BOOK III. (continued 2)

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

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

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

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

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

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

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

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

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

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

CHAP. XXIII. OF THE EPILEPSY AND ITS CURE.

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

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

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

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

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

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

CHAP. XXIV. OF THE JAUNDICE AND ITS CURE.

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

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

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

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

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

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

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

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

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

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

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

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

Of pain of the nerves.

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

Of a tremour of the nerves.

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

Of internal sup­pur­ations.

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

A. CORNELIUS CELSUS

OF

MEDICINE.