -every thing extant in any of the ancients about their _fibulæ_; but -as there is nothing which occurs in any of the old physicians more -particular than in our author, it is not to be wondered, that every -thing in his treatise of real importance to the scope of his enquiry, -is contained in Fabric. ab Aquapendente, lib. ii. de Vulnerib. cap. 5. -et de Chirurgic. Operation. cap. 108. - -The principal places, in which our author mentions _fibulæ_, are lib. -v. cap. 26. p. 292. in the original, p. 293.--Lib. 7. cap. 4. p. -412.--Cap. 19. p. 462. et 464.--Cap. 22. p. 469.--Cap. 25. p. 473. - -The difficulty seems to rest here, that our author should use the -term _fibula_, which in other classical authors is always taken for a -buckle, or something of that kind made of metal, without distinguishing -it from the ordinary _fibula_, as one should imagine he would have -done, had he intended thread. Could it be a metal wire with a loop at -one end, and the other first put through the wound, then passed into -the loop, and twisted; which it would be easier to cut than pull out? -This seems to obviate the strongest objection against its being of -metal, drawn from the verb _incido_, which some moderns would have only -applicable to thread. - -Rhodius _de Acia_, cap. 6. will have the _fibula_ used to the prepuce -of boys (mentioned by our author lib. vii. cap. 25.) to be of metal; -and according to Joann. Britannicus a small ring either of silver, -gold, or copper. - -I have only to add, that instead of _paulatim_ according to Linden and -Almeloveen, I have read _paulum_ with Pinzi, Junta, Aldus, and others. - -65. _Soft thread_, _acia molli_.) _Acia_ occurs no where else but -in this single place of Celsus; the translation is agreeable to the -sentiments of Rhodius _de Acia_, cap. 14. and I think it capable of -no other sense. It may not be improper however to observe, that in -some copies, though they are not of the best authority, _acu_ is read -instead of _acia_, but with no apparent meaning. - -66. _After applying._) I read with Constantine _imposito_ for -_impositum_, which last has no place in the construction with a proper -sense. - -67. _And the flesh within is corrupted._) Malique odoris est, _et -caro intus corrupta_. All the editions of Morgagni[JI] have _carunculæ -corruptae_, and the MS, _carunculaeque corruptae_, which Morgagni likes -better; because it would have been to no purpose to have repeated _caro -ejus corrupta_, which had occurred only a few lines before; whereas -with the other reading, we expunge the colon, and make _carunculae_ -relate to the verb _resolvuntur_. - - [JI] Ep. 7. p. 206. - -68. _The skin a little farther off._) I have here followed the -reading of the older editions, _ulterior_ instead of _deterior_ in -Linden, which agrees much better with the sense of the whole passage. -Vide Morg. ep. 6. p. 149. - -69. _The skin is entire, but the flesh within._) Linden omits -_integra cute_, which is in the older editions, and Morgagni’s -MS[JJ].--As the sense seems to require it, I have taken it into the -translation. - - [JJ] E p. 6. p. 144.] - -70. _Almost all bites._) I read here, omnis _fere_ morsus, with -Nicolaus Junta and the Manutii, and not _feræ_, as Linden and -Almeloveen have it. For Celsus himself makes no distinction between -venenatos et non venenatos morsus. - -71. _Psylli._) Pliny, from the authority of Agatharchides, says, -there was a nation called Psylli, in whose bodies there was some humour -destructive to serpents, by the odour of which they stupified them. -They had a custom among them of exposing their children to the fiercest -of these creatures, that they might try the chastity of their wives, -the serpents not flying from those, that were not of their blood. Plin. -lib. vii. c. 2. This account of Pliny’s has no better foundation than -other vulgar errors: but we may observe, our author was too curious an -enquirer into nature to give credit to such fables. - -72. _Especially in Gaul._) The Gauls tinged their arrows in hunting -with hellebore, and cutting out the wound they made all round, they -pretended it made the flesh more tender. Plin. lib. xxv. c. 5. - -73. _Cerastes_, from κερας, a horn, is a serpent of one or two cubits -in length, of a sandy colour in the body, and near the tail void of -scales; upon its head something rises like horns, and the parts about -the belly are covered with scales, orderly disposed, which as it creeps -along makes a rustling noise like hissing. Æt. Tetrab. 4. Serm. 1. cap. -28. - -74. _Dipsas_, a serpent called by that name, from the immoderate -thirst, which is caused by its bite. It is found in maritime places, is -about a cubit in length, thick, and becoming gradually smaller towards -the tail. Id. cap. 22. - -75. _Hæmorrhois._) Paulus Ægineta tells us, persons bit by an -hæmorrhois are tormented with pains, their bodies become short and -small, there is a violent hæmorrhage from the wound, and if there is a -cicatrix in any part of the body, it bursts and bleeds: the stools are -bloody, the blood discharged is grumous, blood is brought up from the -lungs by coughing; and being seized with a vomiting of blood they die -immediately. He adds, that remedies must be applied before the symptoms -appear; for after they come on, all means are vain. - -76. _Chersydrus._) The name of this imports it to be an amphibious -animal, from χέρσος _terra_, and ὕδωρ _aqua_. - -77. _The Phalangium_ is unknown to Italy, and is of several kinds; -one like an ant, but much larger, with a red head, the rest of its -body black and variegated with white spots. The bite of this is worse -than that of a wasp. The Greeks gave this name also to two species of -spiders, the lupus, and another downy with a large head. Plin. Nat. -Hist. lib. xxix. cap. 4. - -78. _Pastinaca fish_ was of the plani kind, and had a cartilage -instead of a spine. The aculeus, or κεντρὸν of this fish is a remedy -for the tooth-ach, as Dioscorides informs us, and Celsus himself -mentions, lib. vi. cap 9. Dale calls it the poison fish, fire, or -fierce flaw. The liver is said to be good against itching; in oil it -removes lichens and lepras.--This cleansing quality attributed to it, -makes it probable our author intends it here, for no such virtue is -attributed to the water, or sea-parsnip. - -79. _Now this is a very bad kind._) One of the great sources of -corruption is a false punctuation; and as I could make no sense of -this sentence as it now stands, I have translated it agreeably to the -following; _Namque pessimum id genus est. Fereque primum id fit, quod -cacoethes à Græcis nominatur._ As it stood before, the cacoethes was -called the worst kind, which our author contradicts immediately, by -saying that no other species but that can be cured. Some of the older -editions read _ob quæ_ for _namque_, that is, ‘Upon these accounts this -is a very bad kind.’ Which appears to agree better with the context. - -80. _None of these can be removed but the cacoethes._) Here again -the sense of the author is manifestly corrupted by the punctuation in -Linden and Almeloveen; but Morgagni[JK] has set it to right in this -manner:--_Tolli nihil nisi cacoethes potest: reliqua curationibus -irritantur; et quo major vis adhibita est, eo magis. Quidam usi sunt, -&c._ The translation is conformable to this. Which reading is almost -the same with Constantine’s. - - [JK] Ep. i. p. 36. - -81. _Of a good juice._) See book ii. chap. 20. - -82. _Probe._) One kind of the probe or _specillum_ of the ancients -was broad at one extremity for the purpose, which Celsus here mentions. -Vide Scultet. Armament. Chirurg. tab. 8. fig. 6. - -83. _Chironian._) So called, says Paulus Ægineta, because it requires -a very great physician, such as Chiron. Lib. iv. cap. 46. - -84. _These are the methods prescribed by physicians._) This -translation is agreeable to the reading of the most ancient editions, -particularly Nicolaus, Pinzi, Junta, and Aldus. _Quæ cum medici -doceant, quorundam rusticorum, &c._ In Linden and Almeloveen the -passage has a quite different turn: _Quæ cum medici doceant, ab -iis requirenda. Quorundam, &c._--That is, ‘These being the methods -prescribed by physicians, they will be best practised under their -direction.’ - -85. _Leaven._) The common leaven for bread among the Romans was paste -worked up without salt, and boiled after the manner of pulticula, then -suffered to stand till it turned sour. Plin. lib. xviii. cap. 11. - -86. _From its figure, our authors call it panus._) _Panus_, a clue -or ball of wool or yarn; πη̃νος, or πα̃νος the Greeks used in the same -sense, but did not apply it, as the Romans did, to this tumour. - -87. _The same applications._) I have here followed the reading of -Pinzi Manut. Ruell. Stephens and Morgagni’s MS. autem for _aut_, and -_tantum modo_ for _tantummodo_. Morgagni, Ep. vi. p. 156. - -88. _If it does not slip out, &c._) Almeloveen and Linden read, _si -non dilabitur sede, qua innititur_; whereas the prior editions wrote, -_si non labitur, sede quale innititur_; i. e. ‘if it does not slide, -but rests upon a smooth surface.’ This Morgagni[JL] likes much better, -as agreeable to Celsus himself, who adds, _si inæquale quoque et -asperum_, &c, that is, in the first case where the probe rested, but -upon a plain surface, the caries was but little advanced; whereas under -the following appearances it was more considerable. - - [JL] Ep. vi. p. 162. - -89. _Collyrium._) This name, at present, is appropriated to medicines -designed for the eyes; in which sense the ancients also used it. But -they gave it a greater latitude, to denote likewise a composition -of powders brought to a consistence by some liquid, and formed into -something like a tent, of various sizes, according to the cavities it -was designed for. Thus Scribonius Largus orders a collyrium of the -bigness of a pine kernel, to be introduced into the anus, Cap. xxxvii. -comp. 142. - -90. _Which is more ulcerated._ _Quæ magis exulcerata est._) Several -of the ancient editions read _quia_ for _quæ_, that is, ‘Because it is -more ulcerated.’ - -91. _Spreads wide._) This whole passage was very much corrupted in -the old editions. We are obliged to Linden for several corrections in -it; but he reads this part _Proceditque et latet_, that is, _It spreads -and conceals itself_. As this can hardly be the meaning of the author, -I read _Procedit latè_, which is in Pinzi, Junta, Aldus, and others; -only I take the liberty of expunging _et_. - -92. _Cimolian chalk._) I have here kept close to the author’s term -_subcærulea_. Pliny and Dioscorides describe this kind as inclining to -purple. See note book ii. chap. 33. - - - - -NOTES - -TO - -BOOK VI. - - -2. _Gum._) Our author here manifestly distinguishes between _lachryma -and pituita_. The ancients imagined the _pituita_ to be concreted -tears, whereas it is the sebaceous matter secreted from the glands of -Meibomius. To translate it in one word I have therefore given it the -vulgar English name. - -3. _Phlegm._) Vid. lib. ii. cap. 23. - -4. _Diet ought to be somewhat fuller than formerly._) In Almeloveen -and Linden, _Post hæc cibo pleniore, quam ex operum consuetudine_. The -reading in the older editions was _ex eorum dierum consuetudine_, which -Morgagni prefers, Ep. vi. p. 153. and is the reading I have followed. - -5. _Burnt antimony._) The antimony is rubbed over with suet, and hid -in the fire till the suet is burnt, and then being taken out, it is -extinguished in the milk of a woman, that has had a male child, or in -old wine. Dioscorid. lib. v. c. 873. - -6. _Specillum asperatum._) Paulus Ægineta, treating of the same -disorder, mentions this instrument by the name of _blepharoxyston_, -that is, _an instrument for scraping the eye-lids_. It is delineated by -Heister, p. 2. tab. 16. fig. 5. - -7. _Psoricum._) Dioscorides gives the same process for making of -psoricum: only he orders the vessel to be buried in dung for forty -days, about the heats of the dog star. Lib. v. cap. 890. - -8. _Hot waters._) By our author’s using the plural number here, it -may be doubted, whether he does not intend mineral hot waters. - -9. _Strigil._) This is used by other authors to signify a currycomb, -or that instrument, with which the sordes were scraped off the skin at -the baths; but in this place it can be taken for nothing else but a -tube or syringe. - -10. The _specillum oricularium_, from its use here, as well as in -other places, must have been some kind of forceps. - -11. _A board is laid down._) I could make no proper sense of this -sentence according to the present pointing, and therefore have altered -the punctuation in this manner; _tabula quoque collocatur, media -inhærens, capitibus utrinque pendentibus, &c._ - -12. The _teda_ is a tree very like the pine, abounding with resin. -Pliny says, that all the trees, that afford resin, by an excess of fat -are changed into the teda. Hence teda is often used for a torch in -Latin authors. Vid. Plin. Nat. Hist. lib. xvi. c. 10. & lib. xvii. c. -24. - -13. _Sory_ was a mineral of much the same virtues as _misy_ and -_chalcitis_: it is strong scented, and creates a nausea. It is produced -in Egypt, Africa, Spain, and Cyprus. Dioscorid. lib. v. c. 893. - -14. _Rhus_ is a shrub growing in rocky places, of about two cubits -in length; it has long leaves, and reddish, the fruit of it is like -a grape stone. The bark about is very useful: it has a styptick -quality, and is used for the same purposes as acacia. It was used by -the tanners. Dioscorid. lib. i. c. 138. It is supposed to be rhus -obsoniorum, or sumach of the moderns. - -15. _In the inner part._) For _ulteriore_ in Almeloveen, I chuse to -read with Constantine _interiore_. - -16. _In nine cyathi._) There is no liquid mentioned in Linden’s or -Almeloveen’s edition, but most of the others have _Ex novem cyathis -vini_. - -17. _That the skin be kept from falling in contact, &c._) This -is agreeable to the reading of Linden and Almeloveen, _Illam esse -servandam ne considat, ulcerique agglutinetur_. But [JM] Morgagni would -here restore the reading of his editions and the MS. _Illam non esse -servandam ne considat_, &c. that is, ‘It must always be cut off in -such a case;’ which indeed is rendered probable by our author’s first -ordering circumcision, when there is a loss of substance in the penis; -and then his adding _Perpetuumque est_, as if that were a general rule -for the same operation in like circumstances. - - [JM] Ep. 6. p. 145. - -18. _Vulsella._) This instrument is delineated by Scultet. Arm. -Chirurg. tab. 4. fig. 1. - -19. _Cicatrix is formed._ _Fit cicatrix._) I find no variety in any -of the copies, which I have seen. The sense however seems to require -_crusta_ instead of _cicatrix_; because the caustic medicines would -produce an eschar, whereas no cicatrix would be formed, till the eschar -cast off, and the ulcer was deterged and incarned. - -20. _Consumed either by stronger medicines, &c._) This is agreeable -to the reading of the older editions--_Si hac ratione non tollitur: -vel medicamentis vehementioribus, vel ferro adurendum est._--Linden -and Almeloveen have it thus: _Si hac ratione non tollitur, vel aliis -medicamentis similibus, vel vehementioribus: ferro adurendum est_. -That is, ‘If it is not removed by this method, or like medicines, or -stronger, it must be burnt by the actual cautery.’ Which, Morgagni[JN] -justly observes, besides the incongruity of recommending similar -medicines after the first have failed, alters the sense much for the -worse. - - [JN] Ep. vi. p. 146. - - - - -NOTES - -TO - -BOOK VII. - - -1. _Physician makes a wound._) An English reader may naturally -suppose that the term should be _surgeon_; but as our author here uses -the word _medicus_, I did not think myself at liberty to depart from -it; especially as his not using _chirurgus_ was from choice, since -this word occurred in the preceding paragraph. Celsus supposes an -accomplished physician acquainted with all the branches. - -2. _Nevertheless, it is not right to trust, &c._) In this translation -I have followed Linden and Almeloveen. But the reading in most of the -old editions, as Nicolaus, Pinzi, Junta, Aldus, Gryphius, &c. is _Neque -tamen fas non est nihil cucurbitula agere_; that is, ‘Yet it is not an -inviolable rule always to employ the cupping-vessel.’ Which I must own, -appears most agreeable to the sense of this place; because our author -immediately proceeds to consider a case, in which cupping can be of no -service. See Morg. Ep. vi. p. 151. - -3. _Even before the suppuration is formed._) I have here followed the -old reading, _tum pure quoque maturior hæc interdum esse consuevit_, -which seems to agree better with our author’s reasoning; for as he -had just blamed Meges for introducing the new term _callus_ instead -of _tunica_, without necessity; so he adds, that he was mistaken also -in believing that it was never found but inclosing an old collection -of matter. He on the contrary says, that it sometimes appears before -the generation of pus. Linden and Almeloveen read _tum, pure quoque -maturiore, hæc interdum esse consuevit_; that is, ‘And this is found, -even when the suppuration is more ripened.’ Whether the connexion -of this with what went before be natural, the reader may judge for -himself. I do not know but these learned editors may have put another -sense upon _maturiore, when the suppuration is sooner ripened_: which -would be pretty much the same with the old reading. However the first -is preferred by Morgagni, Ep. vi. p. 152. - -4. _Lest convulsions follow, which may debilitate, &c._) This -translation is agreeable to the reading in Linden and Almeloveen; but -all the older editions read thus, _ne vel distendantur hi, vel membrum -debilitent_; i. e. ‘Lest either convulsions follow, or the limb be -disabled.’ And this appears the more probable, as one of them might -happen without the other following. And so it is quoted by Fabricius ab -Aquapendente. - -5. _And some again require a wound, &c._) _Jamque alia rectam plagam -desiderant, ut in carne: alia vero vehementer cutem extenuant, in -quibus tota ea super pus excidenda est._ There are several variations -in the reading of the copies of this paragraph, but they do not remove -the difficulty. Morgagni[JO] very ingeniously conjectures, that after -Celsus had considered such as were quite mature, he next mentioned -such as were not quite ripe; and did not talk here of cutting off the -whole skin, because he afterwards says, _Est etiam in rerum natura, ut -cutis latius excidenda sit_; and that what is here said of the skin -being extenuated, was repeated from above by carelessness. All the old -editions and MSS. have _itemque_ for _jamque_; none of them _ut_; the -MS. _tuto_ for _tota_. Upon the whole, he seems inclined to read it -thus: _Itemque alia rectam plagam desiderant in carne; in quibus tuto -ea super pus incidenda sit_; i. e. ‘Others again require a wound in a -straight direction in the flesh, in which it may be proper and safe to -make an incision above the pus.’ - - [JO] Ep. vii. p. 181. - -6. _Crude lint._) Fabricius ab Aquapendente and Rhodius take this -crude lint to be such as has not been boiled in a lixivium. - -7. _Loosing this knot. Soluto nodo._) Morgagni[JP] here prefers -the old reading, _salvo nodo_, _without loosing the knot_, for this -reason, that our author immediately orders the knot to be loosed every -third day, for changing the string. And thus also it is quoted by -Aquapendente, De chirurg. operation. cap. 93.--Celsus has here followed -Hippocrates, Lib. de fistul. where he orders the string to be drawn -and twisted every day, as much as it is loosened by the putrefaction -of the fistula; but he says nothing of untying the knot every day. -The difference is not material; for if _salvo nodo_ be the reading, -the string must be made tighter in the manner Hippocrates directs. -According to the reading of Linden, the method is plain, nor does it -seem to be attended with any difficulty; for it is untied twice a day -to move the ligature; and also untied every third day, for the sake of -introducing a fresh ligature, because the old one must not be suffered -to rot. - - [JP] Ep. vi. p. 151. - -8. _A very small habenula may be cut out._) Linden and Almeloveen -read here, _habenula tenuis admodum injiciatur_, which I think has no -proper connection either with what goes before or follows. It is true, -Aquapendente has given two explications of this passage, according to -the same reading, De chirurg. operat. cap. 93. Neither of which appears -to me consistent with the reasons Celsus gives for this method: I have -therefore chosen to follow Nicolaus, Pachel, Pinzi, Junta, Aldus, and -others, who have _ejiciatur_ for _injiciatur_, which seems to clear up -the difficulties of this place.--Our author uses _habena_ often for a -strap; but by _habenula_ here he must understand a small slip or stripe -of flesh. - -9. _Gum_ in this place (_pituita_) must signify a purulent fluid. - -10. _Like a spatha._) A knife was said to resemble a spatha, when -it ended in an acute point with sharp edges on both sides, which -our author mentions chap. x. for the excision of a polypus in the -nose.--The needle here described is thin and broad, so that it was more -like this instrument than a common needle. Vid. Fabric. ab. Aquapend. -de Oper. Chirurg. cap. 107. - -11. _Of the colour of wax._) I have here departed from the reading of -all the copies, and instead of it admit the correction of Mercurialis -_cereus_ for _cæruleus_, which is approved by the best judges, and -seems to be confirmed by its affinity to the gold colour immediately -following. Vid. Mercurial. Var. Lect. lib. v. cap. 5. & Le Clerc. Hist. -de la Medicine, p. 2. liv. 4. sect. 2. chap. 5. - -12. _The needle sharp pointed, but not too slender._) The reading in -Almeloveen is _Tum acus admovenda est, aut acuta, aut certe non nimium -tenuis_. As I could find no sense from this reading, or any other that -is proposed, I have taken the liberty to read thus, _Tum acus admovenda -est acuta, at certe non nimium tenuis_. - -13. _With timidity._ _Timide._) Though this reading may be defended, -yet as what our author adds of the needle finding no resistance should -make an operator more cautious, it is possible he wrote _temere_. - -14. _Below the bone._) I have here followed the old reading _sub -osse_, and not as Almeloveen has it _ab osse_, which plainly appears -to be erroneous by what our author says, when he mentions this species -again, _Manifestum sub osse descendere_. - -15. _Humour still flows._) Here is a manifest error in Linden and -Almeloveen, who read _tumor_ instead of _humor_, which all the old -copies have. Morgagni, ep. 5. p. 150. - -16. _And therefore cannot be separated._) In the original _Ideoque -legi non possunt_. Our author here barely mentions the _lectio -venarum_, and a little below speaks of it as a distinct operation in -these words, _Sed nihil melius est, quam quod in Gallia quoque comata -sit, ubi venas in temporibus, et in superiore capitis parte legunt_. -In the conclusion of the chapter he promises a full explanation of it, -when he comes to the varices of the legs. The place he refers to is the -_31st_ chapter of this book, where the reader will find, he does not -once use the word _lego_ through the whole: not that he forgot it, for -he puts us in mind of this very passage in the beginning: _Huc autem et -earum venularum, quæ in capite nocent,--curationem distuli_; he then -proceeds to describe two methods of cure by the actual cautery, and -excision. In the first process I find nothing applicable to _lego_, -there as well as here, cauterizing being quite a different thing; -but in the second, namely the excision, the veins are separated from -the contiguous parts, and are taken up by several blunt hooks, at the -distance of four fingers breadth from each other, then, one of these -hooks being raised, the vein is cut through and pulled away: so in -all the rest (the terms are _Excipitur_, _diducitur_, _attrahitur_, -_evellitur_, _rursus abscinditur_.) Now from the various senses, which -_lego_ bears in the classics, it seems without a strain capable of -signifying any step of this operation. And as it is not uncommon among -the ancients to include several known consequences under one term, I -must own it appears to me our author intends them all, when he uses the -word _lego_ in this chapter. - -17. _Through what remains._) Instead of _super est_ in Linden and -Almeloveen, which seems to be directly contrary to our author’s -meaning, I read in one word _superest_, with the older editions. - -18. _Defects in these three parts, if they be small, &c._) Linden -and Almeloveen read _Curta igitur in his tribus, ac si qua parte parva -sunt, &c._ The more ancient editions have _Ac si qua parva paria -sunt_; neither of which seem to give the author’s meaning. I cannot -help thinking the whole passage should run thus. _Curta igitur in his -tribus, si qua parva sunt, curari possunt: si qua majora sunt, aut -non accipiunt curationem, &c._ For neither _paria_ nor _parte_ appear -to be at all proper after what was said in the conclusion of the last -chapter, where he expressly confined these defects to the three parts -abovementioned. I have therefore ventured to translate according to -that reading; a liberty however I durst not take without advertising -the reader. - -19. _Sometimes however the skin--left deformed._) I have here -translated according to the reading of Linden and Almeloveen, from -which I find no other variety than that of _autem_ for _tamen_. But -this observation by no means agrees with the general rule contained in -the next words, _Hujusmodi loci altera pars incidenda, altera intacta -habenda est._ If we are allowed to reject _haud_, it will run thus: -_Sometimes however it happens, that to draw forward the skin on one -of the sides, would effectually disfigure the part it has left._ This -sense appears quite consistent both with the general rule, _Hujusmodi -loci, &c._ and its application, _Ergo ex imis auribus, &c._ - -20. _Two regulæ._) _Regula_ is commonly taken for a ruler. Our author -himself directs a single regula to be applied to a fractured bone, -where there is a protuberance, to keep that down, Lib. viii. cap. 10. -In this place he mentions the end proposed by them. It seems probable -that they were two pieces of wood fixed together by a hinge, and used -in the same manner as farriers use the instrument by them called -barnacles. - -21. _In two lines._) Instead of _duæ tunicæ_, I read here with -Nicolaus, Aldus, Stephens, and others, _duæ lineæ_. - -22. _Small glands_, _Glandulis_.) Most of the old copies have instead -of this word, _medullis_. But Aquapendente in quoting this place, -follows the same reading with Linden and Almeloveen. - -23. _The coats however, &c._) I have here followed the old reading -_tunicæ_, for _tunicarum_ in Linden and Almeloveen. According to which -the translation would run, ‘They (_the testicles_) are pained however -in wounds and inflammation of the coats, which contain them.’--Which -must appear quite inconsistent with what our author had said the line -before, so that Morgagni[JQ] very properly asks how they can be void of -all sensation, and yet be pained in diseases of their coats? - - [JQ] Ep. v. p. 135. - -24. _By an assistant._) I read _ministro_ instead of _sinistro_, -which is in Linden.--See Morgagni, Ep. vi. p. 147. - -25. _Sometimes upon account of their health._ _Interdum valetudinis -causa._) Some of the older editions insert before this, _Interdum -vocis_, _Sometimes on account of their voice_. I do not know how this -came to be dropped afterwards: for it is certain this was one very -common reason for infibulating. - -26. _Sticks where that grows narrower._) In Almeloveen and Linden, -_Nonnunquam etiam prolapsus in ipsam fistulam calculus, qui subinde -ea extenuatur._-----Which I think is capable of no sense, and have -therefore taken the liberty to follow Morgagni’s conjecture _qua_ for -_qui_. Ep. i. p. 38. - -27. _Being first slightly anointed with oil, &c._ _Leniter prius -unctos oleo simul in anum ejus demittit._) The old editions, without -any mention of the oil, have, _Leniter prius unum deinde alterum in -anum ejus demittit_; that is, _Introduces gently the fore and middle -fingers, first the one and then the other_. - -28. _Come out prone_, that is, _with its end foremost_, _ut pronus -exeat_.) This Constantine changed in the margin into _Ut ne pronus -exeat_, which Linden received into the text. Constantine explains -_prone_ by lying on its side, and says it is hardly possible to extract -an oblong stone in that posture, supposing, no doubt, that it must -necessarily lie across the orifice. See Morgagni, Ep. v. p. 128. - -29. _Then in that part where the bottom of the wound is straiter, -&c._ _Deinde ea parte qua strictior ima plaga est._) Thus all the -printed copies read. This passage has given rise to a variety of -opinions on the nature of the first and second wound: some imagining -that the first, which is called the lunated incision, was concave -towards the rectum; others, on the contrary, from the word _coxæ_ -being used for the ilia as well as the ischia, believed it was concave -towards the scrotum. - -Then, with respect to the transverse incision made through the neck of -the bladder, some have thought that the word transverse was used as -it regarded the first wound, so that the second incision was nearly -perpendicular to the first, and the urethra was divided longitudinally; -others again have supposed, that the incision was made transverse, with -regard to the course of the urethra, that is, the neck of the bladder -was opened transversely. - -Though all the printed copies agree in the above reading, yet Morgagni -informs us that instead of _Qua strictior ima plaga est_, his ancient -MS has _Qua resima plaga est_, which would determine the convexity of -the lunated incision to be towards the rectum; because in that case -the cornua of the lunated incision would point to the superior part of -the body. But this reading does not fix the direction of the _plaga -transversa_, whether it was called so in respect of the parts, or the -first incision: nor does that ingenious author favour us with his own -opinion, but seems to prefer this to the common reading. Ep. vii. p. -189. - -Now it should seem almost certain, that the lunated incision was meant -to be concave towards the rectum; because when made in that direction, -it would probably render the rectum much more loose and supple, than it -is in its natural state, and thereby greatly facilitate the operation, -by allowing the surgeon a much freer use of the two fingers, which are -introduced into the rectum, and consequently admitting him to bring -the stone more easily forwards into the neck of the bladder. One would -suppose, however, that the benefit here suggested to arise from this -lunated incision, was not extremely evident, or it would not have been -dropped so early by succeeding surgeons: Ægineta makes not the least -mention of this process, nor do we know when it was first discontinued. -Perhaps, even in Celsus’s time, there were different methods of -performing this operation; for does not he himself, when describing -Meges’s manner of cutting upon a rough stone, omit the lunated -incision? And does he not imply that there were different methods by -saying, _Quocunque autem modo cervix ea parte secta est_, &c.? - -With regard to the _transversa plaga_, it should seem by the use of -that term, when he describes the manner of cutting women, that it was -transverse with respect to the perineum; and indeed, it is natural to -suppose, when the stone was brought forward by the fingers, and the -neck only of the bladder was to be cut, that the incision should be -made in that direction. But those, who contend that the _transversa -plaga_ was made transverse with respect only to the first incision, -may urge, that Celsus in this very passage orders the incision of the -neck of the bladder to be made so large, that the opening in the _iter -urinæ_ may exceed the dimensions of the stone. If, therefore, Celsus in -this place intends that the urethra should be opened, one would suppose -the incision must be made according to the length of that canal; but I -believe it may be questioned, whether Celsus is sufficiently accurate -in his notions of the anatomy of these parts, to determine his meaning -by that expression. - -It is very remarkable, that how much soever this operation of Celsus’s -may have engaged the attention of later ages, neither Galen, Oribasius, -nor Ægineta make the least mention of his method: nay Ægineta (lib. -vi. cap. 60.) describes the cutting on the gripe nearly as it has been -practised in our own age. - -30. _A crotchet_, in the original _uncus_.) Our author here describes -the instrument he mentions, and as the use is the same, and the form -not very different from that once employed by modern surgeons, I have -taken the liberty to use their term. But the reader will please to -observe, that this _uncus_ is different from that mentioned in chapter -xxix. used in extracting a dead fœtus. - -31. _On the external part smooth._) As the ancient editions have -_exteriori_, which is made extremely clear by our author’s description, -_Qua corpori jungitur_, it is hardly worth while to observe that -_interiori_ in Linden must be an error of the press. - -32. _Knees._) Other copies have _inguinibus_, instead of _in genibus_. - -33. _Which by pressing upon the bladder._) Instead of _Atque vesicam -urgendo_, in Linden and Almeloveen, I read _Quæ vesicam urgendo_, with -Nicolaus, Pachel, Pinzi, and several other old editions. - -34. _Into the anus._ _In anum._) This is the reading of all the -copies, which I have seen; but it is highly probable our author -wrote _colem_ for _anum_. For as I see no propriety in introducing a -pipe into the anus, so in the very case before us, a catheter in the -urethra, is at present esteemed the best method of cure. - -35. _Sore places._) It appears that in this place, Celsus uses the -word _cicatrix_ for a wound as well as a scar, of which I do not -remember another instance in his work. - -36. _Which are brought to digestion._) I have here followed the -old reading, _in quibus pus moveri debet_, because I think it more -agreeable to our author’s practice.----Constantine had inserted _non_, -in which he was followed by Linden and Almeloveen; he supported his -correction by referring to p. 290. lib. 5. in the original, where -Celsus gives directions about a hæmorrhage from wounds; but I own I can -see nothing there to incline me to his opinion. - - - - -NOTES - -TO - -BOOK VIII. - - -1. Morgagni[JR], with Paaw, thinks it probable, that there is some -chasm in the text, because Celsus does not describe the coronal suture, -which he could not be ignorant of. - - [JR] Ep. 4. p. 91. - -2. _Over these muscles too, &c._ _Super bos quoque musculos, qui -tempora contegunt, os medium, in exteriorem partem inclinatam, positum -est._) Thus Linden and Almeloveen. All the other copies have, _sub -his musculis, qui tempora connectunt_; in the following words they -differ, which Ronsseus would read thus, _os medium in interiorem partem -inclinatam_; in this he was followed by Paaw, who was of opinion, that -Celsus intended here the _processus petrosus_; which Morgagni thinks -quite foreign to the question. It is probable, says the same author, -that Linden changed _sub his musculis_ into _super hos musculos_, to -make the description answer to the _processus zygomaticus_, which -our author describes a little after, under the name of _jugale_. His -own conjecture is, that Celsus wrote _sub his musculis, qui tempora -continent_, and that he meant that part of the temporal bone which is -covered by the crotaphite muscle. Morgag. Ep. 7. p. 212. 214. But as -this description of a bone is inserted in the midst of the sutures, -there is some foundation to suspect the whole to be an interpolation. - -3. _The maxilla is a soft bone._ _Maxilla vero est molle os._) Thus -all the editions read, but Morgagni[JS] suspects _molle_ should be -_mobile, a moveable bone_; for Celsus himself calls the sternum a -strong and hard bone, which is not to be compared in that respect with -the maxilla.--It is no objection to this reading, that the author adds, -_solaque ea movetur_, for that is to exclude the upper jaw-bone. The -reader will please to observe, that maxilla, by our author, is applied -only to the lower jaw-bone, for he includes the upper jaw-bones under -the malæ. - - [JS] Ep. 7. p. 211. - -4. _Is broader below._) I have here followed the proposed emendation -of Morgagni, _infra_ for _intra_. Ep. 1. p. 40. - -5. _And all the vertebræ._) What follows relating to the structure -and connection of the vertebræ, appears to be very much corrupted, in -so much, that the reading in all the copies makes our author contradict -himself. I shall be content with mentioning some observations of -Morgagni’s upon the reading of Linden. The words in the parenthesis -(says he) _exceptis tribus summis_, _except the three uppermost_, were -surely never wrote by Celsus, at least not as they stand; for if the -three first vertebræ want depressions in their superior surfaces, how -comes the first to receive into its depressions the two small processes -of the head, as our author immediately adds? - -The adding of _parvis_ to _tuberibus_ he judges to be superfluous, -because Celsus had said just before _exiguis ejus processibus_. He -conjectures that _secunda superioris parti inferiori inseritur_ is -interpolated, because the connection is more natural without these -words. A little after follows _tertia eodem modo secundam excipit_, as -if a process stood out from the inferior part of the second vertebra, -to be surrounded by the third in the same manner, that its processus -dentatus is surrounded by the first; so that all these five words he -seems with justice inclined to expunge. - -After these Linden adds, _Jamque vertebra tertia tubercula, quæ -inferiori inserantur, excipit_; which at first view must appear highly -absurd. I therefore have followed, in the translation, the reading of -Nicolaus, Pachel, Pinzi, Stephens, and Morgagni’s manuscript, _exigit_ -for _excipit_.--See Morgagni Ep. vii. from 173 to 177. - -6. _The six inferior ones._) Almeloveen and Linden read here _septem_ -inferiores, others write _undecim_, as if the following description -related to all the ribs. But that is false, as appears by the sequel, -and it is plain, from the whole passage, our author could write nothing -else than _sex_. - -7. _But at the first rib, &c._) This whole paragraph is extremely -obscure. The variation of reading in the older copies does not in -the least lessen the difficulty. If we were allowed to understand by -_jugulum_, _the neck_, the whole description, lame as it is, could then -answer no bone but the _clavicle_; but _jugulum_ in no other place -of this work seems to be used for any thing else but the _clavicle_, -so that _id ipsum, &c._ would appear to be the beginning of the -description of that bone.--Morgagni thinks, that though the description -is far from just, yet that most of the words, as they now stand, -relate to the _spine of the scapula_, which may be said to sustain the -clavicle; and it is observable, that if our author does not intend the -_spina scapulæ_ here, he makes no mention of it at all. Vide Morgagni, -Ep. vii. p. 177. I must own the reading appears to me so much depraved, -that it is impossible to determine, precisely, what our author has had -in view. - -8. _Is a little concave, &c._) This translation follows Linden and -Almeloveen. In all the other copies the reading is _leniter gibbus, -et in priorem et posteriorem, interiorem et exteriorem partem_, as if -the bone was concave on no side. Morgagni[JT] therefore proposes a -reading agreeable to truth. _Leniter gibbus in priorem et posteriorem -et interiorem, cavus in exteriorem_; _i. e._ gently convex in its fore -and posterior, and internal part; concave externally. - - [JT] Ep. vii. p. 216. - -9. _The two bones of the fore arm at first, &c._) The reading in -Linden and Almeloveen is _primo vero duo radii et brachii ossa, &c._ -which at once appears to be wrong, because Celsus had said before, _quæ -res sedem brachio præstat, quod constat ex duobus ossibus_, to which -two he immediately gives the names of Radius and Cubitus, so that it -would be sufficient, as Morgagni observes, to have wrote _duo brachii -ossa_, or if they must be named _duo radii et cubiti ossa_ according to -the first of which I have translated. The other editions have _primo -vero duobus radiis brachii ossa_. See Morgagni, Ep. i. p. 28. - -10. _Properly enough, &c._) _Sura_ was the Roman name for the calf of -the leg, whence our author says, that name is properly enough given to -the fibula. - -11. _The same may be collected._) _Colligi idem potest._ Morgagni[JU] -would have the old reading restored here, _nigrities colligi quidem -potest_. _A blackness may be discovered_, &c. because these words in -the next chapter, _sive autem nigrities quam terebra detexit, &c._ make -it plain the terebra was only used in sounding the blackness. - - [JU] Ep. vi. p. 159. - -12. _But if the blackness goes thorough._) Sin autem nigrities, and -then there follows _est aut si caries_, which appears a manifest error -by reason of what follows. With Constantine and Ronsseus, I therefore -judge these words should be expunged, and have taken no notice of them -in the translation. - -13. _Is made by the angle of a chisel._) I here take the reading of -the older editions, _angulo scalpri sinus exiguus fit_. I suppose _sit_ -in Linden and the later copies has been a typographical error. See -Morgagni, Ep. vi. p. 162. - -14. _Being raised in the same._) I have here translated agreeably -to the old reading _excitatæ nares_, instead of which, by a palpable -error, Linden and Almeloveen had _exercitatæ nares_. Morgagni, Ep. i. -p. 29. - -15. _The swelled part._) In Almeloveen and Linden it is _tumens -locus_, instead of which the old reading was better, _tum is locus_, -_then this par_t; because our author had not mentioned any swelling -before. Vid. Morgagni, Ep. v. p. 140. - -16. _For if any part is separated from a vertebra, or is any way -broken._) This is according to the reading of Linden and Almeloveen; -but several of the older copies have _Si id, quod ex vertebra excedit, -aliquo modo fractum est_; that is, _If the part, that stands out from a -vertebra (the spinal process) is any way fractured_. This agrees very -well with what is said afterwards of the fragments being spinous. - -17. _Which should be rolled about the fracture._ _Quæ circa fracturam -ter voluta._) I find no various reading in any of the editions, but -I think I can produce one from our author himself, who is far from a -profusion of words and repetitions, and thinks this circumstance of -importance enough to make a rule bcsy itself in the following words; -_Satisque est eam ter hoc quoque modo circuere_. Upon his authority I -have therefore ventured to omit the first _ter_. - -18. _And if means only are found, &c._) The period in Linden and -Almeloveen runs thus, _Ac, si nihil aliud quam dolori occurrendum est, -idem, qui fuit, ejus usus est_; that is, ‘And if nothing else is to be -done but to remove the pain, its use continues the same as before.’ As -it is evident this cannot be our author’s meaning, I have followed in -the translation the old reading _occursum_ for _occurrendum_. - -19. _Broader than the wound._) I follow here the old reading -_latioribus_ for _laxioribus_ in Linden, of which I could find no -proper sense. In the following words I have also removed the point at -_vulnus potest_ as the ancient editions have it, and the connection -seems to require. - -20. _Must be applied with that part, &c._) This is according to -Linden’s edition.--None of the more ancient seem to give the true -reading of this whole passage taken together, but some of them afford -hints. Instead of _Acutæ ossis prominentis cuspidi_, Pinzi has _Recte -se habendi capiti_; others _Recte se habenti capiti_. Upon the whole I -think Morgagni’s[JV] reflections upon this passage extremely probable; -our author had before ordered a sharp point of a fragment to be either -cut off or filed down and smoothed: he is now considering how the -fragment itself is to be replaced. If we read it thus, the sense seems -to be pretty clear: _Vulsella, quali fabri utuntur, injicienda est -capiti ossis recte habenti, ab ea parte, qua sima est, &c._ that is, -‘A workman’s vulsella should be applied with that part, which turns -inward, to the sound end of the bone, that by its convex part the -prominent bone may be thrust into its place.’ - - [JV] Ep. v. p. 129. - -21. _Unite obliquely._ _Solent tamen interdum adversa inter se ossa -confervere._) Thus Linden and Almeloveen.--But by what follows it is -plain _adversa_ was never wrote by our author in this place. Many -editions have _transversa_; others _diversa_, which I think is the -only probable reading, and have taken it in the same sense as Morgagni -does.--Ep. vi. p. 164. - -22. _Of the scapula recedes from the humerus._ _Os scapularum ab -humero recedit._) Morgagni very ingeniously suspects that instead of -_ab humero_ our author wrote _ab jugulo_, because the clavicle is -joined with the scapula, as the tibia with the fibula. Ep. vii. p. 209. -As it now stands _ab humero_, it would come under the second head; -_Modo articuli suis sedibus excidunt_. - -23. _Yet it is of no use._ _Et ut aliquid decoris eo loco, sic nihil -usus admittitur._) Thus Linden and Almeloveen, and I find no other -variation in any of the copies, except _sit_ for _sic_, which does not -alter the sense. Our author had said immediately before, ‘That bones -thus separated never come together again,’ which makes it improbable -he would add, ‘That some comeliness would remain.’ For this reason -I suspect we should read _amittitur_ for _admittitur_, and then the -meaning will be quite opposite, thus, ‘And though their comeliness is -impaired, yet their use continues the same as before.’ - -24. _Is less firmly held after it is reduced._) In a luxation of the -humerus from a lax habit Hippocrates advises the use of the actual -cautery, but with great caution, for fear of injuring the blood vessels -or tendons; and when the ulcers are clean and fit for cicatrizing, to -bind the arm close down to the side, and allow no motion, that the -cicatrix may contract the part the more, and strengthen the joint. -He censures the practice of his predecessors, who cauterized on the -external and anterior side, which ever way the bone had been luxated, -and observes that when the humerus is liable to slip into the arm-pit, -this would rather push it downward, than prevent its luxation. He -proposed therefore the new method of applying the cautery to that part, -toward which the bone is liable to be protruded. Hippocrat. de Articul. -p. 787, 788, and 789. - -25. _That even frequent speaking, by the motion of the mouth, hurts -the nerves of the temples._) This is according to the reading of Linden -and Almeloveen. The old editions have _adeo ut sermo quoque frequens -motu oris per nervos lædat_; that is, _that even frequent speaking, by -the motion of the mouth by the nerves, hurts_. See Morgagni, ep. v. p. -130. - -26. _Tone of the nerves be restored._) I follow here the old editions -in reading _restituta_ for _destituta_. - -27. _That the finger may be restored, &c._) In Linden and Almeloveen, -_ut ita in locum, unde lapsus est digitus, restituatur_. [JW]Morgagni -observes, that our author had said, there were as many different cases -and the same signs as in the hands; but according to this reading he -takes no notice of the cure of lateral luxations. Whereas the whole is -set right by restoring the old reading, which was, instead of these -words, that are quoted from the original, _Atque id, quod in latus -elapsum est, digitis restitui_, _i. e._ “and that which is luxated -laterally ought to be reduced by the fingers.” - - [JW] Ep. vi. p. 166. - -28. _Having treated of the humerus._) _Cum de humeris dixerim._ -We might here (says Morgagni) have taken _humeris_ for the superior -extremities as _cruribus_ for the inferior, but the MS. and all my -editions have _cum de his dixerim: de his quoque_ (or as Stephens has -it _de iis quoque_) _quæ in cruribus, &c._ Ep. vi. p. 167. - -29. _By keeping the middle or upper part of the joint in some -canaliculus._) This whole sentence _Potest tamen conditus articulus -medius aut summus canaliculo aliquo contineri_, in all the old -editions is placed at the end of the _24th_ chap. and not here.--But -[JX]Morgagni suspects, and as it appears to me, very justly, it should -be rather referred to luxated fingers than toes, and that Linden -guided by some MS. had transferred it from the _24th_ to the _19th_, -from whence it was transposed to this place by the carelessness of the -copiers, where it stands very improperly. - - [JX] Ep. vi. p. 169. - - - - -THE - -INDEX. - -N.B.--n. _refers to the notes_. - - - A. Page - - Abstinence, too great, hurtful, 18 - - ---- of two kinds, 71 - - Acopon what, n., 26 - - Acorum, n., 21 - - Actions, natural what, 4 - - Æsculapius, why deified, 1 - - ---- register kept at his temple, its use, n., 1 - - Ages, the proper regimen for each, 25 - - ---- what reasons favourable or hurtful to each, 36 - - ---- the peculiar disorders of each, 37 - - Alica, n., 12 - - Allum, n., 27 - - Alopecia, 263 - - Ammoniacum thymiama, n., 31 - - Ammonius Alexandrinus, an improver of surgery, 309 - - Andreas, 186 - - Antimony, n., 30 - - ---- washed, n., 38 - - Aphronitre, n., 28 - - Apollonius, an empiric, 3 - - Apollonius Mus, 186 - - Apollonii, two surgeons, 309 - - Apples (poma) what, n., 6 - - Asclepiades alters the method of practice, 3 - - ---- finds a man carried to burial alive, 45 - - ---- his book upon general remedies, 68 - - ---- account of the duty of a physician, 91 - - ---- practice in a tertian, 111 - - Autumn the most dangerous season, and why, 34 - - ---- its usual distempers, 35 - - - B. - - Balsam, n., 20 - - Baths, ancient described, n., 4 - - ---- their use, 72 - - ---- cautions concerning them, 72 - - ---- whether proper in fevers, 72 - - Beef sometimes most easily concocted, 160 - - Berry gnidian, n., 28 - - Bleeding, the proper subjects for it, 60-61 - - ---- how to be performed, and where, 62 - - ---- dangers attending the operation, 63 - - Boys to be differently treated from men in distempers, 103 - - - C. - - Cachexia, its causes, 129 - - Cachrys, n., 31 - - Cadmia, n., 29 - - Cardamomum, n., 20 - - Caries, its depth how known, 389 - - Cassia black, n., 33 - - Cassius an ingenious physician in Celsus’s time, 14-172 - - Catapotia what, n., 20 - - Causes of diseases occult and evident, 3 - - Cedria, n., 31 - - Celsus his opinion in the controversy between the rationalists - and empiricks, 9-11 - - ---- of the methodists, 12 - - ---- use of dissections, 15 - - ---- his complaints of the conduct of patients, 71 - - ---- says one physician cannot attend many patients, 93 - - ---- his practice with regard to food in continued fevers, n., 16 - - ---- in a tertian, 111 - - ---- opinion of the paracentesis, 128 - - ---- practice in a jaundice, 136 - - ---- whether the drink should be cold or hot in a purging, 177 - - Cerastes, n., 35 - - Ceruss burnt, n., 32 - - Chalk Cimolian, n., 14 - - Chalcitis, n., 27 - - Changes in the way of life to be gradual, 19 - - ---- of place, 19 - - Changing a disease, sometimes useful, 106 - - Chersydrus, 239 - - Chirurgery the most ancient branch of medicine, 2 - - ---- its effects the most evident, 308 - - ---- its province, 309 - - Chrysippus a physician, 2 - - Chrysocolla, n., 28 - - Cleophantus his practice in a tertian, 111 - - Clibanum, n., 10 - - Clysters, when proper, 65 - - ---- their kinds and management, 66 - - ---- for nourishing, 122 - - Coition, when to be used, 16 - - Cold, to whom useful, and hurtful, 30 - - Coldness what, 90 - - Collyrium what, and how used, n., 37 - - ---- of Nileus the best of all, 271 - - Colour, what portends an approaching illness, 38 - - Conchylia, n., 11 - - Concoction, various opinions about it, 5 - - Copper, scales of, n., 10 - - ---- calcined, n., 28 - - ---- flower of, n., 29 - - Crocomagma what, n., 31 - - Cupping, its uses, 64 - - Cutiliæ, n., 24 - - Cyperus long and round, n., 21 - - Cytisus, n., 24 - - - D. - - Days critical, 94 - - Defrutum, n., 7 - - Delirium, in the paroxysm of an intermittent, not dangerous, 114 - - Democritus skilled in medicine, 2 - - ---- declared the marks of death fallacious, 45 - - Dietetice a part of physic, 3 - - ---- differently treated by the rationalists and empirics, 4 - - Digestion what, n., 2 - - Diocles the Carystian, 2 - - ---- his graphiscus for extracting weapons, 318 - - Diphryges, n., 29 - - Dipsas, n., 35 - - Diseases attributed to the anger of the gods, 1 - - ---- unknown, instance of one, 10 - - ---- increasing and declining, their marks, 87 - - Diuretics not good in disorders of the fauces, 154 - - Drink, astringent, what, 178 - - Dropsy, more easily cured in slaves than free men, 124 - - - E. - - Ears, the danger of their disorders, 281 - - Earth, Eretrian, n., 30 - - Empedocles, skilled in medicine, 2 - - Empirics, their doctrine and arguments, 6-11 - - Erasistratus, a physician, 2 - - ---- dissected living bodies, 5 - - ---- his opinion about drinking in fevers, 92 - - Euelpistus, an improver of surgery, 309 - - Excess, small, less dangerous in drinking than eating, 18 - - Exercises proper for the valetudinary after employment, 17 - - ---- what and how long, 18 - - - F. - - Far, what, n., 15 - - Fatigue, management after, 19-21 - - Ferula, n., 24 - - Fevers, what not dangerous, 39 - - ---- bad, 40 - - ---- prognostics of their continuance, 41 - - ---- not easily known from the pulse, or heat, 100 - - Fevers, marks of their presence, 101 - - ---- what discharges necessary in them, and when, 102 - - Fibula, n., 34 - - Fistula, opposite to the intestines, dangerous, 315 - - Fomentations, warm, what their effects, 74 - - Food, when given in fevers by the ancients, 92 - - ---- a variety of it when useful, 101 - - Foramina, in the head, how many, 382 - - Frankincense, n., 23 - - ---- soot of, n., 28 - - Fractures of the skull how discovered, 393-394 - - Friction, its various effects all depending on one principle, 68 - - ---- the proper times for using it, and its degrees, 69 - - - G. - - Garum, n., 13 - - Gestation, when proper, 70 - - ---- its various kinds, 70 - - Glaucias, an empiric, 3 - - Gorgias, an improver of surgery, 309 - - Gum, n., 27 - - ---- in the eyes, n., 38 - - Gypsum, what, n., 15 - - - H. - - Habits of body, different regimen for them, 22 - - ---- corpulent and slender, diseases of, 38 - - Heat, to whom useful and hurtful, 31 - - Hæmorrhois, n., 35 - - Hellebore, white, when properly used for purging, 65 - - Heraclides of Tarentum, an empiric, 3 - - ---- his practice in a quartan condemned, 112 - - Heron, two of that name improvers of surgery, 309 - - Herophilus an empiric, 2 - - ---- dissected living bodies, 5 - - Hippocrates, the first that separated medicine from philosophy, 2 - - ---- said to be the disciple of Democritus, 2 - - ---- delivers the best prognostics, 33 - - ---- gives short and full directions for friction, 68 - - ---- his doctrine of critical days refuted by Celsus, 94 - - ---- deceived by the sutures, 394 - - Hours, the Roman, n., 8 - - Hydromel, how made, n., 10 - - Hypocistis, n., 29 - - Hyssop, how used for a vomit, by Hippocrates, n., 6 - - - I. - - Iatrolipta, what, n., 4 - - Ignis sacer, n., 33 - - Infibulating boys, the method, 361 - - Inflammation, its marks, 107 - - Incisions, general rules for them, 312 - - Intrita, what, n., 16 - - Intestines, their wounds, whether curable, 345 - - Issues, general rule about them, 181 - - - L. - - Laser, what, n., 17 - - Lead, calcined, n., 27 - - ---- dross of, n., 30 - - ---- washed, n., 31 - - Lithotomy, the proper age, &c. for it, 363 - - ---- patient’s posture, 363 - - Lithotomy, the transverse wound, n., 44 - - ---- Meges’s improvement in the operation, 366 - - Lotus, n., 6 - - Lycium, n., 23 - - - M. - - Machaon, 1 - - Madness of Ajax and Orestes, what, n., 18 - - Malabathrum, n., 33 - - Malagma, n., 20 - - Matter, n., 30 - - Medicine, its design and rise, 1 - - ---- by whom improved, &c., 2 - - ---- how divided, 2 - - ---- a conjectural art, 10-46 - - Meges, the most learned surgeon, 309 - - ---- his account of the coat of an abscess censured, 311 - - Melinum, n., 27 - - Methodists, their doctrine, 11 - - Metrodorus, his management under a dropsy, 125 - - Milk, when hurtful and where proper, 131 - - Mind, to be kept easy in sickness, 99 - - Minium, what, n., 25 - - Misy, n., 27 - - Mulse, n., 6 - - Myrrh, called stacte, n., 33 - - - N. - - Nard, n., 20 - - ---- ointment of, n., 31 - - Nature, its great power, 55 - - Navel, a tumour of, its causes, 342 - - Nitre, n., 15 - - - O. - - Oesypum, n., 32 - - Oil, cicine, n., 32 - - ---- cyprine, n., 15 - - ---- of iris, n., 15 - - ---- of laurel, n., 31 - - ---- of myrtle, n., 14 - - ---- of quinces, 14 - - ---- of roses, 14 - - ---- Syrian, n., 23 - - Ointment, Susine, n., 32 - - Omphacium, n., 28 - - Operations, chirurgical, the proper season for them, 324 - - Ophiasis, 263 - - - P. - - Palate, to be often consulted in medicines, 175 - - Panaces, n., 20 - - Panus, 248 - - Passum, how prepared, n., 12 - - Paper, burnt, n., 30 - - Pastinaca fish, 239 - - Pestilence, 2-31 - - Petron, remarkable for using contrary methods, 106 - - Phacia, 264 - - Phalangium, n., 36 - - Philosophers studied physic, and why, 2 - - Philoxenus, an improver of surgery, 309 - - Phrenitic patients, whether to be kept in the light or in - the dark, 116 - - ---- whether to be bled, 116 - - Phymosis, its chirurgical cure, 360 - - Podalirius, 1 - - Polenta, what, n., 19 - - Poppy tears, n., 30 - - Poison swallowed, more dangerous than a venomous bite or sting, 240 - - Praxagoras, 2 - - Prepuce, the operation for bringing that over the glans, 360 - - Preserves, hurtful, 19 - - Prognostics, certain, 44 - - Propolis, n., 28 - - Psoricum, n., 38 - - Psylli, 237 - - Pthisis, incident to the strongest age, 131 - - Ptisan, how prepared, n., 10 - - Pulse, pulticula, n., 12 - - Purging, when useful, 24-66 - - ---- when improper, 41-66 - - Pythagoras, skilled in physic, 2 - - - R. - - Rationalists, their doctrine and arguments, 3-6 - - Remedies, their operation, 59 - - ---- contrary, sometimes successful, 105 - - ---- but rash, 105 - - Rhus, Syrian, n., 39 - - Root, Pontic, n., 43 - - - S. - - Salamander, n., 29 - - Salsamentum, n., 11 - - Sansucus, n., 30 - - Seasons, the regimen for each, 25 - - ---- considered with regard to health, 34 - - Serapion, author of the empiric sect, 3 - - Sesamum, n., 24 - - Shuddering, a common cause of it, 109 - - Siligo, what, n., 11 - - Sleep, a good or bad sign, 38 - - Sory, n., 39 - - Sostratus, an improver of surgery, 309 - - Specillum asperatum, 276 - - ---- oricularium, 286 - - Spitting, what it indicates, 55 - - Spleen, contracted by smith’s forge water, how discovered, 165 - - Spodium, n., 29 - - Spring, its distempers, 34 - - Strigil, n., 38 - - Struthium, n., 30 - - Stone in the bladder, symptoms of, 48 - - ---- sarcophagus, n., 26 - - ---- Asian, 26 - - ---- Phrygian, n., 29 - - ---- scissile, 30 - - Stools good, 40 - - ---- bad, 42-46 - - Subruinæ, n., 24 - - Summer, its diseases, 34 - - Suppurations, their several causes, 50 - - ---- not yet visible how known, 51 - - ---- good and bad kinds, 55 - - Surgeon, qualifications of, 309 - - Sutures in the head, 382 - - ---- how they may deceive, 394 - - Sweats, what they indicate, 39 - - ---- how procured, 72 - - - T. - - Teda, n., 39 - - Thapsia, n., 31 - - Tharrias, his opinion and practice in a lethargy, 123 - - ---- practice in an ascites, 128 - - Themison a follower of Asclepiades, 3 - - ---- departs from him in his old age, 3 - - Tragum, n., 12 - - Tryphon, the father, an improver of surgery, 309 - - - U. Urine in sickness good, 40 - - ---- bad, 42 - - ---- its appearances, if a fever is to be tedious, 42 - - ---- various indications from it, 48 - - ---- how discharged by a catheter, 362 - - - V. - - Veins cauterized, their treatment after, 334 - - Verdigrease rasile, n., 32 - - Vervains what, 85 - - Vomits rejected by Asclepiades, 20 - - ---- when useful, 20 - - Vulsella, n., 39 - - - W. - - Water, its trial, 77 - - ---- cold, useful to the head, 27 - - Weather more or less healthful, 34 - - ---- the effects of the several kinds, 35 - - Winds, their effects upon the body, 35 - - ---- what most healthful, 35 - - Wine Aminæan, n., 22 - - ---- Allobrogic, n., 24 - - ---- Rhetic, 24 - - ---- Signine, 24 - - ---- salt, n., 6 - - ---- resinated, n., 13 - - -FINIS. - - _Printed by C. Stewart._ - - - - -_Just Published by DICKINSON & Co._ - -_Infirmary Street, Edinburgh._ - - - COLLOQUIA ANATOMICA, PHYSIOLOGICA, - - atque CHEMICA, - - Quæstionibus et Responsis; - - Ad usum INGENUAE JUVENTUTIS accommodata. - - Auctore - - ARCHIBALDO ROBERTSON, M.D. - - Et apud Edinenses Sermonum Practicorum de Arte - - Medicinali Praelectore. - - Editio Secunda. - - * * * * * - - LEXICON LINGUAE LATINAE - COMPENDIARIUM; - - Or, a COMPENDIOUS DICTIONARY of the LATIN TONGUE, - - BY THE LATE - - ALEXANDER ADAM, LL. D. - - Rector of the HIGH SCHOOL of EDINBURGH. - - SECOND EDITION. - - To which is added, - - An ENGLISH AND LATIN DICTIONARY, - - With an INDEX of PROPER NAMES, - - BY - - ADAM DICKINSON. - - - - -=Corrected misspellings= include the following: - - necesssary → necessary - belived → believed - plaintain → plantain - accout → account - paroxyms → paroxysm - cardamon → cardamom - prescriptipn → prescription - inflammmation → inflammation - w ich → which - n → in - wiound → wound - j w → jaw - humour → tumour - chissel → chisel - Hippocates → Hippocrates - Baslam → Balsam - the the → the - linimen → liniment - intrument → instrument - carelesness → carelessness - -=Spelling inconsistencies= include (but not limited to) the following: - - antient/ancient - aromatick/aromatic - cummin/cumin - diuretick/diuretic - encrease/increase - fore arm/fore-arm/forearm - haemorrhage/hæmorrhage/hemorrhage - milstone/mill-stone - teprion/tephrion - tremor/tremour - - -The following typographic errors have been corrected: - -a) the block of index entries commencing with U were incorrectly placed - _after_ V and have been repositioned; - -b) an incorrect index page reference to ‘Passum’ has been corrected; - -c) a group of Book V notes that were incorrectly numbered 89–96 have - been renumbered 84–91 to correspond with the text anchors; - -d) an incorrectly numbered note in Book V has been renumbered Note 63a; - -e) incorrectly numbered Note 1 in Book VI has been renumbered as Note - 92 in Book V. - -*** END OF THE PROJECT GUTENBERG EBOOK OF MEDICINE IN EIGHT BOOKS *** - -***** This file should be named 64207-0.txt or 64207-0.zip ***** -This and all associated files of various formats will be found in: - https://www.gutenberg.org/6/4/2/0/64207/ - -Updated editions will replace the previous one--the old editions will -be renamed. - -Creating the works from print editions not protected by U.S. copyright -law means that no one owns a United States copyright in these works, -so the Foundation (and you!) can copy and distribute it in the -United States without permission and without paying copyright -royalties. 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