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 ].

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

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

Of pains of the head, and a hydro­ceph­alus.

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

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

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

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

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

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

Of the cyni­cus spas­mus.

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

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

Of a palsy of the tongue.

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

Of a catarrh and gravedo.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Of a dif­fi­culty of breath­ing.

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

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

Of an ulcer in the fauces.

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

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

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

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

Of a cough.

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

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

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

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

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

Of a spitting of blood.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Of an ex­ces­sive dis­charge of urine.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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