Transcriber’s notes:
This e-book has an unusual structure, being a compilation of eight
smaller books accompanied by eight related sets of _numbered_
explanatory notes provided by the author. It also contains several
hundred footnotes scattered throughout the text (many being Greek
spellings of words in the text). These have been given _alphabetic_
labels and are now grouped together as endnotes.
Numerous asterisks are present in parts of the text; these represent
uncertain quantities, not footnotes. The text also contains archaic
characters that may not display correctly with all viewing devices or
fonts. For best viewing, the device’s character encoding should be set
to Unicode (UTF-8), and one of the following fonts selected: Arial
Unicode MS, DejaVu, Segoe UI Symbol or FreeSerif.
The text has been preserved as in the original, including inconsistent
punctuation, capitalisation and hyphenation. Archaic and
inconsistent spellings have been retained except where obviously
misspelled in the original. A list of these and other corrections has
been appended at the end.
A. CORN. CELSUS
OF
MEDICINE
_IN EIGHT BOOKS_.
TRANSLATED
WITH NOTES CRITICAL AND EXPLANATORY
BY
JAMES GREIVE, M.D.
_A NEW EDITION._
EDINBURGH:
Printed at the University Press;
FOR DICKINSON AND COMPANY, INFIRMARY-STREET.
1814.
TO
MR SHARP,
SURGEON TO GUY’S HOSPITAL,
FELLOW OF THE ROYAL SOCIETY,
AND
MEMBER OF THE ROYAL ACADEMY OF SURGERY AT PARIS.
SIR,
The favourable opinion you have been pleased to express of the
following translation, and the trouble you have taken to revise the
chirurgical part, are obligations, which I embrace this opportunity of
acknowledging with the highest pleasure.
And though I had not received such marks of your friendship, yet there
is no person, to whom a translation of CELSUS can be more properly
addressed; since no writer in this age appears to have a more just
esteem for this excellent author, or to have imitated his conciseness
and elegance, with so much success.
I am,
with great esteem,
SIR,
your most obedient,
humble servant,
JAMES GREIVE.
LONDON, _January 26th, 1756_.
PREFACE.
It has been a question much debated, whether, and how far the writings
of the ancient physicians are of service to direct our practice in
the cure of diseases; but without repeating what has been already
said on this point, I imagine their usefulness may be inferred from
this single consideration, that the mechanism of the human body being
always and every where the same, a faithful history of diseases must
necessarily be one of the surest guides to the application of proper
remedies. Moreover, if the diagnostics and prognostics be of the
greatest moment in physic, and are only to be collected from long and
accurate observation, then the records left us by the ancients, who
were so assiduous in their observations, so clear and exact in their
descriptions, must be allowed to contain a valuable treasure of medical
knowledge.
We have seen, in the present age, many learned physicians, who, though
they readily admit the improvements of the moderns, nevertheless apply
themselves with great industry to the study of the ancients; and
indeed, to say nothing of the superiority of some of the ancients in
stile and composition, as a matter of taste, I think it can hardly
be denied, that a man, capable of making proper allowances for the
variations in respect of climate and manner of living, may receive
great benefit from the materials left us by these ingenious writers
of antiquity, and find many hints, which, pursued with diligence, and
applied with caution, may both correct and enlarge his practice.
Celsus is justly esteemed one of the most valuable amongst the
ancients. He is so often quoted, with approbation, by our best writers
in physic, and so much admired by the learned world for propriety,
ease, and elegance, that it is a needless attempt in these days to draw
his character. However, he is so little mentioned by the ancients, that
our curiosity cannot be gratified with any particulars of his life; nor
can we even determine what was his profession, if it does not appear
from his writings.
Quintilian often mentions a treatise of his upon rhetoric, which though
he hardly ever quotes, but where he differs from him, he allows to be
composed with accuracy. But whatever he thought of his oratory, he
gives an honourable testimony to the extent of his learning. For to
persuade his student of eloquence to make himself master of all the
sciences, after mentioning the greatest geniuses that ever appeared in
Greece or Rome, as Homer, Plato, Aristotle, Cato the censor, Varro,
and Cicero, he adds, “Why should I name any more instances? when even
Cornelius Celsus, a man of a moderate share of genius, has not only
composed treatises on all these arts, but has also left precepts of
the military art, agriculture, and medicine. The bare attempt requires
us to believe he understood all these subjects: but to give perfection
to so great a work is a difficult task, to which no man was ever found
equal[A].”
[A] Fab. Quintilian, lib. xii. c. 11.
Some have complained of the partiality, or jealousy of the rhetorician,
who allows Celsus only a moderate share of genius. Others esteem it
no diminution to be placed in a rank below the writers above named.
Without doubt, this would do him very great honour: but if we even
take the character literally, still we are to consider Quintilian as
having every where in view the perfection of oratory. Now this, it
should appear, Celsus hardly affected, by his confining the orator
to questions in dispute[B]; which in great measure excludes the
descriptive and moving parts of the art: therefore Quintilian’s man
of middling genius may be a perfect writer in the instructive manner,
though he want the qualifications for the bar or the forum. But to do
Celsus some farther honour, may it not be supposed, that had Quintilian
been as competent a judge of his medical, as of his rhetorical
writings, he would not have stiled him, _Vir mediocri ingenio_. I
have made bold to hazard this observation from an opinion, that none
but a physician can form a just idea of the excellence of this work;
much less could any but a physician be the author of it. Celsus the
physician might very well write on agriculture, &c. but it by no means
follows, that Celsus, not versed in the practice of physic, could
have written accurately on diseases. If then this notion be just, it
may reasonably be concluded, that his medical writings were the most
perfect, as being the fruit of his principal and particular studies.
[B] Id. lib. iii. c. 5.
Columella (_De re rustica_) often quotes him with great deference to
his authority; he equals him to the most learned writers on husbandry;
and when he is correcting a vulgar error, expresses his surprise
that Cornelius Celsus could be misled, “who was not only skilled in
agriculture, but took in the whole compass of natural knowledge[C].” I
shall not recite all the passages, where he mentions Celsus, but cannot
help transcribing one, it is so expressive of our author’s manner. It
is on the article of bees, “concerning which (says he) it is impossible
to surpass the diligence of Hyginus, the profusion of ornaments in
Virgil, and the _elegance_ of Celsus. Hyginus has with great industry
collected the precepts, which lay scattered in the ancients; Virgil
has adorned the subject with poetic flowers; and in Celsus we find a
judicious mixture of both these manners[D].”
[C] Columell. lib. 2. c. 2.
[D] Id. lib. ix. c. 2.
From Columella’s mentioning Celsus as a contemporary, but not as
a living writer[E], and our author’s speaking of Themison in the
same manner[F], Le Clerc infers, with great probability, that Celsus
wrote towards the latter end of the reign of Augustus, or at latest,
in the beginning of Tiberius; in which last period he is placed by
Fabricius[G]. And that he cannot have been later, appears not only from
these authorities, but almost undeniably from the purity and elegance
of his style, more nearly allied to the Augustan, than any of the
succeeding ages.
[E] Id. lib. i. c. 1.
[F] Celsi praefat. lib. i.
[G] Biblioth. Latin. lib. ii. c. 4.
Both Columella and Quintilian seem to speak of him as a Roman, and
indeed our author himself, when he is giving the Greek name for any
distemper, and is to add the Roman, frequently uses this phrase,
_nostri vocant, our countrymen call it_, or some other expression of
the same nature[H].
[H] _Nostri anginam vocant_, lib. iv. c. 4.--_Apud nos indecorum, sed
commune his herniae nomen est_, lib. vii. c. 18.--_Nostri vero sub
eodem nomine, quo priora habent_, ib.
We have seen by the above quotations, how many treatises were composed
by Celsus, which have all perished in the barbarous ages, except this
work on medicine; which from the manner of its beginning, _Ut alimenta
sanis corporibus agricultura, sic medicina ægris sanitatem promittit_,
seems to have immediately followed his book on husbandry: for this
easy transition is very common with our author in connecting different
subjects. What confirms this is, that H. Stephens, upon the authority
of an ancient manuscript, has prefixed as the title, _Aurelii Cornelii
Celsi de re medica libri octo; operis ab eo scripti de artibus pars
sexta_. It would be still more evident, if we could depend upon the
manuscript in the library of Alex. Paduan: in which, at the end of
the fourth book is written, _Artium Cornelii Celsi liber nonus, idem
medicinæ liber quartus explicit feliciter_[I]. For his agriculture
contained five books[J], with which the first four of this work make up
the nine.
[I] Morgagni Ep. 2. p. 41.
[J] _Quippe Cornelius totum corpus disciplinae quinque libris
complexus est_, Columell. lib. 1. c. 1.
Every trifling circumstance relating to our author has employed the
industry of his learned commentators. The English reader will therefore
forgive me for observing, that in most of the manuscripts, his name
is written A. Cornelius Celsus. And Rubeus informs us, the ancient
manuscript in the Vatican library has this title, _Auli Cornelii Celsi
liber sextus, idemque medicinæ primus_. As _Aurelius_ was the name of
a Roman family, it is not probable that this would be his praenomen;
on the contrary, _Aulus_ is found to be a common praenomen in the
Cornelian family[K]. For these reasons, I read his name A. that is
_Aulus, &c._ instead of _Aurelius_, as most of the printed copies have
it.
[K] Morgagni Ep. iv. p. 75.
From our author’s admirable abstract of the history of physic, it is
easy to see he had studied and thoroughly digested the writings of the
preceding physicians, and been attentive to the practice, as well as
to the arguments of the several sects. We have no reason to doubt he
made the best use of them; for we see that he confined himself to no
one party, but selected from each what he judged to be most salutary.
Though he has quoted many authors, sometimes with a view to recommend
their practice in particular cases, at other times to shew the
impropriety of it; yet through the whole, Hippocrates and Asclepiades
seem to have been highest in his esteem; but he does not give up his
judgment implicitly to these for he often leaves both, and advances
very good reasons for differing from them. He ingenuously owns[L],
that he has borrowed the prognostics from Hippocrates, “because,” says
he, “though the moderns have made alterations in the method of curing,
nevertheless they allow, that he has left the best prognostics.” With
regard to the critical days, he entirely condemns his doctrine, and
follows Asclepiades in rejecting the notion as idle and chimerical[M].
But from both these authors he dissents in his rules about bleeding.
[L] Præfat. lib. ii.
[M] Lib. iii. c. 4.
It would be superfluous for me to prefix to this translation a general
view of Celsus’s practice in the various diseases; for besides that
this is already done by the learned Le Clerc[N], our author’s method
is so clear and concise, that the reader will acquire, with ease, the
most perfect idea from the book itself.
[N] Histoire de la medicine, P. ii. liv. iv. sect. ii. chap. 4, &c.
Whenever he differs in opinion from writers, whose authority he
otherwise reveres, we find his reasoning modest, concise, close, and
admirably well adapted to the subject in dispute; but the delicacy
of his expression, when he condemns others, and the caution with
which he avoids speaking of himself, have led some to believe he was
not a practitioner: though the strongest argument against his having
practised physic is drawn from the silence of Pliny, who names Celsus,
in several books, among the authors from whom he took his materials,
and never ranks him in the list of physicians, whom he separates
from the others. But I am surprised it has escaped the observation
of the critics, that these catalogues of physicians consist only of
foreigners, whom Pliny distinguishes from other foreigners, who were
not physicians; whereas Celsus stands always amongst the Romans. Now
Pliny, in his list of Roman writers, has not noted their several
professions: for in most of the places, where we read the name of
Celsus, we also find that of Antonius Castor, without any mention of
his profession, though Pliny himself in another place tells us[O], he
was a physician of great reputation, whom he saw living in retirement,
and cultivating a kind of physic-garden, when he was above an
hundred years old. Thus, the name of Antonius Castor would have been
lost with his writings, notwithstanding the figure he made among his
contemporaries, had he not happened to be mentioned by Pliny. And hence
it appears, that nothing can be inferred from the silence of Pliny and
the other ancients, in regard to the profession of Celsus; though he
should not be Cornelius the physician, mentioned by Galen, as Le Clerc
thinks it probable he is.
[O] Plin. Nat. Hist. lib. xxv. c. 2.
I might have urged many passages in this book to prove that he was a
physician, if I had not reason to think the present age is already
satisfied in that point. There are two, however, so remarkable, that
they ought not to be omitted. When our author is considering the proper
time for allowing nourishment, after saying that some gave their
patients food in the evening, he gives reasons against that method,
and then adds, “_Ob haec ad mediam noctem decurro_, i. e. For these
reasons I defer it till midnight.” Thus most of the older copies read,
and also Morgagni’s manuscript; so that Linden is not easily to be
forgiven for making alterations in so material a place[P]. In the other
passages there is no variation in the reading. In that species of the
ancyloblepharon, where the eye-lid unites with the white of the eye,
our author, after describing the method of cure, immediately adds,
“_Ego sic restitutum neminem memini. Meges se quoque multa_, &c. _i.
e._ I do not remember an instance of any person cured in this way.
Meges also has told us that he has tried many methods, and never was
successful, because the eye-lid always united again to the eye[Q].” The
form of expression here used by our author, in a manner peculiar to
a practitioner, would come very improperly from a mere compiler. The
connection of these two sentences by _quoque_ seems to put our author’s
own observation upon the same footing with that of Meges, whom he
quotes on several occasions as a most accomplished surgeon[R].
[P] Lib. iii. c. 5.
[Q] Lib. vii. c. 7. See Le Clerc.
[R] Though numberless passages will occur in the course of the book,
where Celsus expressly delivers his own judgment, yet as the reader
may perhaps chuse to have some of the most remarkable at one view,
the following references will serve for that purpose. Lib. i. c. 3.
p. 30. _Neque ignoro_, &c. _Commoneo tamen_, &c. Lib. ii. c. 14. p.
88. _Quas tamen_, &c. p. 89. _Neque ignoro quosdam_, &c. Lib. iii. c.
2. p. 140. _Ego tum hoc puto_, &c. c. 14. p. 144. _Tutius tamen_, &c.
c. 18. p. 150. _Quid igitur est_, &c. Lib. iv. c. 4. p. 200. _Melius
huic rei_, &c. c. 17. p. 227. _Interdum teretes videmus_, &c. c. 19.
p. 230. _Ego experimentis_, &c. Lib. vi. c. 4. p. 345. _Sed nihil
melius est_, &c. Lib. vii. c. 12. p. 446. _Ego autem cognovi_, &c.
c. 14. p. 450. _Sed abunde est_, &c. Lib. viii. c. 2. p. 509. _Neque
audiendi_, &c. c. 3. p. 512. _Ut quando os perrumpitur, sentiamus_,
&c. c. 4. p. 517. _Sed multo melius est_, &c. c. 8. p. 528. _Ex
dolore colligimus_, &c. c. 13. p. 546. _Ponendum autem hoc esse
credidi_, &c. Any person, who will be at the pains to examine these
passages, will easily see, that they strongly support the conclusion
drawn from the two above recited. [See Linden or Almeloveen’s
edition.]
It may not be amiss, however, to take notice of a distinction Celsus
makes between two kinds of professors of physic. When he is shewing
the necessity of circumspection in the physician, he adds, “From[S]
these things it may be inferred, that many people cannot be attended
by one physician; and that the man to be trusted is he, who knows his
profession, and is not much absent from the patient. But they, who
practice from views of gain, because their profits rise in proportion
to the number of patients, readily fall in with such rules, as do not
require a close attendance, as in this very case. For it is easy for
such as seldom see the patient, to count the days and the paroxysms:
but it is necessary for him to sit by his patient, who would form a
true judgment of what is alone fit to be done, when he will be too
weak, unless he get food.” As his censure is so severe upon a practice,
which he thought too extensive, it is natural to suppose, that his
was confined to his acquaintance, and that his fortune and generosity
rendered him superior to the view of living by the profession.
[S] Lib. iii. c. 4.
To all the later copies of Celsus is prefixed an index of the several
editions, which makes it needless for me to give an account of them.
All the older ones, printed in the fifteenth and sixteenth centuries,
abound with numberless gross errors, that in many places utterly
destroy the construction. These, Vander Linden undertook to correct,
and the authorities he used for that purpose are contained in a
catalogue annexed to his preface, in which he tells us he has made very
few changes from his own conjecture, and none of these, but where the
subject evidently required them. In the dedication he says, “Who would
imagine, that after the diligent labours of so many illustrious men,
as Egnatius, Cæsarius, Constantine, Stephens, Pantinus, Ronsseus, and
Rubeus, I should have corrections to make in more than two thousand
places?”
As it was proper I should translate from one particular edition, I
chose for that purpose Linden’s; or Almeloveen’s, who has followed
him almost in every letter; as these are generally esteemed by far
the most correct: though it must be owned, that Linden has made many
alterations without necessity, and sometimes for the worse. Where the
sense was either obscure or inconsistent with the context, I have
often been assisted by the more ancient editions. On such occasions I
have given my authority and reasons in the notes. In passages where I
found a reading in the old copies much preferable to Linden’s, but not
altogether necessary upon account of the sense, I have marked it in a
note, without adopting it into the next.
There are very few places, where I have ventured to alter the reading
on my own conjecture, and these are all noted in the margin, where I
have assigned my reasons, which, I hope, will convince the learned
reader. My notes will shew in how many instances I have been obliged to
the excellent epistles of Morgagni. This learned and ingenious author
has, in my opinion, entered more into the spirit and true meaning of
Celsus, than any of the preceding commentators[T].
[T] The first three of these epistles were annexed to an edition
of Celsus, by Vulpius, at Padua, in the year 1722; five more were
added to another by the same editor in the year 1752; in both which
editions he has every where followed (only correcting typographical
errors) the text of Almeloveen.
Had there been so correct an edition of Celsus, as I think may be made,
with proper judgment, from the editions and manuscripts extant, it
would have shortened my labour.
That Celsus divided his books into chapters, appears from several
passages: whereas no person, as far as I can find, pretends, that the
marginal contents came from the author himself. The editions differ
in these; but as it is of small importance, I have not troubled the
reader with any remarks on that article. Where I found those of Linden
evidently wrong, I have endeavoured to supply the defect.
With regard to the materia medica, the notes are drawn chiefly from
Pliny and Dioscorides, whom I esteemed the best authors on that
article. When I have given English names to any of the simples, I
follow the most judicious moderns; though it must be remembered, that
many of them cannot be determined with absolute certainty.
Through most of the compositions the text is miserably corrupted; and
what is worse, I do not find, that by comparing the various editions
this part can be restored. I had once some thoughts of labouring this
point particularly, but as it would have been expected I should support
every alteration with proper reasons, and as I despaired of executing
it so, as to meet with universal approbation, and after all it would
have been more a matter of curiosity than of real use, I omitted that
part of my design; besides, this must have considerably increased the
number of my notes, which I have endeavoured should be as few as the
nature of the undertaking would admit of. For these reasons I have
closely adhered to the text of Linden, without even departing from it,
where the nature of the whole composition will evidently demonstrate
the proportions of several ingredients to be highly incongruous.
It has been my principal care to convey the precise meaning of my
author, and also to preserve the genius of his style, where the English
idiom would allow. I have likewise been careful not to wrest any
expression of Celsus, in order to deceive the reader into a greater
opinion of his knowledge, than he really deserves. His merit is
sufficiently great without pretending to find in him any discoveries,
the honour of which is due to the moderns. Every man of learning, who
is acquainted with the state of physic among the ancients, and knows
how far it differs from the modern, must be sensible of the difficulty
of translating an author so elegant and concise, with the strictness
necessary in a work of this nature. Such judges, I hope, will censure
the faults, which cannot escape their observation, with the candour
inseparable from true criticism.
It only remains, that I return thanks to my ingenious and learned
friends of the faculty, who have favoured me with their opinions on
several passages, particularly to Dr. Maghie of Guy’s hospital.
CONTENTS.
BOOK I. Page
PREFACE 1
CHAP. I. Rules for the healthy, 16
II. Rules for valetudinary people, 17
III. Observations suited to new incidents, and the different
constitutions, sexes, and ages; and the seasons of the
year, 19
IV. Rules for those that have a weakness in the head, 26
V. Directions for those that labour under a lippitude,
gravedo, catarrh, and disorders of the tonsils, 27
VI. The proper regimen for people liable to a purging, 28
VII. Rules for those that are liable to a pain of the colon, 29
VIII. Rules for one that has a weak stomach, 29
IX. Directions for those that are liable to pains of the
nerves, 30
X. Directions in a pestilence, 31
BOOK II.
PREFACE, 33
CHAP. I. Of the different seasons, weather, ages, constitutions,
and the diseases peculiar to each, 34
II. Of the signs of an approaching illness, 38
III. Good symptoms in sick people, 39
IV. Bad symptoms in sick people, 40
V. Signs of long sickness, 42
VI. The symptoms of death, 43
VII. Of the signs in particular diseases, 46
VIII. What symptoms are dangerous, or hopeful in particular
diseases, 52
IX. Of the cure of diseases, 59
X. Of bleeding, 60
XI. Of cupping, 64
XII. Of purging by internal medicines and clysters, 65
XIII. Of vomiting, 67
XIV. Of friction, 68
XV. Of gestation, 70
XVI. Of abstinence, 71
XVII. Of sweating, 72
XVIII. The different kinds of food and drink, 74
XIX. General properties of different foods, 77
XX. Of things containing good juices, 78
XXI. Of foods containing bad juices, 78
XXII. Of mild and acrid things, 79
XXIII. Of those things which generate a thick and a fluid phlegm, 79
XXIV. Of what agrees with the stomach, 80
XXV. Of things hurtful to the stomach, 80
XXVI. Of those things which occasion flatulencies; and the
contrary, 81
XXVII. Of those things which heat and cool, 81
XXVIII. Of what is easily corrupted in the stomach, 82
XXIX. Of what opens the belly, 82
XXX. Of what binds the belly, 83
XXXI. Of diuretic meats and drinks, 83
XXXII. Of soporiferous, and exciting substances, 84
XXXIII. Of those things which draw, repel, or cool, or heat, or
harden, or soften, 84
BOOK III.
CHAP. I. General division of distempers, 86
II. General diagnostics of acute and chronic, increasing and
declining diseases; the difference of regimen in each;
and precautions necessary upon the apprehension of an
approaching illness, 87
III. Of the several kinds of fevers, 89
IV. Of the different methods of cure, 91
V. Particular directions for giving food in the different
species of fevers, 95
VI. The proper times for giving drink to persons in fevers;
and the kinds of aliments suited to the several stages of
the distempers; together with some general observations, 99
VII. The cure of pestilential, and ardent fevers, 103
VIII. The cure of a semitertian, 105
IX. The cure of slow fevers, 105
X. Remedies for the concomitant symptoms of fevers, 107
XI. Remedies against a coldness of the extremities, preceding
a fever, 108
XII. The cure of a shuddering before fevers, 109
XIII. The cure of a quotidian fever, 110
XIV. The cure of a tertian, 111
XV. The cure of a quartan, 112
XVI. The cure of a double quartan, 113
XVII. The cure of a quotidian arising from a quartan, 114
XVIII. Of the several kinds of madness, and their cure, 115
XIX. Of the cardiac disorder, and its cure, 121
XX. Of the lethargy, and its cure, 123
XXI. Of the several species of the dropsy, and their cure, 124
XXII. Of the several species of consumptions, and their cure, 129
XXIII. Of the epilepsy, and its cure, 133
XXIV. Of the jaundice, and its cure, 135
XXV. Of the elephantiasis, and its cure, 136
XXVI. Of apoplectic patients, and their cure, 137
XXVII. Of a palsy, and its cure, 138
Of a pain of the nerves, 139
Of a tremor of the nerves, 139
Of internal suppurations, 140
BOOK IV.
CHAP. I. Of the Internal parts of the human body, 141
II. Of the disorders of the head, and their cure, 144
Of pains of the head, and a hydrocephalus, 144
Of the cynicus spasmus, 146
Of a palsy of the tongue, 147
Of a catarrh and gravedo, 147
III. Of diseases of the neck, and their cure, 149
IV. Of diseases of the fauces, 151
Several species of angina, 151
Difficulty of breathing, 152
An ulcer in the fauces, 154
A cough, 154
A spitting of blood, 155
And their cure, 157
V. Of the disorders of the stomach, and their cure, 158
VI. Of pains of the sides and a pleurisy, and their cure, 161
VII. Of a peripneumony, and its cure, 162
VIII. Of the diseases of the liver, and their cure, 164
IX. Of the diseases of the spleen, and their cure, 165
X. Of the diseases of the kidneys, and their cure, 166
XI. Of the cholera, and its cure, 167
XII. Of the coeliack distemper of the stomach, and its cure, 169
XIII. Of the distemper of the small gut, and its cure, 170
XIV. Of the distemper of the large intestine, and its cure, 171
XV. Of a dysentery, and its cure, 172
XVI. Of a lientery, and its cure, 174
XVII. Of worms in the belly, and their cure, 175
XVIII. Of a tenesmus, and its cure, 175
XIX. Of a simple purging, and its cure, 176
XX. Of the diseases of the womb, and their cure, 178
XXI. Of an excessive discharge of semen, and its cure, 180
XXII. Of the diseases of the hips, and their cure, 181
XXIII. Of a pain in the knees, and its cure, 182
XXIV. Of the diseases of the joints of the hands and feet, and
their cure, 182
XXV. Of the treatment of patients recovering, 184
BOOK V.
PREFACE, 186
CHAP. I. Medicines for stopping blood, 187
II. Agglutinants and restringents, 187
III. Medicines for promoting a suppuration, 188
IV. Medicines for opening wounds, 188
V. Cleansers, 188
VI. Corroding medicines, 189
VII. Eating medicines, 189
VIII. Caustics, 190
IX. Medicines for forming crusts upon ulcers, 190
X. Resolvents for crusts, 190
XI. Discutients, 191
XII. Evacuating and drawing medicines, 191
XIII. Lenients, 191
XIV. Incarning medicines, 192
XV. Emollients, 192
XVI. Cleansers of the skin, 192
XVII. Of the mixture of simples, and the proportion of the
weights, 193
XVIII. Of malagmas, in all thirty-six recited, 194
XIX. Of plaisters, in all twenty-nine recited, 201
XX. Of troches, in all seven recited, 207
XXI. Of pessaries, in all seven recited, 208
XXII. Medicines, used either in a dry form, or mixed with
liquids, 210
XXIII. Of antidotes, and their use, 212
XXIV. Of acopa, 213
XXV. Of catapotia, 214
XXVI. Of five different kinds of disorders incident to the
body; and of the nature, symptoms, and cure of wounds, 217
Bad consequences from wounds, 230
Cure of an old ulcer, 231
Cure of an erysipelas, 232
Cure of a gangrene, 232
XXVII. Of wounds caused by bites, poisons taken internally,
and burns, 235
XXVIII. Of external disorders proceeding from internal causes,
and their cure, 240
Of a carbuncle, 241
Of a cancer, 242
Of a therioma, 244
Of the ignis sacer, 245
Of the chironian ulcer, 246
Of ulcers occasioned by cold, 247
Of the scrophula, 247
Of a furuncle, 248
Of phymata, 248
Of a phygethlon, 248
Of abscesses, 248
Of fistulas, 250
Of the cerion ulcer, 253
Of the acrochordon, &c. 254
Of pustules, 256
Of the scabies, 257
Of the impetigo, 258
Of the papula, 258
Of the vitiligo, 259
BOOK VI.
CHAP. I. Of hairs falling off the head, 261
II. Of a porrigo, 261
III. Of the sycosis, 262
IV. Of the areæ, 263
V. Of vari, lenticulæ, and ephelides, 264
VI. Of the disorders of the eyes, carbuncles of the eyes,
pustules, wasting, lice in the eye-lids, dry lippitude,
dimness, a cataract, palsy, mydriasis, a weakness, and
external hurts in the eyes, and the various collyriums
adapted to each disorder, 265
VII. Of the diseases of the ears; pain, pus in the ears,
worms, dulness of hearing, a noise, extraneous bodies
in the ears, 281
VIII. Of the diseases of the nose, 287
IX. Of the toothach, 288
X. Of the diseases of the tonsils, 290
XI. Of ulcers of the mouth, 291
XII. Of ulcers of the tongue, 293
XIII. Of parulides and ulcers in the gums, 293
XIV. Of an inflammation of the uvula, 295
XV. Of a gangrene of the mouth, 295
XVI. Of parotid swellings, 297
XVII. Of a prominent navel, 297
XVIII. Of the diseases of the private parts, 298
Diseases of the anus, rhagadia, and condylomata, 303
Of the hæmorrhoides, 304
Of a prolapsus of the anus or womb, &c. 305
XIX. Of ulcers in the fingers, 306
BOOK VII.
PREFACE, The province of surgery, &c. 306
CHAP. I. Of contusions 310
II. Of the operations necessary in suppurated tumours 310
III. Of the good or bad symptoms of suppurations 313
IV. Of fistulas, in the ribs, belly, and anus 314
V. Of extracting weapons out of the body 317
VI. Of a ganglion, meliceris, atheroma, steatoma, and other
tubercles of the head 320
VII. Of the diseases of the eyes cured by manual operations;
of vesicles in the upper eye-lids 321
Of a crithe, chalazium, and unguis 322
Of an encanthis 324
Of the ancyloblepharon, and the ægilops 324
Of hairs in the eye-lashes irritating the eye 326
Of the lagopthalmus 328
Of an ectropium, and the staphyloma 328
Description of the eye 329
Of a cataract 330
Of a flux of gum, and the requisite operations 331
VIII. Of the operations required in the ears 334
IX. The operation necessary in a want of substance in the
ears, lips, and nose 335
X. Of the extirpation of a polypus in the nose 337
XI. The chirurgical cure of an ozæna 337
XII. Of the operations in the mouth; of the teeth 338
Of indurated tonsils, of the uvula 339
Of the tongue, an abscess under it, and chopt lips 340
XIII. Of the bronchocele 341
XIV. Of the operations performed at the navel 342
XV. The method of discharging the water in hydropic people 344
XVI. Of wounds in the belly and intestines 345
XVII. Of a rupture of the peritonæum 346
XVIII. A description of the testicles, and their diseases 347
XIX. General directions for operations in the foregoing
diseases about the testicles 351
XX. Of the cure of a rupture of the intestine into the
scrotum 354
XXI. Of the cure of a rupture of the omentum into the scrotum 356
XXII. Of the cure of a ramex of the scrotum 357
XXIII. Of the cure of a sarcocele 359
XXIV. Of the cure of a ramex in the groin 359
XXV. The operations requisite in the disorders of the penis 360
XXVI. Of the operation necessary in a suppression of urine;
and lithotomy 362
XXVII. Of a gangrene after cutting for the stone 370
XXVIII. Of the operations required, when a membrane or flesh
obstructs the vagina in women 373
XXIX. The method of extracting a dead fœtus out of the womb 373
XXX. The operations required in diseases of the anus 376
XXXI. Of varices in the legs 378
XXXII. Operations required in cohering and crooked fingers 379
XXXIII. Of the operation required in a gangrene 380
BOOK VIII.
CHAP. I. Of the situation and figure of the bones of the human
body 381
II. General division of disorders in the bones. Of a
blackness and caries, and their treatment 388
III. Of the use of the modiolus, and perforator, and other
instruments, especially for the bones of the head 390
IV. Of fractures of the skull 393
V. Of fractures of the nose 399
VI. Of fractures of the ears 400
VII. Of a fractured maxilla, together with some general
observations relating to fractures 401
VIII. Of a fractured clavicle 402
IX. Of fractures of the ribs and spine 404
X. Of fractures of the humerus, fore-arm, thigh, leg,
fingers, and toes 406
XI. Of luxations 414
XII. Of a luxated maxilla 416
XIII. Of a luxation of the head 417
XIV. Of a luxation of the spine 418
XV. Of a luxation of the humerus 419
XVI. Of a luxation of the cubitus 420
XVII. Of a luxated hand 421
XVIII. Of luxations in the palm 422
XIX. Of luxations of the fingers 422
XX. Of a luxation of the femur 423
XXI. Of a luxation of the knee 424
XXII. Of a luxated ancle 425
XXIII. Of luxations in the soles of the feet 425
XXIV. Of luxated toes 426
XXV. Of luxations attended with a wound 426
ROMAN MEASURES OF CAPACITY FOR THINGS LIQUID, REDUCED TO ENGLISH WINE
MEASURE, THE WINE PINT HOLDING 28-7/8 SOLID INCHES.
No. I.
|_Pints_ |_Sol. in. dec._
Ligula |0,-1/48 |0,117-5/12
+------+ | |
| 4 |Cyathus |0,-1/12 |0,469-2/3
+------+-----+ | |
| 6 | 1 |Acetabulum |0,-1/8 |0,704-1/2
+------+-----+-----+ | |
| 12 | 3 | 2 |Quartarius |0,-1/4 |1,409
+------+-----+-----+-----+ | |
| 24 | 6 | 4 | 2 |Hemina |0,-1/2 |2,818
+------+-----+-----+-----+----+ | |
| 48 | 12 | 8 | 4 | 2 |Sextarius|1 |5,636
+------+-----+-----+-----+----+ | |
Possibly No. I. may be better understood in the following form.
No. II.
_Eng. wi. _Solid
_Ligulæ. Cyathi. Acetab. Quart. Hem. Sext._ pint._ inch._
48 or 12 or 8 or 4 or 2 == 1 == 1. and 5.636
24 or 6 or 4 or 2 == 1 -- - == 0. 17.255-1/2
12 or 3 or 2 == 1 -- - -- - == 0. 8.627-3/4
6 or 1-1/2 == 1 -- - -- - -- - == 0. 4.313-7/8
4 == 1 -- - -- - -- - -- - == 0. 2.875-11/12
1 -- - -- - -- - -- - -- - == 0. 0.718-47/48
ROMAN MEASURES OF CAPACITY FOR THINGS DRY, REDUCED TO ENGLISH CORN
MEASURE, THE ENGLISH CORN PINT HOLDING 33-3/5 INCHES.
No. III.
|_Pints_ |_Sol. in. dec._
Ligula |0,-1/48 |0,01
+------+ | |
| 4 |Cyathus |0,-1/12 |0,04
+------+-----+ | |
| 6 |1-1/2|Acetabulum |0,-1/8 |0,06
+------+-----+-----+ | |
| 24 | 6 | 4 |Hemina |0,-1/2 |0,24
+------+-----+-----+----+ | |
| 48 | 12 | 8 | 2 |Sextarius|1, |0,48
+------+-----+-----+----+ | |
THE SAME TABLE IN ANOTHER FORM.
No. IV.
_Eng. corn _Solid
_Ligulæ. Cyathi. Acetab. Heminæ. Sextarius._ pint._ inches_
48 or 12 or 8 or 2 == 1 == 1. and 0.48
24 or 6 or 4 == 1 -- -- == 0. 17.04
6 or 1-1/2 == 1 -- -- -- -- == 0. 4.26
4 == 1 -- -- -- -- -- -- == 0. 2.84
1 -- -- -- -- -- -- -- -- == 0. 0.71
Note, The tables, No. I. and No. III. are exactly copied from Dr
Arbuthnot, No. XII. and XIII. I have here gone no higher than the
sextarius, as that is the greatest measure mentioned by Celsus; it has
its name from making the sixth part of the Roman congius.
I would have taken the table of weights from Dr Arbuthnot also, if
he had given one accommodated to Celsus; but as he has not, I have
composed the following, No. VI. according to the division of Celsus
himself, who tells us[U], that he divides the _uncia_, or _ounce_, into
_seven denarii_, and the _denarius_ into _six sextantes_.
[U] Lib. v. cap. 17.
Besides these, in several compositions our author uses _semuncia_ and
_sescuncia_, that is _half an ounce_ and _ounce and half_; and to save
the reader the trouble of reduction, I have given them also a place in
the table.
The accurate Mr Greaves[V], from repeated experiments, concluded the
_Roman denarius_ to contain 62 grains English Troy weight, from which
the proportions of the other weights are determined.
[V] Dissertation on the Denarius.
No. V.
_Grains._ _Scruples._ _Drachms._ _Ounces._ _Pound Troy._
gr. ℈ Ʒ ℥ ℔
5760 or 288 or 96 or 12 == 1
480 or 24 or 8 == 1
60 or 3 == 1
20 == 1
1
CELSUS’S WEIGHTS COMPARED WITH APOTHECARIES’ WEIGHTS.
No. VI.
Grains of Sextan- Dena- Semun- Ses- Li- Apothecaries’.
Troy wt. tes. rii. ciæ. Unciæ. cun. bra. ℥ Ʒ ℈ gr.
5208 or 504 or 84 or 24 or 12 or 8 == 1 == 10 : 6 : 2 : 8
651 or 63 or 10-1/2 or 3 or 1-1/2 == 1 -- - == 1 : 2 : 2 : 11
434 or 42 or 7 or 2 == 1 -- -- -- -- - == 0 : 7 : 0 : 14
217 or 21 or 3-1/2 == 1 -- -- -- -- -- -- - == 0 : 3 : 1 : 17
62 or 6 == 1 -- -- -- -- -- -- -- -- -- - == 0 : 1 : 0 : 2
10-1/3 == 1 -- -- -- -- -- -- -- -- -- -- -- - == 0 : 0 : 0 : 10-1/2
1 -- -- -- -- -- -- -- -- -- -- -- -- -- - == 0 : 0 : 0 : 1
Note 1st. The Romans divided all integers, as they did their _as_,
into twelve equal parts called _unciæ_. Thus the _sextans_ was the
sixth part of the _as_, containing _two of these unciæ_, _quadrans_ one
fourth, or _three unciæ_, _triens_ the third part, or _four unciæ_,
_semis_ one half, or _six unciæ_, _bes_ or _bessis_ two-thirds, or
_eight unciæ_, _dodrans_ three-fourths being _nine unciæ_. The weight
of these then differs, as the integer is the _libra_, the _uncia_, or
_denarius_, which the attentive reader will easily reduce, if he is
disposed to calculate the quantities, observing that they are not to
be taken for aliquot parts of the denarius, but when they follow the
mark of the denarius. The integer preceding, and the nature of the
composition will be the best explication.
Note 2. The denarius mark was X or Ӿ, as containing originally
ten small asses. This by the copiers has been often confounded with X,
denoting the number of _ten denarii_; so that after all the pains of
critics and commentators, the proportions of the ingredients in several
compositions seem to be irrecoverably lost. For this reason, I suppose
the later editors have thought fit to change it for the common asterisk.
Note 3. The characters for quantities are variously marked in different
authors, and the same note has several values. There is one of this
uncertainty in Celsus, that is _Z_, which we are told expresses the
_libra_, the _sescuncia_, the _sextans of a pound_, the _denarius_ and
the _sextans of a denarius_[W]. Which of these different values it
bears in any particular place must be determined by the connection.
When it follows the mark of the _denarius_, it can mean no more than
the _sextans_ of a _denarius_.
[W] Rhodius de Ponderib. et Mensur. Cels.
Note 4. p. stands for _pondo_, which is an indeclinable word, and when
joined with numbers, signifies _libra_ or a _pound_; when with other
weights, it stands for no more than _pondus_ or _weight in general_.
For an example of the reduction of Celsus’s weights to ours, the
following may serve.
Lib. v. cap. 19. no. 7. Philotas’s plaister contains,
Of Eretrian earth ℥ Ʒ ℈ gr.
-- chalcitis, each p. iv.*. == 1/2 : 0 : 0 : 8 viz. Ʒi. gr. ii.
-- myrrh multiplied by 4
-- calcined copper, each p. x.*. == 1 : 2 : 1 : 0 --and so all
-- isinglass p. vi. *. == 0 : 6 : 0 : 12 the rest.
-- rasile verdigrease
-- round allum
-- crude misy
-- birthwort, of each p. viii.*. == 1 : 0 : 0 : 16
-- copper scales p. xx.* == 2-1/2 : 0 : 2 : 0
-- male frankincense, p. ii.*. == 0 : 2 : 0 : 4
-- oil of roses
-- Bitter oil, of each three cyathi, or 1 quartarius == between 1/4
and 1/3 of an English pint.
-- vinegar, a sufficient quantity.
ERRATA,
IN THE TEXT.
Page 110 line 9 _for_ substances, _read_ medicines.
---- 189 ---- 26 _for_ flour _read_ flower.
---- 240 ---- 22 _for_ warm ingremedies _read_ warming remedies.
---- 249 ---- 14 _for_ comes _read_ come.
---- 257 ---- 30 _for_ verjuice _read_ omphacium.
---- 271 ---- 16 _for_ wines _read_ wine.
---- 323 ---- 31 _for_ straight _read_ strait.
---- 350 ---- 18 _dele_ also.
A. CORNELIUS CELSUS
OF
MEDICINE.
_BOOK I._
PREFACE.
As agriculture promises food to the healthy, so medicine promises
health to the sick. There is no place in the world, where this art is
not found: for even the most barbarous nations are acquainted with
herbs, and other easy remedies for wounds and diseases. However it has
been more improved by the Greeks than any other people: though not
from the infancy of that nation, but only a few ages before our own
times; as appears by their celebrating Æsculapius as its most ancient
author; who, because he cultivated this science with somewhat more
accuracy, which, before him, was rude and of low esteem, was received
into the number of their gods.(1) After him his two sons, Podalirius
and Machaon, following Agamemnon to the Trojan war, were not a little
useful to their fellow soldiers. But even these, according to Homer’s
account, did not undertake the plague, nor the other various kinds of
diseases, but only cured wounds by incisions, and medicines: from which
it appears, that they entirely confined themselves to the chirurgical
part of medicine, and that this was the most antient branch. From the
same author we may also learn, that diseases were then believed to
arise from the anger of the immortal gods,(2) and that relief used
to be sought from them. It is also probable, that though there were
few remedies for distempers known, men nevertheless generally enjoyed
good health from the sobriety of their lives, yet untainted by sloth
and luxury. For these two vices, first in Greece, and then among
us, rendered men liable to many diseases. And hence that variety of
remedies now used, which was neither necessary in ancient times, nor
is yet in other nations, scarcely protracts the lives of a few of us
to the verge of old age. For the same reason, after those, whom I have
mentioned, no men of eminence practised medicine, till learning began
to be pursued with greater application; which, as it is of all things
most necessary to the mind, so it is no less hurtful to the body. And
at first the science of healing was accounted a branch of philosophy;
so that the cure of diseases, and the study of nature, owed their rise
to the same persons: and for this very good reason, because they, who
had impaired their bodies by anxious thought, and nightly watchings,
stood most in need of its assistance. And thus we find, that many
amongst the philosophers were skilled in this science; of whom the most
celebrated were Pythagoras, Empedocles, and Democritus. Hippocrates
of Cos, who, according to some authors, was the disciple of the last
mentioned of these, and is so justly admired both for his knowledge in
this profession, and for his eloquence, was the first worthy of notice,
who separated medicine from the study of philosophy. After him, Diocles
the Carystian, then Praxagoras and Chrysippus; after these, Herophilus
and Erasistratus applied themselves to this art, and differed widely
from each other in their methods of cure.
(1) For references 1, 2, 3, &c. see Notes at the end.
During this period, physick was divided into three parts: the
first cured by diet, the second by medicines, the third by manual
operations: the first they termed, in Greek, Diætetice,[X] the second
Pharmaceutice,[Y] and the third Chirurgice.[Z] The most illustrious
professors of that branch, which treats diseases by diet, endeavoured
to extend their views farther, and took in the assistance of natural
philosophy; being persuaded that, without it, medicine would be a
weak and imperfect science. After these came Serapion, who first
of all maintained, that the rational method of study was foreign to
the art of medicine, and confined it to practice and experience. In
his steps followed Appollonius and Glaucias, and some time after
Heraclides of Tarentum, and others of no small note; who, from the
doctrine they asserted, stiled themselves Empiricks[AA]. And thus the
Dietetick branch was also divided into two parts, one set of physicians
pursuing theory, the other following experience alone. However, after
these we have enumerated above, no one attempted any thing new, till
Asclepiades, who greatly changed the art of medicine. And Themison, one
of his successors, has also lately, in his old age, departed from him
in some things. And these are the men, to whom we are chiefly indebted
for the improvements made in this salutary profession.
[X] Διαιτητικὴ.
[Y] Φαρμακευτικὴ.
[Z] Χειρουργικὴ.
[AA] Εμπειρικοὶ.
As that branch of medicine, which respects the cure of diseases, is the
noblest, as well as the most difficult of the three, we shall first
treat of that part. And because in this the chief dispute is, that some
alledge an acquaintance with experiments to be only requisite, while
others affirm experience alone to be insufficient, without a thorough
knowledge of the constitution of bodies, and what naturally happens
to them; it will be proper to recite the principal arguments on both
sides, that we may the more easily deliver our own opinion upon the
question.
Those then, who declare for a theory in medicine, look upon the
following things as necessary: the knowledge of the occult and
constituent causes of distempers; next, of the evident ones; then, of
the natural actions; and, lastly, of the internal parts. They call
these causes occult, in which we inquire of what principles our bodies
are composed, what constitutes health, and what sickness. For they
hold it impossible that any one should know how to cure diseases, if
he be ignorant of the causes, whence they proceed; and that it is not
to be doubted, but one method of cure is required, if the redundancy
or deficiency in any of the four principles(3) be the cause of
diseases, as some philosophers have affirmed; another, if the fault
lie wholly in the humours, as Herophilus thought; another, if in
the inspired air, as Hippocrates believed; another, if the blood be
transfused into those vessels(4), which are designed only for air,
and occasion an inflammation, which the Greeks call phlegmone[AB], and
that inflammation cause such a commotion as we observe in a fever,
which was the opinion of Erasistratus; another, if the corpuscles
passing through the invisible pores should stop, and obstruct the
passage, as Asclepiades maintained: that he will proceed in the proper
method of curing a disease, who is not deceived in its original cause.
Nor do they deny experience to be necessary, but affirm, it cannot be
obtained without some theory; for that the more ancient practitioners
did not prescribe any thing, at hazard, for the sick, but considered
what was most suitable, and examined that by experience, to which they
had before been led by some conjecture. That it is of no moment _in
this argument_, whether most remedies were discovered by experiment,
provided they were at first applied with some rational view: and that
this holds in many cases; but new kinds of distempers often occur, in
which practice has hitherto given no light; so that it is necessary
to observe whence they arose; without which no mortal can find out,
why he should make use of one thing, rather than another. And for
these reasons they investigate the occult causes. They term those
causes evident, in which they inquire, whether the beginning of the
distemper was occasioned by heat or cold, fasting or surfeit, and the
like. For they say, he will be able to oppose the first appearances,
who is not ignorant of their rise. Those actions of the body which
they call natural, are inspiration and exspiration, the reception and
concoction of our meat and drink, as also the distribution(5) of
the same into the several parts of the body. They also inquire how it
happens, that our arteries rise and fall; from what causes proceed
sleep and watching; without the knowledge of which, they conceive it
impossible for any person either to oppose the beginnings of diseases,
that depend on these particulars, or cure them when formed. As of
all these things they look upon concoction to be of the greatest
importance, they insist chiefly upon it; and some of them following
the opinion of Erasistratus, affirm that the food is concocted in
the stomach by attrition; others, after Plistonicus, the disciple of
Praxagoras, by putrefaction; others, upon the credit of Hippocrates,
believe concoction is effected by heat. After them follow the disciples
of Asclepiades, who hold all these hypotheses to be vain and idle;
for that there is no concoction at all, but the matter, crude as it
is received, is distributed through the whole body. And in these
things they are by no means agreed: however, it is not disputed, that
according to the different hypotheses, a different regimen of diet is
to be observed by sick people. For if it be performed by attrition,
such food is to be chosen, as will most easily be broken to pieces; if
by putrefaction, such as most quickly undergoes that change; if heat
be the cause of concoction, then such as most effectually cherishes
heat. But if there be no concoction at all, then none of these kinds
of aliment are to be chosen: but such are to be taken, as are least
liable to change from the state in which they are received. And, by
the same way of reasoning, when there is a difficulty of breathing,
when sleep or watchings oppress, they are of opinion, that the man,
who has first learned in what manner these happen, will be capable of
curing them. Besides, as pains, and various other disorders, attack
the internal parts, they believe no person can apply proper remedies
to those parts, which he is ignorant of; and therefore, that it is
necessary to dissect dead bodies, and examine their viscera and
intestines; and that Herophilus and Erasistratus had taken far the best
method _for attaining that knowledge_, who procured criminals out of
prison, by royal permission, and dissecting them alive, contemplated,
while they were even breathing, the parts, which nature had before
concealed; considering their position, colour, figure, size, order,
hardness, softness, smoothness, and asperity(6); also the processes
and depressions of each, or what is inserted into, or received by
another part; for, _say they_, when there happens any inward pain, a
person cannot discover the seat of that pain, if he have not learned
where every viscus or intestine is situated; nor can the part, which
suffers, be cured by one, who does not know what part it is; and that
when the viscera happen to be exposed by a wound, if one is ignorant of
the natural colour of each part, he cannot know what is sound and what
corrupted; and for that reason is not qualified to cure the corrupted
parts; besides they maintain, that external remedies are applied with
much more judgment, when we are acquainted with the situation, figure,
and size of the internal parts; and that the same reasoning holds in
all the other instances above mentioned. And that it is by no means
cruel, as most people represent it, by the tortures of a few guilty,
to search after remedies for the whole innocent race of mankind in all
ages.
[AB] Φλεγμονὴ.
On the other hand, those, who from experience, stile themselves
empiricks, admit indeed the evident causes as necessary; but affirm the
inquiry after the occult causes and natural actions to be fruitless,
because nature is incomprehensible. And that these things cannot be
comprehended, appears from the controversies among those, who have
treated concerning them, there being no agreement found here either
amongst the philosophers or the physicians themselves: for, why should
one believe Hippocrates rather than Herophilus? or, why him more than
Asclepiades? that if a man inclines to determine his judgment by
reasons assigned, the reasons of each of them seem not improbable;
if by cures, all of them have restored the diseased to health; and
therefore we should not deny credit either to the arguments or
authority of any of them. That even the philosophers must be allowed to
be the greatest physicians, if reasoning could make them so; whereas
it appears, that they have abundance of words, and very little skill
in the art of healing. _They say also_ that the methods of practice
differ according to the nature of places; thus one method is necessary
at Rome, another in Egypt, and another in Gaul. That if the causes of
distempers were the same in all places, the same remedies ought also
to be used every where. That often too the causes are evident; as for
instance in a lippitude(7), or a wound, and nevertheless the method
of cure does not appear from them: that if the evident cause does
not suggest this knowledge, much less can the other, which is itself
obscure. Seeing then this last is uncertain and incomprehensible, it is
much better to seek relief from things certain and tried; that is, from
such remedies as experience in the method of curing has taught us, as
is done in all other arts; for that neither a husbandman nor a pilot
is qualified for his business by reasoning, but by practice: and that
these disquisitions have no connection with medicine, may be inferred
from this plain fact, that physicians, whose opinions in those matters
have been directly opposite to one another, have notwithstanding
equally restored their patients to health: that their success was to
be ascribed to their having derived their methods of cure, not from
the occult causes, or the natural actions, about which they were
divided, but from experiments, according as they had succeeded in the
course of their practice. That medicine, even in its infancy, was not
deduced from these inquiries, but from experiments: for of the sick,
who had no physicians, some from a keen appetite, had immediately
taken food in the first days of their illness, while others feeling a
nausea, had abstained from it; and that the disorder of those, who had
abstained, was more alleviated; also, some in the paroxysm of a fever
had taken food, others a little before it came on, and others after its
remission; and that it succeeded best with those who had done it after
the removal of the fever: in the same manner some used a full diet in
the beginning of a disease; others were abstemious; and that those
grew worse, who had eaten plentifully. These and the like instances
daily occurring, that diligent men observed attentively, what method
generally answered best, and afterwards began to prescribe the same to
the sick. That this was the rise of the art of medicine, which by the
frequent recovery of some, and the death of others, distinguishes what
is pernicious from what is salutary; and that when the remedies were
found, men began to discourse about the reasons of them: that medicine
was not invented in consequence of their reasoning, but the theory
was sought for after the discovery of medicine. They ask too, whether
reason prescribes the same as experience, or something different; if
the same, they infer it to be needless, if different, mischievous.
That at first, however, there was a necessity for examining remedies
with the greatest accuracy, but now they are sufficiently ascertained;
and that we neither meet with any new kind of disease, nor want any
new method of cure. That if some unknown distemper should occur, the
physician would not therefore be obliged to have recourse to the occult
things; but he would presently see to what distemper it is most nearly
allied, and make trial of remedies like to those, which have often been
successful in a similar malady, and by the resemblance between them
would find some proper cure. For they do not affirm, that judgment is
not necessary to a physician, and that an irrational animal is capable
of practising this art; but that those conjectures, which relate to the
occult things, are of no use; because it is no matter what causes, but
what removes a distemper: nor is it of any importance in what manner
the distribution is performed, but what is most easily distributed;
whether concoction fails from this cause or that; or whether it be
properly a concoction, or only a distribution: nor are we to inquire
how we breathe, but what relieves a difficult and slow breathing; nor
what is the cause of motion in the arteries, but what each kind of
motion indicates. That these things are known by experience: that in
all disputes of this kind, a good deal may be said on both sides; and
therefore genius and eloquence obtain the victory in the dispute; but
diseases are cured not by eloquence, but by remedies; so that if a
person, without any eloquence, be well acquainted with those remedies,
that have been discovered by practice, he will be a much greater
physician than one who has cultivated his talent in speaking without
experience. That these things, however, which have been mentioned, are
only idle: but what remains is also cruel, to cut open the abdomen and
præcordia of living men, and make that art, which presides over the
health of mankind, the instrument, not only of inflicting death, but
of doing it in the most horrid manner; especially if it be considered,
that some of those things, which are sought after with so much
barbarity, cannot be known at all, and others may be known without
any cruelty; for that the colour, smoothness, softness, hardness,
and such like, are not the same in a wounded body, as they were in
a sound; and further, because these qualities, even in bodies that
have suffered no external violence, are often changed by fear, grief,
hunger, indigestion, fatigue, and a thousand other inconsiderable
disorders; which makes it much more probable, that the internal parts,
which are far more tender, and never exposed to the light itself, are
changed by the severest wounds and mangling. And that nothing can be
more ridiculous than to imagine any thing to be the same in a dying
man, nay one already dead, as it is in a living person: for that the
abdomen(8) indeed may be opened(9), while a man breathes; but as
soon as the knife has reached the præcordia(10), and the transverse
septum is cut, which by a kind of membrane divides the upper from the
lower parts, (and by the Greeks is called the Diaphragm[AC]) the man
immediately expires; and thus the præcordia, and all the viscera never
come into the view of the butchering physician, till the man is dead;
and they must necessarily appear as those of a dead person, and not
as they were while he lived; and thus the physician gains only the
opportunity of murdering a man cruelly, and not of observing, what are
the appearances of the viscera in a living person: if, however, there
be any thing which can be observed in a person, that yet breathes,
chance often throws it in the way of such as practise the healing art;
for that sometimes a gladiator on the stage, a soldier in the field,
or a traveller beset by robbers, is so wounded, that some internal
part, different in different people, may be exposed to view; and thus
a prudent physician finds their situation, position, order, figure,
and the other particulars he wants to know, not perpetrating murder,
but attempting to give health; and learns that, by compassion, which
others had discovered by horrid cruelty. That for these reasons it is
not necessary to lacerate even dead bodies; which, though not cruel,
yet may be shocking to the sight, since most things are different in
dead bodies; and even the dressing of wounds shows all that can be
discovered in the living.
[AC] Διάφραγμα.
Since these points have often been, and still continue to be disputed
with great warmth by physicians in large volumes, ’tis proper to add
some reflections, that may seem to come the nearest to the truth, and
which neither slavishly follow either of these opinions, nor are too
remote from both, but lie, as it were, in the middle, betwixt these
opposite extremes; which those, that inquire after truth without
partiality, may find to be the surest method for directing the judgment
in most warm controversies, as well as in this now before us. For,
with regard to the causes of health or diseases, in what manner the
air, or food, is either conveyed or distributed, the philosophers
themselves do not attain to an absolute certainty; they only make
probable conjectures. Now, when there is no certain knowledge of a
thing, a mere opinion about it cannot discover a sure remedy. And it
must be owned, that nothing is of greater use, even to the rational
method of curing, than experience. Altho’ then many things are taken
into the study of arts, which do not, properly speaking, belong to
the arts themselves, yet they may greatly improve them by quickening
the genius of the artist; wherefore the contemplation of nature,
though it cannot make a man a physician, yet may render him fitter
for the practice of medicine. Indeed, it is very probable, that both
Hippocrates and Erasistratus, and all the others, who were not content
with treating fevers and ulcers, but examined in some measure into the
nature of things, tho’ they did not by such study become physicians,
yet became more able physicians by that means. And medicine itself
requires the help of reason, if not always amongst the occult causes,
or the natural actions, yet often; for it is a conjectural art; and
not only conjecture in many cases, but even experience is found not
consistent with its rules. And sometimes neither fever, nor appetite,
nor sleep, follow their usual antecedents in the regular course. A new
distemper sometimes, though very seldom, appears; that such a case
never happens is manifestly false; for, in our own time, a certain
lady, from a quantity of flesh(11) falling down from her private
parts, and growing dry, expired in a few hours; so that the most
celebrated physicians neither found out the genus of the distemper,
nor any remedy for it. I suppose the reason they forbore to attempt
any thing was, that none of them was willing to run a risk upon his
own conjecture only in a person of her quality, for fear he should be
thought to have killed, if he did not save her; yet it is probable
that some one, without that regard to the opinion of the world, might
have contrived something, which upon trial would have succeeded. Nor
is a similitude always serviceable in this kind of practice; and
where it is, this properly belongs to the rational part, to consider
amidst a number of similar kinds, both of diseases and remedies, what
particular medicine ought to be preferred. When such an incident
occurs, the physician ought to invent something, which though perhaps
it does not always answer, yet most commonly may: and he shall draw
his new method, not from the occult things (for they are dubious and
uncertain) but from those, that can be fully known, that is, from the
evident causes. For it makes a considerable difference, whether the
distemper was occasioned by fatigue, or thirst, or cold, or heat,
or watching, or hunger; or whether it arose from too much food and
wine, or excess of venery. And he ought not to be ignorant of the
constitution of his patient, whether his body be too moist, or too dry:
whether his nerves(12) be strong or weak; whether he be frequently
or seldom ailing; and whether his illnesses are severe or slight, of
long continuance or short; what way of life he has pursued, laborious
or sedentary, luxurious or frugal; for from these, and such like
circumstances, he must often draw a new method of cure.
Nevertheless even these things ought not to be so passed over, as
if they were uncontroverted; for Erasistratus has affirmed, that
distempers were not occasioned by them, because other people, and even
the same person at different times, would not fall into a fever upon
them. And some of the Methodists of our own age, from the authority of
Themison (as they would have it thought) assert, that the knowledge of
no cause whatever bears the least relation to the method of cure; and
that it is sufficient to observe some general symptoms of distempers;
and that there are three kinds of diseases, one bound, another
loose(13), and the third a mixture of these. For that sometimes the
excretions of sick people are too small, sometimes too large; and
sometimes one particular excretion is deficient, while another is
excessive. That these kinds of distempers are sometimes acute, and
sometimes chronic; sometimes increasing, sometimes at a stand(14),
and sometimes abating. As soon then as it is known, to which of these
classes a distemper belongs if the body be bound, it must be opened;
if it labours under a flux, it must be restrained; if the distemper be
complicated, then the most urgent malady must be first opposed. And
that one kind of treatment is required in acute, another in inveterate
distempers; another, when diseases are increasing; another, when at
a stand; and another, when inclining to health. That the observation
of these things constitutes the art of medicine, which they define
as a certain way of proceeding, which the Greeks call _Method_[AD],
and affirm it to be employed in considering those things, that are in
common to the same distempers: nor are they willing to have themselves
classed either with the rationalists, or with those, who regard only
experiments; for they dissent from the first sect, in that they will
not allow medicine to consist in forming conjectures about the occult
things; and also from the other in this, that they hold the observation
of experiments to be a very small part of the art.
[AD] Μέθοδος.
As to what Erasistratus maintains; in the first place, plain fact
contradicts his opinion; because a distemper very seldom happens,
unless after some of these occurrences, that have been mentioned. And
then it does not follow, that what does not affect one person, may not
hurt another; nor what does not affect the same person at one time, may
not hurt him at another; for there may be some latent circumstances in
a body, either in respect of weakness, or some disorder, which either
are not in another, nor were in the same body at a different time;
and these, though of themselves not considerable enough to cause a
distemper, yet may render a body more liable to other injuries: but if
he had been sufficiently skilled in the contemplation of the works of
nature (which the physicians with very good reason endeavour to attain)
he must have known this also, that nothing happens from one single
cause; but that is to be taken for the cause, which seems to have
contributed most to the effect. Now it is possible, that what does not
move at all while alone, may in conjunction with other things excite a
great commotion. Besides, Erasistratus himself, who says, that a fever
arises from a transfusion of the blood into the arteries, and that this
happens in a plethoric body, can assign no reason, why of two persons
equally plethoric, the one should fall into a distemper, and the other
be free from all danger, which manifestly happens every day. From hence
it appears, that supposing this transfusion to be real, nevertheless,
when there is a plethora, it does not happen of itself, but when some
one of the conditions above-mentioned goes along with it.
But the followers of Themison, if they assert their maxims to hold
universally, are still more rationalists than those, that pass under
that name; for though one rationalist does not maintain all that
another approves, there is no necessity to invent a new appellation
for him; provided, which is the principal thing, he does not proceed
upon memory alone, but takes in reason too. But if, which is nearer
to the truth, the art of medicine hardly admits of any universal
precepts, then they are in the same class with those, who depend upon
experiments alone: and the more so, because any unskilful person can
discover, whether a distemper has bound up a man, or rendered him
lax. Now if what relaxes a constringed body, or restrains a loose, be
drawn from reason, such a practitioner is a rational physician: but if
from experience, as he must confess, who will not allow himself to be
a rationalist, then he is an empirick. And so, according to him, the
knowledge of the distemper is foreign to the art, but the remedy lies
within the bounds of experience. Nor is any improvement made by them
upon the profession of the empiricks, but on the contrary, something
is taken from it; the empiricks attending with great circumspection to
many circumstances; whereas these regard only the easiest, and no more
than the common things. For in like manner those, who are employed in
curing cattle, since it is impossible for them to be informed by the
dumb animals, what is peculiar in the case of each, regard only what
is common to them all: and foreign nations, as they are not acquainted
with any subtile theory of medicine, take notice only of the common
symptoms: those also, who take under their care a great number of
patients, because they are not able to consult the distinct necessities
of each with the utmost attention, have respect only to those generals.
Nor indeed were the ancient physicians ignorant of this method, but
they were not content with it; for even the most ancient writer
Hippocrates said, that in practice it is necessary to regard both the
general and peculiar circumstances. Nor is it possible even for them to
confine themselves within the narrow limits of their own profession;
for there are different kinds both of the bound, and lax disorders;
which is more easily observed in the lax, for it is one thing to vomit
blood, another to vomit bile, and another to vomit the food: and
there is also a difference betwixt labouring under a simple purging,
and a dysentery; between being weakened by sweats, and wasted by a
consumption. A humour also breaks out upon particular parts, as the
eyes, for instance, and the ears; and no member of the human body is
free from that danger. Now not one of these disorders is cured exactly
in the same manner as another; so that in these, medicine descends from
the general observation of the lax kind, to the peculiar. And in this
again another kind of knowledge of peculiarity is often necessary;
because the same thing will not relieve all, that labour under similar
distempers. For though there are certain things, which either bind
the belly, or open it in most people; yet some are to be met with, in
whom the same intention is gained by means contrary to the common. So
that in such, the general observation is hurtful, and the peculiar
only salutary. And a right apprehension of the cause often removes a
distemper. Upon this account it was, that the most ingenious physician
of our age, the late Cassius, being called to one in a fever distressed
with violent thirst, when he found, that his complaints began after
hard drinking, ordered him to drink plentifully of cold water. When
his patient had drank this, and by the mixture had weakened the force
of the wine, he was presently freed from the fever by a sleep, and a
sweat. Which remedy the physician very judiciously adapted to the case,
not from the consideration of his body being either bound or loose, but
from the cause that had preceded. There is also another peculiarity
to be regarded, which is that of place and season, according to these
authors themselves; who, when they are giving directions for the
management of the healthy, order them more carefully to avoid cold,
heat, satiety, labour, and venery, in sickly places or seasons; and
to take more rest in such seasons or places, if they have any sense
of weight hanging upon their body; and in such circumstances neither
to disturb the stomach by vomiting, nor the belly by purging. These
things indeed are certain; yet they descend from generals to some
things that are particular: unless they would have us believe, that
healthy men should observe the temper of the air, and the season of
the year, and that sick people don’t need to take that care, to whom
all precaution is so much the more necessary, by how much an infirm
state of health is more liable to receive injury. Besides, there are
very different properties of distempers in the same person. And one,
who has been sometimes unsuccessfully tried by medicines, which seemed
proper for his disorder, is often recovered by the contrary. There are
also many distinctions to be observed in the giving of food, of which
I shall only name one instance. A youth bears hunger more easily than
a boy; better in a thick, than a clear air; more easily in winter than
summer; with more ease, one, that is accustomed to a single meal, than
another, who eats a dinner also(15); a sedentary person more easily,
than one that takes exercise. Now generally food ought to be prescribed
so much the sooner, as the person is less able to bear the want of it
in health. For these reasons I am apt to think, that he, who is not
acquainted with the peculiarities, ought only to consider the general:
and that he, who can find out the peculiar, ought not to neglect, but
take them in too for the direction of his practice. And therefore,
where the knowledge is equal, yet a friend is a more useful physician,
than a stranger. To return to my point then, my opinion is, that
medicine ought to be rational, but to draw its methods from the evident
causes, all the obscure being removed, not from the attention of the
artist, but from the practice of the art. Again, to dissect the bodies
of living men is both cruel and superfluous. But the dissection of dead
subjects is necessary for learners: for they ought to know the position
and order of the parts, which dead bodies will show better, than a
living and wounded man. But as for the other things, which can only be
observed in living bodies, practice itself will discover them in the
cure of the wounded, somewhat more slowly, but with more tenderness.
Having delivered my sentiments upon these points, I shall lay down the
proper rules for the management of people in health, and then proceed
to what relates to diseases and their cure.
CHAP. I.
RULES FOR THE HEALTHY.
A sound man, who is both in health, and his own master, ought to
confine himself to no rules; and neither call for the assistance of a
physician nor an iatroalipta(16). ’Tis good for him to diversify his
way of life; to be sometimes in the country, sometimes in the city,
and frequently in the fields; to sail, to hunt; sometimes to rest,
but exercise himself frequently: for indolence enervates the body,
labour strengthens it: the first brings on a quick old age, the other
makes a long youth. ’Tis also proper to make use sometimes of the
warm bath(17), and sometimes of the cold; to anoint sometimes, and
at other times to neglect it; to avoid no kind of food, that may be
in common use; sometimes to eat in company, at other times to retire
from it; sometimes to eat more than is sufficient, and at other times
no more; to take food rather twice in the day than once; and always
as much as he can, provided he concoct it. But as exercise and food
of this kind are necessary, so the exercise and diet of wrestlers are
inconvenient: both because the order of exercise being interrupted by
some necessary business of life, hurts the body; and because those
bodies, which are very high fed, like their’s, soonest decay, and are
most liable to diseases.
[Sidenote: _Of Coition._]
Coition is neither to be too much desired, nor too much feared. Seldom
used, it excites the body; frequent, relaxes. But as the frequency
is to be judged of, not by the number of repetitions, but by nature,
regard being had to the age and constitution, we may know it not to
be useless, when it is neither followed by a languor of the body, nor
pain. It is worse in the day-time, but safer in the night; _but the
general rule will hold for both_, if neither meat be taken after the
first, nor the other be followed by wakefulness and labour. These
things are to be observed by strong people; and care must be taken,
that the reliefs of sickness be not wasted in good health.
CHAP. II.
RULES FOR VALETUDINARY PEOPLE.
But greater precaution is necessary for the valetudinary; amongst
whom are the greatest number of those that live in cities, and almost
all that are fond of study: that care may rectify the disorders which
arise from their constitution, situation, or study. Any of these
then, who has concocted well, will rise in the morning safely; he
that finds the concoction not completed, ought to lie still; and if
he be under a necessity of rising, to go to sleep afterwards. He that
has not concocted at all, should be entirely at rest, and neither
venture upon labour, nor exercise, nor business. He that is troubled
with crude belching, without pain of the præcordia, ought now and
then to drink cold water, and withal to confine himself to certain
rules; to live in a house well lighted, that enjoys the summer’s
breeze and the winter’s sun; to avoid the meridian sun, the morning
and evening cold, as also the air of rivers and lakes; and by no means
to expose himself to the sun breaking out in a cloudy sky, lest he
be sometimes affected with heat, and sometimes with cold, which very
often occasions gravedoes(18) and catarrhs. These inconveniences
are to be guarded against with greater diligence in sickly places,
in which they even cause a pestilence. We may know a body to be in
health, when every day in the morning the urine is first white, and
then of a light red colour: the first shows that the concoction is
going on, and the other, that it is compleated. When any person awakes,
he ought to wait a little, and then, unless it be the winter time, to
wash his mouth plentifully with cold water; in long days, to take the
air in the middle of the day, before meat; or, if he cannot do that
conveniently, after it. In winter especially, to rest the whole night;
but, if he is obliged to study in the night, to do it not immediately
after eating, but after concoction. He, that in the day-time has been
employed either in domestic or civil business, ought to set apart some
time for the refreshment of his body; the principal part of which
is exercise, which ought always to go before meat: in one that has
laboured little(19), and has concocted well, it should be stronger;
in one who has been fatigued, and has not concocted well, it may be
more gentle. Proper exercises are, reading aloud, handling of arms, the
ball, running, and walking; which last is better not upon plain ground:
for an ascent and descent agitates the body with some variety, unless
it be very weak. And it is better in the open air, than in a portico;
better in the sun, if the head can bear it, than in a shade; better
in a shade formed by walls, or parks, than under a roof; a straight
walk is better than a winding. In most cases a beginning sweat should
put an end to exercise, or at least lassitude, that does not amount to
fatigue; and that sometimes in a less, sometimes in a greater degree.
In all these exercises, there should neither be, as among wrestlers, an
inviolable rule, nor too violent labour. Exercise is rightly followed,
sometimes by unction, either in the sun, or before a fire, at other
times by the bath, which is best in a room as high, light, and spacious
as may be. Neither of these should be always done; but either one of
them oftner than the other, as agrees best with the constitution. After
these, it is necessary to take some rest. When food is to be taken, it
is never proper to overload: but too great abstinence is often hurtful:
if there be any small excess committed, it is often safer in drinking
than eating. It is best to begin with salt fish(20), greens, and
such like. After these flesh, which is best roasted, or boiled. All
preserves, upon a double account, are hurtful, both because people are
tempted by their agreeable taste to exceed in quantity, and though the
quantity be moderate, they are of difficult concoction. A desert is not
hurtful to a good stomach, but turns sour upon a weak. And therefore
one, that is less firm in that part, will do better to use dates,
apples, and such fruit for that purpose. After drinking somewhat more
than thirst requires, no more should be eaten. With a full stomach
a man should set about no action. When one has eat plentifully, the
concoction is more easy, if he concludes the meal with a drink of cold
water, then continues awake for a little while, and afterwards has a
sound sleep. If a person has made a hearty meal in the day-time, he
ought not to expose himself after it, either to cold, heat, or labour;
for these do not so readily hurt with an empty as a full body. If
upon any occasion one is to want food for a time, all labour is to be
avoided.
CHAP. III.
SOME OBSERVATIONS SUITED TO NEW INCIDENTS, AND THE DIFFERENT
CONSTITUTIONS, SEXES, AND AGES, AND THE SEASONS OF THE YEAR.
What we have delivered above, is nearly of universal extent: but some
precautions are necessary for new incidents, and for the constitutions,
sexes(21), and ages, and the seasons of the year. For it is neither
very safe to remove from a healthy place into a sickly; nor from a
sickly into a healthy. It is best to remove from a healthy place to a
sickly, in the beginning of winter; from a sickly to a healthy, in the
beginning of summer. It is neither fit to overload with food after much
fasting, nor is fasting good after too full eating. And those persons
endanger themselves, who, contrary to their custom, either once or
twice a day eat immoderately. Again, sudden ease is very hurtful after
great labour, and sudden labour after too great inactivity. For this
reason, when one has a mind to make any change in his way of living,
he must accustom himself to it gradually. All kinds of labour are more
easily endured even by a boy or an old man, than by a man that is not
used to it. And upon this account too, a life over inactive is not
good; because there may happen to be a necessity for labour. But if at
any time a person altogether unused has occasionally laboured, or even
one, that is accustomed to it, has laboured much harder than ordinary,
he ought to sleep with an empty stomach; and so much the rather, if
he have a bitter taste in his mouth, or a dimness in his eyes, or his
belly be disordered, For then he must not only sleep with an empty
stomach, but even continue to fast the following day, unless rest has
quickly carried off the disorder. And if that be the case, he should
get up, and walk a little at a slow pace. But if a person has been
at more moderate labour, so that he was not obliged to go to sleep,
nevertheless he ought to walk in the same manner.
What follows is to be generally observed by those, that after fatigue
are to eat: when they have walked a little, if they have not an
opportunity of bathing, they ought to be anointed in a warm place,
either in the sun, or before a fire, and then to sweat. But if they
have that conveniency, they should first of all sit down in the
tepidarium; next, after they have rested a little, go down into the
warm bath; then anoint with a good deal of oil, and rub gently, and
again go into the bath; this done wash the mouth with warm water,
and then with cold. A very hot bath is not fit for such people. And
therefore if any one is so much over fatigued as to be feverish, it is
sufficient for him, in a tepid room, to dip himself up to the groin in
warm water, with a small mixture of oil: after that, to rub over the
whole body, but principally those parts, that have been in the water,
with oil, in which there is an addition of wine and a little powdered
salt. Afterwards it is proper for all people, that are fatigued, to
take food, and that of a moist nature; to be content either with water,
or at most a diluted drink, especially such as is diuretic. It is fit
also to know this, that drinking cold water is very pernicious to one,
that is sweating by labour; and hurtful to those, that are fatigued by
a journey, even when the sweat has abated. Asclepiades believed it to
be bad for those too, that had immediately come from the bath. This
holds true in those, who are easily purged, but not with safety, and
are liable to shudderings, but is not universal; because it is most
agreeable to nature, that a hot stomach should be cooled by drinking,
and a cold one heated. Which rule when I lay down, I own at the same
time, that cold water should not be given to one, that is in a sweat,
though occasioned by bathing. It is common also after various food,
and frequent diluted drinks, for a vomit to be serviceable, and the
following day a long rest, and then gentle exercise. If one be troubled
with frequent yawning(22), he should drink wine and water by turns,
and seldom make use of the bath. A change of labour also relieves from
fatigue; and when any person is distressed by some unusual kind of
labour, that which he is accustomed to, refreshes him. It is very safe
for a person, who is fatigued, to rest upon a couch, if he has before
made it a daily practice; on the contrary, it wearies one, that is not
used to it. For whatever is contrary to custom proves hurtful, whether
it be indulgence or severity.
There are some methods peculiarly adapted to the case of a man fatigued
by walking. Frequent friction, even upon the journey, relieves him; at
the end of the journey first sitting down, and then unction; afterwards
he may foment with warm water, or use the warm bath, rather to his
lower, than his upper parts. But if any one has been scorched in the
sun, he must immediately go to the bagnio, and rub over his body
and head with oil, and then go down into the bath, warmed to a good
degree; after that, first warm water must be poured over the head, and
then cold. But he, that has been chilled with cold, must wrap himself
up, and sit down in the laconicum, till he sweat; then anoint, and
afterwards bathe; eat moderately, and drink wine unmixed.
He that has been upon sea, and is troubled with a nausea, if he has
vomited much bile, ought to abstain from food wholly, or take very
little: if he has brought up acid phlegm, he may notwithstanding
take food, but lighter than ordinary: if he has had a nausea without
vomiting, he should abstain from food, or take a vomit after meat. He
that has sat the whole day, either in a chariot or in the theatre,
should by no means run, but walk slowly. It has been frequently
serviceable to stay a long while in the bath, and then to sup slightly.
If one grows hot in the bath, it will refresh him to take vinegar, and
hold it in his mouth: if that is not at hand, cold water may be used in
the same manner. Above all things it is proper to know the constitution
of the body: because some are slender, others fat; some hot, others
cold; some moist, others dry; some costive, and others lax. There are
very few instances of men, who have not a weakness in some part or
other of their body. A person of a slender habit should take methods
to gain flesh, one of a plethoric should diminish his bulk; one of a
hot temperament ought to cool himself, the cold to warm him; one of a
humid should dry, and one of a dry should moisten; he that is loose in
the belly should harden it, and he that is bound should relax; and in
general, means must always be used to help that part which is most
liable to disorders.
[Sidenote: _The means of fattening the body._]
The body is fattened by gentle exercise, frequent rest, unction, and
the warm bath, if it be after dinner; a costive belly, moderate cold in
the winter, a full sleep, but not over long, a soft couch, tranquillity
of mind, the eating and drinking of sweet and fat things, frequent
meals, and as much food as it is possible to digest.
[Sidenote: _Of extenuating the body._]
The body is extenuated by going into warm water(23), and especially
if it be salt, the bath with an empty stomach, a scorching sun, and all
heat, care, watching, either too short or too long sleep; lying upon
the ground in the summer time, and upon a hard couch in the winter;
running, much walking, and all violent exercise, vomiting, purging,
acid and austere things, and a single meal in the day, also a custom of
drinking wine, that’s not very cold, upon an empty stomach.
Since I have classed vomiting and purging amongst the methods for
extenuating, I must say something in particular about them. I observe,
that vomiting is rejected by Asclepiades in that book, which he
composed upon the preservation of health; nor do I blame him, if he
was offended with the custom of those, who by such daily evacuation
endeavour to procure a voracious appetite. But he has gone something
farther. He has also in the same book forbid purging. And indeed
this is hurtful, if it be procured by too strong medicines. It can
be no universal maxim however, that these should be laid aside
entirely; because it is possible, that the nature of constitutions
and particular junctures may make them necessary, provided they be
used with moderation, and not without necessity; and even he himself
has granted, that if any thing be corrupted, it ought to be expelled.
So that this method is not to be altogether condemned, but there may
be many occasions for it, and it requires a more particular and nice
observation.
[Sidenote: _Of vomits._]
A vomit is more useful in the winter than summer, because in that
season there is more phlegm, and a greater heaviness in the head. It
does no good to those, that are slender, and have a weak stomach;
but it is useful to those, that are of a full habit, and all bilious
people, if they have either overloaded themselves, or their concoction
has been impaired: for if they have taken a greater quantity than
can be concocted, they ought not to run the risk of its corrupting;
or if it is already corrupted, nothing is more proper than to have
it expelled in the most expeditious way possible. For this reason,
whenever they are attacked with bitter eructations, attended with pain
and weight of the præcordia, they must immediately have recourse to
this remedy. It is likewise proper for one, who has a scorching heat
in the breast, and a frequent spitting or a nausea, or for one who
has noise in his ears, or a humour in the eyes, or a bitterness in
the mouth; as also for one, who changes either his air or situation,
and to those, who are troubled with a pain of the præcordia, if they
have not vomited for several days. I am sensible, that in these cases
rest is prescribed, which cannot always be had by those, who are under
a necessity of stirring about; nor indeed has it the same effect in
every body. I grant then, that vomits should not be taken with a
view of indulging the luxurious appetite: that they are sometimes
useful remedies, I believe upon the credit of experience; but I would
advise any, who wishes to be healthy, and live to old age, not to
make a daily practice of it. When one chuses to vomit after meat, if
he does it easily, he should first drink only warm water; if with
difficulty, let him add a little salt or honey to the water; but he,
that intends to vomit in the morning, should first drink mulse(24),
or eat hyssop(25), or radish, and then drink warm water, as has been
directed already. All the other things which the ancient physicians
prescribed, are hurtful to the stomach. If it is weak after the vomit,
a little food is to be taken, but of a proper kind; and if the fauces
have been much irritated, three cyathi of cold water may be drunk. He,
that has vomited, if it was in the morning, ought to take a walk, then
anoint, afterwards sup; but if after supper, on the following day he
should bathe, and sweat in the bagnio; he will do well to make the next
meal slight, and the bread he uses at it should be stale, wine austere
and unmixed, the flesh roasted, and all the food of the driest kind.
He that chuses to vomit twice in the month, will find it answer the
purpose better, if he do it for two days successively, than if he were
to repeat it on the fifteenth day, unless such an intermission should
cause a weight at his breast.
[Sidenote: _Of purging._]
When the belly is costive, so as to evacuate very sparingly, and from
that cause flatulencies, dimness of sight, pains of the head, and other
disorders of the superior parts, grow troublesome, then ’tis fit to
take a purge: for what assistance can rest or abstinence afford in
these disorders, of which they are the principal causes? He that wants
to be lax, let him first use such food and wine as produce that effect:
and if they don’t succeed, let him take aloes. But purging, though it
be sometimes necessary, yet, when it is frequent, becomes dangerous;
for thus the body will be habitually deprived of its nourishment, and
by that means become valetudinary, for a body in a weak state is the
most liable to all kinds of distempers.
[Sidenote: _What heats and cools the body._]
The body is heated by unction, salt water, and more so if it be warm;
all salt provisions, and austere wine. On the contrary, it is cooled
by bitter and fleshy substances, taken with an empty stomach; the bath
after meals, and sleep, unless it be too long, and all acids; the
coldest water; oil, if it be mixed with water; and lotus(26).
[Sidenote: _What moistens and dries the body._]
The body is rendered humid(27) by less exercise than ordinary,
frequent bathing, a full diet, much drink, a walk after it, and
continuing awake. Walking long, and briskly, has of itself the same
tendency; and morning exercise, if one does not eat presently after
it; and those kinds of food, which come from cold climates, or rainy,
or otherwise damp. On the contrary, dryness is caused by immoderate
exercise, hunger, unction, heat without moisture, immoderate use of
salt, cold water, and the taking of food immediately after exercise,
and such particularly as comes from dry and hot climates.
[Sidenote: _What binds and relaxes the belly._]
The belly is bound by labour, sitting still, rubbing potter’s chalk
upon the body, and by diminishing the usual quantity of food, as also
if it be taken but once a day by one who is accustomed to it twice; by
drinking little, and not till one has eat as much, as he designs for
the time; rest after meat. On the other hand, the belly is relaxed
by an increase of walking and food, motion after meat, and drinking
frequently in the time of meals. ’Tis necessary also to know this that
a loose belly is bound by a vomit, and a costive one is loosened by the
same: and a vomit immediately after meat binds it; but one that comes
some time after, renders it lax.
[Sidenote: _Of the different ages_.]
As to the different ages, people in middle life bear want of food most
easily; young men not so well; least of all boys, and very old men.
The more uneasiness one finds from it, he ought to take victuals the
oftener; and that frequency is more especially necessary for one, that
is growing. Warm bathing is fit both for boys and old men. Wine should
be given to boys more diluted, to old men less; but such as occasions
flatulencies, to neither of them. It is of less consequence what
victuals young men eat, and how dressed. Those that are loose in the
belly while young, for the most part are costive when they grow old;
such as are costive, in their youth, are often loose in old age. It
is best for a young man to have a lax belly, and for an old man to be
bound.
[Sidenote: _Of the seasons. Winter._]
It is necessary also to consider the seasons of the year. It is proper
to eat more in the winter; to take a smaller quantity of drink, but
less diluted; to make much use of bread, and flesh rather boiled
_than roasted_, and greens sparingly; to take food once a day, unless
the belly be too much bound. If one dines, it is better to take some
trifling thing, and that dry, without flesh, and without drink. In that
season of the year, all warm things, or such as promote heat, are best.
Nor is venery altogether so hurtful then, as at some other times.
[Sidenote: _Spring._]
But in the spring the quantity of food is to be lessened, and the
drink increased, but more diluted; more use is to be made of flesh and
greens, and there must be a gradual change from boiled to roast flesh.
Venery is most safe in that season of the year.
[Sidenote: _Summer._]
But in summer the body requires meat and drink more frequently;
therefore it is convenient to take a dinner. Flesh and greens are most
proper in that season; drink very much diluted, that it may at once
remove thirst, and not inflame the body; bathing in cold water; roast
flesh, cold food, or such as is cooling. As food must be often taken,
so it must be in small quantities.
[Sidenote: _Autumn._]
Now in autumn there is the greatest danger, upon account of the
frequent changes of the air. And for this reason one should never go
abroad, especially in the colder days, without warm cloaths and shoes,
nor sleep in the air in the night-time, or at least be well covered.
At this time the diet may be something more full, the drink less, but
stronger. Some imagine apples(28) to be hurtful, which for the most
part are eaten immoderately through the whole day, while no abatement
is made from the more substantial food. Thus the mischief does not
proceed from them, but from the aggregate of all that is taken; for
none of them contribute less to it than these. But it is not fit to
use them oftener than the other kinds. Lastly, it is necessary when
an addition is made in this article, to lessen the quantity of the
stronger food. Venery is neither good in the summer, nor in autumn; but
is less hurtful in autumn; in summer, if possible, there ought to be a
total abstinence from it.
CHAP. IV.
RULES FOR THOSE THAT HAVE A WEAKNESS IN THE HEAD.
Our next business is to consider the cases of those, who have a
weakness in any particular part of the body. He, that has a weakness
in his head, if he has concocted well, ought to rub it gently with
his hands in the morning; and never, if he can avoid it, put any
covering upon it, or clip the hair close to the skin; it is proper for
him to avoid exposing it to the moon, and more especially before her
conjunction with the sun, but never to go out after meat: if he have
his hair, to comb it every day; to walk much, but if he can, neither
under a roof, nor in the sun; and also to avoid the scorching heat
of the sun, particularly after meat or wine. He should rather anoint
than bathe, and the unction should be performed, never before a flame,
sometimes at a glowing red fire. If he come to the bath, he ought first
to wrap himself up, and sweat a little in the tepidarium, anoint there,
and then go into the calidarium; when he has sweat, not to go into the
bath, but to pour hot water over his head, so that it may run over all
his body, then tepid water in the same manner, and lastly cold; and
the last longer upon his head than the other parts; after which to rub
it for some time; lastly, to dry and anoint. Nothing is so beneficial
to the head as cold water; for this reason, he that has a weak head,
should every day in the summer hold it for some time under a pretty
strong stream. And though he has anointed without going into the bath,
and is not able to bear dipping in cold water, nevertheless he should
always pour cold water upon his head. But when he is unwilling to have
the other parts of his body touched, he must bend his head forward, so
that the water may not fall down into his neck; and that it may not
offend his eyes, or any other part, he is to throw it back now and then
with his hands, as it runs down. It is necessary for him to use a spare
diet, which is easily concocted; and if he finds his head uneasy, when
his stomach is empty, he must eat in the middle of the day; if fasting
does not injure it, once a day is more eligible. Mild diluted wine is
more proper for his common drink than water, that when his head grows
worse, he may have some refuge left; and it is neither fit for him
to drink wine always, nor water; each of them is a remedy, when used
alternately. He must neither write nor read, nor speak with vehemence,
especially after supper; at which time neither is thinking very safe
for him; but above all things a vomit is hurtful.
CHAP. V.
DIRECTIONS FOR THOSE THAT LABOUR UNDER A LIPPITUDE, GRAVEDO, CATARRH,
AND DISORDERS OF THE TONSILS.
Nor is the use of cold water beneficial to those only, who are
distressed with a weakness in their head; but also to such as are
troubled with constant lippitudes, or gravedoes, catarrhs, and
disorders in their tonsils. Such people must not only pour cold water
upon their head every day, but also wash their mouth with a large
quantity of it; and all, that find relief from this practice, must
especially make use of it, when the air has been rendered unwholesome
by southerly winds. And as all strong attention or fatigue of mind
after meat is hurtful to every body, so it is more particularly to
those, who are liable to pains in their head, or windpipe, or any other
disorders in their mouth. A person subject to gravedoes and catarrhs,
may avoid these disorders by changing his air, place, or water, as
little as possible; and by covering his head in the sun, so as it may
neither be overheated, nor suffer by cold from the sudden intervention
of a cloud; by shaving his head with an empty stomach after concoction,
and neither reading nor writing after meat.
CHAP. VI.
THE PROPER REGIMEN FOR PEOPLE LIABLE TO A PURGING.
He, that is frequently troubled with a purging, ought to exercise his
upper parts by the ball, and such like motions; to walk, while his
stomach is empty; to avoid too great heat from the sun, and constant
bathing; to anoint without sweating. He should not use a variety of
food, and by no means meat stewed into broth, or vegetables of the
leguminous kind, or those greens that pass quickly through the body;
in fine, to take all such things as are slowly concocted. Venison,
hard fish, and the roasted flesh of tame animals, are very proper. It
is never fit to drink salt wine(29), nor even the weak, nor sweet
wine, but the austere, of a strong body, and not over old. If he chuses
mulse, it must be prepared with boiled honey. If cold drinks don’t
disturb his belly, he must use them principally. If any thing has
disagreed with him at supper, he ought to vomit, and to repeat it the
day following; on the third day to eat a small quantity of bread dipped
in wine, or eggs fried in oil, or in defrutum(30), and things of a
like nature: after that to return to his usual diet. After meat always
to rest, and neither apply his thoughts to any subject closely, nor
give himself a shock by walking however gently.
CHAP. VII.
RULES FOR THOSE THAT ARE LIABLE TO A PAIN OF THE COLON.
But if the large intestine, which is called colon[AE], is often pained,
since that disorder is nothing else but a kind of flatulence, the
intention to be pursued is, that concoction may be duly performed; the
patient must practise reading, and other exercises, make use of the hot
bath, and take his food and drink hot; lastly, let him avoid cold by
all means, every thing that is sweet, and leguminous vegetables, and
whatever generally causes flatulencies.
[AE] κόλον.
CHAP. VIII.
RULES FOR ONE THAT HAS A WEAK STOMACH.
A man, whose stomach is infirm, ought to read aloud, after reading to
walk, then to exercise himself with the ball or arms, or any other
kind, which agitates the superior parts; upon an empty stomach, not
to drink water, but hot wine; to take food twice a day, but in such
quantity, as he can easily concoct; to make use of small and austere
wine, and to take his drink after meat rather cold. The indications of
a weak stomach are paleness, leanness, pain in the præcordia, nausea,
involuntary vomiting, a pain of the head, when the stomach is empty:
where these signs are not found, the stomach is strong. And we are not
to believe our countrymen, who, when they are indisposed, and have
a strong inclination for wine or cold water, defend their luxury by
pretending the stomach does not do its office. But those that concoct
slowly, and whose præcordia on that account are inflated, or who, by
reason of any heat, are accustomed to be thirsty in the night-time,
before going to rest may drink two or three cyathi of wine through a
small pipe. It is good also against a slow concoction to read aloud,
then to walk, afterwards to anoint or bathe, to drink always cold wine,
and after meat to drink largely, but in the way I mentioned already by
a siphon: lastly, to conclude all the drinks with cold water. He, whose
food grows sour in his stomach, before he eats, should drink egelid
water, and vomit. But if the use of this should occasion a looseness,
whenever he is relieved of that complaint, he should by all means make
use of cold drinks.
CHAP. IX.
DIRECTIONS FOR THOSE THAT ARE LIABLE TO PAINS OF THE NERVES.
He that is subject to pains in the nerves, as is common in the gout
of the hands or feet, ought as much as possible to exercise the part
affected, and expose it to labour and cold; unless the pain has
become violent, in which case rest is best. Venery is always hurtful.
Concoction is necessary, as well in this, as in all disorders of
the body: for crudity injures it more than any thing; and whenever
the body is out of order, the diseased part feels it most sensibly.
As concoction is an adversary to all diseases, so some again are
relieved by cold, and others by heat. Either of which every one ought
to procure, according to the habit of his body. Cold is hurtful to an
old or slender man, to a wound, to the præcordia, intestines, bladder,
ears, hips, shoulders, private parts, teeth, bones, nerves, womb, and
brain. It also renders the surface of the skin pale, dry, hard, and
black. From this proceed shudderings and tremours. But it is beneficial
to young people, and all that are of a full habit. The mind also is
more brisk, and the concoction goes on better, when ’tis cold, if
due care is taken to guard against it. Cold water poured on, besides
being useful to the head, does good to the stomach. It is likewise of
service to the joints, and pains, which are not attended with ulcers;
also to persons, that are too ruddy, if they be free from pain. Heat
helps whatever cold hurts; and those too that have blear eyes, if they
have neither pain nor an effusion of tears; also contracted nerves,
and especially those ulcers which arise from cold. It causes a good
colour in the body, and promotes the excretion of urine. In too great
a degree, it enervates the body, softens the nerves, and relaxes
the stomach. But neither cold nor heat is by any means safe, coming
suddenly upon persons unaccustomed to it; for cold occasions pains
in the sides, and other disorders, and cold water causes scrophulous
swellings; heat hinders concoction, prevents sleep, wastes by sweat,
and renders the body obnoxious to pestilential distempers.
CHAP. X.
DIRECTIONS IN A PESTILENCE.
There are some rules necessary to be observed in a pestilence by a
man, who continues in good health, but cannot however be secure. At
that time it is proper to take journies and to sail. When that can’t
be done, to use gestation, gentle walking in the open air before the
heat of the day, and unction with the same moderation; and as has been
directed above, to avoid fatigue, crudity, cold, heat, and venery, and
confine himself to a strict regimen. If he feel any heaviness hanging
about his body, then he is neither to rise in the morning, nor walk
barefooted at any time, much less after meat or the bath; nor to vomit
either with an empty stomach, or after supper: neither should the belly
be purged; and if it grow loose of itself, it must be restrained.
Abstinence should rather be observed, if the body is plethoric. Also it
is proper to avoid the bath, sweating, sleeping in the middle of the
day, especially after meat; which by the way, it is more convenient to
take once a day, and that sparingly, lest it should occasion crudity:
every other day to drink alternately water and wine. These rules being
carefully observed, as little alteration as possible should be made
in the usual course of life. And as they are to be practised in every
pestilence, so principally in that, which is occasioned by southerly
winds. And the very same precautions are necessary for those that take
journies, when they have set out from home in a sickly season of the
year, or have come into sickly countries. But if the nature of any
engagements should prevent the observance of the other rules, yet it
will be necessary to live abstemiously; and thus to change from wine
to water, and from that to wine again, in the manner that has been
prescribed above.
A. CORNELIUS CELSUS
OF
MEDICINE.
_BOOK II._
PREFACE.
Of the approach of a disorder there are many signs. In the explication
of which, I shall, without hesitation, make use of the authority of
the ancients, and more especially that of Hippocrates; as even the
more modern physicians, although they have made alterations in the
method of curing, nevertheless confess, that he has delivered the best
prognostics from these signs. But before I speak of those antecedents,
which give cause to apprehend distempers ensuing; it seems not improper
to explain, what seasons of the year, what kinds of weather, what times
of life, what constitutions are most safe from, or most obnoxious to
dangers, and what kinds of disorders are most to be feared in each of
these. Not but in any weather(1), men of all ages and all habits,
fall into all kinds of distempers, and die of them too; but because
some events are more frequent than others. And therefore it is useful
for every person to know, against what, and when, he should be most
upon his guard.
CHAP. I.
OF THE DIFFERENT SEASONS, WEATHER, AGES, CONSTITUTIONS, AND THE
DISEASES PECULIAR TO EACH.
The most healthful season then is the spring, next to that the winter,
the summer is more dangerous than either, the autumn by far the most
dangerous of all. With regard to the weather, that is best, which is
equal, whether it be cold or hot: that, which varies most, is the
worst. For this reason it is, that the autumn destroys the greatest
number. For generally in the middle of the day it is hot, the nights,
mornings, and evenings too, are cold: thus the body relaxed by the
_preceding_ summer, and by the frequent meridian heats _of autumn_,
is exposed to sudden cold. But as this is most common in this season,
so it is hurtful, whenever it happens. When the weather is equal,
serene days are most healthful: rainy are better than those that are
only misty or cloudy: and in winter those days are best, that have no
wind at all; in summer, that have the westerly breezes. If the winds
blow from any of the other quarters, the northerly are more salutary
than the easterly or southerly. Nevertheless these sometimes differ
according to the situation of countries. For generally in every place a
wind, that comes from the inland parts, is healthful; one from the sea
is sickly. And not only health is more certain in a good temperature
of the weather, but even the more malignant distempers, which happen
to come on then, are more mild and sooner removed. That air is the
worst for a sick person, which has occasioned his distemper; insomuch
that in such a case, a change for weather in it’s own nature worse is
favourable.
The middle age is safest, because it is neither endangered by the
heat of youth, nor the coldness of old age. Old age is more liable to
chronical diseases, and youth to acute ones. The body most promising
for health is the square, neither over slender, nor over fat. For a
tall stature, as it is comely in youth, so it quickly wears out by age.
A slender body is weak, a corpulent heavy.
Whatever disorders arise from the motion of the humours, are generally
to be most apprehended in the spring(2); so that, at this season,
lippitudes, pimples, hæmorrhages, abscesses of the body, which the
Greeks call apostemata[AF], atrabilis, which they name melancholia[AG],
madness, epilepsy, angina, gravedoes, and catarrhs, usually occur.
Also those distempers in the joints and nerves, which sometimes are
troublesome, and sometimes easy, at this time of the year are the
most apt both to begin and return. Neither is the summer altogether
free from most of the above-mentioned distempers; but adds moreover
fevers, either ardent, or tertian, vomitings, purgings, ear-achs,
ulcers of the mouth, gangrenes, both in the other parts of the body,
and chiefly in the private parts; and all these disorders that waste a
man by sweat. There is hardly any of these, that is not found in the
autumn; but there arise then, besides irregular fevers, pain of the
spleen, dropsical disorders(3), consumption, which the Greeks call
phthisis[AH]; difficulty of urine, which they term stranguria[AI];
the distemper of the smaller intestine which they name ileos[AJ],
there happens also what the Greeks call lienteria[AK]; pains of the
hips, epileptic disorders. And the same season is mortal to those that
are worn out with long diseases, and such, as have been oppressed by
the preceding summer; and it dispatches some by new distempers, and
involves others in very tedious ones, especially quartan agues, which
may even continue through the winter. Nor is any season more liable to
the plague, of whatever kind it be, however various in its manner of
hurting. The winter provokes pains of the head, the cough, and whatever
disorder is contracted in the fauces, sides, or bowels.
[AF] ἀποστήματα.
[AG] μελαγχολία.
[AH] φθίσις.
[AI] στραγγουρία.
[AJ] εἰλεος.
[AK] λειεντερία.
With regard to the varieties of weather, the north wind raises a
cough, exasperates the fauces, binds the belly, suppresses urine,
excites shudderings, also pain of the side and breast; yet it braces a
sound body(4), and renders it more mobile and brisk. The south wind
causes dulness of hearing, blunts the senses, raises a pain of the
head, opens the belly, and renders the whole body heavy, moist, and
languid. The other winds, by how much they approach more nearly to
either of these, produce effects the more similar to each of them. All
heat inflames the liver and spleen, enervates the mind, and occasions
faintings, and hæmorrhages. Cold causes sometimes convulsions, and
sometimes a tetanus, the Greek name for the first is spasmos[AL],
and for the other tetanos[AM]: it produces blackness in ulcers, and
a shuddering in fevers. In dry weather we meet with acute fevers,
lippitudes, dysenteries, stranguries, pains of the joints; in rainy,
tedious fevers, diarrhœas, angina, gangrenes, epilepsies, palsy, which
the Greeks call paralysis[AN]. Nor is the present weather only to
be considered, but also what has been its course for some time. If
a dry winter has been attended with northerly winds, and the spring
with southerly, and rains, there most commonly ensue lippitudes,
dysenteries, fevers, and these chiefly in more delicate bodies,
particularly women. But if southerly winds and rains have prevailed in
the winter, and the spring be cold and dry, then indeed pregnant women,
whose time is near, are in danger of a miscarriage; and those, that go
their full time, bring forth weakly children, not likely to live. Other
people are attacked with dry lippitudes, and if they are old, with bad
gravedoes and catarrhs. But if the southerly winds have continued from
the beginning of winter to the end of spring, people are very quickly
taken off by pleurisies, and fevers attended with a delirium, which is
called phrenitis[AO]. But when the heat begins with the spring, and
continues through the summer, profuse sweating in fevers necessarily
follows. But if a dry summer has been attended with northerly winds,
and the autumn with rains, and southerly, all the following winter
we find coughs, catarrhs, hoarseness, and in some a consumption. But
if the autumn too is equally dry, and the same northerly winds blow,
all the more delicate bodies, amongst which I placed women, enjoy a
good state of health: and for the more robust, they may possibly be
attacked with dry lippitudes, and fevers either acute, or tedious, and
atrabiliary disorders.
[AL] σπασμὸς.
[AM] τέτανος.
[AN] παράλυσις.
[AO] φρεν̃ιτιϛ.̃
As to the different ages, children, and those a little more advanced,
have their health best in the spring, and are most safe in the
beginning of summer; old men in the summer, and beginning of autumn;
young and middle aged men in the winter. The winter is more hurtful
to old men, and the summer to youths. For the peculiar weaknesses,
that appear at different times of life, first of all infants and young
children will be troubled with spreading ulcers of the mouth, which
the Greeks call aphthæ[AP], vomitings, nightly watching, humour in
the ears, and inflammations about the navel. The peculiar complaints
of such as are teething, are exulcerations in the gums, convulsions,
slight fevers, purgings, and these are chiefly troublesome about the
cutting of the canine teeth. Infants of the fullest habit, and whose
bellies are very much bound, are most liable to these dangers. But when
they have grown up a little, there appear disorders of the glands,
and different inclinations of the vertebræ, which compose the spine,
scrophulous swellings, some painful kinds of warts, by the Greeks
called acrochordones[AQ], and many other tubercles. In the beginning
of puberty, many of the above-named, and long fevers, and hæmorrhages
from the nose. And generally all children are most in danger first
about the fortieth day, then the seventh month, then the seventh year,
after these at the time of puberty. Moreover any distempers, which
commence in infancy, and are terminated neither by puberty, nor in men
by their first commerce with women, nor in women by the appearance of
their menses, commonly continue long: yet more frequently these puerile
disorders of long standing are removed by these means. Youth is most
subject to acute disorders, and epileptic, and to a consumption: and
they are commonly young men, who spit blood. After this age, come
on pleurisies and peripneumonies, lethargy, cholera, madness, and
discharges of blood from certain mouths, as it were, of the veins,
by the Greeks called hæmorrhoides[AR]. In old age, difficulty of
breathing, and making urine, gravedo, pains of the joints and kidneys,
palsies, bad habit of body, which the Greeks call cachexia[AS],
nightly watchings, tedious disorders of the ears, of the eyes, and
nose, and especially a loose belly, and its consequences a dysentery,
or lientery, and other indispositions incident to that habit. Besides
these the slender are distressed with consumptions, purgings,
catarrhs, and pains of the bowels, and sides. The corpulent generally
are oppressed with acute diseases, and difficulty of breathing, and
often die suddenly, which seldom happens in a more slender body.
[AP] ἄφθαι.
[AQ] ἀκροχορδ́ονες.
[AR] αἱμοῤῥοίδες.
[AS] καχεξία.
CHAP. II.
OF THE SIGNS OF AN APPROACHING ILLNESS.
Before an illness, as I mentioned above, there appear some signs of
its approach. All of them have this in common, that the body alters
from its ordinary state; and not only for the worse, but even for
the better. For this reason, if one has become more plump, and looks
better, and of a more florid complexion than usual, he ought to hold
these advantages suspected. For because these things can neither
continue at a stay, nor admit further improvement, they generally run
backward very fast, like some heavy body tumbling down. But it is a
worse sign, when one is emaciated contrary to his natural habit, and
has lost his colour and comeliness: because bodies redundant can allow
something to be carried off by a distemper; the deficient have not
wherewithal to bear the force of the distemper itself. Besides there
is cause to be presently alarmed, if the limbs are heavy; if frequent
ulcers break out; if the body has grown hotter than common; if sleep
be too heavy; if the dreams are tumultuous; if one awakes oftner than
usual, and then falls asleep again; if the body of a person asleep
sweats in some parts contrary to custom, especially if that be about
the breast, or neck, or legs, or knees, or hips; also if the mind is
languid; if there is a reluctance to speaking and motion; if the body
be indisposed to action; if the præcordia are pained, or the whole
breast, or which happens in most people, the head; if the mouth is
filled with saliva; if the eyes feel pain in turning; if the temples
be strait bound(5): if the limbs have shudderings; if the breathing
is difficult; if the arteries in the forehead are dilated and beat
strong; if there be frequent yawnings; if the knees feel tired, or
the whole body be afflicted with a lassitude. Several of these things
often, some of them always, precede a fever. This, however, ought to
be first considered, whether any of these happen frequently to a person
without any consequent uneasiness. For there are some peculiarities
in the constitutions of particular persons, without the knowledge of
which, it is not easy to prognosticate what is to happen. With reason
therefore a man is free from apprehensions about those things, which
he has often escaped without danger: he only is justly uneasy, to whom
these appearances are new, or who has never been secured from their bad
effects without proper precautions.
CHAP. III.
GOOD SYMPTOMS IN SICK PEOPLE.
When any person is seized with a fever, it is certain he is not in
danger, if he lies either upon his right or left side, as may have
been usual with him, with his legs a little drawn up, which by the
way is commonly the lying posture of a person in health; if he turns
himself with ease; if he sleeps in the night-time, and keeps awake in
the day; if he breathes easily; if he does not struggle; if the skin
about the navel and pubes be full(6); if his præcordia be equally
soft on both sides, without any sense of pain; or although they are a
little swelled, yet yield to the impression of the fingers, and are
not pained. This illness, though it will continue some time, yet will
be safe. The body also, which is every where soft, and in the same
degree of heat, and which sweats all over equally, and whose fever is
removed by that sweat, is in a fair way of doing well. When the body
is recovering its health, sneezing also is amongst the good signs,
and an appetite, either continued from the beginning, or even coming
after a nausea. Nor should that fever alarm, which terminates in one
day; nor indeed that, which though it has prevailed for a longer time,
yet has totally intermitted betwixt paroxysms, so as the body became
free from all complaint, which the Greeks call eilicrines[AT]. If any
thing happens to be discharged by vomiting, it ought to be a mixture
of bile and phlegm: and the sediment of the urine white, smooth,
equal; so that, if there is any thing like small clouds swimming in
it, that subsides to the bottom. And the stools in one, who is safe
from danger, are soft, figured, and evacuated at nearly the same
intervals, as was usual in health, and in quantity duly proportioned to
the nourishment, that is taken. A loose belly is worse: but even this
should not immediately be esteemed dangerous, if the discharge be of a
harder consistence in the morning, or gradually turn less liquid, and
the excrements be reddish, and their offensive smell don’t exceed that
of the like discharge of a healthy man. And there is nothing bad in
voiding some worms at the end of the distemper(7). If a flatulency
has occasioned a pain and swelling in the upper parts without an
inflammation, a rumbling of the belly from thence to the lower parts
is a good sign; and more so, if it has found an easy passage with the
excrements.
[AT] Εἱλικρινὲς, sincere, or unmixed; so that it is explained
naturally enough by our author _integrum_, _sound_, which I chuse to
render by _free from all complaint_, because we never apply the term
_sound_ to a body, that has any distemper hanging about it.
CHAP. IV.
BAD SYMPTOMS IN SICK PEOPLE.
On the other hand there is hazard of a dangerous distemper, when
the patient lies supine, with his arms and legs extended: when he
inclines to sit up during the greatest violence of an acute distemper,
especially in a peripneumony: when he is distressed with wakefulness
in the night, even although he sleep in the day time. Now sleep, which
happens betwixt the fourth hour(8) and night, is worse than that,
which is betwixt morning and the same hour. But it is worst of all,
if he neither sleep in the night, nor the day time: for that cannot
well happen without a constant delirium. Neither is it a good sign
to be oppressed with sleep beyond measure: and the worse, the nearer
the sleep comes to being continued day and night. It is also a sign
of a dangerous distemper to breathe quickly, and with vehemence; for
shudderings to have come on after the sixth day; to spit matter;
to expectorate with difficulty; to have constant pain; to be much
distressed with the distemper; to toss the arms and legs about; to weep
involuntarily; to have a glutinous humour sticking to the teeth; for
the skin about the navel and pubes to be emaciated; for the praecordia
to be inflamed, painful, hard, swelled, tense: the case is worse, if
these appearances be more on the right side than on the left: but the
danger is still greatly increased, if at the same time the pulsation
of the arteries there be violent. Again, it indicates a bad distemper
to be too quickly emaciated; to have the head, feet, and hands cold,
with the belly and sides hot; or for the extremities to be cold during
the violence of an acute distemper; or to shudder after sweating; or
after vomiting to have the hiccough, or the eyes to be red; or after
having an appetite for food, or at the end of long fevers, to loath
it; to sweat much, and especially a cold sweat; or to have sweats not
equally diffused over the whole body, and such as do not terminate
the fever. They are also bad fevers, which return every day at the
same time; or those, that always have paroxysms equally violent, and
which do not remit every third day; or those, that continue so as to
increase in their paroxysms, and only remit in their intervals, but
never leave the body quite free from disorder. It is worst of all, if
the fever does not at all remit, but continues with equal violence.
It is dangerous too for a fever to come after a jaundice, especially
if the praecordia have continued hard on the right side; or on the
left, if attended with pain there. Every acute fever ought to give us
no small apprehensions: and always in such a fever, or after sleep,
convulsions are terrible. It is also a sign of a bad distemper to wake
with a fright, and likewise in the beginning of a fever for the mind to
be presently disordered, or any limb to become paralytic. In that case,
though the patient escape with life, yet for the most part that limb is
debilitated. A vomiting also of pure phlegm or bile is dangerous; and
if it be green, or black, it is worse. Urine is bad, where the sediment
is reddish or livid; and worse, in which there is a kind of small and
white threads: and worst of all, that, which bears the resemblance of
small clouds, composed as it were of particles of bran. Thin and white
urine is bad, but especially in phrenitic patients. It is bad to have
the belly entirely bound. And a purging too in fevers is dangerous,
where it will not allow a man to rest in his bed; especially if the
discharge be very liquid, or whitish, or pale, or frothy. Besides these
it portends danger, if the excretion be small in quantity, glutinous,
smooth, white, and at the same time of a palish colour; or if it is
either livid, or bilious, or bloody, or of a more offensive smell than
common. An unmixed discharge also, which comes after long fevers, is
bad.
CHAP. V.
SIGNS OF LONG SICKNESS.
After the foregoing symptoms have appeared, ’tis known, that a
distemper will become tedious: for it must necessarily be so, unless it
be mortal. And there is no other hope in violent diseases, than that
the patient may escape by eluding the first shock of the distemper,
that there may be room for the application of proper methods of cure.
But some signs appear in the beginning of a distemper, from which we
may gather, that although it does not prove mortal, yet it will last
for a considerable time. In fevers not violent, when a cold sweat comes
on only about the head or neck; or when the body sweats without the
fever intermitting; or when the body is sometimes cold, and sometimes
hot, and the colour changes; or when in fevers an abscess, which has
been formed in some part, does not prove salutary; or when the patient,
considering the time of his illness, is but little emaciated. Also, if
the urine at some times is thin and limpid, and at other times has some
sediment; and if what subsides be smooth, and white, or red; or if it
have the appearance of motes; or if it send up air bubbles.
CHAP. VI.
THE SYMPTOMS OF DEATH.
But though in such circumstances there is reason to fear, yet there
remains some hope. But we are sure a person is come to the last stage,
when the nose is sharp, the temples shrivelled, the eyes hollow, the
ears cold, and languid, and slightly inverted at their extremities,
the skin about the forehead hard and tense, the colour either black
or very pale; and much more so, if these things happen without any
preceding wakefulness, or purging, or fasting: from which causes this
appearance sometimes arises, but then it vanishes in one day. So that
if it continues longer, it is a forerunner of death. And if it remains
the same for three days in a tedious distemper, death is very near:
and more especially if besides the eyes can’t bear the light and shed
tears; and the white part of them grows red; and their small vessels
are pale; and humour floating in them at last sticks to the angles; and
one eye is less than the other; and they are either very much sunk,
or much swelled; and when the eye-lids in sleep are not closed, but
betwixt them there appears some part of the white of the eye; provided
it be not occasioned by a flux; when the eye-lids also are pale, and
the same paleness discolours the lips and nose; and also when the lips,
and nose, and eyes, and eye-lids, and eye-brows, or some of these, are
distorted, and the patient from pure weakness loses his hearing, or
sight.
Death is also to be expected, when the patient lies supine, and his
knees are contracted; when he slides downward now and then towards
his feet; when he lays bare his arms and legs, and tosses them about
irregularly, and there is no heat in them; when he gapes with his
mouth; when he sleeps constantly; when being insensible, he grinds
his teeth, and had not that custom in health; when an ulcer, which
broke out either before, or in the time of his sickness, has grown
dry, and turned either pale or livid, The following symptoms are
also deadly; pale-coloured nails, and fingers; a cold breath; or if
one in a fever, and acute disease, or madness, or peripneumony, or
pain of the head, gathers the wool off the cloaths with his hands, or
draws out and smooths their edges, or catches at any small prominences
in an adjoining wall. Pains also, that have begun in the hips and
lower parts, if they have been translated to the bowels, and suddenly
ceased, are sure prognostics of approaching death; and more so, if any
of the other symptoms have also concurred. And it is impossible to
save that person, who labouring under a fever without any tumour, is
suddenly, _as it were_, strangled, or cannot swallow his spittle; or
one, whose neck, while the fever and habit of body remain the same,
is turned aside, so that it is equally impossible for him to swallow
any thing; or him, who at the same time has a continued fever, and
extreme weakness of body; or when, without an abatement of the fever,
the external surface of his body is cold, and the internal parts so
hot as to produce thirst; or one, who, the fever continuing as in the
former case, is distressed at once with a delirium and difficulty of
breathing; or one, who, after drinking hellebore, has been seized with
convulsions; or one, that has lost his speech after being intoxicated
with liquor, for he is commonly carried off by convulsions, unless
either a fever has supervened, or he has begun to speak at the time,
when the effects of the liquor shall be over. A pregnant woman is also
easily destroyed by an acute distemper. And likewise any person, whose
disorder is increased by sleep; and one, who in the beginning of a
recent disorder, vomits, or voids by stool, atrabilis; and the event is
the same, where this has been discharged in either of these ways, when
the body has been already extenuated, and wasted by a long illness. A
bilious spitting, and purulent, whether they come up separately, or
mixed, shew that there is danger of death. And if this appearance has
commenced about the seventh day of a disease, the consequence is, that
the patient will die about the fourteenth, unless some other symptoms
more benign, or malignant, come on: and these after symptoms, the more
gentle or violent they are, signify that death will happen so much the
later, or sooner. A cold sweat likewise in an acute fever is mortal;
and in every disease, a vomiting variegated with different colours;
and especially if it be fetid. And it is also extremely bad to vomit
blood in a fever. The urine is commonly of a bright yellow colour and
thin in great crudity; and often before it has time to concoct, kills
the patient. Upon this account, if it continue so for any time, it
prognosticates danger of death. But the worst of all and most deadly
is the black, thick, and fetid. And such as this is the worst in men
and women; but in children that, which is thin and watery. A variegated
discharge also by the belly is very bad; and such as contains
strigments(9), blood, bile, and something green, and these either at
different times, or all together in a kind of mixture, but so as each
of them appear distinctly. Yet ’tis possible for one to endure this
somewhat longer. But a speedy death is denoted, when the discharge is
liquid, and withal either black, or pale, or fat; especially if besides
it have an intolerable stench.
I am sensible I may be asked, how it happens, if the signs of future
death are infallible, that some, who are entirely given over by
physicians, should recover, and that some are reported to have come
to life again, even when they were carried out to be buried? Nay, the
justly famed Democritus maintained, that even the marks that life was
gone, which physicians had trusted, were not certain: so far was he
from allowing, that there could be any certain prognostics of death.
In answer to which I shall not insist, that some marks, which bear
a great resemblance to each other, often deceive not the able, but
the unskilful physicians, (which Asclepiades knowing, when he met a
funeral, cried out, that the person, whom they were about to bury, was
alive) and that the art is not to be charged with the faults of any of
its professors. But I will answer with more moderation; that medicine
is a conjectural art, and that the nature of conjecture is such, that
although it answers for the most part, yet sometimes it fails. And
if a _prognostic_ may deceive a person, perhaps in one of a thousand
instances, it must not therefore be denied credit, since it answers
in innumerable others. And this I say not only with regard to the
mortal, but also to the salutary _symptoms_. For hope too is sometimes
disappointed, and one dies, whom at first the physician thought in
no danger. And those things, which have been contrived for curing,
sometimes occasion a change for the worse. Nor is it possible for human
weakness to avoid this, in so great a variety of constitutions. But
medicine however deserves credit, which most frequently, and in the
greatest number of sick people by far, is of service. Nevertheless we
ought not to be ignorant, that the prognostics both of recovery and
death are more fallacious in acute distempers.
CHAP. VII.
OF THE SIGNS IN PARTICULAR DISEASES.
Having then mentioned those signs, which belong to diseases in general,
I shall now proceed to point out those marks, which may attend the
particular kinds of them. Now there are some of these, which happen
before, and others in the time of fevers, which discover either the
state of the internal parts, or what is likely to follow. Before
fevers, if the head be heavy, or there be a dimness in the eyes after
sleep, or there be frequent sneezings, some disorder from phlegm about
the head may be feared. If a person abound with blood, or be very hot,
the consequence is, that there may be an hæmorrhage from some part.
If any person is emaciated without an evident cause, he is in danger
of falling into a bad habit of body. If the præcordia are pained, or
there is a troublesome flatulency, or if the urine is discharged the
whole day unconcocted, ’tis plain there is a crudity. Such as have a
bad colour for a long time without a jaundice, are either distressed
with pains of the head, or labour under a malacia. Those, whose faces
long continue pale and swelled, have disorders either of the head,
or bowels, or belly. If a boy in a continued fever has no passage in
his belly, and his colour is changed and he is deprived of sleep, and
is constantly bemoaning, himself, convulsions are to be apprehended.
A frequent catarrh in a slender body and tall, gives ground to fear
a consumption. When for several days there is no stool, it portends
either a sudden purging, or a slight fever. When the feet swell,
and there is a long continued purging, or pain in the bottom of the
belly and hips, a dropsical disorder is impending: but this kind of
distemper commonly arises from the ilia. Those also are exposed to
the same danger, whose belly, discharges nothing, when they have a
stimulus, unless with difficulty, and the excrements hard. When there
is a swelling in the feet, and when the like tumour, sometimes in the
right, sometimes in the left side of the belly alternately rises and
falls, that disorder seems to arise from the liver. It is a mark of the
same distemper, when the intestines about the navel are pained, which
the Greeks call strophos[AU], and pains of the hip continue without
being relieved either by time or remedies. If a pain of the joints,
for instance in the feet or hands, or in any other part, be attended
with a contraction of the nerves there; or if any limb fatigued by
slight exercise, is equally distressed by heat and cold, we may expect
the gout either in the feet or hands, or that there will be a disease
in that joint, where the pain is felt. Such as have had hæmorrhages
from the nose, while they were children, which afterwards ceased, must
either be afflicted with pains of the head, or have some troublesome
exulcerations in their joints, or fall into some languishing distemper.
Women, whose menses are suppressed, will be subject to excruciating
pains of the head, or a disorder in some other part. And those are
liable to the same dangers, who have complaints in their joints,
such as pains and swellings coming and going, without the gout, and
such-like distempers. Particularly if their temples are often pained,
and their body sweats in the night-time, and their forehead itches,
there is fear of a lippitude. If a woman after delivery has violent
pains, with no other bad symptoms, about the twentieth day there will
either be an eruption of blood from the nose, or some abscess in the
lower parts. And _in general_ in any person, a violent pain about the
temples and forehead, will be removed in one of these two ways: more
probably by an hæmorrhage, if the person be young; if somewhat more
advanced, by a suppuration. A fever, which goes off suddenly without
any apparent reason, without good signs, commonly returns. A person,
whose fauces are filled with blood, both in the day-time, and in the
night, will be found to have an ulcer there, if neither pains of the
head, nor of the præcordia, nor a cough, nor vomiting, nor slight
fever have preceded. If a woman is attacked with a slight fever from a
disorder in the groin, and the cause does not appear, there is an ulcer
in the womb. Thick urine, in which there is a white sediment, implies
that there is a pain about the joints, or the bowels, and fear of some
impending distemper. When it is green, it shows, that the bowels will
be pained, or that there will be a swelling attended with some danger;
or at least, that the body is not sound. But if there is blood or
pus in the urine, either the bladder or kidneys are ulcerated. If it
be thick, and contain in it some small caruncles, or something like
hairs; or if it be frothy, or fetid; or sometimes bring off something
like sand, and sometimes like blood; and the hips be pained, and those
parts, which lie between them, and above the pubes; and besides these
if there be frequent eructations, sometimes a bilious vomiting, and the
extremities be cold, and there is a frequent inclination to make water,
but great difficulty in it, and what comes away be limpid, or reddish,
or pale, and gives some small relief, and the belly be discharged with
much wind; in such circumstances the distemper lies in the kidneys.
But if the urine drops away slowly, or if blood is discharged with it,
and in that some bloody concretions, and it is made with difficulty,
and the internal parts about the pubes are pained, the fault is in the
bladder. Those, that have calculous concretions, are known by these
symptoms. The urine is made with difficulty, and comes away slowly, and
by drops, and sometimes involuntarily, is sandy; sometimes blood, or
bloody concretions, or something purulent is discharged with it. Some
make it more readily standing upright, others lying upon their back:
especially those, that have large stones; some even in an inclined
posture, and these by drawing out the penis, alleviate their pain.
There is also a sensation of weight in that part, which is increased
by running, and every kind of motion. Some also in the paroxysm of
the pain, cross their feet over one another, often changing them. But
women are often obliged to rub the external orifice of their pudenda
with their hands: sometimes applying their finger to that part, when
it presses upon the neck of the bladder, they feel the stone. But
where any expectorate frothy blood, their disorder is in the lungs. A
pregnant woman, whose belly is very loose, may possibly miscarry. If
the milk flows from her breast, the fœtus is weak. Hard breasts shew
the child to be sound. A frequent hiccough, and of longer continuance
than ordinary, is a sign of an inflammation of the liver. If tumours
upon ulcers have suddenly disappeared, and this has happened in the
back, we may be apprehensive either of convulsions, or a tetanus: but
if in the fore part of the body, either a pleurisy or madness is to
be expected. Sometimes also a purging, which is the safest of them
all, follows such an accident. If the hæmorrhoidal veins, in one used
to a discharge of blood from them, suddenly stop, either a dropsical
disorder or a consumption ensues. A consumption also comes on, if
suppurated matter derived from a pleurisy cannot be carried off within
forty days. But where there is a long continued grief attended with
long fear and watching, the atrabiliary distemper is the consequence.
Those, who have frequent hæmorrhages from the nose, labour under a
swelling of the spleen, or pains of the head: and they commonly see
imaginary objects floating before their eyes. But those, whose spleens
are large, have their gums diseased and a stinking mouth, or an
hæmorrhage in some part. If none of these happen, bad ulcers will be
formed in their legs, and black cicatrices from them. Where there is
a cause of pain and no sense of it, the mind is disordered. If blood
has been collected in the abdomen, it is there converted into pus. If
a pain removes from the hips and the lower parts into the breast, and
no bad symptom has supervened, there is danger of a suppuration in
that place. Those, that without a fever have a pain, or itching, with
redness and heat, in any part, will have a suppuration there. Limpid
urine also in a valetudinary person portends some suppuration about the
ears.
[AU] στρόφος.
Now as these appearances, even without a fever, contain indications of
what is latent or future, they are much more certain when accompanied
with a fever; and then symptoms of other disorders also shew
themselves. Wherefore when a person speaks more quickly than he used
to do in health, and of a sudden talks much, and that with greater
confidence than ordinary; or when one breathes slow, and with great
force, and the pulse beats high, with hard and swelled præcordia,
then there is a fear of approaching madness. Frequent motion of the
eyes also, and a darkness arising before them, together with head-ach;
or loss of sleep without any pain, and a continual watching day and
night; or lying upon the belly contrary to custom, if that is not
occasioned by a pain of the belly itself; also an unusual grinding
of the teeth, while the body continues strong, are signs of madness.
If an abscess has been formed, and subsides before a discharge by
spitting comes on, the usual fever still continuing, there will be
danger first of madness, and then of death. An acute pain also of the
ear, with a continued and strong fever, often disorders the mind: and
of this malady younger people sometimes die in seven days; those that
are older hold out something longer: because their fevers are not
equally violent, nor their distraction so great; so that they last
till the distemper is resolved into pus. A suffusion of blood in the
breasts of a woman betokens approaching madness. Those, that have long
fevers, will either have an abscess formed somewhere, or pains of the
joints. Those, whose breath is greatly straitened in passing through
the fauces in fevers, will soon fall into convulsions. If an angina
suddenly disappears, the distemper is removing into the lungs; and that
is often fatal before the seventh day: and if that does not happen, the
consequence is a suppuration in some part. Lastly, after long purgings
come dysenteries; after these a lientery; after violent catarrhs a
consumption; after pleurisies diseases of the lungs; after which
madness; after great heats of the body a tetanus or convulsion; after
a wound of the head a delirium; after great torment for want of sleep,
convulsions; when the blood vessels above ulcers are in strong motion,
there will be an hæmorrhage.
A suppuration is produced many ways(10); for if fevers unattended
with pain continue long without any manifest cause, the disorder
is transferred upon some particular part: but this happens only in
younger people; for in the elderly, a quartan ague is the common
consequence of such a disease. A suppuration also happens, if the
præcordia being hard and pained have neither carried off the patient
before the twentieth day, nor an hæmorrhage from the nose has ensued;
and this holds chiefly in youths, especially if in the beginning of
the distemper they had dimness of the eyes, or pains of the head: but
then the abscess forms in the lower parts _of the body_. But if there
be a soft tumour in the præcordia, and it has not ceased within sixty
days, and the fever continues all that time, then the abscess forms
in the superior parts: and if there is not a discharge of blood from
the nose(11) in the beginning, it breaks out about the ears. And as
every tumour of long standing generally tends to suppuration, so one,
that is seated in the præcordia is more likely to have that issue, than
one that is in the belly: and one, that is above the navel, than one,
that is below it. Also if there is a sense of lassitude in a fever, an
abscess is formed either in the jaws, or the joints. Sometimes too the
urine continues long and thin, and crude, and the other symptoms are
good: in this case for the most part an abscess is formed below the
transverse septum (which the Greeks call diaphragma). If a peripneumony
is removed neither by expectoration, nor by cupping, nor bleeding, nor
a proper regimen, it sometimes gives rise to some vomicæ, either about
the twentieth day, or thirtieth, or fortieth, and even sometimes about
the sixtieth. Now we must date our reckoning from that day, in which
the person was first taken with the fever, or seized with a horror, or
felt a weight in the part. But these vomicæ are generated sometimes in
the lungs, sometimes about the ribs. Where the suppuration is seated,
it raises a pain and inflammation, and there is a greater heat there:
and if one has lain down upon the sound side, he imagines it loaded
with some weight. And every suppuration, that is not yet visible, may
be known by the following signs: the fever does not wholly intermit,
but is more mild in the day-time, and increases at night, there is
plentiful sweating, an inclination to cough, and hardly any thing
brought up by it, the eyes are hollow, cheeks red, the veins under the
tongue white, the nails of the hands crooked, the fingers, especially
their extremities, hot; there are swellings in the feet, difficulty
in breathing, loathing of food, pimples breaking out over the whole
body. But if the pain, cough, and difficulty of breathing have come on
immediately at the beginning, the vomica will break before, or about
the twentieth day. If these have begun later, they must of course
increase; but the less quickly they have appeared, the more slowly will
they be removed. It is common also in a severe distemper for the feet,
hands, and nails to turn black: and if death has not followed, and the
other parts of the body are restored, yet the feet fall off.
CHAP. VIII.
WHAT SYMPTOMS ARE DANGEROUS, OR HOPEFUL IN PARTICULAR DISEASES.
Our next business is to explain the particular marks in every kind
of distemper, which either afford hope, or indicate danger. If the
bladder be pained, and there be a discharge of purulent urine, and
also a smooth and white sediment in it, there is no danger. In a
peripneumony, if the pain is mitigated by the spitting, although that
be purulent, yet if the patient breathes easily, expectorates freely,
and is not much distressed with the distemper, he may possibly recover
his health. Nor need we immediately give way to fears, if the spittle
is mixed with some reddish blood, provided that presently ceases.
Pleurisies, that suppurate, when the matter is carried off within
forty days, are thereby terminated. If there is a vomica in the liver,
and the matter discharged from it be unmixed and white, the patient
easily recovers, for that disorder is seated in the membrane. Now these
kinds of suppurated tumours are tolerable, which are directed towards
the external parts, and rise to a point. But of those, which point
inward, the more mild are such, as while close, don’t affect the skin,
and suffer it to remain without pain, and of the same colour with the
other parts. Also pus from whatever part it is discharged, if it be
smooth, white, and uniform, is not at all dangerous; and if after the
evacuation of it the fever has presently abated, and the nausea and
thirst have ceased to be troublesome. If at any time also a suppuration
falls into the legs, and the patient’s discharge by spitting becomes
purulent instead of reddish, the danger is less. But in a consumption,
he that is to recover, will have his spitting white, uniform, and of
the same colour, with out phlegm: and whatever falls down from the
head by the nostrils, should be of a like nature. ’Tis far best to be
altogether free from a fever: next to this, that it be so gentle, as
neither to prevent the taking of food, nor occasion a frequent thirst.
In this distemper that state of the belly is safe, in which every day
consistent excrements are evacuated, in quantity proportioned to the
food; and so is that body, which is least slender, and has the broadest
and most hairy chest, and whose cartilage is small and fleshy. In a
consumption too, if a woman has had her menses suppressed, and while
the pain still remains about her breast, and shoulders, and the blood
has of a sudden made its way, the distemper is commonly mitigated:
for both the cough is lessened, and the thirst and febricula cease.
But in the same patients, if their menses do not return, for the most
part the vomica breaks: and the more bloody the discharge from it is,
so much the better. A dropsical disorder is the least to be feared,
which has begun without any preceding distemper. Of the next favourable
sort is that, which succeeds a long distemper, if at the same time the
bowels be firm; if the breathing be easy; if there is no pain; if the
body is not hot; and is equally lean in its extremities; if the belly
is soft; if there be no cough, no thirst; if the tongue even in sleep
does grow dry; if there is an appetite for meat; if the belly yields
to purging medicines; if spontaneously it discharges excrements soft
and figured; if it grows less(12); if the urine is altered by the
change of wine, and by drinking certain medicinal potions; if the body
is free from lassitude, and easily bears motion: for where one has all
these symptoms, he is altogether safe; where most of them appear, the
patient is in a hopeful way. Diseases of the joints, as the gout in the
feet or hands, if they have attacked the patients young, and have not
brought on a callus, may be removed; and they are most of all allayed
by a dysentery, and when by any means the belly becomes loose. Also
an epilepsy, that begins before puberty, is easily removed; and where
a person sensibly feels the approaching fit first affecting some part
of the body. It is best, that it begin at the hands or feet; next to
them, at the sides; but worst of all, when it begins at the head. And
in these patients also, excretions by the belly are of the greatest
service. Now a purging is not in the least hurtful, which is without
a fever, if it quickly, ceases; if upon feeling the belly, there is no
motion perceived; if wind is discharged at the end of a stool. Nay even
a dysentery is not dangerous, if blood and strigments are discharged,
provided the patient is without a fever, and the other concomitants of
this distemper: insomuch, that a pregnant woman may not only be cured,
but her fœtus also preserved. And it is an advantage in this disorder,
if the patient has come to some age. On the contrary, a lientery is
more easily cured in tender age: especially if the urine begins to
be excreted, and the body to be nourished with food. The same age is
most favourable in pains of the hip, and arms, and in every paralytic
disorder. Amongst these, the hip, if it be without numbness, if its
coldness be slight, although it be greatly pained, yet it is easily and
quickly cured; and a paralytic limb, if it continue to be nourished,
may be recovered. A palsy of the mouth also is cured by a loose belly.
And all purging does good to one labouring under a lippitude. Madness
is removed by the appearance of a varicous swelling, or sudden eruption
of blood from the hæmorrhoidal veins, or a dysentery. Pains of the
arms, which are propagated either to the shoulders, or hands, are
cured by vomiting of atrabilis. And whatever pain moves downward, is
more easily cured. A hiccough is cured by sneezing. A vomiting stops
long purgings. A woman, that vomits blood, is relieved by the flux
of her menses. She, whose menses are deficient, if there has been an
hæmorrhage from the nose, is free from all danger. And one, that is
hysteric(13) or has a difficult labour, is relieved by sneezing. To
one, that has a heat and tremour, a delirium is salutary. Dysenteries
are of service to splenetic people. Lastly, a fever itself, which
may seem very wonderful, is often a remedy _for other distempers_.
For it both cures pains of the præcordia, that are not attended with
inflammation, and relieves in a pain of the liver; and entirely removes
convulsions, and a tetanus, if it comes after them; and where the
distemper of the smaller intestine has been occasioned by a difficulty
in making urine, if by the heat it promotes urine, it gives ease.
Pains of the head attended with dimness of the eyes and redness with
an itching in the forehead, are removed by a discharge of blood,
either spontaneous or procured. If pains of the head and forehead
arise from being exposed to the wind, or cold, or heat, they are cured
by a gravedo, and sneezing. A sudden shuddering puts an end to an
ardent fever, which the Greeks call causodes[AV]. When in a fever,
there is a deafness, if blood is discharged from the nose, or the
belly turns loose, that disorder is entirely removed. Nothing is more
prevalent against deafness, than bilious stools. Those, that have small
abscesses, which the Greeks call phymata[AW], formed in the urethra,
are cured, when pus is discharged from thence. Now as most of these
favourable turns happen of themselves, we may conclude, that nature has
very great power in these very helps, which are applied by art.
[AV] καυσώδης.
[AW] φύματα.
On the contrary, when there is a pain in the head in a continued
fever, and it does not at all remit, it is a bad and mortal symptom:
and boys from the seventh to the fourteenth year are most liable to
this danger. In a peripneumony, if the spitting did not come on in the
beginning, but after the seventh day, and has continued above other
seven days, it is dangerous: and the more mixed and less distinct the
colours are, so much the worse. And yet nothing is worse, than for
it to be excreted entirely homogeneous, whether it be reddish, or
bloody, or white, or glutinous, or pale, or frothy: but the worst of
all colours is black. A cough and catarrh are dangerous in the same
disease; also a sneezing, which in other cases is reckoned salutary;
and there is the greatest danger of all, if these things have been
followed by a sudden purging. Now generally the symptoms, which are
either good or bad in peripneumonies, are so in pleurisies too. A
discharge of bloody pus from the liver is mortal. These are the worst
kinds of suppurations, which tend inward, and discolour the external
skin at the same time. Of that kind, that breaks outward(14), the
worst are those, that are largest and flattest. But if the fever has
not gone off, when the vomica is broke, or the pus evacuated, or after
its ceasing returns again; also if there be a thirst, or a nausea,
or a loose belly, or livid and pale pus, if the patient expectorates
nothing but frothy phlegm; then there is certain danger. And of these
kinds of suppurations, which have been produced by diseases of the
lungs, old men commonly die: but those; those that are younger, by
the other kinds. But in a consumption, a mixed and purulent spitting,
a continued fever, which also destroys the appetite, and torments with
thirst, in a slender body are sure prognosticks of immediate danger. If
one has lasted under this distemper even for a considerable time, when
the hairs first fall off, when the urine has something floating upon
it like cobwebs, and the spittle has a fetid smell, and particularly
when after these a purging has appeared, he will die soon: and more
especially if it be autumn: in which season commonly those, that have
got over the other part of the year, come to the close of their life.
It is also mortal in this distemper to have expectorated pus, and
afterwards for that to have entirely disappeared. It is likewise common
for this disease in young people to arise from a vomica or fistula;
and they do not readily recover, unless many salutary symptoms have
ensued. With regard to others, virgins are the hardest to cure, or
those women, that fall into a consumption from a suppression of the
menses. A healthy person who has been taken with a sudden pain of his
head, and then fallen into a deep sleep, so as to snore, and does not
awake, will die before seven days are expired: and more especially
if, when a looseness has not preceded, his eyelids are not closed
in sleep, but the white of his eyes appears. Death however is not
the certain consequence, if a fever comes on, which may remove the
distemper. A dropsical disorder occasioned by an acute distemper, is
seldom cured: especially if followed by the opposite symptoms to those
above-mentioned. A cough likewise is equally destructive of hope in
this distemper: also an hæmorrhage either upward or downward, and a
collection of water in the middle of the body(15). Some people too in
this disease have swellings, which afterwards subside, and then appear
again. Such indeed are more safe than those mentioned before, if they
take the proper care: but they commonly perish from a persuasion of
their being well. Some people with good reason will wonder, how any
thing can at once both be hurtful to our bodies, and in part conduce
to their preservation. For whether a dropsy has filled one with water,
or a great quantity of pus has been collected in a large abscess, for
the whole to be discharged at once is equally mortal, as for a sound
person to lose all his blood by a wound. If the joints of any person
are pained, so that some tubercles from a callus grow upon them, they
are never cured: and the disorders of those parts, which have either
begun in old age, or have continued from youth to that time of life,
though they may be sometimes mitigated, yet are never entirely removed.
An epilepsy also, that begins after the twenty-fifth year, is difficult
to cure: and much more so that, which has begun after the fortieth; so
that, although there may be some hope from nature, scarce any thing
is to be expected from medicine at that age. In the same disease if
the whole body is affected at once, and the patient is not sensible of
the fit beginning in any part, but falls down suddenly, whatever his
age be, he rarely gets free of the distemper: but if his intellects
be injured, or a palsy has come on, there is no room for medicine.
In purgings too, if attended with a fever; if with an inflammation
of the liver, or præcordia, or belly; if with an intolerable thirst;
if the disease has continued long; if the discharge of the belly is
variegated; if it is expelled with pain, there is danger even of
death: and more especially if with these _symptoms_ a dysentery has
grown inveterate. And this distemper sweeps off children chiefly to
their tenth year: at other times of life, it is more easily endured.
A pregnant woman also may be carried off by such a case: and although
she herself recovers, yet she loses her child. Moreover a dysentery
occasioned by atrabilis is mortal: or a sudden and black discharge from
the belly, when the body is already wasted by that distemper. But a
lientery is more dangerous, if the purging be frequent; if the belly is
discharged at all hours, both with a rumbling, and without it; if it
continues with equal violence both night and day; if what is excreted,
is either crude, or black, and besides smooth and fetid; if thirst is
troublesome; if urine is not made after drinking (the cause of which
is, that all the liquor at that time descends, not into the bladder,
but into the intestines) if the mouth is ulcerated; if the face is red,
and marked with certain spots of all colours; if the belly is puffed
up as it were by fermentation(16), fat and full of wrinkles; and if
there is no appetite for food. And as in these circumstances death is
the plain consequence; it is much more evidently so, if the disease
is already of long standing; especially if withal the patient be old.
In the distemper of the smaller intestine, a vomiting, hiccough,
convulsion, and delirium, are bad symptoms. In the jaundice it is the
most pernicious symptom for the liver to be indurated. Those, that have
disorders in the spleen, if they be seized with a dysentery, which
afterwards turns to a dropsy or a lientery, it is scarce in the power
of medicine to save. The distemper of the smaller intestine arising
from a difficulty of urine, unless it be removed by a fever, kills
within seven days. If a woman after delivery is seized with a fever,
and violent and constant pains of the head, she is in danger of dying.
If there is a pain and inflammation in those parts, which contain the
bowels, it is a bad sign to fetch the breath often. If a pain of the
head continues long without a perceptible cause, and removes into the
neck and shoulders, and again returns into the head; or comes from the
head to the neck and shoulders, it is dangerous: unless it produce
some vomica, so that the pus may be expectorated; or unless there is
an hæmorrhage from some part; or scurf break out plentifully in the
head, or pustules over the whole body. It is an equally formidable
distemper when a numbness and itching wander about; sometimes over the
whole head, sometimes in a part of it; or when there is something like
a sensation of cold in the part, and these reach even to the end of
the tongue. And though in these cases abscesses are beneficial, yet
there is less hope of a recovery by their means, as they are seldom
formed after such disorders begin. In pains of the hip, if there is
a great numbness, and the leg and hip are cold, and the belly has no
passage, but when assisted, and the excrements are slimy, and the age
of the person exceed forty, the distemper will be very tedious, and at
least of a year’s continuance; neither will it be possible to remove
it, unless it be either in the spring or autumn. At the same time of
life, the cure is equally difficult, when a pain of the arms removes
into the hands, or reaches to the shoulders, and produces a torpor and
pain, and is not relieved by a bilious vomiting. A paralytic limb in
any part of the body, if it has no motion, and pines away, will not
recover its former state; and the more inveterate the distemper, and
the more advanced in years the patient is, so much the less probable
is the cure. And in every paralytic disorder, the winter and autumn are
improper seasons for medicine: some benefit may possibly be hoped for
in the spring and summer. And this distemper, when moderate, is cured
with difficulty; when violent, it cannot be cured at all. Every pain
also, which moves upward, yields less to medicine. If the breasts of a
pregnant woman have shrunk suddenly, there is danger of a miscarriage.
In a woman that has milk, and has neither had a child, nor is pregnant,
the menses are suppressed. A quartan ague in the summer is short, but
in the autumn commonly long; especially that, which has come on, when
the winter was approaching. If there has been an hæmorrhage followed
with madness and convulsions, there is danger of death. Also if a
convulsion has seized a person purged by medicines and still empty;
or if the extremities are cold in the time of great pain. Nor does
a person return to life, who has been hanged, and taken down with a
frothing mouth. A black and sudden discharge of the belly, like black
blood, whether it be attended with a fever or not, is pernicious.
CHAP. IX.
OF THE CURE OF DISEASES.
Having considered those signs, which may give us hope or fear, we
must proceed to the methods of curing diseases. Now these are divided
into the general and particular: the general, which relieve several
distempers, the particular, which are confined to single disorders. I
shall first treat of the general. But there are some of those, that not
only support the sick, but conduce to the preservation of the healthy,
others are made use of in sickness only.
Now every thing that assists the body, either evacuates somewhat, or
adds, or draws, or restrains, or cools, or heats, and at the same time
either hardens, or mollifies. Some things also are useful not in one
way only, but even in two, that are not contrary to each other. An
evacuation is made by bleeding, cupping, purging, vomiting, friction,
gestation, and all exercise of the body, abstinence and sweat. Of these
I shall now treat.
CHAP. X.
OF BLEEDING.
To let blood by the incision of a vein is not new: but to practise
this in almost every distemper is new. Again, to bleed younger people,
and women, that are not pregnant, is of ancient use. But to attempt
the same in children and old people, and in pregnant women, is not
an old practice. For indeed the ancients judged, that the first and
last stages of life were not able to bear this kind of remedy; and
they were persuaded, that a pregnant woman, who had been thus treated,
would miscarry. But afterwards experience proved, that none of these
rules were universal, and that some other circumstances were rather
to be regarded, by which the intention of the physician was to be
directed. For the material point is not, what the age may be, or what
is contained within the body, but what degree of strength there is.
Upon this account if a young man is valetudinary, or a woman not with
child be weak, bleeding is bad: for the remaining strength, is by this
evacuation destroyed. Whereas to a stout boy, and a robust old man,
and a strong pregnant woman, it may be used with safety. ’Tis true an
unskilful physician may be greatly deceived in such patients: because
there is commonly less strength at these times of life. And a pregnant
woman stands in need of strength after her cure, to support not only
herself, but her fœtus also. But whatever requires either attention
of mind, or prudence, is not to be immediately rejected: since the
excellency of the art here consists, not in numbering the years, nor
in regarding conception alone, but in considering the strength, and
collecting from thence, whether there will be left sufficient to
support either a boy, or an old man, or two bodies at once in one
woman. There is a difference also between bodies strong, and corpulent:
and those, that are slender, and infirm. In the slender, blood more
abounds, but in those of a fuller habit, flesh. Wherefore the first
bear this evacuation more easily: and he, that is over fat, is soonest
distressed by it. For this reason the strength of the body is to be
estimated rather by the state of the vessels, than from its appearance.
Nor are these the only particulars to be considered, but also what kind
of distemper it is: whether a redundancy, or deficiency of matter has
been hurtful; whether the body be corrupted or sound. For if there be
a deficiency, or the humours be sound, this method is prejudicial. But
if either the quantity of matter is hurtful, or it is corrupted, no
other remedy is more successful; for this reason a violent fever, when
the skin is red, and the veins are full and turgid, requires bleeding:
likewise diseases of the bowels, and palsies, and the tetanus, and
convulsions; in fine, whatever strangulates the fauces, so as to cause
a difficulty in breathing; whatever suddenly stops the speech; any
pain, that is intolerable; and any internal rupture, or bruise, from
whatever cause; also a bad habit of body; and all acute distempers;
provided, as I observed above, they hurt not by weakness, but by
redundancy.
But it may possibly happen, that a distemper may indeed require this
method, and at the same time the body may seem hardly able to bear it:
but yet if there appears no other remedy, and the patient must perish,
unless he shall be relieved even by a rash attempt; in this case, it
is the part of a good physician to shew, that there is no hope without
bleeding; and to confess what bad consequences may be apprehended even
from that remedy; and after that, to bleed if desired. It is by no
means proper to hesitate about it in such a situation as this: for it
is better to try a doubtful remedy, than none at all. And this ought
especially to be practised, when there is a palsy; when one has lost
his speech suddenly; when an angina suffocates; when the preceding
paroxysm of a fever has almost killed a person, and another equally
severe is likely to follow, and the strength of the patient seems
unable to bear it.
Though bleeding ought not to be performed in a state of crudity, yet
even that does not hold always. For the circumstances will not at all
times wait for concoction. So that if any person has fallen front
a height, or has received a contusion, or vomits blood from some
sudden accident, although he has taken food a little before, yet that
evacuation is proper, lest if the matter settle, it distress the body.
The same rule will hold in other sudden cases too, where there is a
danger of suffocation. But if the nature of the distemper will allow a
delay, it must not be done, till all remaining suspicion of crudity is
removed. Upon this account, the second or third day of an illness seems
most proper for this operation. But as sometimes it is necessary to
bleed even on the first day, so it is never good after the fourth, when
by time alone, the matter is either dissipated, or has corrupted the
body; so that the evacuation may weaken, but cannot make it sound. But
when a vehement fever prevails, to bleed in the time of its violence is
killing the patient. Therefore an intermission(17) is to be awaited
for: if it does not intermit, when it has ceased to increase: if there
be no hopes even of a remission, in that case the only opportunity
offered, though less favourable, is not to be neglected.
Further this remedy, where it is necessary, generally were best to be
divided into two days; for it is better at the first to lighten the
patient, and after that to cleanse him thoroughly, than to run any risk
of his life by dissipating all his strength at once. And if this method
be found to answer in the cure of a dropsy, how much more must it of
necessity answer with regard to the blood?
If the disorder be in the whole body, the evacuation ought to be made
from the arm: if in any particular place, from the part affected, or
at least as near to it as may be; because it cannot be performed every
where, but only in the temples, and in the arms, and near the ancles. I
am not ignorant, that it is the opinion of some, that blood should be
let at the greatest distance from the part where it does harm; for that
thus the course of the matter is diverted; but in the other way it is
drawn into that very place, which is distressed. But this is altogether
false. For it first empties the part nearest: and the blood flows from
the more remote, as long as the evacuation is continued: when this is
stopt, because there is no more attraction, it then ceases to come.
Yet experience itself seems to have shewn, that in a fracture of the
skull blood is to be let rather from the arm: and if the disorder is
in one arm, it must be performed in the other: I suppose for this
reason, because if any miscarriage should happen, those parts, which
are already hurt(18), are more exposed to injuries. Sometimes also an
hæmorrhage breaking out in one part, is stopt by bleeding in another.
For it ceases to flow, where we would not have it, when we apply what
will stop its course there, and open another passage for it.
Altho’ bleeding is very easy to one, who has experience; yet it is very
difficult to one, that is ignorant. For the vein lies close to the
arteries; and to these the nerves. So that if the lancet has touched a
nerve, a convulsion will follow, which destroys a man miserably. And
then a wounded artery neither unites again, nor heals; and sometimes it
occasions a violent hæmorrhage. If also the vein itself happens to be
cut quite through, the two ends are compressed, and discharge no blood.
Again, if the lancet is entered with fear, it lacerates the surface
of the skin, and does not open the vein. Sometimes too the vein lies
concealed, and is not easily found. Thus many circumstances make that
difficult to an ignorant person, which is very easy to the skilful.
The vein is to be cut at the middle. And when the blood flows from it,
its colour and consistence ought to be observed. For if it be thick
and black, it is bad; and therefore the discharge is useful: if red
and pellucid, it is sound; and that evacuation is so far from being
beneficial, that it may even hurt, and is immediately to be stopt. But
such an accident cannot happen to the physician, who knows in what case
bleeding is to be used. It more commonly happens, that it flows on
the first day equally black thro’ the operation. And altho’ it be so,
yet if the discharge is sufficient, it must be stopt: and an end must
always be put to it, before the person faints.
Then the arm is to be bound up, putting upon it a penecillum(19)
dipt in cold water, and squeezed; and on the following day, the vein
must be rubbed with the middle finger, that its recent union may be
resolved, and it may again discharge blood. Whether it happens on the
first or second day, that the blood, which at first flowed thick, and
black, has begun to appear red and pellucid, there is then a sufficient
quantity taken away, and what remains is pure: so that the arm is to be
immediately bound up, and kept so, till the cicatrice is firm; which
firmness it very soon acquires in a vein.
CHAP. XI.
OF CUPPING.
There are two sorts of cucurbitals: the one of copper, the other of
horn. That of copper is open at the one end, and close at the other;
that of horn is likewise open at one end, and at the other has a small
hole. Into the copper one burning linen is put, and its mouth is clapt
close to the body, and is prest down, till it adhere to it. The horn
kind is only applied to the body, and after that, when a person has
sucked out the air by the small hole, and that is closed with wax, it
sticks, as well as the other. Both of these are made not only of these
two materials, but of any thing else. Where no better can be got, a
small cup with a narrow mouth is fit enough for the purpose. When it
adheres, if the skin has been cut before with a scalpel, it will bring
out blood: if the skin is whole, air. Wherefore when the offence is
from matter contained within, the first method is to be pursued: when
it is only a flatulency, the other is commonly used.
Now the principal use of a cucurbital is, when a disorder is not in the
whole body, but only in a part, the emptying of which is sufficient to
render it sound. And this very thing is a proof, that in the cure of
any member, bleeding by a lancet too is to be performed rather in the
part which is already hurt: because no body puts the cucurbital upon
a different part, unless to divert the flux of blood thither, but on
that, which is diseased, and which is to be relieved.
There may possibly be a necessity for using the cucurbital in chronic
distempers (although they be already of some standing) if there be
either corrupted matter, or a flatulency. Likewise in some acute
distempers, if at the same time the body requires to be lightened, and
the strength will not admit of bleeding from a vein. And this remedy,
as it is less violent, so it is more safe; and is never dangerous,
though it be made use of in the greatest violence of a fever, or even
in the time of crudity. For this reason, when there is a necessity for
bleeding, if the opening of a vein is very dangerous, or the disorder
is fix’d in a noble part of the body, we must also have recourse to
this instrument. We must be sensible however, that as it is attended
with no danger, so it gives a feebler aid; and that is not possible to
relieve a violent distemper, but by an equally violent remedy.
CHAP. XII.
OF PURGING.
In almost every distemper the ancients endeavoured to purge by various
medicines and frequent clysters: and they gave either black hellebore,
or polypody of the oak, or scales of copper(20), or the milk of
sea-spurge(21), a drop of which taken upon bread purges plentifully;
or asses, or cow’s, or goat’s milk, with the addition of a little salt;
and this they boiled, and taking away what had been curdled, they
obliged the patient to drink what remained like whey.
But generally _purging_ medicines injure the stomach. Wherefore aloes
is to be mixed with all cathartics. If the purging be severe, or
frequent clysters be administered, it weakens a man. For that reason
it is never proper in an illness to give medicines with that view,
unless there be no fever concomitant: as when black hellebore is given
to those that labour under atrabilis, or a melancholy madness, or any
paralytic disorder. But where there are fevers, it is better to take
such food and drink for that purpose, as may at once both nourish,
and prove laxative. And there are some kinds of disorders, with which
purging by milk agrees.
[Sidenote: _Of clysters._]
But for the most part the belly is to be opened by clysters. Which
method, somewhat censured, though not entirely laid aside by
Asclepiades, I observe to be generally neglected in our own age. That
moderation, which he seems to have followed, is most proper, that
neither this remedy should be often tried, nor be entirely omitted, but
used once, or at most twice, if the head is heavy, or the eyes dim;
if there is a disorder of the large intestine, which the Greeks call
colon; if there are pains of the lower belly, or in the hips; if any
thing bilious be accumulated in the stomach, or even any flux of phlegm
or a humour like water thither; if the breathing is difficult; if there
is no natural discharge from the belly; especially if the excrements
are near the anus, and still remain within; or if the patient, while he
has no passage, nevertheless perceives the smell of excrements in his
breath; or if the stools appear corrupted; or if an early abstinence
has not removed a fever; or when a case may require bleeding, and the
strength will not allow of it, and the time for that operation is past;
or if one has drank much before an illness; or if a person, who was
frequently loose, either naturally or by some accident, is suddenly
bound in the belly. But the following rules are to be observed, that it
be not used before the third day; nor while any crudity remains; nor
in a body weak and exhausted by long sickness; nor to a person, whose
belly discharges sufficiently every day, or one that is loose; nor
during the paroxysm of a fever; because what is injected at this time,
is retained within the belly, and being thrown upon the head, greatly
increases the danger. On the day before, the patient ought to fast,
that he may be prepared for this remedy. On the day of the operation
to drink, some hours before, hot water, that his superior parts may
be moistened; then the injection is to be performed with pure water,
if we be content with a gentle medicine; if somewhat more powerful is
required, hydromel(22); if a lenient, a decoction of fœnugreek, or
ptisan(23), or mallows, in water: if it be intended to restringe, a
decoction of vervains(24). Sea-water, or any other water with the
addition of salt, is acrid: but both of these are better boiled. A
greater degree of acrimony is given by adding either oil, or nitre, or
honey also. The more acrid it is, it evacuates the more; but it is not
so easy to bear. The injection ought neither to be cold, nor hot; lest
it hurt either way. When it is injected, the patient ought to confine
himself as much as possible in bed, and not yield immediately to the
first stimulus he finds to go to stool; and not till necessity obliges
him. And commonly this evacuation by lightning the superior parts
mitigates the distemper itself. When a person has fatigued himself by
going to stool, as often as he was obliged, he ought to take rest for a
little time; and lest he grow faint, even on the same day to take food.
The quantity of which ought to be determined by considering the nature
of the paroxysm that is expected; or whether there is no danger of any.
CHAP. XIII.
OF VOMITING.
As a vomit even in health is often necessary to persons of a bilious
habit; it is likewise so in those distempers, which are occasioned
by bile. Upon this account it is necessary to those, that before
fevers are distressed with horrors and tremors; to all those, that
labour under a cholera; and all, that are attacked with madness, and a
concomitant mirth; and those also, who are oppressed with an epilepsy.
But if the distemper be acute, as the cholera; if it be a fever, while
there are tetani, the rougher medicines are improper, as has been
observed above in the article of purging; and it is sufficient to take
such a vomit, as I prescribed for people in health. But when distempers
are of long standing, and stubborn, without any fever, as an epilepsy
or madness, we must use even white hellebore. Which it is not proper
to administer in the winter, or summer; it is best in the spring: in
the autumn it does tolerably well. Whoever prescribes it, ought first
to take care, that the body of his patient be moist. It is necessary
to know, that every medicine of this kind, which is given by way of
potion, is not always beneficial to sick people, to healthy always
hurtful.
CHAP. XIV.
OF FRICTION.
Concerning friction(25), Asclepiades looking upon himself as the
inventor of it, has said so much in that book, which he entitled ‘of
general remedies,’ that tho’ he mentions only three things, that, and
wine, and gestation, yet he has taken up the greatest part of his
treatise upon the first. Now as it is not fit to defraud the moderns
of the merit either of their new discoveries or judicious imitations,
_so it is but just_ at the same time to assign those things, which were
practised among some of the ancients, to their true authors. It cannot
indeed be doubted, that Asclepiades has been both fuller and clearer
in his directions, when and how friction ought to be used; but he has
discovered nothing, which was not comprized in a few words by the
most ancient author Hippocrates; who said, that friction, if violent,
hardens the body; if gentle, softens it; if plentiful, extenuates; if
moderate, increases its bulk: from whence it follows, that it is to be
made use of, when a lax body requires to be braced; or to soften one,
that is indurated; or to dissipate where the fulness is hurtful; or to
nourish that, which is slender and infirm.
Nevertheless, if a person examine more curiously into these different
species (which is not here the province of a physician) he will easily
understand that the effects of them all proceed from one cause; that
is, the carrying off of something. For a part will be bound, when that
thing is taken away, the intervention of which had caused it to be
lax; and another is softened by removing that, which occasioned the
hardness; and the body is filled, not by the friction itself, but by
that food, which afterwards makes its way to the skin, relaxed by a
kind of digestion(26). And the degree of it is the cause of these
effects so widely different.
But there is a great deal of difference betwixt unction, and friction.
For it is necessary for the body to be anointed, and gently rubbed even
in acute and recent distempers; but this must be done in the time
of their remission, and before taking food. But to make use of long
friction is not proper, either in acute or increasing disorders; except
when the intention of it is to procure sleep in phrenitic patients.
This remedy is very agreeable to inveterate distempers, and where they
have abated somewhat of their first violence. I am not ignorant that
some maintain, that every remedy is necessary for distempers, while
they are increasing, not when they are going off spontaneously. But
this is not just; for a distemper, though it would come to a period of
itself, may notwithstanding be sooner terminated by the application of
remedies. The use of which is necessary upon a double account, both
that the health may be restored as soon as possible; and that the
disorder, which remains, be not irritated again by any slight cause:
for a distemper may be less violent, than it has been, and yet not
entirely removed; but there may be some remains of it, which the use of
remedies may dissipate.
But though friction may be used in the decline of an illness, yet it
is never to be practised in the increase of a fever; but if possible,
when the body is entirely free of it; if that can’t be done, at least
when there is a remission. It ought also to be performed sometimes over
the whole body, as when we would have an infirm person take on flesh;
sometimes in particular parts, either because the weakness of that
part itself, or of some other, requires it. For both inveterate pains
of the head are mitigated by the friction of it (yet not during their
violence) and any paralytic limb is strengthened by rubbing it: but
much more commonly, when one part is pained, a different one is to be
rubbed; and particularly, when we want to make a derivation from the
upper or middle parts of the body; and with this intention we rub the
extremities. And these people are not to be regarded, who prescribe
to a certain number, how often a person is to be rubbed: for that is
to be estimated from his strength. Thus if one is very weak, fifty
times may be sufficient: if of a more robust habit, it may be done two
hundred times. And then _in different proportions_ betwixt these two
according to the strength. Whence it also happens, that the motion of
the hands in friction must be less frequent in a woman than a man;
less frequent in a boy or an old man, than a young man. Lastly, if
particular parts are rubbed, they require much and strong friction.
For the whole body cannot be quickly weakened by a part, and there is
a necessity for dissipating as much of the matter as we can, whether
the intention be to relieve the part we brush, or another by means of
it. But where a weakness of the whole body requires this treatment all
over, it ought to be shorter and more mild; so as only to soften the
surface of the skin, to render it more apt to receive new matter from
fresh nourishment. A patient is known to be in a bad situation, when
the surface of his body is cold, and the internal part is hot with a
concomitant thirst, as I observed above. But even in this case friction
is the only remedy, which, if it have brought out the heat, may make
way for the use of some medicine.
CHAP. XV.
OF GESTATION.
Gestation is most proper for chronic distempers, and those that are
already upon the decline. And it is useful both to those, who are
quite free of a fever, but yet are not able to exercise themselves;
and those, that have the slow relicks of distempers, which are not
otherwise expelled. Asclepiades said, that gestation was to be used
even in a recent and violent, and especially an ardent fever, in
order to discuss it. But that is dangerous; and the violence of such
a distemper is sustained better by remaining quiet. Yet if any person
will make trial of it, he may do it under these circumstances, if his
tongue is not rough, if there be no tumour, no hardness, no pain in his
bowels, nor head, nor præcordia. And gestation ought never to be used
at all in a body that is pained, whether in the whole, or in any part,
unless the pain be in the nerves alone; and never in the increase of a
fever, but upon its remission.
There are many kinds of gestation: in the use of which the strength
and circumstances of the patient are to be considered; that they may
neither dissipate too much a weak man, nor be out of the reach of one
of small fortune. The most mild kind of gestation is in a ship, either
in a port, or a river; or in a litter, or a chair; more brisk in a
chariot; more violent in a ship on the ocean. And each of them may be
rendered both more sharp, and more mild. If none of them can be done,
the bed must be suspended and moved to and fro. If even that can’t be
accomplished, at least a prop is to be put under one foot(27) of the
bed, and thus the bed moved back and forward by the hand. And indeed
the mild kinds of exercise agree with the weakest; the stronger with
those, who have been for several days free from the fever; or those,
who feel the beginnings of severe distempers, but are yet without a
fever (which is the case in a consumption, and indispositions of the
stomach, and a dropsical disorder, and sometimes in a jaundice) or when
some distempers, such as an epilepsy or madness, continue, though for a
considerable time, without any concomitant fever. In which disorders,
these kinds of exercises also are necessary, which were mentioned in
that place, where we prescribed rules for the conduct of sound, but
weakly men.
CHAP. XVI.
OF ABSTINENCE.
There are two kinds of abstinence. One, when the patient takes no food
at all: the other, when he takes only what is proper. The beginnings
of diseases call for fasting and thirst: after that in the distempers
themselves moderation is required, so that nothing but what is proper
be taken, and not too much of that; for it is not fit after fasting,
to enter immediately upon a full diet. And if this be hurtful even to
sound bodies, that have been under the necessity of wanting food for
some time, how much more is it so to a weak, not to say a diseased one?
And there is nothing which more relieves an indisposed person, than a
seasonable abstinence. Intemperate men amongst us chuse for themselves
the seasons of eating, and leave the quantity of their food to the
physicians. Others again compliment the physicians with the times,
but reserve the quantity to their own determination. Those fancy
themselves to behave very genteelly, who leave every thing else to the
judgment of the physicians, but insist upon the liberty of chusing the
kind of their food; as if the question was, what the physician has a
right to do, not what may be salutary to the patient; who is greatly
hurt as often as he transgresses either in the time, measure, or
quality of his food.
CHAP. XVII.
OF SWEATING.
A sweat is procured in two ways; either by a dry heat, or a bath. A
dry heat is raised by hot sand, the laconicum, and clibanum(28), and
some natural sweating places, where a hot vapour exhaling out of the
earth is inclosed by a building, as there is at Baiæ amongst the myrtle
groves. Besides these, it is solicited by the sun and exercise. These
kinds are useful, wherever an internal humour offends, and is to be
dissipated. Also some diseases of the nerves are best cured by this
method. And the others may be proper for weak people: the heat of the
sun and exercise agree only with the more robust; when they are falling
into a disorder, or even during the time of distempers not violent,
provided they be free of a fever. But care must be taken, that none of
these be attempted either in a fever(29), or in the time of crudity.
But the use of the bath is twofold. For sometimes after the removal
of fevers, it is a proper introduction to a fuller diet and stronger
wine for the recovery of health: sometimes it removes the fever itself.
And it is generally used, when it is expedient to relax the surface
of the skin, and solicit the evacuation of the corrupted humour, and
to change the habit of the body. The ancients used it with greater
caution: Asclepiades more boldly. And there is no reason to be afraid
of it, if it be seasonable: before the proper time, it does harm.
Whoever has been freed of a fever, as soon as he has escaped the fit
for one day, on the day following, after the usual time of its coming
on, may safely bathe. And if the fever used to be periodical, so as to
return upon the third or fourth day, whenever it has missed, the bath
is safe. And even during the continuance of fevers, if they be of the
slow kind, and the patients have splenetic disorders of long standing,
it is proper to make trial of this remedy: on this condition however,
that the præcordia be not hard nor swelled, nor the tongue rough, and
there be no pain either in the trunk of the body or in the head, and
the fever be not then increasing. And in these fevers indeed, which
have a certain period, there are two opportunities for bathing; the
one, before the shuddering; the other, after the fit is ended. In those
again, who are long distressed with slow febriculas, either when the
fit is entirely off; or if that does not happen, at least when it has
remitted, and the body is as sound, as it generally is in that kind of
illness.
A valetudinary man, that is going into the bath, ought to be careful
not to expose himself to any cold before. When he has come to the
bagnio, he is to stand still a little, and try whether his temples are
bound, and if any sweat breaks out: if the first has happened, and the
other not followed, the bath will be improper that day: he must be
anointed slightly, and carried back, and by all means avoid cold, and
be abstemious. But if his temples are not affected, and a sweat begins,
first there, and then elsewhere, he must wash his mouth with plenty of
warm water, then go into the bath; and there he must observe, whether
at the first touch of the warm water he feels a shuddering upon the
surface of his skin; which can scarcely happen, if the circumstances
above-mentioned were as they should be: however, this is a certain sign
of the bath’s being hurtful.
One from the state of his health may know, before he go into the warm
water, whether it be proper to anoint himself after it. However for the
most part (except in cases where it shall be expressly ordered to be
done after) upon the beginning of a sweat the body is to be anointed
gently, and then to be dipped in the warm water. And in this case also
regard must be had to his strength; and he must not be allowed to faint
by the heat, but must be speedily removed, and carefully wrapped up
in cloaths, lest any cold get to him; and there also he must sweat,
before he take any food.
Warm fomentations are millet-seed, salt, sand: any of these heated,
and put into a linen cloth: even linen alone, if there be less heat
required; but if greater, extinguished coals, wrapt up in cloths, and
applied round a person. Moreover bottles(30) are filled with hot oil:
and water is poured into earthen vessels, which from their resemblance
in shape are called lenticulæ(31): and salt is put into a linen bag,
and dipt into water well heated, then set upon the limb that is to be
fomented. And at the fire are placed two ignited pieces of iron, with
pretty broad heads: one of these is put into dry salt, and water is
sprinkled lightly upon it; when it begins to grow cold, it is carried
back to the fire: the other is made use of in the same manner; so each
of them alternately: and in the mean time, the hot and salt liquor
drops down through the cloth, which relieves the nerves contracted by
any disease. All of them have this property in common of dissipating
that, which either loads the præcordia, or suffocates the fauces, or is
hurtful in any limb. When each of these sorts of fomentations is to be
used, shall be directed under the particular kinds of distempers.
CHAP. XVIII.
OF THE DIFFERENT KINDS OF FOOD AND DRINK.
Since we have treated of those things, which relieve by evacuation,
we must now proceed to those, which nourish us, that is, our food and
drink. Now these are not only the common supports in all distempers,
but even of health too. And it is of importance to be acquainted with
the properties of them all: first, that the healthy may know, in what
manner they are to make use of them: secondly, that in treating of the
method of curing diseases, it may suffice to mention in general the
species of what is to be taken, without being under the necessity of
naming each particular upon every occasion.
It is fit to know then, that all leguminous vegetables, and those
grains, which are made into bread, are of the strongest kind of food
(I call that the strongest, in which there is the most nourishment)
also every quadruped, that is tame, all large wild beasts, such as
the wild goat, deer, wild boar, wild ass; every great bird, such as
the goose, peacock, and crane; all large fishes, the cetus(32), and
others of a like size; also honey, and cheese. So that it is no wonder
that particular kind of bread(33) should be very strong, which is
made of corn, fat, honey, and cheese. Of a middle nature ought to be
reckoned those pot-herbs, whose roots or bulbusses we use for food;
amongst quadrupeds the hare; all birds, from the least upwards to the
phœnicopter(34); also all fish, that will not bear salt, or such, as
are salted whole. Of the weakest kind are all potherbs, and whatever
grows on a stalk, such as the gourd, and cucumber, and caper, and all
the apple kind, olives, snails(35), and also conchylia(36).
But although these are thus distinguished, yet there are great
differences between things even of the same class; and one is either
more substantial, or weaker than another. For instance, there is more
nourishment in bread, than in any thing else. Wheat is more firm
than millet: and that again than barley: and the strongest kind of
wheat is the siligo(37); after that the finest flour; next, that
which has nothing taken from it, which the Greeks call autopyron[AX]:
still weaker than these is the second flour: the weakest is grey
bread. Amongst the leguminous vegetables the bean or lentil is more
substantial than pease. Amongst the potherbs, turnep and navew gentle,
and all the bulbous kind (in which I rank the onion also, and garlick)
are more substantial than the parsnip, or that which is particularly
called radicula (garden radish.) Also cabbage, and betes, and leeks,
are stronger than lettuce, or gourd, or asparagus. But amongst the
fruits of the surculous tribe, grapes, figs, nuts, dates, apples
properly so called, are of the firmer kind. And amongst these the juicy
are stronger than the mealy(38) fruits. Also of these birds, which
are of the middle kind, those are stronger, which make more use of
their feet, than their wings: and of those, that trust more to flying,
the larger birds are stronger than the small ones, as the beccaficos,
and thrush(39). And those also, which live in the water, afford a
lighter food than those, which cannot swim. Amongst the tame animals
pork is lightest; beef heaviest. Also of the wild, the larger any
animal is, so much the stronger food it is. And of those fishes also,
which are of the middle kind, the heaviest, though we make most use of
them, are first all those, that are made salsamenta(40), such as the
lacertus(41); next such, as though more tender than the other, yet
are in themselves hard, as the aurata, corvus, sparus, oculata; in the
next rank are the plani fish, after which lighter still are lupi and
mulli: and then all rock fish.
[AX] αὐτόπυρον.
And there is not only a difference in the classes of things, but also
in the things themselves; which arises from their age, the different
parts of their body, the soil, air, and the case they are in. For every
four footed animal(42), that is sucking, affords less nourishment;
also a dunghill fowl, the younger it is. In fish too, the middle age,
before they have reached their greatest bulk. _For the parts_, the
heels, cheeks, ears, and brain of a hog; of a lamb or kid, the whole
head with the petty toes, are a good deal lighter than the other parts;
so that they may be ranked in the middle class. In birds, the necks
or wings are properly numbered with the weakest. As to the soil, the
corn, that grows upon hilly parts, is stronger than what grows upon a
plain. Fish got in the midst of rocks, is lighter than those in the
sand; those in the sand, than those in the mud. Whence it happens, that
the same kinds either from a pond, or lake, or river, are heavier: and
that, which lives in the deep, is lighter than one in shoal water.
Every wild animal also is lighter than a tame one: and whatever is
produced in a moist air, than another in a dry. In the next place, all
the same foods afford more nourishment, fat than lean; fresh more than
salt; new than stale. Again, the same thing nourishes more, when it
is stewed into broth, than roasted, more roasted than fried. A hard
egg is of the strongest kind; soft, or sorbile(43) of the weakest.
And though all grains, made into bread, are most firm, yet some kinds
washed, as alica(44), rice, ptisan, or gruel made of the same, or
pulse(45), and bread moistened with water, may be reckoned with the
weakest.
With regard to drinks, whatever is prepared from grain, also milk,
mulse, defrutum, passum(46), wine either sweet or strong, or
must, or very old wine, are of the strongest kind. But vinegar, and
wine a few years old, or austere, or oily, is of the middle kind.
And therefore none of these should be given to weak people. Water is
weakest of all. And the drink, that is made of grain, is stronger in
proportion to the hardness of the grain itself: and that wine, which is
produced in a good soil, more so than in a poor soil; or in a temperate
air, than one, which is either over moist or too dry, and either over
cold or too hot. Mulse, the more honey it contains, defrutum, the more
it is evaporated in boiling, and passum, the drier the grape is from
which it is prepared, are so much the stronger. Rain water is lightest;
next spring water, then river water, then that of a well; after these
snow, or ice; water of lakes is heavier than these; and that of fens
heaviest of all. The trial is both easy and necessary to those, that
want to know its nature. For the lightness appears from weighing it;
and amongst those, that are of equal weight, the sooner any of them
grows hot or cold, and the more quickly herbs are boiled in it, the
better it is.
It is a general rule, that the stronger each kind is, so much the less
easily it is concocted; but when once concocted, it nourishes more.
Wherefore the nature of the food must be determined by the degree
of one’s strength; and the quantity proportioned to the kind. Upon
this account weak men must make use of the weakest things; a middle
kind best supports those, that are moderately strong; and the most
substantial is fittest for the robust. Lastly, A person may take a
greater quantity of what is lighter: but in what is most substantial,
he ought to moderate his appetite.
CHAP. XIX.
GENERAL PROPERTIES OF DIFFERENT FOODS.
And these above-mentioned are not the only distinctions; but some
things afford good juices, others bad, which two kinds the Greeks
term euchyma and cacochyma[AY]; some are mild, others acrid; some
generate in us a thicker phlegm, others a more fluid; some agree with
the stomach, others not; likewise some produce flatulencies, others
have not that property; some heat, others cool; some readily turn
sour in the stomach, others are not easily corrupted there; some open
the belly, others bind it; some promote urine, others retard it; some
are soporiferous, others excite the senses. Now all these must be
known for this reason, that different things are proper in different
constitutions or states of health.
[AY] εὔχυμα et κακόχυμα.
CHAP. XX.
OF THINGS CONTAINING GOOD JUICES.
Good juices are afforded by wheat, siligo, alica, rice, starch(47),
tragum(48), milk, soft cheese, all venison, all birds of the middle
class; of the larger kind also, those that we mentioned above; the
middle kind betwixt tender and hard fishes, as the mullus, and lupus;
pot-herbs, lettuce, nettle, mallows, cucumber, gourd, purslane, snails,
dates; any of the apple kind, that are neither bitter, nor acid; wine
sweet or mild, passum, defrutum, olives, or any of this fruit preserved
in either of the two last mentioned liquors; the wombs(49), cheeks,
and legs of hogs, all fat flesh, and glutinous, all livers, and a
sorbile egg.
CHAP. XXI.
OF FOODS CONTAINING BAD JUICES.
Of bad juices are millet, panick, barley, leguminous vegetables, the
flesh of tame animals very lean, and all salt meat, all salt fish
and garum(50), old cheese, skirret, radish, turneps, navew gentle,
bulbusses(51), cabbage, and more especially its sprouts, asparagus,
betes, cucumber, leek, rocket, cresses, thyme, catmint, savory, hyssop,
rue, dill, fennel, cumin, anise, dock, mustard, garlick, onion,
spleens, kidneys, intestines, every kind of apple, that is acid or
bitter, vinegar, every thing, that is acrid, acid, or bitter, oil, also
rock-fish, and those, that are of the tenderest kind, or those again,
which are either too hard and strong tasted, as those found in ponds,
lakes, or muddy rivers generally are, or those, that have grown to an
excessive bulk.
CHAP. XXII.
OF MILD AND ACRID THINGS.
The following are mild; gruel, pulse, pancake(52), starch,
ptisan, fat flesh, and all glutinous flesh, such as we have in all
tame animals, but especially in the heels, and legs of swine, the
petty-toes, and heads of kids, calves, and lambs, and the brains of
them all. Also milk, and what are properly called sweets, defrutum,
passum, pine-nuts.
Things acrid are, whatever is too austere, all acids, all salt
provisions; and even honey, which is the more so, the better it is:
likewise garlick, onion, rocket, rue, cresses, cucumber, bete, cabbage,
asparagus, mustard, radish, endive, basil, lettuce, and the greatest
part of pot-herbs.
CHAP. XXIII.
OF THOSE THINGS WHICH GENERATE A THICK AND A FLUID PHLEGM.
A thick phlegm is generated by sorbile eggs, alica, rice, starch,
ptisan, milk, bulbous roots, and almost every thing that is glutinous.
The contrary effect is produced by all salted, and acrid, and acid
substances.
CHAP. XXIV.
OF WHAT AGREES WITH THE STOMACH.
Whatever is austere or acid, or whatever is moderately sprinkled with
salt, is agreeable to the stomach: also un-leavened bread, and washed
alica, or rice, or ptisan; and all birds, and all venison; and both
of these either roasted or boiled: amongst the tame animals, beef;
if any of the rest is made use of, rather lean than fat; in a swine
the heels, cheeks, ears, and barren wombs; amongst pot-herbs endive,
lettuce, parsnip, boiled gourd, skirret; of the apple kind, the
cherry, mulberry, service fruit, mealy pears, such as are either those
called crustumina(53) or næviana, also those called tarentina, or
signina; the round apples, or scandiana, or amerina, or quinces, or
pomegranates, wormwood(54), jar raisins, soft eggs, dates, pine-nuts,
white olives preserved in strong brine or tinctured with vinegar, or
the black kind, which have grown thoroughly ripe upon the tree, or
been kept in passum or defrutum; austere wine, although it be grown
rough, also resinated(55); hard fish of the middle class, oysters,
pectines(56), murex and purpura(57), periwinkles; food and drink
either cold or hot.
CHAP. XXV.
OF THINGS HURTFUL TO THE STOMACH.
The stomach is offended by every thing tepid, all salt provisions, all
meat stewed into broth, every thing too sweet, all fat substances,
gruel, leavened bread, and the same made either from millet or barley,
oil, roots of pot-herbs, and whatever greens are eaten with oil or
garum, honey, mulse, defrutum, passum, milk, all cheese, fresh grapes,
figs both green and dry, all leguminous vegetables, and things, that
usually prove flatulent; also thyme, catmint, savory, hyssop, cresses,
dock, nipplewort, and walnuts. From this account it may be inferred,
that it is no rule that what affords a good juice, agrees with the
stomach; nor that what agrees with the stomach, is for that reason of
good juice.
CHAP. XXVI.
OF THOSE THINGS, WHICH OCCASION FLATULENCIES, AND THE CONTRARY.
Flatulencies are generated by almost all the leguminous vegetables,
every thing fat, or over sweet, all stewed meat; must, and even any
wine, that has not got age: amongst pot-herbs, garlick, onion, cabbage,
and all roots (except skirret and parsnip) bulbusses, dry figs too, but
more especially the green, fresh grapes, all nuts, except pine-nuts,
milk, and all cheese, and lastly, whatever is too crude.
Little or no flatulency is occasioned by venison, wild fowl, fish,
apples, olives, conchylia, eggs either soft or sorbile, old wine. But
fennel and dill even relieve flatulencies.
CHAP. XXVII.
OF THOSE THINGS WHICH HEAT AND COOL.
Heat is excited by pepper, salt, all flesh stewed into soup, garlick,
onion, dry figs, salt fish, wine which is the more heating, the
stronger it is.
Those greens are cooling, whose stalks are eaten without boiling, as
endive, and lettuce: likewise coriander, cucumber, boiled gourd, bete,
mulberries, cherries, austere apples, mealy pears, boiled flesh, and
especially vinegar mixed either with meat or drink.
CHAP. XXVIII.
OF WHAT IS EASILY CORRUPTED IN THE STOMACH, AND THE CONTRARY.
The following kinds easily corrupt in the stomach, leavened bread, and
such as is made of any other grain than wheat, and all kinds of the
sweet bread mentioned before(58), milk, honey, also sucking animals,
and tender fish, oysters, greens, cheese both new and old, coarse or
tender flesh, sweet wine, mulse, defrutum passum; lastly, whatever is
either juicy, or too sweet, or over thin.
But unleavened bread, birds, especially the harder, hard fish, and not
only the aurata for instance, or scarus(59), but even the lolligo,
locusta, polypus, do not easily corrupt; also beef and all hard flesh:
the same is preferable if it be lean, and salted; and all salt fish;
periwinkles, the murex and purpura, austere wine, or resinated.
CHAP. XXIX.
OF WHAT OPENS THE BELLY.
The belly is opened by leavened bread, and the more so if it be
coarse, or made of barley; cabbage if it be not well boiled, lettuce,
dill, cresses, basil, nettle, purslane, radishes, capers, garlick,
onion, mallows, dock, bete, asparagus, gourd, cherries, mulberries,
all mild apples, figs even dry, but more especially green, fresh
grapes, fat small birds, periwinkles, salt fish and garum, oysters,
pelorides(60), sea-urchins, muscles, and almost all shell fish, and
chiefly the liquor of them, rock fish, and all tender fish, blood of
the cuttle fish; and any fat meat, and the same stewed, or boiled;
birds that swim; crude honey, milk, all sucking animals, mulse, sweet
or salt wine, soft water(61), every thing tepid, sweet, fat, boiled,
stewed, salt, or diluted.
CHAP. XXX.
OF WHAT BINDS THE BELLY.
On the contrary the belly is bound by bread made of the siligo, or
flour of wheat; especially if it be unleavened; and more so if it be
also toasted: and this virtue is even increased, if it be twice baked:
pulse made either from alica, or panick, or millet; also gruel prepared
from the same; and more so, if these have been toasted first. Lentils
with the addition of betes, or endive, or cichory, or plantain, and
more so, if these have been toasted before: endive also by itself or
cichory toasted, with plantain; small greens, cabbage twice boiled;
hard eggs, and more so if roasted; small birds, black bird, ring-dove,
especially boiled in vinegar and water, crane and all birds that run,
more than they fly; hare, wild goat; the liver of those animals, that
have suet, especially that of beef, and the suet itself; cheese, which
is grown strong by age, or by that change, which we observe in the
foreign kind; or if it be new, boiled with honey or mulse; also boiled
honey, unripe pears, fruit of the service-tree, more especially those
that they call torminalia(62), quinces and pomegranates, olives
either white or early ripe, myrtle-berries, dates, the purpura and
murex, wine either resinated or rough, and wine undiluted, vinegar,
mulse, that has been boiled, also rough defrutum, passum, water either
tepid or very cold, and hard, that is, such as keeps long without
stinking, therefore particularly rain water, every thing hard, lean,
austere, rough, and scorched, and the same flesh rather roasted, than
boiled.
CHAP. XXXI.
OF DIURETIC MEATS AND DRINKS.
The urine is promoted by whatever grows in the garden of a good smell,
as smallage, rue, dill, basil, mint, hyssop, anise, coriander,
cresses, rocket, fennel. Besides these, asparagus, caper, catmint,
thyme, savory, nipplewort, parsnip, especially the wild kind, radish,
skirret, onion; of venison principally the hare; small wine, pepper
both round and long, mustard, wormwood, pine-nuts.
CHAP. XXXII.
OF SOPORIFEROUS AND EXCITING THINGS.
Sleep is procured by the poppy, lettuce, especially the summer kind,
when its stalk is replete with milk, mulberries, and leeks.
The senses are excited by catmint, thyme, savory, hyssop, particularly
pennyroyal, rue and onion.
CHAP. XXXIII.
OF THOSE THINGS, WHICH DRAW, REPEL, OR COOL, OR HEAT, OR HARDEN, OR
SOFTEN.
Many things are powerful in drawing out matter: but as these consist
principally of foreign medicines, and not so much adapted to the
cases of those who are to be relieved by diet, I shall postpone the
mention of them for the present: and shall only name those things,
which are commonly at hand, and are fit for corroding, and thus
extracting whatever is hurtful in those distempers, concerning which
I am presently to treat. This virtue resides in the seeds of rocket,
cresses, radish; but most of all mustard. The same power is also found
in salt, and figs.
Sordid wool(63) dipt either in vinegar, or wine, with an addition of
oil; bruised dates, bran boiled in salt water or vinegar, are all at
the same time both restringent and emollient.
But the following things both restringe and cool, the wall herb (which
they call parthenium or perdicium, _feverfew_) serpyllum, pennyroyal,
basil, the blood herb (which the Greeks call polygonon[AZ],) purslane,
poppy-leaves, and clippings of vines, coriander-leaves, henbane, moss,
skirret, smallage, nightshade (which the Greeks call struchnos)[BA],
cabbage-leaves, endive, plantain, fenel-seed, mashed pears or apples,
chiefly quinces, lentils; cold water, especially rain water, wine,
vinegar; and bread, or meal, or sponge, or pieces of cloth, or sordid
wool, or even linen, moistened in any of these liquors; Cimolian
chalk(64), tarras(65), oil of quinces(66), or myrtles(67), or
of roses(68), bitter oil(69), leaves of vervains bruised with their
tender stalks; of this kind are olive, cypress, myrtle, mastich-tree,
tamarisk, privet, rose, bramble, laurel, ivy, pomegranate.
[AZ] πολύγονον.
[BA] στρύχνος.
Boiled quinces, pomegranate bark, a hot decoction of vervains, which
I mentioned before, powder from the lees of wine, or myrtle-leaves,
bitter almonds, all restringe without cooling.
A cataplasm made from any meal is heating, whether it be of wheat,
or of far(70), or barley, or bitter vetch, or darnel, or millet,
or panick, or lentil, or beans, or lupines, or lint, or fenugreek;
the meal after being boiled is laid on hot. But every kind of meal
boiled in mulse is more effectual for this purpose, than the same
prepared with water. Besides these, Cyprine oil(71), or iris(72),
marrow, fat of a cat, mixed with oil, especially if it be old, salt,
nitre(73), git, pepper, cinquefoil.
And _we may observe_ in general, that those things, which both
restringe violently and cool, are hardening: and those which heat and
dissipate, are softening: but the most powerful cataplasm for softening
is made from the seeds of lint or fenugreek.
Now physicians make use of all these things variously, both by
themselves, and mixed; so that we rather see what each of them was
strongly persuaded of, than what upon certain trial he found to be
useful.
A. CORNELIUS CELSUS
OF
MEDICINE.
_BOOK III._
CHAP. I.
GENERAL DIVISION OF DISTEMPERS.
Having already considered all that relates to distempers in general, I
come to treat of the cure of each distinctly. Now the Greeks divided
them into two kinds, the one they called acute, the other chronic. And
because their process was not always the same, for this reason some
ranged the same distempers among the acute, which others reckoned in
the number of the chronic. From whence it is plain, that there are more
kinds of them. For some are short and acute, which either carry off a
person quickly, or are themselves soon terminated. Others are of long
continuance, from which there is neither a speedy recovery, nor speedy
death. And the third kind are those, which are sometimes acute, and
sometimes chronic; and this happens not only in fevers, where it is
most frequent; but also in other diseases. And besides these, there is
a fourth kind; which can neither be called acute, because they are not
mortal; nor yet chronic, because if remedies are used, they are easily
cured. When I come to treat of each, I shall point out to what kind
they belong.
Now I shall divide all of them into those, that seem to affect the
whole body, and those, which occur in particular parts. After a few
general observations upon them all, I shall begin with the first.
Though there is no distemper in which fortune can pretend to more
power than art, or art than nature; since medicine can do nothing in
opposition to nature: yet a physician is more excusable for want of
success in acute, than in chronic disorders. For in the first, there is
but a small space, within which, if the remedies do not succeed, the
patient dies: in the other case, there is time both for deliberation,
and a change of medicines; so that very seldom, where a physician is
called at its beginning, an obedient patient is lost without his fault.
Nevertheless, a chronic distemper, when it is firmly rooted, becomes
equally difficult with an acute one. And indeed the older an acute
distemper is, so much the more easily it is cured; but a chronic one,
the more recent it is.
There is another thing we ought not to be ignorant of; that the
same remedies don’t agree with all patients. Whence it happens,
that the greatest authors extol some one remedy, some another, each
recommending his own as the only one, according as they had succeeded
with themselves. It is fit therefore, when any thing does not answer,
not to pay so much regard to the author of it, as to the patient, and
to make trial of one thing after another. _Remembering_ however, that
in acute distempers, what does not relieve, must be quickly changed:
in the chronic, which time both causes, and removes, whatever has not
immediately done service, is not to be hastily condemned; much less
must that be discontinued, which does but give a small relief, because
its good effects are completed by time.
CHAP. II.
GENERAL DIAGNOSTICS OF ACUTE AND CHRONIC, INCREASING AND DECLINING
DISEASES; THE DIFFERENCE OF REGIMEN IN EACH; AND PRECAUTIONS NECESSARY
UPON THE APPREHENSION OF AN APPROACHING ILLNESS.
It is easy to know in the beginning, whether a distemper be acute, or
chronic: not in those only, that are always the same; but in those
also, that vary. For when the paroxysms and violent pains without
intermissions distress, the disease is acute. When the pains are
gentle, or the fever slow, and there are considerable intervals betwixt
the fits, and those symptoms accede, which have been explained in
the preceding book, it is plain, that the distemper will be of long
continuance.
It is necessary also to observe, whether the distemper increases, or is
at a stand, or abates: because some remedies are proper for disorders
increasing, more for those, that are upon the decline. And those,
which are suitable to increasing disorders, when an acute distemper
is gaining ground, ought rather to be tried in the remissions. Now a
distemper increases, while the pains and paroxysms grow more severe;
when the paroxysms return after a shorter interval, and last longer
than the preceding did. And even in chronic disorders, that have not
such marks, we may know them to be increasing, if sleep is uncertain,
if concoction grows worse, if the intestinal excretion is more fetid,
if the senses are more heavy, the understanding more slow, if cold or
heat runs over the body, if the skin grows more pale. But the contrary
symptoms to these are marks of its decrease.
Besides in acute distempers, the patient must not be allowed
nourishment so soon, not till they be upon the decline; that fasting by
a diminution of matter may break its violence; in chronic disorders,
sooner, that he may be able to endure the continuance of the disease.
But if the distemper happens not to be in the whole body, but only in
a particular part, yet it is more necessary to support the strength of
the whole body, than of the part; since by means of that _strength_ the
diseased parts may be cured. It also makes a great difference, whether
a person has been properly or wrong treated from the beginning: because
a method of cure is less successful, where it has been often applied
unsuccessfully. If one has been injudiciously treated, but still
possesses his natural strength, he is quickly restored by a proper
management.
But since I began with those symptoms, which afford marks of an
approaching illness, I shall commence the methods of cure from the
same period. Wherefore if any of those things(1), which have been
mentioned, happen, rest and abstinence are best of all: if any thing is
drunk, it should be water; and sometimes it is sufficient to do that
for one day; sometimes for two days, if the alarming symptoms continue;
and immediately after fasting, very little food must be taken, water
must be drunk; the day after, wine; then every other day by turns
water and wine, till all cause of fear be removed. For by these means
often a dangerous distemper impending is averted. And a great many are
deceived, while they hope upon the first day immediately to remove a
langour either by exercise, or bathing, or a gentle purge, or vomiting,
or sweating, or drinking wine. Not but this may sometimes happen, or
answer their expectations, but that it more frequently fails; and
abstinence alone may cure without any danger. Especially as that may
be regulated according to the degree of one’s apprehensions: and if
the symptoms are slight, it is sufficient only to abstain from wine; a
diminution of which assists more than lessening the quantity of food:
if they are somewhat more dangerous, it may serve the turn not only to
drink water (_as in the first case_), but to forbear flesh too: and
sometimes to take less bread than ordinary, and confine one’s self to
moist food, especially greens. And it may be sufficient then only to
abstain entirely from food, wine and all motion, when violent symptoms
give the alarm. And without doubt scarce any body will fall into a
distemper, who does not neglect it, but takes care by these means to
oppose its beginning in due time.
CHAP. III.
OF THE SEVERAL KINDS OF FEVERS.
These are the rules to be observed by such as are in health, that are
only apprehensive of the cause. We next proceed to the cure of fevers,
which is a kind of disease, that affects the whole body, and is the
most common of all. Of these one is a quotidian, another a tertian, and
a third a quartan. Sometimes some fevers also return after a longer
period, but that seldom occurs. With regard to the former, they are
both diseases _in themselves_, and a cure _for others_.
But quartan fevers are more simple. They begin commonly with a
shuddering; then a heat breaks out; after the paroxysm is over, the
patient is well for two days. So that it returns upon the fourth day.
Of tertians again there are two kinds. One of them both beginning and
ending like the quartan; with this difference only, that there is one
day’s intermission, and it returns upon the third. The other kind
is much more fatal, which indeed returns upon the third day, but of
forty-eight hours, thirty-six are occupied by the fit (and sometimes
either less or more,) nor does it entirely cease in the remission; but
is only mitigated. This kind most physicians call semitertian[BB].
[BB] ἑμιτριτα̃ιος.
But quotidians are various, and different in their appearances. For
some of them begin with a heat, others with a coldness, others with a
shuddering. I call that a coldness, when the extremities of the limbs
are chilled; a shuddering, when the whole body trembles. Again, some
end, so as to be followed by an interval quite free from indisposition;
others so, as that though the fever somewhat abates, yet some relicks
remain, till another paroxysm comes on; and others often remit little
or nothing, but continue as they began. Some again are attended with a
very vehement heat, others more tolerable; some are equal every day,
others unequal, and alternately milder one day and more severe another:
some return at the same time the following day, others either later
or sooner: some by the fit and the intermission take up a day and a
night, some less, others more: some, when they go off, cause a sweat,
others do not; and in some a sweat leaves the patient well, in others
it only renders the body weaker: sometimes also one fit comes on each
day, sometimes two or more. Whence it frequently happens, that every
day there are several both paroxysms and remissions; yet so as that
each of them answers to some preceding one. Sometimes too the fits are
so irregular, that neither their durations nor intermissions can be
observed. Nor is it true, which is alledged by some, that no fever is
irregular, unless it arise from a vomica, or an inflammation, or an
ulcer. For the cure would always be easier, if this were fact. For what
is occasioned by the evident causes, may also proceed from the occult.
Nor do those dispute about things, but words, who alledge, that when
feverish paroxysms come on in different manners in the same distemper,
these are not irregular returns of the fever, but new and different
fevers successively arising. Which however would have no relation
to the method of cure, though it were true. The intervals also are
sometimes pretty long, at other times scarce perceptible.
CHAP. IV.
OF THE DIFFERENT METHODS OF CURE.
This then is the general nature of fevers. But the methods of cure
differ, according to their different authors. Asclepiades says, that
it is the duty of a physician to effect the cure safely, speedily,
and with ease _to the patient_. This is to be desired: but generally
too great haste and too great indulgence both prove dangerous. What
moderation must be used in order to obtain all these ends as far as
possible, the principal regard being always had to the safety _of
the patient_, will come into consideration, when we treat of the
particulars of the cure.
And the first inquiry is, how the patient is to be treated in the
beginning of the distemper. The ancients by the use of some medicines
endeavoured to promote concoction; for this reason, that they were
extremely afraid of crudity: next they discharged by frequent clysters
that matter, which seemed to hurt. Asclepiades laying aside the use of
medicines, ordered clysters not so frequently as they, but in almost
every distemper. And he professed his principal cure for a fever was
the disease itself. He thought also, that the strength of the patient
was to be worn out by light, watching, and great thirst: insomuch that
he would not even allow the mouth to be washed in the first days.
So much are those mistaken, who imagine the whole of his regimen to
be agreeable. For indeed in the advance of the distemper he even
administered to the luxury of the patient; but at the beginning he
acted the part of a tormentor.
Now I grant that medicinal potions and clysters, ought to be used but
sparingly. And yet I do not think these are to be administered with a
view to destroy the patient’s strength: because the greatest danger
arises from weakness. Wherefore it is proper only to diminish the
redundant matter; which is naturally dissipated, when there is no new
accession to it. For this reason the patient must abstain from food in
the beginning, and in the day-time be kept in the light, unless he be
weak, because even that contributes to the discharge. And he ought to
lye in a very large room.
As to thirst and sleep, the best mean is, that he be awake in the
day-time, and rest in the night, if possible; and neither drink
plentifully, nor be too much tormented with thirst. His mouth also
may be washed, when it is both dry, and has a fetid taste; although
such time is not seasonable for drinking. And Erasistratus very justly
observed, that often the mouth and fauces require moisture, when
there is no want of it in the internal parts; and that it is of no
consequence, that the patient is uneasy. Such then ought to be the
treatment at first.
Now the best medicine is food seasonably administered: when that must
be given first, is a question. Most of the ancients were slow in giving
it; often on the fifth or sixth day: and that perhaps the nature of the
climate in Asia or in Egypt admits of. Asclepiades, after he had for
three days fatigued the patient in every way, appointed the fourth for
food. But Themison of late considered, not when the fever had begun,
but when it had gone off, or at least was abated; and waiting for the
third day from that time, if the fever had not returned, he gave food
immediately; if it did come on, when it had ceased; or if it continued
constantly, when at least it was mitigated.
Now none of these rules is always to be followed. For it may be proper
to give food on the first day, it may on the second, it may on the
third, it may not before the fourth or fifth; it may after one fit,
it may after two, it may after several. For the qualities of the
distemper, constitution, air, age, and season of the year make some
difference. And no time can be universally fixed in things so widely
different from each other. In a distemper that weakens more, food must
be sooner allowed; also in an air that is more dissipating. Upon this
account in Africa for no day it seems proper to prescribe fasting. It
should be given also sooner to a boy, than a young man; more quickly
in summer, than winter. This one thing must be practised always and
every where, that a physician sitting by should now and then observe
the strength of the patient, and as long as that continues, encounter
the disease by abstinence; if he begins to apprehend weakness, support
him by food. For it is his business to be careful neither to load the
patient by superfluous matter, nor when he is weaker, to kill him by
fasting. And this I find in Erasistratus, who though he did not direct,
when the belly, when the body itself was to be evacuated, yet by saying
that these were to be regarded, and that food was to be given, when the
body stood in need of it, has plainly enough shewn, that it ought not
to be given, while there w as a sufficient quantity of strength, and
that care should be taken, that it was not too much exhausted.
From these things it may be inferred, that many people cannot be
attended by one physician; and that the man to be trusted is he, that
knows his profession, and is not much absent from the patient. But
they, that practise only from views of gain, because their profits
arise in proportion to the number of patients, readily fall in with
such rules, as do not require close attendance; as in this very case.
For it is easy even for such, as seldom see the patient, to count the
days and the fits: but it is necessary for him to sit by his patient,
who would form a true judgment what is alone fit to be done; when he
will be too weak unless he get food. In most people however the fourth
day is usually the most proper for beginning to give food.
But there is still another doubt about the days themselves, because the
ancients chiefly regarded the odd days, and called them critical[BC],
as if on these a judgment was to be formed concerning the patients.
These days were the third, fifth, seventh, ninth, eleventh, fourteenth,
and twenty-first; so that the greatest influence was attributed to the
seventh, next to the fourteenth, and then to the twenty-first. And
therefore with regard to the nourishment of the sick, they waited for
the fits of the odd days: then afterwards they gave food, expecting
the approaching fits to be easier; insomuch that Hippocrates, if the
fever had ceased on any other day, used to be apprehensive of a relapse.
[BC] κρισίμοι.
This Asclepiades justly rejected as idle, and said that no day was more
or less dangerous to the patients, by its being either even or odd.
For sometimes the even days are worse; and food is given more properly
after the paroxysm of the fevers: sometimes also in the same distemper
the quality of the days is changed: and that becomes more severe,
which had used to be more mild: and the fourteenth day itself is even,
upon which the ancients laid a great stress. And when they maintained,
that the eighth was of the same nature with the first, because the
second number of seven began from it, they were inconsistent with
themselves in not taking the eighth, or tenth, or twelfth day, as the
more important: for they attributed more to the ninth and eleventh.
When they had done this without any plausible reason, they passed on
from the eleventh, not to the thirteenth, but to the fourteenth. It is
a remark of Hippocrates too, that the fourth day is worst to him, that
is to be relieved on the seventh. So that even by his own account, upon
an even day both the fever may be more violent, and a sure indication
given of what is to follow. And the same author elsewhere takes every
fourth day to have the strongest influence with regard to both events;
that is the fourth, seventh, eleventh, fourteenth, seventeenth: in
which he passes from the odd to the even reckoning. Neither in this
indeed has he kept to his point: since the eleventh is not the fourth,
but the fifth day after the seventh. Whence it appears, in whatever
light we consider the number, no true reasoning can be found in his
doctrine. But with regard to these the ancients were misled by the
Pythagoric numbers at that time in great vogue: whereas here as well as
in other cases a physician ought not to count the days, but to consider
the paroxysms themselves; and upon them to found his conjecture when
food is to be given.
But this is of more importance, to know whether the proper time for
giving food be, when the tumultuous motion of the vessels has pretty
much subsided, or while some relicks of the fever still remain. For the
ancients prescribed nourishment, when the body was in the soundest
state: Asclepiades, upon the decline of the fit, but before it was
over; his reason for which was weak; not but that food is to be given
sometimes more quickly, if another paroxysm is apprehended soon; but
because certainly it ought not to be given, but when the body is in
its best condition: for what is received by a body free from disorder
is less liable to corruption. Neither is it true, which Themison
imagined, if a patient was to be well for two hours, that it would be
better to give it then, that it might be digested(2), while the body
was in health. Indeed if it could be so speedily digested, that would
be best. But as so short a time is not sufficient, it is better that
the beginning of food should be upon the end of one paroxysm, than
that any of it should lie in the stomach, when another begins. Thus
if a pretty long interval is to follow, it is to be given, when the
person is freest of all indisposition; if but a short one, before the
patient be quite well. What has been said of the sound state during an
intermission, holds likewise with respect to the greatest remission
we find in a continued fever. But it is also a question, whether it
is necessary to wait so many hours, as use to be taken up by the fit;
or whether it is sufficient to pass over the first part of them, that
those patients may be more easy, who sometimes have not a perfect
intermission. But it is most safe to suffer the whole time of the fit
to be over first: although when the paroxysm has been long, the patient
may be indulged sooner; nevertheless so that at least the one half be
suffered to elapse first. And this is not only to be observed in the
kind last mentioned, but in all fevers.
CHAP. V.
PARTICULAR DIRECTIONS FOR THE GIVING OF FOOD IN THE DIFFERENT SPECIES
OF FEVERS.
These observations are of a more general nature belonging to all kinds
of fevers: I shall now descend to the particular species of them.
Wherefore if there has been only one fit, which has gone off, and that
arose either from the inguen(3), or from fatigue, or from heat,
or from some such accident, so that there is no reason to apprehend
danger from any internal cause, the following day, when the time of
the fit has passed without any disorder, food may be given. But if the
heat come from within; and a heaviness of the head or præcordia has
followed; and there is no apparent cause for the disturbance of the
body; although health has followed one fit, yet because a tertian may
be apprehended, the third day is to be expected; and when the time for
the fit is over, food is to be given, but very little of it; because
a quartan may also be feared. But upon the fourth day, if the body
is well, it may be freely used. If indeed the paroxysm has followed
upon the second, third, or fourth day, then we may conclude it to be a
disease. But the method of cure in tertians and quartans (whose periods
are certain, whose fits leave no indisposition, and the intervals are
in a good measure calm) is easier: of which I shall speak in their
proper place.
At present I shall treat of those, which distress every day. Wherefore
it is most convenient to give food to the patient every third day;
that the abstinence of one day may lessen the fever, on the other
nourishment may recruit the strength. But when the fever is quotidian,
and goes entirely off, it ought to be given as soon as the body becomes
well. But if though there are not distinct fits immediately succeeding
each other, yet there are feverish heats without intermission, and
these daily increase without going entirely off, then _it is to be
allowed at that point of time_, when a greater remission is not to be
expected: if on one day the fit is more severe, and on another milder,
after the most severe. Now commonly a more severe fit is followed by
an easier night: whence it happens also, that a more troublesome night
precedes a severer fit.
But if the fever is continued, and is never mitigated, and there is
a necessity for giving food, the proper time for doing this is much
disputed. Some, because patients are commonly easier in the morning,
think that the opportunity. Which if it be so, is a proper time,
not because it is the morning, but because the patients then have a
remission. If even at that time the patient has no ease, since upon
this very account that time is worse, that whereas from its own nature
it ought to be better, from the force of the distemper it is not so;
and likewise because the middle of the day follows, after which as
almost every patient grows worse, there is room to fear, lest he be
then more distressed, than he used to be: therefore, some give food
to such a patient in the evening. But since at that time sick people
are commonly worst, there is cause to be afraid, lest if we raise any
commotion then, the disorder may be increased. For these reasons others
defer it(4) till midnight, when the severest is just over, and while
the same is at the greatest distance. It is more safely given before
day-light, when most sick people get the quietest sleep; next to that
in the morning, the time which is naturally the easiest of all.
But if the fits are irregular, because in such a case there is room
to fear, that they may follow immediately after food; whenever a
patient is relieved from the paroxysms he ought to eat. But if several
paroxysms come on the same day, it is necessary to consider, whether
these be in all respects equal (which can scarcely happen) or unequal.
If they be in every point equal, food ought rather to be given after
that fit, the end of which does not fall betwixt mid-day and the
evening. If they are unequal, it must be considered what the difference
is. For if one is more severe, and the other more mild, it ought to be
given after the more severe fit: if the one is longer, and the other
shorter, after the longer: if one is more severe, and the other of
longer continuance, it must be examined, which of the two distresses
most, the one by its violence, or the other by its continuance; and
it must be given after the most weakening. But it is plainly the most
important point of all, how great the remissions are, and of what
nature, which happen between the fits. For if an uneasiness remains
after one paroxysm, and the body feels no indisposition after the
other; when the body is well, it is the fitter time for food.
If a feverishness always continues, but yet one remission is longer
than the other, that is rather to be chosen: so that when the fits are
continued, food may be administered immediately upon the decline of the
first. For this is an universal rule, and may serve for directing all
our measures in this article, to give food at the greatest distance
always from a future fit; and with this caution to give it in the best
state of the body. Which must be observed not only between two fits,
but also amongst several. But whereas it is most generally proper to
give food every third day, yet if the body is weak it must be given
every day: and much more so, if the fevers are continued without any
remission: and it is the more needful, the more they weaken the body;
or if two or more fits attack on the same day. Which occurrence also
requires the giving of food every day immediately from the first, if
the pulse has presently sunk; and oftener on the same day, if in the
midst of several fits the strength of the body now and then fails.
Yet in these this observation must be regarded; that after such fits
less food be given, where if the strength of the body would admit,
none would be given at all. Now as a paroxysm must either be instantly
expected, or beginning, or increasing, or at its height, or abating;
and again in its abatement either at a stand, or entirely gone off;
it is certain the best season for food is, when the fever is ended;
next to that, when in its abatement it stops; thirdly, if there be a
necessity, whenever it begins to abate: all other times are dangerous.
But if upon account of weakness there is an absolute necessity for it,
it is better to give somewhat, when its increase is at a stand, than
while it still increases; better when it is instantly expected, than
when it is beginning. Nevertheless no time is improper for supporting
one, who faints for want.
Nor indeed is it sufficient for a physician to regard only the fevers,
but also the state of the whole body, and direct his cure by that;
whether the patient has a sufficient measure of strength or not,
whether some troublesome passions affect the mind. And as the sick
should always be in a state of tranquillity, that they be distressed in
body only, and not in mind at the same time; so it is more especially
necessary immediately after food; so that if there be any thing, which
would render them uneasy, it is the best way, while they are sick, to
conceal it from them; if that cannot be done, at least to forbear after
food; and after their time of sleep, and when they have awaked, then to
communicate it.
CHAP. VI.
THE PROPER TIMES FOR GIVING DRINK TO PERSONS IN FEVERS, AND THE KINDS
OF ALIMENT SUITED TO THE SEVERAL STAGES OF THE DISTEMPER, TOGETHER WITH
SOME GENERAL OBSERVATIONS.
But patients are more easily managed with regard to food; because
in spite of some inclination of their own, the stomach then refuses
it. But in the article of drink the struggle is hard; and the more
violent, the higher the fever is: for this inflames the thirst, and
demands water most importunately, when it is most dangerous. But the
patient is to be informed, that when the fever has abated, the thirst
also will immediately decline; and that the paroxysm will be longer,
if any nourishment be given to him: and that he that drinks none, is
sooner freed from the thirst. However as even people in health can
bear hunger a good deal easier than thirst, it is necessary to indulge
the sick more with regard to drink than food. But on the first day no
moisture ought to be given, unless the pulse has suddenly sunk so low,
that there is a necessity for giving food also; but on the second and
following days likewise, where food is not to be allowed, yet if the
thirst be violent, drink may be given.
What was said by Heraclides of Tarentum is not altogether without
reason; that when either bile or crudity make a patient uneasy; it is
expedient by a moderate quantity of a drink to mix new matter with the
corrupted. This rule ought carefully to be observed, that the same
times be chosen for drink as for food: when it is to be given without
the other, let it be at a time, when we would desire the patient
to sleep, which commonly thirst prevents. It is generally allowed,
that as too much moisture is hurtful to every person in a fever, it
is especially so to such women, as have fallen into fevers after
child-bearing.
But as the fever and the manner of its remission direct to the proper
seasons for food and drink, so it is not very easy to know, when the
patient has a fever upon him, when he is better, or when his strength
fails; without which these cannot be properly administered. For we
principally trust the pulse, a most fallacious mark; because this is
often slower or more quick from the age, and sex, and difference of
constitutions. And generally when the body is in good enough health,
if the stomach be weak, sometimes also in the beginning of a fever,
it rises and sinks; so that the person may seem to be weak, when he
can very well stand a severe fit that is just approaching. On the
other hand, the pulse is often raised, and the vessels relaxed by the
influence of the sun, and the bath, and exercise, and fear, and anger,
and any other passion of the mind. So that, when a physician first
comes in, the anxiety of the patient, doubtful how he may think him,
accelerates the pulse. For this reason it is the business of a skilful
physician not to take hold of the patient’s arm with his hand, as soon
as he comes in; but first to sit down with a cheerful countenance, and
ask him how he does; and if he has any apprehension, to encourage him
with plausible discourse: then to apply his hand to his wrist(5).
Now if the sight of the physician quickens the pulse, how easily may a
thousand other accidents disorder it! Another mark, to which we trust,
is heat, equally deceitful; for this is excited by warmth, labour,
sleep, fear, and anxiety.
Wherefore it is fit to consider those things; but not to trust
entirely to them. And we may at once assure ourselves that a
person has no fever, whose pulse moves regularly, and who has such
a heat as is common to people in health; and that a fever is not
necessarily breeding, when there is heat and motion; but only with
these circumstances, if the surface of the skin, be unequally dry; if
there be a heat in the forehead, and at the same time arising from
the internal part of the præcordia; if the breath rushes out of the
nostrils very hot; if the colour be changed either for a redness or
an unusual paleness; if the eyes are heavy, and either very dry or
somewhat moist; if when a sweat comes on, it is partial; if the pulse
does not beat at equal intervals. Upon this account the physician ought
to sit down neither in the dark, nor at the patient’s head, but in a
light place opposite to him, that he may take all the marks from the
countenance of the patient as he lies.
Now where there has been a fever, and it has decreased, it is, proper
to take notice, whether the temples or other parts of the body grow a
little moist, so as to portend an approaching sweat. And if there is
any prognostic of it, upon that to give warm water to drink, the effect
of which is salutary, if it diffuse a sweat over the whole body. For
this purpose the patient ought to keep his hands under a good quantity
of clothes; and to cover his legs and feet in the same manner. By
laying on such a load many people mismanage patients in the very height
of the fever, and especially where it is of the ardent kind. If the
body begins to sweat, it is necessary to warm a linen cloth, and slowly
to wipe every part. But when the sweat is entirely off, or if it have
not come on, when the patient is warmest, and seems fit for food, he
is to be gently anointed under the clothes, then wiped, and after that
food is to be given him.
Liquid food is most proper for persons in fevers, at least as near
as possible to liquids, and that of the lightest kind, particularly
gruel; and even this, if the fever be violent, ought to be very thin.
Clarified honey also is properly added to it, that the body may be more
nourished: but if that offends the stomach, it should be omitted; and
so should the gruel itself in like case. Instead of it may be given
either intrita,(6) mixed with hot water, or washed alica; if the
stomach is firm, and the belly bound, with hydromel; or if the first
is weak, and the other loose, with vinegar and water. And this kind of
food is sufficient for the first day: but on the second day something
may be added, yet of the same nature, either greens, or conchylia,
or apples. And while fevers are increasing, this is the only proper
food. But when they either go off, or abate, we must always begin with
something of the lightest nature, and make an addition of the middle
kind, having in the mean time a regard both to the strength of the
patient, and of the disease.
To set a variety of food before a patient (as Asclepiades directs) is
never proper, but when he is oppressed with a nausea, and his strength
fails; that by tasting a little of each he may escape being famished.
But if the patient wants neither strength nor appetite, he must be
tempted by no variety; lest he take more than he is able to concoct.
Neither is that true, which he alleges, that food of various kinds
is more easily concocted; it is indeed taken in more easily; but to
concoction the genus and quantity of the food are material. Neither
is it safe during great pains, nor in an encreasing distemper, for a
patient to fill himself with food; but when there is already a turn
towards recovery.
There are also other observations necessary to be made in fevers: and
that indeed must be considered, which some regard solely, whether the
body be bound or loose: the one of which suffocates, and the other
dissipates. For if it is bound, the belly must be opened by clysters,
urine promoted, and a sweat sollicited by every method. In this kind of
disorder it is serviceable even to let blood, to agitate the body by
strong gestations, to keep the person in the light, to enjoin fasting,
thirst, and watchfulness. It does good also to take the person into the
bath, first to plunge him into the warm bath, then anoint him. Then he
should return to the warm bath, and foment his groin plentifully with
water; sometimes mix oil in the bath with warm water; take food more
seldom, and at greater distances than ordinary, and such as is slight,
simple, soft, warm, and small in quantity; especially greens, such as
dock, nettles, mallows, or the broth of shell-fish, or muscles, or
locustae; and eat no flesh, but what is boiled. But the quantity of
drink ought to be more liberal, both before meat, and after it, and
while eating too, beyond what thirst will require. And after the bath
may be given even fat broth, or wine of the sweeter kind: during which
course once or twice salt Greek wine may be used.
But on the contrary, if the body incline to discharge excessively, then
sweat must be restrained, and rest enjoined; and the patient may have
his room darkened, and go to sleep, whenever he shall chuse it; the
body is not to be agitated, unless by a gentle gestation, and to be
relieved according to the nature of its disorder. For if the belly is
loose, or the stomach does not retain, when the fever has abated, it
is proper to give warm water to drink plentifully, and make him vomit;
unless there is a pain either in the fauces, or praecordia, or side, or
the distemper be inveterate.
If again a sweat prevails, the skin must be hardened, either by nitre
or salt, mixed with oil. But if that disorder is more slight, the body
must be anointed with pure oil: if more violent, with oil of roses, or
of quinces, or of myrtles, with an addition of austere wine.
Whoever is disordered by any discharge, upon coming to the bath, must
first be anointed, and then go in. If the disorder is in the skin, it
will be better for him to use cold water than warm. As to his meals,
his food should be substantial, cold, dry, simple, and the least liable
to corruption, toasted bread, roasted flesh, austere wine, or at least
inclining to austerity; and if the belly is loose, let him drink it
hot; if sweating be the disorder, or vomiting, it must be cold.
CHAP. VII.
OF THE CURE OF PESTILENTIAL AND ARDENT FEVERS.
The case of pestilential fevers demands attention and a peculiar
treatment. In this it is by no means good to try fasting, or medicines,
or clysters. If the strength will admit, it is best to let blood;
especially if the fever be attended with a burning heat. If that is not
safe, when the fever is either abated, or less violent, to cleanse the
breast by a vomit. But there is a necessity to order the bath sooner in
this than in other distempers; to give wine strong and hot, and every
thing glutinous; amongst which flesh of the same kind. For the more
quickly that such constitutions of the air destroy, so much the sooner
must remedies be laid hold of, even with a degree of rashness. But if
he be a boy, that labours under it, and have not sufficient strength
for bleeding, he must be cupped, and have a clyster either of water,
or the cream of ptisan; then lastly he is to be nourished by light
food. It is a general rule, that boys ought to be treated altogether
in a different method from men. Wherefore in this, as well as in every
other kind of distemper, greater caution must be used at that age in
the following articles: not to bleed, not to give a clyster without
necessity, nor to torment by watching, or fasting, or excessive thirst,
nor to attempt the cure by wine. The patient must vomit after the
fever: then the lightest kind of food is to be given; after that he is
to sleep: the day following, if the fever continue, he must fast; on
the third day return to the same diet. And we must endeavour, as much
as possible in the midst of a seasonable abstinence to nourish him by
food at proper times, laying aside every thing else.
[Sidenote: _Of an Ardent fever._]
If an ardent fever is very violent, no medicinal potion is to be given;
but during the paroxysms the patient must be cooled by water and oil:
which are to be agitated together, till they grow white. He is also to
be kept in a spacious room, where he can draw a great deal of pure air;
and not be suffocated by many cloaths, but be covered very lightly.
Vine leaves also dipped in cold water may be put upon his stomach. And
he is not to be tormented with excessive thirst. He is to be allowed
nourishment sooner; that is after the third day: and before meat he
must be anointed all over with the above-mentioned liquor. If there is
a collection of phlegm in his stomach, upon the decline of the paroxysm
he must be forced to vomit; and then he must eat cold greens, or fruit
of the apple kind, such as agrees with the stomach. If the stomach
remains dry, there must be immediately given the cream either of
ptisan, or alica, or rice, boiled with recent fat. When the distemper
is at the height, but not before the fourth day, after a great thirst
preceding, cold water is to be given copiously, that he may drink even
beyond satiety; and when the belly and praecordia are filled above
measure, and sufficiently cooled, he ought to vomit. Some indeed do not
insist upon vomiting; but make use of cold water as a medicine, given
only to satiety. After either of these methods he is to be well covered
with cloaths, and laid so as to go to sleep. And commonly after long
thirst and wakefulness, after being satiated with full draughts, after
a remission of the heat, a sound and long sleep comes on; by means of
which a great sweat breaks out, and that is a most immediate relief;
but only in those, who have the burning heat, but no pains, nor tumour
of the praecordia, and nothing to prevent it in the lungs, or fauces;
or have had no ulcer, nor faintings, nor looseness of the belly. But
if one in such a fever as this coughs gently(7), he ought neither
to struggle with a violent thirst, nor drink cold water; but to be
treated in the same manner, as is directed in other fevers.
CHAP. VIII.
THE CURE OF A SEMITERTIAN.
But where there is that kind of tertian, which the physicians call
semitertian, it requires careful observation to prevent being deceived.
For it has generally more frequent paroxysms and intervals, so as it
may seem a different kind of distemper; and the fit is protracted to
twenty-four hours(8) and thirty-six: that what is really the same,
does not seem to be so. And it is highly necessary both that food
should not be given, unless in that remission, which is certain: and
as soon as that comes, to give it immediately. And many patients die
suddenly by the mistake of their doctor either way. And unless there
is some important reason against it, blood ought to be let in the
beginning; and then food should be given, such as will not raise the
fever, and yet support under its long continuance.
CHAP. IX.
THE CURE OF SLOW FEVERS.
Sometimes too we find slow fevers continuing without remission, and no
room left either for food or any remedy. In this case it ought to be
the care of the physician to change the distemper: for perhaps it may
become more easy to cure. For this reason the body of the patient is
often to be gently rubbed with cold water with oil infused, because
sometimes it thus happens, that a shuddering arises, which may be some
beginning of a new commotion; after that, when the body has grown
hotter, a remission may follow too. In these cases friction with oil
and salt seems to be a useful method.
But if coldness of the extremities, and numbness, and restless changes
of postures continue long, it is not amiss, even during the fever,
to give three or four cyathi of mulse, or well diluted wine together
with food. For the fever is often encreased by it; and a greater heat
arising at the same time both removes the former disorders, and affords
hope of a remission, and from that of a cure.
And indeed the method of cure is not new, to make use of contrary
medicines, by which at this time some recover patients committed to
their charge, who were long under the care of more cautious physicians.
For even amongst the ancients before Herophilus and Erasistratus, but
after Hippocrates, was one Petron, who, as soon as he was called to a
person in a fever, laid a great many cloaths upon him, that he might
at once excite a great heat and thirst. After that, when the fever
began to be a little abated, he gave cold water to drink; and if it
once raised a sweat, he pronounced the patient to be out of danger: if
it had not procured that discharge, he gave still more cold water, and
then obliged him to vomit. If by either method he freed the person from
the fever, he immediately gave him roast pork and wine. If it did not
give way to these methods, he boiled water with salt, and obliged him
to drink it, that by vomiting he might cleanse his belly(9).
And these particulars made up his whole practice. Which was not
less acceptable to those, whom the successors of Hippocrates had
not recovered, than it is to those in this age, who have been long
unsuccessfully treated by the followers of Herophilus or Erasistratus.
Nor is this kind of medicine upon this account not to be esteemed rash;
because if it has been pursued from the beginning, it kills more,
_than it cures_. But since the same things cannot agree with every
body, those commonly, who are not restored by a rational method, are
relieved by temerity; and for that reason physicians of that class
manage another’s patients better than their own. But it is a practice
not unbecoming even the man of circumspection, at times both to change
a distemper, and to increase one, and to inflame fevers; because where
the disorder, that is present, does not admit of a cure, another may,
which is to succeed in its place.
CHAP. X.
REMEDIES FOR THE CONCOMITANT SYMPTOMS OF FEVERS.
It is necessary also to consider, whether fevers are simple, or whether
other disorders are not likewise concomitant; that is, whether the
head be pained, the tongue rough, or the præcordia tense. If there be
pains in the head, it is proper to mix oil of roses with vinegar, and
to apply that(10); then to have two pieces of cloth, which are as
broad and as long as the forehead; to have one of these alternately
in the vinegar and rose-oil, and the other on the forehead; or to put
on sordid wool dipped in the same. If vinegar is offensive, pure oil
of roses must be used. If even the rose-oil is offensive, bitter oil.
If these do little service, dry iris, or bitter almonds, or any of
the cooling herbs may be powdered. Any of them mixed with vinegar and
laid upon the part lessens the pain: but in some one of these is more
successful, and in others another. Relief is also procured by bread
laid on with poppies, or with oil of roses, cerus, or litharge. It is
also not improper to smell at either serpyllum or dill.
But if there is an inflammation and pain in the præcordia, in the first
place restringent cataplasms must be applied; and not the hotter kind,
lest there should be a greater flux of matter thither. After that, as
soon as the inflammation has abated, recourse must be had to hot and
moist, in order to discuss what remains. Now the marks of inflammation
are four, redness, and swelling, together with heat, and pain. So much
was Erasistratus mistaken, when he declared there was no fever without
it.
Wherefore if there is pain without inflammation, nothing is to be
applied at all; for the fever itself will presently remove that. But
if there is neither an inflammation, nor fever, but only a pain of the
præcordia, warm and dry fomentations may be immediately used. If the
tongue is dry and scabrous, it is first to be wiped with a penecillum
dipped in hot water; and then anointed with a mixture of rose-oil and
honey. The honey cleanses, and the oil of roses restringes, and at the
same time does not suffer it to grow dry. But if it is not rough, but
only dry, after wiping it with the penecillum it ought to be anointed
with rose-oil mixed with a little wax.
CHAP. XI.
REMEDIES AGAINST A COLDNESS OF THE EXTREMITIES PRECEDING A FEVER.
It is common also for a coldness to precede fevers, which of itself
is a very troublesome kind of disorder. When it is expected, the
patient must be forbid all drink: for giving this a little before
much increases the malady. He is also to be timely covered with many
cloaths. Dry and hot fomentations are to be used to those parts, for
which we are apprehensive; in such a manner that the most violent heat
may not begin immediately, but increase gradually. And those parts are
to be rubbed with the hands anointed with old oil, and some of the
warming medicines may be added to it. And some physicians are content
with one friction with any kind of oil. In the remissions of such
fevers some give three or four cyathi of gruel, while the fever still
continues; and then, when it is quite over, refresh the stomach with
cold and light food. I think this ought to be then tried, when food
once given, and that after the fever, does little service.
But great care must be taken, that we be not deceived as to the
time of the remission; for even in this kind of distemper, often
the fever seems to abate, and again increases. Wherefore we must
trust no remission, but that, which both continues, and lessens
the restlessness, and excessive heat of the body, which the Greeks
call(11) zesis[BD]. This is a rule generally received, if every day
the fits are equal, to give a little food every day: if unequal, food
must be given after the most severe; after the milder hydromel.
[BD] ζίσις.
CHAP. XII.
THE CURE OF A SHUDDERING BEFORE FEVERS.
A shuddering commonly precedes those fevers, that have a certain
period, and a perfect remission, and for this reason are the most safe,
and most easily admit of a cure: for where the periods are uncertain,
neither clysters, nor the bath, nor wine, nor any other remedy can be
duly administered. For it is uncertain when the fit will come: so that
if it come on suddenly, the greatest detriment may happen to accrue
from that, which was intended to give relief. And nothing else can be
done, than that the patient practise a strict abstinence in the first
days of the disease: then upon the decline of that fit, which is most
severe, let him take food.
But where the period is certain, all these things are more easily
tried; because we can more readily inform ourselves of the succession
both of the fits and the intervals. Now in this kind, when they are of
long standing, fasting is not good: in the first days only we are to
make use of it to oppose the distemper; after that the cure is to be
divided, and first the shuddering, then the fever is to be removed.
Wherefore as soon as a person has shuddered, and after the shuddering
has grown hot, it is fit to give him warm water to drink a little salt,
and force him to vomit: for generally such a shuddering arises from
something bilious oppressing the stomach. The same method is to be
pursued, if at the next period also it has again appeared: for thus it
is often removed. And by this time one may find out the species of the
fever.
Wherefore when the third fit is expected, which may possibly come on,
the patient must be brought to the bagnio, and care must be taken
that he be in the bath at the time of shuddering. If he have felt it
there also, let him do the same nevertheless, when the fourth fit is
expected: for by this repetition it is often removed. If the bath
proves unsuccessful, before the fit let him eat garlick, or drink
hot water with pepper: for these too raise a heat, which repels the
shuddering. After that, before the shuddering has time to come on, let
him cover himself up in the manner above directed under the article
of coldness: and it is proper immediately to apply all round his body
pretty hot fomentations, and chiefly extinguished tiles, and coals
wrapped up in cloths.
If notwithstanding the shuddering has broke out, he must be anointed
within the cloaths plentifully with hot oil; to which also may be added
some of the warming substances: and friction may be used, to as great
a degree as he is able to bear, and especially in his hands and feet,
and let him hold in his breath. And it must not be given over, although
the shuddering do return: for often the perseverance of the physician
overcomes the distemper of the body.
If he has vomited, warm water must be given, and he obliged to vomit
again; and the same methods must be repeated, till the shuddering is
removed. But beside these a clyster must be given, if the shuddering
gives way slowly: for that has a good effect by exonerating the
body. The last remedies after these are gestation and walking. Now
in distempers of this kind, the fittest food is such as may prove
laxative, and glutinous flesh. When wine is given, let it be austere.
CHAP. XIII.
THE CURE OF A QUOTIDIAN FEVER,
Now these observations relate to the periodical returns of all fevers:
but the several species of them are to be distinctly treated, according
to their different natures. If it be a quotidian, for the first three
days by all means abstinence should be observed; then food be taken
every other day. If the distemper has become inveterate, after the
fit it is proper to try the bath and wine, especially if, when the
shuddering is removed, the fever remains.
CHAP. XIV.
THE CURE OF A TERTIAN FEVER.
But if the fever be either a tertian, which has a perfect intermission,
or a quartan, on the intermediate days, it is proper to walk, and make
use of other exercises and unctions. Cleophantus, one of the more
ancient physicians, in these distempers used to pour a great quantity
of hot water upon the head of the patient long before the fit, and
then to give him wine. Yet Asclepiades, though he adopted most of his
precepts, has justly omitted this: for it is of doubtful effect.
When there is a tertian fever, he says it is proper to administer a
clyster the third day after the fit; on the fifth, after the shuddering
to procure a vomiting; then after the fever, according to Cleophantus’s
practice, to give the patients food and wine, while they are yet hot;
on the sixth day to keep them in bed: for thus it will happen, that
the fit will not return on the seventh day. That this may often answer
is very probable. Yet it is safer in this order to make trial of these
three remedies, vomiting, purging by clysters, and drinking of wine,
for three days, that is, on the third, and fifth, and seventh; and not
to drink wine, till after the fit upon the seventh day.
But if the distemper is not removed in these first days, and it grows
inveterate, on the day the fit is expected, let the patient keep his
bed; after the fit be rubbed; and after eating let him drink water: the
day following, when he takes no food, let him intermit his exercise and
unction, and rest content with water alone. And this indeed is best.
But if his weakness bear hard upon him, he ought both to take wine
after the fit, and a little food on the intermediate day.
CHAP. XV.
THE CURE OF A QUARTAN FEVER.
The same method is to be followed in a quartan. But since this is
very slowly terminated, unless it have been removed in the beginning,
greater accuracy must be observed in prescribing from its first
appearance, what ought to be done it. Wherefore if a person is attacked
with a fever and shuddering, and it has gone off, all that day and the
following, and the third, he ought to confine himself to a stricter
regimen, and on the first day drink only warm water after the fever;
the two following days to abstain from that as much as possible; on the
fourth day, if the fever returns with the shuddering, to vomit, as has
been directed before; then after the fit, to eat sparingly, and drink a
quadrans of wine; the day after that, and the third to abstain; taking
only warm water if he be thirsty. On the seventh day he should prevent
the coldness, by going into the bath before its time, fast and observe
the former regimen strictly(12); if the fever has returned, have a
clyster: when the body has rested after that, he should be anointed and
brushed briskly; take food and wine in the same way, and for the two
following fast, not neglecting the friction. On the tenth day he must
try the bath again; and if the fit has come on after, brush in the same
manner, and drink wine more plentifully. And thus the consequence is,
that a rest of so many days, and abstinence, with the practice of the
other injunctions, may remove the fever.
If notwithstanding these it continues, another method of cure entirely
different is to be pursued; and all our measures must be directed to
this point, that the body may easily bear what is to be long endured.
For this reason the practice of Heraclides of Tarentum ought to be
less approved, who prescribed clysters in the beginning, after that
fasting to the seventh day. Which course though a person should be able
to undergo, yet when he is even freed of the fever, he will scarcely
have strength to recruit; and so if the fever frequently returns, he
must sink under it. Wherefore if the distemper shall continue upon the
thirteenth day, the bath must neither be tried before the fever nor
after it, unless sometimes when the shuddering is already removed.
Now the shuddering is to be repelled by the same means, as have been
directed before. Then after the fever it is proper to be anointed,
and rubbed briskly; to eat heartily of substantial food; to take
as much wine as he inclines; the day following, when he has rested
sufficiently, to walk, take exercise, be anointed, and stoutly brushed;
to take food without wine; on the third day to abstain.
On the day that he shall expect the return of the fever, it is proper
for him to rise before _its hour_, and exercise himself, and to
endeavour to have its time coinciding with his exercise: for thus it is
often dispelled. But if it has seized him in the midst of his exercise,
in that case to give over. In a disorder of this kind the remedies are
unction, friction, exercise, food and wine. If the belly is bound, it
must be opened.
Now these things are easily performed by the more robust; but if the
patient be grown weak, gestation must stand instead of exercise. If he
cannot even bear this, yet friction must be used. If this also when
vehement distresses him, the cure must be confined to rest, unction,
and diet: and care must be taken, lest any crudity change the distemper
into a quotidian. For a quartan kills no body: but if it be changed
into a quotidian, the patient is in a bad way: which however never
happens, unless by the fault either of the patient or the physician.
CHAP. XVI.
THE CURE OF A DOUBLE QUARTAN.
But if there are two quartans, and those exercises, which I have
prescribed cannot be used, there is a necessity either entirely to
rest, or if that is difficult, to walk gently, then sit down, with the
feet and head carefully wrapped up; as often as the fit has come on,
and gone off, to eat sparingly, and drink a little wine; at other
times, unless the weakness be very great, to abstain. But if there is
hardly any intermission between two fits, to take food after both are
over: then in the interval both to move a little, and after unction to
eat. Now since an inveterate quartan is very seldom cured unless in the
spring, in that season especially attention must be given, that nothing
be done, which may obstruct the recovery of health. And it is of
service in an old quartan to alter now and then the manner of living,
to change from wine to water, from water to wine, from mild food to
such as is acrid, and on the contrary; to eat radish, then vomit, or
open the belly by chicken broth; to add warming medicines to the oil
for friction; before the fit to take two cyathi of vinegar, or one of
mustard, with three of Greek salt wine; or pepper, castor, laser(13),
and myrrh, mixed in equal proportions, and diluted with water; for by
these, and such like the body must be agitated, that so a change may be
made from its present state.
If the fever has disappeared, it is proper to be long mindful of its
periodical day; and on that day to guard against cold, heat, crudity,
and fatigue: for it easily returns, unless it be feared for some time
after the recovery of health.
CHAP. XVII.
THE CURE OF A QUOTIDIAN ARISING FROM A QUARTAN.
But if a quotidian is formed from a quartan, when that has happened
in the beginning(14), it is proper to abstain for two days; in the
evening to make use of friction, and give only water to drink. On the
third day it often happens, that the fit does not come. But whether it
has appeared or not, food must be given after the time for the fit: and
if it continue, the strictest abstinence possible must be enjoined for
two days, and friction used every day.
CHAP. XVIII.
OF THE SEVERAL KINDS OF MADNESS AND THEIR CURE.
I have now gone through the treatment of fevers. There remain other
disorders of the body, which come on after them: some of which, that
cannot be assigned(15) to any certain part, I shall immediately
subjoin. I shall begin with madness, and treat of the first kind of
it, which is both acute, and happens in a fever; the Greeks call it
phrenitis[BE].
[BE] φρεν̃ιτις.
First of all it is necessary to know, that sick people sometimes in a
febrile paroxysm lose their judgment, and talk incoherently. Which,
though it be not trifling, and cannot happen unless in a violent fever,
yet is not equally dangerous; for it is commonly of short continuance:
and when the violence of the fit is abated, the judgment presently
returns. Nor does this kind of distemper require any other remedy, than
what has been already directed for curing a fever.
It becomes then a phrenitis, when the delirium begins to continue
without interruption; or when the patient, though he still have his
reason, yet forms to himself some vain images: it is perfect, when the
mind gives itself up to these images. Now there are several kinds of
it: for amongst phrenitic people some are merry, others sad; some are
more easily commanded, and their disorder goes no farther than words;
others grow outrageous, and do acts of violence; and of these last
again some only employ force, others even make use of cunning, and
present a specious appearance of judgment, while they are catching at
opportunities of doing mischief; but they are discovered by the issue.
Such of them as only rattle, or do no harm but in trifles, it is
needless to load with severe restraints. Those, who are more violent
in their actions, it is proper to bind, lest they should hurt either
themselves or any other person. Nor should we trust any of them, if in
order to get rid of his chains he pretends to be well, though he speak
sensibly, and make lamentable complaints; because this is nothing else
but the cunning of a mad person.
Generally the ancients kept such patients in the dark; for this reason,
that it hurts them to be terrified: and they judged, that darkness of
itself contributed something to the quiet of the mind. But Asclepiades,
alleging that darkness itself strikes terror, ordered them to be kept
in the light. But neither of these holds always. For one person is
more disturbed by the light, and another by darkness: and some are to
be met with, in whom no difference can be found either the one way or
the other. Therefore it is best to try both methods; and to keep him,
that has a horror at darkness, in the light; and him, that is afraid
of light, in darkness. But where there is no such difference, if the
patient have strength, he must be confined in a light place; if not, in
a dark one.
To make use of remedies in the greatest violence of the phrenzy is
needless: for at the same time the fever also increases. Wherefore
nothing is to be done then, besides confining the patient. But when
the circumstances allow, speedy help must be administered. Asclepiades
asserted, that to bleed such was just the same as to murder them: upon
this principle, that there was no madness, but when the fever was very
high; and that bleeding could not be properly performed, unless in
its remission. He himself endeavoured to procure sleep in such cases
by much friction. But since both the violence of the fever prevents
sleep, and friction is not useful unless in its remission, he ought to
have omitted this remedy too. What then is to be said to this case?
Many things are properly done in imminent danger, which should not be
practised on any other occasion. And even a continued fever has times,
in which, though it does not remit, nevertheless it does not increase.
And this though not the best, yet is a pretty favourable season for the
application of remedies. And if the strength of the patient admits of
it, he may also lose blood.
There may be the same reason(16) for doubting whether a clyster
should be administered. Then after the interval of a day, it is fit to
clip the hair of the head close to the skin; then to foment it with
a decoction of some of the restringent herbs; or to foment it first,
after that clip, and foment it again; and lastly to embrocate the
head and nostrils with oil of roses; to hold also to the nostrils rue
bruised with vinegar, and to provoke sneezing by medicines efficacious
for that purpose. These things however are to be done only to persons,
who don’t want strength. If there be a weakness, the head is only to
be moistened with oil of roses, adding to it serpyllum or something of
the like nature. Also whatever be the degree of strength, two herbs are
useful, nightshade and the wall-herb, if the head be bathed with the
expressed juice of them both. When the fever has remitted, friction
must be used; but more sparingly in those, that are too merry, than in
those, that are too sad.
It is necessary to apply to the minds of people thus mad in a manner
suitable to the temper of each. For the groundless apprehensions of
some are to be alleviated: as was done to a very rich man in fear
of starving, whom they relieved by frequent accounts of estates
bequeathed to him. The audaciousness of others must be restrained,
as is practised in the case of those, who require even stripes to
keep them under government. The unseasonable laughter of some must
be checked by chiding and threats. The sorrowful thoughts of others
must be dispelled: for which purpose concerts of music, and cymbals
and noise are useful. Yet these patients must be oftener humoured
than contradicted: and the mind is to be led by slow degrees, and
not evidently, from their irrational assertions to better notions.
Sometimes also the attention of the person must be strongly engaged;
a method taken with studious men, to whom a book is read, either with
propriety of accent, if they be pleased with it, or with an improper
tone of voice, if that offends them: for by correcting they begin to
give their attention. Moreover they must be obliged to repeat any thing
they may remember. Some also have brought those to eat, that had no
inclination for it, by placing them in the midst of people at a feast.
To every body thus affected, sleep is both hard to be obtained,
and highly necessary; for by this most of them recover. For this
purpose, and at the same time for composing the mind, the ointment of
saffron(17) with that of iris rubbed upon the head is useful. If
notwithstanding they continue wakeful, some endeavour to procure them
sleep by giving them to drink a decoction of poppies or henbane; others
put mandrake apples under their pillow: others apply to their forehead
either amomum or sycamine tear. This name I find among the physicians.
But why do the Greeks call the mulberry-tree sycaminus[BF], when there
is no tear of the mulberry-tree? But this name they give to the tear of
a tree growing in Egypt, which they call sycomorum[BG]. Many physicians
now and then foment the face and head with a sponge dipt in a decoction
of poppy-heads.
[BF] συκάμινος.
[BG] συκόμορον.
Asclepiades affirmed these things to be hurtful: because they often
change the distemper into a lethargy. His advice is, that the first day
the patient should abstain from meat, drink, and sleep; on the evening
water should be given him to drink; then friction should be used so
gentle, that even the hand that rubbed, should not press strongly; the
day after, all these things being repeated, on the evening gruel and
water should be allowed him, and the friction again repeated: for by
this we would procure sleep. This sometimes happens; insomuch that by
his own confession, too much friction may even endanger a lethargy.
But if by these means sleep is not obtained, then at last it must
be procured by the medicines above-mentioned: still with the same
moderation, which is also necessary in this case; lest it be not in our
power afterwards to wake the person, whom we desire to sleep. A fall of
water near is also some help to sleep; or gestation after meat, and in
the night time; especially the motion of a suspended bed.
Nor is it improper, if bleeding has not gone before, and the
understanding be still disturbed, and there be no sleep, to make an
incision in the occiput, and apply a cucurbital: because this, by
lessening the distemper, may bring on sleep. Moderation must also be
used as to his diet: for the patient must neither be full-fed, lest
he grow outrageous, nor must he be tormented with hunger, lest from
his weakness he fall into a cardiac disorder. He must use weak food,
and especially gruel, and drink hydromel, three cyathi of which are
sufficient in winter, and four in summer.
There is another kind of madness, which continues a longer time;
because generally it begins without a fever, afterwards excites slight
feverish fits; and goes no farther than a sadness, which seems to
proceed from atrabilis. In this bleeding is useful. If there be any
reason against that, the first remedy is abstinence; the second to
purge by white hellebore and vomiting: after either of these friction
is to be used twice a day; if the patient be pretty strong, frequent
exercise too, a vomit fasting, food of the middle kind is to be given
without wine. As often as I mention this kind of food, I would be
understood, that it may be given even of the weakest, provided one be
not confined to that alone: that only the strongest is to be refrained.
Besides, the belly is to be kept as soft as possible: terrors are to be
dispersed, and rather good hopes are to be given. Entertainment must be
sought in amusing stories and diversions, such as the person in health
used to be most pleased with. If there are any works of his performing,
they must be commended, and placed before his eyes. His groundless
sorrow is to be mildly reprimanded. Arguments must be offered now and
then to persuade him, that in those very things, which disturb him,
there is more matter for joy than anxiety. If a fever has also come on,
it must be cured in the same manner as other fevers.
The third kind of madness is the longest of all; insomuch that it does
not shorten life. Which kind is most incident to people of strong
constitutions. Now there are two species of this: for in some the
deception arises from _false_ images, not from the understanding:
such a madness the fables of the poets represent that of Ajax, or
Orestes(18): others are disordered in their judgment. If imaginations
mislead, first of all it must be observed, whether they be melancholy
or merry. If melancholy, black hellebore ought to be given as a purge;
in the merry kind, the white as an emetic. And if the patient will not
take it in a potion, it must be added to bread, that it may the more
easily deceive. For if he be thoroughly purged, it will in a great
measure lessen the distemper. And therefore if hellebore once given has
done little service, after a proper interval it ought to be repeated.
And it should be known that this distemper is more mild, when attended
with laughter, than with gravity. And this rule also is universal
in all diseases, when any person is to be purged in the inferior
parts(19), that the belly be first opened; when the superior parts,
it must be bound.
But if the madness affect the judgment, the patient is best treated by
some kind of tortures. When he has said or done any thing wrong, he is
to be punished by hunger, chains, and stripes: he must be forced both
to attend and get something by heart, and retain it in his memory.
For thus it will happen, that gradually by fear he may be obliged to
consider, what he does. It is also serviceable in this disorder to be
put into sudden consternation and fear; and the same tendency commonly
has every thing, that disturbs the mind greatly; for some change may
be brought about, when the mind is withdrawn from that state, in which
it was before. It likewise makes a difference, whether the patient
laugh now and then without cause, or be sorrowful and dejected. For the
merriment of a mad person is better cured by those terrours, which I
mentioned above. If sadness be his extreme, gentle, but long friction
twice a day is useful; also pouring of cold water upon the head, and
dipping the body in water and oil.
The following are general rules: that mad people ought to be strongly
exercised; to make much use of friction; to take neither fat flesh nor
wine; to take food, after purging, of the middle kind, and as light as
possible; that they should neither be alone, nor amongst strangers, nor
those which they either despise, or look upon with indifference: they
ought to go into other countries, and, if their judgement returns, to
take a journey into distant parts once a year.
Sometimes, though seldom, a delirium arises from fear; which kind of
madness is of a similar species, and is to be cured by a like diet:
except that in this kind of madness alone wine is properly given.
CHAP. XIX.
OF THE CARDIAC DISORDER AND ITS CURE.
That kind of distemper, which by the Greeks is called cardiacus[BH],
is directly contrary to the last mentioned; although phrenitic people
often fall into it: for the mind in that is disordered, in this it is
sound. This is nothing else but an excessive weakness of the body;
which from a languishing stomach is dissipated by immoderate sweating.
And one may immediately know that this is the disease, when the
pulsations of the arteries are small and weak, and sweat uncommon both
in degree and continuance, breaks out from the whole breast, and neck,
and even from the head, the feet only and legs being more dry and cold.
This distemper is of the acute kind.
[BH] καρδιακὸς.
The first step in the cure is to apply restringent cataplasms to the
præcordia; the second to restrain the sweat. That is accomplished by
bitter oil, or that of roses, or quinces, or myrtles. With any of these
the body is to be gently anointed; and then a cerate of some one of
them is to be applied.
If the sweat nevertheless prevails, the person is to be rubbed over
with gypsum, or litharge, or Cimolian chalk, or to be sprinkled now
and then with the powder of these. The same purpose is answered by the
powder of dry myrtle or bramble-leaves, or the dried lees of austere
and strong wine. And there are a great many more things of the same
nature, which if they cannot be had, sprinkling of common dust will
have a good effect. And besides these, that the body may sweat less,
the person ought to be covered with a light garment, and set in a place
not hot, with the windows open, so that he may be even sensible of the
stream of air.
The third remedy is to succour the weakness of the patient by eating
and wine. Food is not to be given in great quantity indeed, but often,
both in the night and day; so as it may nourish, and not load. It
ought to be of the weakest kind, and agreeable to the stomach: and
unless there be a necessity, we ought not to be in haste to give wine.
If there is reason to fear the person is fainting, then both intrita
with wine, and wine itself, austere but small, and somewhat diluted,
with the cold taken off it, may be given pretty frequently and freely;
with the addition of polenta(20), provided the patient takes little
food. And the wine ought to be neither very weak nor very strong: and
the patient in a day and a night may very well drink two or three
heminæ; if it be a person of a large make, even more: if he has no
appetite for food, it is fit first to anoint him, then to pour cold
water all over him, and then give it him.
But if his stomach be so relaxed, that it hardly retains, both before
meat and after it, he ought to vomit spontaneously(21); and again
after vomiting to take food. If even that do not stay, to sup a cyathus
of wine, and at the distance of an hour to eat again. If the stomach
return that too, the whole body must be rubbed over with bruised
bulbous roots(22): when these have grown dry, the effect is, that the
wine may be retained in the stomach, and from that, the heat may return
to the whole body, and the tone of the vessels be restored.
The last remedy is to inject by way of clyster(23) the cream either
of ptisan or alica, for that also will support the strength. Nor is
it amiss to hold something refreshing, such as rose oil and wine, to
the nose of the person, when he is restless and hot: and if there is
any coldness in the extremities, to cherish them with hands anointed
and warm. By which means if we have been able to gain these points,
that the violence of the sweat abates, and life is prolonged, time
itself now begins to work a cure. When he seems to be out of danger,
yet we must be cautious, that he do not relapse quickly into the same
weakness. Therefore omitting only the wine, he ought every day to take
more substantial food, till his body recover sufficient strength.
CHAP. XX.
OF THE LETHARGY, AND ITS CURE.
There is also another distemper, which in a different way is opposite
to the phrenitic one. In phrensies sleep is hardly obtained, there is
a disposition to fool-hardy enterprises: in this there is a languor,
and an almost invincible necessity of sleeping. The Greeks call it
lethargus[BI]. This too is of the acute kind, and unless it is cured,
kills quickly.
[BI] λήθαργος.
Therefore some endeavour to rouse such patients by holding to _their
nose_ those things, which provoke sneezings, and such as excite by
their offensive smell; for instance, burnt pitch, sordid wool, pepper,
hellebore, castor, vinegar, garlick, onion. They also burn galbanum by
them, or hartshorn; if this is not to be got, any other horn; for when
these are burnt, they stimulate by their offensive smell.
But a certain _author_, Tharrias, affirmed, that this disposition to
sleep is concomitant upon a _febrile_ paroxysm, and that it abates,
when the latter is gone off: and therefore that such practitioners,
as rouse them frequently, give them unnecessary pain. Now it makes a
considerable difference whether the patient awakes upon the termination
of the fit, or whether the weight of sleep oppresses him, when the
fever is abating, or even after its going off. For if he awakes, it is
needless to treat him as one asleep: for he is not made better by being
awake; but if he be better, he will keep awake of himself. If his sleep
is continual, he must in such a case be roused; but at those times,
when the fever is lowest, that he may discharge somewhat, and take
food. Cold water suddenly poured on excites more powerfully than any
thing. After the remission therefore the whole body must be anointed
over with a great quantity of oil, and three or four amphorae of water
must be poured upon the head, so as to stream over all the body. But
this we shall make use of, if the patient’s breathing be equal, if
the præcordia be soft. But if the case shall be different, the other
remedies are preferable, which were mentioned before. And as to the
sleep, this method is the most suitable.
With regard to the cure _of the distemper_, the head must be shaved;
then fomented with a decoction of bay-leaves, or of rue in vinegar
and water. And the day after, castor must be applied, or rue bruised
with vinegar, or bay-berries, or ivy with rose-oil and vinegar. And
mustard is of singular use, both held to the nostrils in rouzing the
patient, and if applied to the top of the head or forehead, in removing
the distemper itself. Gestation is also useful in this distemper, and
especially food seasonably given, that is, in the greatest remission,
that can be found. Now gruel is most proper till the distemper begins
to decline. And if every day there is a severe fit, this may be given
daily: if every other day, gruel after the most severe; after the
milder hydromel. Wine also given with seasonable food is of no small
use.
But if such a torpor has come after long fevers, all the other rules
are to be observed: but three or four hours before the fit, if the
belly be bound, castor with a mixture of scammony must be given; if
that is not the case, castor alone must be given with water. If the
præcordia are soft, the diet must be pretty full; if hard, we must
keep to the gruels above-mentioned; something being applied to the
præcordia, which can at once repel and soften.
CHAP. XXI.
OF THE SEVERAL SPECIES OF THE DROPSY AND THEIR CURE.
The foregoing is an acute distemper; but the case of those, who are
troubled with water under the skin, may turn to a chronical disease:
for unless it is speedily cured, such patients fall into what the
Greeks call hydrops[BJ] (_dropsy_). There are three species of it;
for at times the belly is very tense, and there is a frequent
rumbling within from the motion of the air: sometimes the surface of
the body is unequal, with tumours of different sizes rising over the
whole: sometimes water is confined within the abdomen, and upon the
body’s being moved, it moves in such a manner, that the course of it
may be seen. The first the Greeks call tympanites[BK]; the second
leucophlegmatia, or hyposarca[BL]; the third ascites[BM]. An excess of
moisture however is common to them all: for which reason ulcers in such
patients are not easily healed. This disease often begins of itself;
and often succeeds another distemper of long standing, and especially a
quartan.
[BJ] ὕδρωψ.
[BK] τυμπανίτης.
[BL] λευκοφλεγματία vel ὑπὸ τὴν σάρκα.
[BM] ἀσκίτης.
It is more easily cured in slaves, than in free people; because as it
requires fasting, enduring of thirst, and a thousand other hardships,
and long patience, such are more readily relieved, that are easily
commanded, than those, whose liberty is hurtful to them. But even
those, that are under the authority of another, if they cannot entirely
command themselves, are not to be recovered. And upon this account no
inconsiderable physician, a disciple of Chrysippus, residing with king
Antigonus, declared that a certain friend of that prince, of known
intemperance, though not very ill of this disease, could not possibly
be cured: and when another physician, Philip of Epirus, undertook to
cure him, he answered, that the other considered only the distemper of
the patient; he, his dispositions. And he was not deceived; for though
he was watched with the greatest diligence not only by the physician,
but even by the king too, yet by devouring his malagmas(24), and
drinking his own urine, he quickly killed himself.
However at the beginning the cure is not very difficult, if rest,
thirst, and fasting be strictly enjoined. But if the disease has
continued long, it is not removed without great trouble. Yet they tell
us, that Metrodorus, a disciple of Epicurus, when he was afflicted with
this distemper, and could not patiently endure the necessary thirst,
after refraining long, used to drink, and then vomit it again. Now if
whatever has been taken, be brought up again, it lessens the uneasiness
considerably: if it is retained in the stomach, it increases the
disorder; therefore it must not be attempted in every one.
But if it be attended with a fever, that in the first place must be
removed by such means as have been prescribed for the cure of that
distemper. When the patient is free of a fever, then we may apply the
usual remedies of the dropsy. And with regard to this, whatever species
it is, if it has not got too deep root, the very same remedies are
necessary. The person must walk much, run sometimes, and his superior
parts especially must be rubbed, so as to bring a warmth into the skin.
In the mean time he must keep in his breath. Sweat is likewise to be
procured, not by exercise only, but also by hot sand, or the laconicum,
or clibanum, and such like means: and natural and dry sweating places
are very beneficial: such as we have at Bajæ amongst the groves of
myrtles. The bath and all moisture is hurtful. Catapotia(25),
composed of two parts of wormwood and one of myrrh, are properly given
to the patient fasting.
The food ought to be of a middle nature, but of the harder kind of
it. No more drink given than to support life: and that is best, which
provokes urine. It is better to attempt that by diet(26), than
medicine. However, if there is a necessity, some of the things, which
have that effect, must be boiled, and the decoction of them given to
drink. This faculty seems to be possessed by the iris, nard(27),
saffron, cinnamon, cassia, myrrh, balsam(28), galbanum, labdanum,
flower of the wild vine, panaces(29), cardamom(30), ebony,
cypress seed, stavesacre, which the Greeks call staphis agria[BN],
southernwood, rose-leaves, acorum(31), bitter almonds, goat’s
marjoram, storax, costus, the flower of long and round cyperus(32);
the first of these the Greeks call cyperus[BO], and the other
schœnus[BP]. Whenever I mention these, I intend not such as grow here,
but those that are imported amongst the spices. However the mildest
of these must be tried first, that is the rose-leaves, or spikenard.
Austere wine also, but very weak, is good.
[BN] σαφὶς ἀγρία.
[BO] κύπειρος.
[BP] σχο̃ινος.
It is convenient likewise to measure the belly every day with a thread,
and to put a mark upon this, where it meets: and each succeeding day
to observe, whether the bulk be enlarged or diminished; for that which
lessens, feels the effect of the medicine. And it is not improper to
measure the patient’s drink, and his urine; for if more moisture is
excreted, than is taken, in such a case there is hope of recovery.
Asclepiades tells us in his writings, that to a person, who had fallen
into a dropsy after a quartan, he prescribed abstinence for two days,
and friction; on the third he gave him food and wine, finding him free
both of the fever and dropsy. Thus far general rules may be laid down
for all the species of the distemper: if the malady rises to a greater
height, different methods of cure are required in each.
Wherefore if there is a flatulency, and from that frequent pain, a
vomit after meat every day, or every other day, is of service. After
that dry and warm fomentations must be used. If the pain is not removed
by these means, cupping without scarification is necessary. If the pain
does not even yield to that, the skin must be cut, and the cucurbitals
applied again. The last remedy, if the cupping has done no service,
is to inject into the belly plenty of warm water, and to take it back
again. Moreover it is necessary to make use of friction three or four
times a day, with oil and some heating medicines. But in this friction
the belly must be avoided; mustard must be applied to it frequently,
till it corrode the skin; and several ulcers must be made in the belly
with hot irons, and these kept open for some time. Boiled squils also
bound upon the skin(33) are good. But for a long time after these
flatulencies all windy food must be avoided.
But if the distemper be what is called leucophlegmatia, it is fit to
expose the swelled parts to the sun; but not too much, lest it inflame
the fever. If the sun is too powerful, the head must be covered, and
friction made use of, the hands being only moistened with water mixed
with salt, and nitre, and a little oil; and that by the hands either
of a child or a woman, as their touch is softer: and if the strength
will allow, it may be continued a whole hour in the forenoon; in the
afternoon for half an hour. Restringent cataplasms also are good;
especially if the body be pretty tender. An incision must likewise
be made on the inside of the leg, about four fingers breadth above
the ancle; from which for some days a good quantity of water may be
discharged, and it is proper also to make deep gashes in the tumours:
and the body must be well agitated by frequent gestation; and when the
wounds are cicatrized, the exercise and food must be increased, till
the body return to its former habit. The food ought to be strong and
glutinous, and chiefly flesh. The wine pretty sweet, if the stomach
will bear it; but in this course, that alternately for two or three
days together, sometimes water and sometimes wine be drunk. It is
proper also to give the seed of sea spurge, which grows large near the
sea, to drink with water. If the person be strong, boiled squills may
be tied upon his belly at the same time. And many authors advise, that
the tumours be beat with inflated bladders.
But if the disease be of that kind, in which there is a large
collection of water within the abdomen, it is fit to walk, but more
moderately; to keep a discutient malagma applied to the part, with a
triple cloth above it, and to bind it on with a roller, though not
too tight. Which practice, introduced by Tharrias, I observe is still
continued by the greatest number of physicians. If it is evident,
that the liver or spleen is affected, it is proper to apply over it a
mellow fig bruised, with the addition of honey. If by such remedies
the belly is not dried, but the water notwithstanding abounds, a more
speedy method must be taken to relieve, that is, to discharge it by
the belly itself. Nor am I ignorant, that Erasistratus disapproved of
this method of cure: for he imagined this to be a distemper of the
liver; and therefore that means should be used to restore that part to
a sound state, and that it was to no purpose to draw off the water,
which, while that bowel is distempered, Would be presently collected
again. But in the first place, this bowel is not only the seat of this
disease: for it arises both in the case of an affected spleen, and a
bad habit of the whole body. And secondly, supposing it to have begun
thence, yet unless the water be discharged, which stagnates there
preternaturally, it hurts both the liver and the other internal parts.
And it is granted, that care should be taken nevertheless to cure the
whole body. For discharging of the water does not work a cure, but
makes room for the operation of medicine, which that obstructs, while
it remains there. Neither does this admit of any dispute, that all in
this disease are not to be thus treated: but robust young men may, who
are either entirely free of a fever, or at least have pretty long
intermissions: for those, who have a vitiated stomach, or have fallen
into this disorder from the atrabilis, or those, who are in a bad habit
of body, are not fit subjects for this treatment. On the day, that
the water is first discharged, giving of food is improper, unless the
patient feels a want of strength. In the following days indeed wine not
much diluted ought to be given, but not in a large quantity, and the
patient must be again gradually accustomed to exercises, frictions,
the heat of the sun, sweatings, fatigues, and proper food, till he be
entirely well. The case requires seldom bathing, and frequent vomits
when fasting. If it be the summer-time, it is proper to swim in the
sea. For a long time after his recovery venery is hurtful.
CHAP. XXII.
OF THE SEVERAL KINDS OF CONSUMPTION AND THEIR CURE.
A consumption is a distemper often of longer continuance, and attended
with greater danger. And of this also there are several species. One
of them is, where the body is not nourished, and as something is
naturally always flying off, and nothing comes in to supply its place,
the person becomes extremely emaciated, and unless it be removed, it
proves mortal. This the Greeks call atrophia[BQ]. It commonly proceeds
from one of two causes: for one man through excessive fear takes less,
another from too great voraciousness takes more food, than he ought to
do: so that either the defect of aliment weakens, or what is redundant
is corrupted.
[BQ] ἀτροφία.
There is another species, which the Greeks call cachexia[BR], where the
habit of the body is bad, and therefore all the aliments are corrupted:
which commonly happens, when bodies depraved by a long distemper,
although they have got quite rid of it, yet do not receive any recruit;
or when the body has been disordered by bad medicines; or when one
has long wanted the necessaries of life; or has made use of victuals
to which he is not accustomed, and bad, or from some such accident. In
this last case besides the consumption it sometimes happens, that the
skin is exasperated with frequent pimples(34), or ulcers, or some
parts of the body swell.
[BR] καχεξία.
The third and by far the most dangerous species is that, to which the
Greeks give the name of phthisis[BS]. It generally takes its rise from
the head(35): and thence falls down upon the lungs. From this an
exulceration proceeds, and there comes a slight fever, which, although
it may have abated, yet returns; in this also there is a frequent
cough, and pus expectorated, and sometimes something bloody. Whatever
comes up, if it be thrown upon the fire, has a bad smell. Therefore
those, that are doubtful of the distemper, try it by this mark.
[BS] φθίσις.
As these are the several species of a consumption, it is necessary
first to consider, which of them is the disease of the patient. Then
if it appears, that the body is only not supplied with nourishment,
to attend to the cause of that; and if the person has taken less
food, than he ought to have done, it is proper to make an addition:
but gradually, lest, if he overload the body unaccustomed to it by
too great a quantity at once, the stomach be oppressed, and and that
retard concoction. If a person has been used to take more than what
was proper, he should fast for one day; then begin with a little food;
making every day some small addition, till he come to a just measure.
It is like-wise proper to walk in places as cold as possible, and avoid
the heat of the sun; to use those exercises, which employ the hands: if
he is weaker, to use gestation, unction, and friction, by his own hands
rather than other if he be able, frequently in the day, both before
meat and after it; and sometimes to add some of the warming medicines
to the oil, till he sweats. It does service too when he is fasting
to take hold of his skin in many parts, and to draw it out, that it
may be relaxed; or to do the same by often impressing a bit of resin
upon it, and quickly pulling it away again. Bathing also is sometimes
good, but after a small meal; and even in the bath itself, some food
is properly given; or if without the bath friction has been used, it
may be immediately after. The food ought to be of that kind, which is
easily concocted and most nourishing. Therefore the use of wine also,
but austere, is necessary to promote urine.
But if the habit of the body is bad, the first thing to be done is to
fast; then a clyster must be administered; next we should give food,
adding exercises, unctions, and frictions. Frequent bathing is more
beneficial to such, but when they are fasting, even till they sweat.
Their diet should be plentiful and varied, of good juices, and such as
does not very easily corrupt, and austere wine. If these methods do not
relieve, blood must be let; but by small quantities, and every day for
some days together, the other rules above laid down being also observed.
But if the distemper is more violent, and there is a true phthisis, it
is necessary to oppose its beginnings: for if this distemper continue
long, it is not easily overcome. If the patient’s strength allow, he
must take a long voyage, change his climate, taking care to remove
into a grosser air, than that he leaves; and therefore from Italy to
Alexandria is a very agreeable change. And generally at the beginning
the body may be well supposed able to stand that fatigue, since this
distemper generally comes on at the strongest age, that is, from the
eighteenth year to the thirty-fifth. If the weakness will not admit of
that, it is very proper however to sail in a ship, but not far. But
if any circumstance render the sailing unfit, the body must be moved
in a litter or some other way; then business must be laid aside, and
every thing, which disturbs the mind; sleep must be indulged; catarrhs
avoided, lest they exasperate, what may have been mitigated by care;
and for that reason crudity must be guarded against, and at the same
time both the heat of the sun and cold, the face defended, the throat
wrapped up, and the cough removed by its peculiar remedies. And as
long as the fever continues to attack, it must be treated sometimes by
abstinence, sometimes also by seasonable food: and at such time water
must be drunk. Milk likewise, which is poison in pains of the head, and
acute fevers, and excessive thirst, occasioned by these, and when the
præcordia are swelled, or the urine is bilious, or in hæmorrhages; yet
in a phthisis, as well as in all tedious and obstinate febriculas, it
may very well be given.
But if a fever does not yet come on, or has already remitted, recourse
must be had to moderate exercise, and especially walking and gentle
friction. The bath is hurtful. The food at first ought to be pungent,
such as garlick, leeks, and the same in vinegar, or in the same way
endive, basil, lettuce; afterwards mild, as gruel(36) made from
ptisan, or alica, or from starch, with the addition of milk. Rice also,
and, if there is nothing else, far will answer the same end. Then
these two sorts of food are to be alternately used; and something of
the middle kind is to be added, and especially brains(37), and small
fish, and such like. Flour also mixed with mutton or goat’s suet, and
boiled, serves for a medicine. Wine ought to be taken light and austere.
Thus far the distemper is combated with no great difficulty. If it is
more grievous, and neither the fever nor the cough abate, and the body
appears to be wasting, there is a necessity for more powerful remedies.
An ulcer must be made with a hot iron in one place under the chin,
another in the throat, two at both breasts, and under the extremity of
the blade-bones, which the Greeks call omoplatæ[BT]; and these ulcers
must not be allowed to heal, unless the cough should cease: which,
it is plain, must also require a distinct method of cure. Then the
extremities are to be brushed briskly three or four times a day; the
chest must be rubbed gently with the hand; after meat, at the interval
of an hour, the legs and arms must also be rubbed. After ten days the
patient is to be put into a bath consisting of warm water and oil. On
the other days he is to drink water; at that time wine must be given
to drink cold, if the cough is gone; if it is not, with the cold taken
off. It is proper also in the remissions to give food every day; to
make use of friction and gestation in like manner; on the fourth or
fifth day to take sometimes the blood herb with vinegar, or to eat
plantain. The juice of plantain alone, or that of horehound boiled up
with honey, is a remedy; of the first of which a cyathus may be supped,
and a spoonful of the other may be licked at times; or one part of
turpentine, and another of butter and honey, mixed together and boiled.
But the most material of all these things, are the diet, gestation,
sailing, and gruel. A loose belly is particularly to be avoided. A
frequent vomiting in this distemper, and especially of blood, is
pernicious. When a person begins to grow a little better, he ought to
increase his exercises, friction and food; and then keeping in his
breath to rub himself; to abstain long from wine, the bath, and venery.
[BT] ὠμοπλάται.
CHAP. XXIII.
OF THE EPILEPSY AND ITS CURE.
Amongst the best known distempers is that, which is called
comitial(38), or the greater. A man falls suddenly down, foams at the
mouth; then after some time returns to himself, and rises of his own
accord. This disorder more frequently attacks men than women; and it
commonly continues long, even to the dying day, and is not dangerous to
life. Sometimes however, when it is recent, it kills a person; and if
it has not been removed by remedies, it is often cured in boys by their
first venereal liberties, in females by the first appearance of the
menses. Sometimes a person falls down with a convulsion of the limbs or
nerves, sometimes without it.
Some endeavour to rouze these by the same means as lethargic people;
which is quite needless: both because even a lethargic person is not
cured by this method; and because he may never awake, and thus perish
for want, whereas the other returns to himself.
When one falls down, if _the fit_ be not attended with a convulsion,
blood ought to be let immediately: if it is, that is not to be done,
unless other circumstances also encourage it. But it is necessary to
give clysters, or to purge with black hellebore, or to do both, if
the strength will allow; then to clip the hair of the head _close_,
and anoint it over with oil and vinegar; to give food the third day
after, as soon as the hour, at which the patient fell down, is past.
Neither are gruels, or victuals otherwise soft and easy of digestion,
or flesh, and least of all pork, fit for such persons; but diet of the
middle kind: for the case requires strength; and crudities are to be
guarded against. At the same time they should avoid the heat of the
sun, the bath, fire, and every thing heating; also cold, wine, venery,
the sight of a precipice, and every thing that terrifies, vomiting,
lassitude, anxieties, all business; and when food has been given on the
third day, they should intermit the fourth, and so on every other day;
observing the same hour for food for fourteen days. When the distemper
has proceeded so far, it has lost the force of an acute one; and if it
continues, it must be treated as a chronic.
But if a physician has not been called on the day, that the person
first fell, but has a man recommended to his care, who is already used
to these falling fits; first of all the regimen above prescribed being
followed, the day is to be expected, on which the fit may return: and
then either bleeding must be used, or a clyster, or black hellebore,
as has been already directed. Then in the following days, he is to be
nourished by the food mentioned before, omitting all such as I said
were to be avoided.
If the distemper should not be removed by these means, recourse must be
had to the white hellebore; and that must be used three or four times,
at the distance of a few days betwixt doses; provided however that he
never repeat it, unless the fit have recurred. On the intermediate days
his strength must be supported by adding some other things to those,
which have been mentioned before. When he has waked in the morning, his
body may be gently rubbed over with old oil, excepting his head and
belly; then let him take a walk, as long and as straight as possible;
after the walk let him be rubbed, in a tepid place briskly and long,
and not less than two hundred times; unless he be infirm; then let a
good quantity of cold water be poured over his head; let him eat a
little; and rest; take a walk again before night; be briskly rubbed a
second time, without touching either his belly or head; afterwards let
him take supper, and with intervals of three or four days, let him for
a day or two together make use of a pungent diet.
If the patient should not be cured even by these means, let his head
be shaved, anointed with old oil, adding to it vinegar and nitre, and
salt water poured upon it; when he is fasting, let him drink castor
and water; make use of no water for drink, unless it has been boiled.
Some have cured themselves of such a disorder by drinking the warm
blood of a gladiator slain. With such people a miserable remedy is
rendered tolerable by a more miserable distemper. As to the assistance
of medicine, the last remedy is to let a little blood from both legs
near the ancle; to make an incision on the back of the head, and apply
cucurbitals; with a hot iron also to make an eschar in two places, in
the back of the head, and below, where the first vertebra is joined
to the head; that by these the noxious humour may be discharged. If
by this method the distemper has not been removed, it will probably
continue for life. To alleviate it, exercise must only be used, and
such food, as has been directed above; and especially every thing
avoided, against which we have given cautions.
CHAP. XXIV.
OF THE JAUNDICE AND ITS CURE.
The distemper is equally known, which is called sometimes
arquatus(39), sometimes regius. If this comes on after the seventh
day of a fever, Hippocrates pronounces the patient to be safe, provided
only the præcordia be soft. Diocles declares without reserve, that if
it comes after a fever, it even does good; if a fever follows it, it is
mortal. Now this distemper is discovered by the colour, especially of
the eyes, in which, what ought to be white, becomes yellow. And it is
generally attended by a thirst, pain of the head, frequent hiccough,
hardness of the præcordia on the right side; and upon violent motion,
a difficulty of breathing, and relaxation of the limbs: and when the
distemper continues long, the whole body turns white, with a certain
sickly paleness.
For the first day it is proper to enjoin the patient to abstinence; on
the second to give a clyster; then if there is a fever, to remove it by
proper diet; if there is not, to give scammony to drink, or white betes
shred in water, or in hydromel bitter almonds, wormwood, anise, but of
the last the smallest quantity. Asclepiades ordered also the drinking
of salt water, and that for two days, with an intention to purge,
rejecting the use of diuretics. Some omitting the former, by the latter
and extenuating diet affirm they obtain the same purpose.
For my part if there be sufficient strength, I prefer the stronger
medicines; if but little, the weaker remedies. If the patient has been
purged, after that it is fit for the three first days to eat sparingly
food of the middle kind, and drink Greek salt wine, that the belly may
continue lax; then for other three days to eat more substantial food
and some flesh too; and hold to the use of water for drink; then to
return to the former diet, only eating more freely of it; and omitting
the Greek, to drink black austere wine; and vary this course by using
sometimes acrid food, sometimes returning to the salt wine. But through
the whole time exercise and friction must be used, and if it be winter,
the bath, if summer, swimming in cold water; a bed and room elegant,
company, place, diversions, frolicks, and every thing else, that has
a tendency to exhilarate the mind: upon which accounts it seems to be
called the royal distemper. A discutient malgama also applied to the
præcordia has a good effect; or a dry fig laid on there, if the liver
or spleen be affected.
CHAP. XXV.
OF THE ELEPHANTIASIS, AND ITS CURE.
That distemper, which the Greeks call elephantiasis[BU], is almost
entirely unknown in Italy, but in some countries is very common, and
is ranked amongst the chronic kind. The whole body is affected with it
in such a manner, that even the bones are said to be spoilt. Upon the
surface of the body are spots and tumours. Their redness by degrees
degenerates into a black colour, the skin is unequally thick and thin,
hard and soft, and is roughened with something resembling scales, the
body wastes, the face, legs, and feet swell. When the distemper is
inveterate, the fingers and toes are hid under the swelling; a slight
fever comes on, which easily destroys the person sunk under so many
maladies.
[BU] ἐλεφαντίασις.
Wherefore without delay, at the beginning of the disease, blood ought
to be let two days successively; or the belly purged with black
hellebore. For three days the person should fast, or eat no more than
is necessary to support him; then the strength is to be recruited a
little, and a clyster administered. After that, when he is somewhat
relieved, exercise must be used, especially running; sweat must be
procured, first by pure labour, and then by dry sweating-rooms;
friction applied; but these with such moderation, that the strength may
be preserved; bathing should be rare; the food without any thing fat,
or glutinous, or flatulent. It is fit to allow wine, but not in the
first days of the disorder. Plantain bruised and rubbed upon the body
seems to be an excellent defence for it.
CHAP. XXVI.
OF APOPLECTIC PATIENTS, AND THEIR CURE.
In this country we _sometimes_, _though_ rarely see apoplectic people,
who are stupified both in body and mind. It happens sometimes from
being thunderstruck, sometimes from a distemper. The last case the
Greeks call apoplexia[BV]. Such people must be bled. And either white
hellebore be made use of, or a clyster given. Then friction is to be
applied; and food taken of the middle kind, by no means fat; some of
the acrid kinds too; and wine must be refrained.
[BV] ἀποπληξία.
CHAP. XXVII.
OF THE PALSY, AND ITS CURE.
But a relaxation of the nerves is a distemper every where common.
But sometimes it attacks the whole body, sometimes particular parts.
Ancient authors called the first apoplexia, the other paralysis: now
I observe the name of paralysis is given to both. And it is common
for those, who have all their limbs extremely relaxed, to be quickly
carried off. And if they are not snatched away, they live indeed for
some time, but yet seldom recover their health; and for the most part
draw out a miserable life, with the loss of their memory too. When
it is partial, it is sometimes an acute distemper, often chronic,
generally incurable.
If all the limbs are greatly affected, bleeding either kills or cures.
Any other method scarcely ever restores health; often only delays
death; in the mean time renders life uneasy. After bleeding, if both
motion and the judgment don’t return, there is no hope left: if they do
return, there is a prospect of recovery.
But where a particular part is relaxed, either blood is to be let, or
a clyster administered, according to the strength of the body and the
distemper. All the other methods to be pursued are the same in both
cases. For the principal thing is to avoid cold: and the patient must
return gradually to exercise, so as immediately to apply to walking,
if he can. If the weakness of his legs be too great for that, he
may either use gestation, or be agitated by moving his bed _to and
fro_: then that member, which is diseased, may be moved of itself if
possible; if that cannot be done, let another person move it, and so
return it to its ordinary habit by a kind of force. It does good also
to irritate the skin of the benumbed limb, either by beating it with
nettles, or keeping mustard upon it, till the part begins to grow
red; when they may be removed. Bruised squills likewise, or bulbous
roots bruised with frankincense, are proper applications. Neither is
it amiss, to vellicate the skin with resin for some time every third
day, and that in several places; and sometimes to make use of cupping
without scarification. Old oil is fittest for unction, or nitre mixed
with vinegar and oil. Further, it is highly necessary to foment with
warm sea-water; or if that is not to be got, with salt-water at least.
And if any where there is a natural or artificial place for swimming
in this kind of water, by all means to make use of it; and the limbs,
which are most disordered, are to be principally agitated there. If
that conveniency cannot be had, nevertheless the bath is useful. The
food ought to be of the middle kind, and chiefly venison; the drink
warm water, without wine. But if the distemper is of long standing,
Greek salt wine may be given as a purge every fourth or fifth day. A
vomit after supper is good.
[Sidenote: _Of pain of the nerves._]
Sometimes there occurs also a pain of the nerves. In this case it is
not convenient, either to vomit, or promote urine by medicines, or
sweats by exercise, a practice advised by some _physicians_. Water
must be drunk twice a day. The body must be rubbed all over gently in
bed for a pretty long time; then the upper parts especially are to be
moved, keeping in the breath even in the time of the exercise. Bathing
must be seldom practised. The air must be changed now and then by
travelling. If there is a pain in any part, it must be anointed with
nitre and water without oil, then wrapped up, and a small quantity of
live coals with sulphur held below it; and thus it is to be fumigated;
and this is to be continued for some time, but when the patient is
fasting, and after he has concocted well. Cucurbitals also are to be
often applied to the part pained, and the same place is to be beat
gently with inflated ox-bladders. It is good also to mix suet with
the powdered seed of cummin or nettle, in equal quantities, and apply
that; to foment with a decoction of sulphur in water. Bottles filled
with warm water are also proper to be clapped on, or bitumen mixed with
barley. Violent gestation must be used, especially in the very article
of the pain, which in other pains is very pernicious.
[Sidenote: _Of a tremour of the nerves._]
A tremour of the nerves is equally increased by vomiting, and diuretic
medicines. The bath and dry sweatings also are hurtful. Water must
be drunk; the patient must walk briskly, also anoint, use friction,
chiefly performed by himself; his superior parts must be opened by
playing at the ball and the like exercises. He may take any food he
chuses, only consulting the concoction. After meat he must avoid cares;
make very little use of venery. If at any time he falls into that,
after it he ought to be rubbed for a long time in his bed with oil, by
the hands of a boy rather than a man.
[Sidenote: _Of internal suppurations._]
As for suppurations(40), which happen in any internal part, when
they begin, our first business is to endeavour by repellent cataplasms
to prevent a hurtful collection of matter; and then, if these have no
effect, to disperse it by discutient malagmas. If we fail in that, it
follows that it be encouraged; next, that it be maturated. And then the
end of every vomica is, that it breaks; and the symptom of this is an
evacuation of matter, either by the mouth or anus. But nothing ought
to be done, by which a full discharge of the pus may be prevented.
Gruels and warm water must be chiefly used. When the pus has ceased
to be discharged, we are to change to such food, as is indeed of easy
_concoction_, but yet more substantial and cold; also cold water, but
beginning with taking the cold off both: and at first some things may
be eaten with honey, as pine-nuts, or sweet almonds, or hazel-nuts.
Afterwards even the honey must be omitted, that a cicatrix may be the
sooner formed. At that time the proper medicine for the ulcer is taking
the juice of leeks or horehound, and adding leeks to every meal. It
will be convenient also to use frictions in those parts, that are not
affected, and gentle walks. And care must be taken not to irritate the
healing ulcers either by struggling or running, or any other means; for
in this distemper, a vomiting of blood is destructive, and therefore by
all means to be guarded against.
A. CORNELIUS CELSUS
OF
MEDICINE.
_BOOK IV._
CHAP. I.
OF THE INTERNAL PARTS OF THE HUMAN BODY.
Thus far we have spoken of those kinds of distempers, which so affect
the whole body, that no certain seats can be assigned to them: I shall
now treat of those which belong to particular parts. Now the diseases
of all the internal parts, and their method of cure will be more easily
understood, when I shall have first given a short description of the
parts they afflict.
The head then and what is contained in the mouth are bounded not only
by the tongue and palate, but by the external parts, which lie exposed
to view. On the right and left side about the throat are large veins,
which are called sphagitides[BW]; and arteries, named carotides[BX],
running upwards, which reach beyond the ears. And in the neck itself
are placed small glands, which sometimes swell, and are painful.
Then two passages begin: one of which is called the aspera arteria,
or wind-pipe; the other the gullet. The wind-pipe is more external,
and goes to the lungs; the gullet more internal, and leads to the
stomach. The former receives the breath, the latter the food. Their
courses being different, where they meet there is something like a
small tongue(1) in the wind-pipe at the entrance of the fauces: when
we breathe this stands erect; when we take meat or drink, it shuts
the wind-pipe. Now the wind-pipe being hard and cartilaginous, is
prominent in the throat; and elsewhere falls back. It is composed of
certain circles formed like the vertebræ in the spine, yet so, that
it is rough on the external part, on the internal smooth like the
gullet; and thus descending to the præcordia it is connected with the
lungs: these are of a spongy nature, and therefore capacious of air;
and behind being joined to the spine, they are divided into two lobes
like an ox’s hoof. With these the heart is connected, being muscular,
situated in the thorax under the left breast: and it has what we may
call two ventricles. But under the heart and lungs is the transverse
septum, consisting of a strong membrane equally nervous, which divides
the abdomen from the præcordia, many vessels also being dispersed over
it: it separates from the superior parts not only the intestines, but
the liver and spleen too. These bowels are next to it, but placed below
it, the one on the right side, and the other on the left. The liver
having its origin under the præcordia from the very septum itself, on
the inside is concave, and the outside gibbous. This projecting rests
gently upon the stomach, and is divided into four lobes. On the lower
part, the gall-bladder adheres to it. But in the left side the spleen
is not connected with the septum, but to an intestine; it is of a
soft and loose texture, of a moderate length and thickness; and this
proceeding a little beyond the region of the ribs into the abdomen, is
chiefly covered by them. And these indeed are joined. But the kidneys
are divided: which adhere to the loins below the last ribs(2), and
the sides next these are round, on the other they turn inward; they
are both stocked with vessels, and covered over with coats(3). These
then are the situations of the bowels. But the gullet, which is the
beginning of the intestines, arises nervous from the seventh vertebra
of the spine, and about the præcordia is united with the stomach.
The stomach, which is the receptacle of food, consists of two coats,
and is placed betwixt the spleen and liver, each of these going a
little over it. There are also some fine membranes, by which these
three are connected together, and are joined to the transverse septum
above-mentioned. After that the lower part of the stomach turning
a little to the right side grows narrower, till it meet the first
intestine. This juncture the Greeks call pylorus[BY]; because like
a gate it emits into the lower parts, what we are to discharge by
excrement. There begins the intestine jejunum, not much folded: this
name is given to it, because it never retains what it has received; but
immediately transmits it into the lower parts. Next to this, is the
smaller intestine, very much folded into sinuses: each of whose rings
are by small membranes connected with the more internal, which being
turned toward the right side, and ending at the right hip, yet fill
more the superior parts. Then this intestine is joined with another
thicker, and running across; which beginning on the right side, towards
the left is open and long; to the right is not so; and therefore it
is called cæcum. But that, which is open, is of large compass and
sinuous, and less nervous than the former intestines, on both sides
rolled different ways, but occupying more of the left and lower parts,
it touches the liver and stomach: then it is joined with some small
membranes, that come from the right kidney; and there turning to the
right, it is directed downward, where it discharges the excrements: and
therefore at that place it takes the name of the intestinum rectum.
All these parts are covered by the omentum, which on the lower part
is smooth and contracted, and on the upper softer. Fat also grows to
it, which like the brain and marrow is insensible. From each kidney
proceeds a tube of a white colour to the bladder; the Greeks call them
ureteres[BZ], because by them they believe the urine to be distilled
into the bladder. The bladder in its sinus is nervous and double; in
the neck full and fleshy, and joined by veins to the intestine and
to that bone, which is under the pubes: itself is loose, and more at
liberty. It is differently placed in men and in women: for in men it
is close to the intestine rectum, rather inclined to the left side: in
women it is situated above their genital parts, and as it hangs, is
sustained by the womb. Then in men the passage of the urine is extended
longer and narrower from its neck to the penis: in women it is shorter,
and wider, and shows itself above the neck of the womb. Now the womb in
virgins is very small: in women, when not pregnant, not much larger,
than to be held in the hand. It begins with a straight and small neck,
which is called the vagina[CA], in a line with the middle of the belly,
then is turned a little to the right hip; then mounting above the
intestine rectum, its sides are connected to the ilia of the woman. The
ilia are situated betwixt the hips and pubes in the lower belly. From
which and the pubes the abdomen reaches upwards to the præcordia; on
the external side the skin appears; on the inside it is lined by a thin
membrane, which is joined to the omentum, and is called by the Greeks
peritonæum[CB].
[BW] σφαγίτιδες.
[BX] χαρωτίδες.
[BY] πυλωρὸς.
[BZ] οὐρητ̃ηρες.
[CA] _Canalis_ is our author’s word.
[CB] περιτόναιος.
CHAP. II.
OF THE DISORDERS OF THE HEAD, AND THEIR CURE.
Having as it were presented these parts to view, as far as it is
necessary for a physician to know them, I shall proceed to the remedies
of the disorders of each, beginning with the head: under which name
I now intend that part, which is covered with hair: for pains of the
eyes, ears, and teeth, and such like, will be treated of elsewhere.
[Sidenote: _Of pains of the head, and a hydrocephalus._]
Now in the head there is sometimes an acute and dangerous distemper,
which the Greeks call cephalæa[CC]. The marks of which are a strong
shuddering, relaxation of the nerves(4), dimness of the eyes,
delirium, vomiting, and withal a suppression of the voice; or an
hæmorrhage from the nose, and with that a coldness of the body, and
fainting; besides these an intolerable pain, especially about the
temples, or occiput. Sometimes too there is a long weakness of the
head, but neither severe nor dangerous, through the whole life.
Sometimes the pain is more violent, but short, yet not fatal; which is
contracted either by drinking wine, or crudity, or cold, or heat of a
fire or the sun. And all these pains are sometimes accompanied with a
fever, and sometimes not: sometimes they afflict the whole head, at
other times a part of it; sometimes the pain extends to a contiguous
part of the face. Besides these there occurs another disorder, which
may continue long: where a humour inflates the skin, and it swells,
and yields to the impression of the finger. This the Greeks call
hydrocephalus[CD].
[CC] κεφαλαία.
[CD] ὑδροκέφαλος.
I have already spoken of the treatment of the second of these kinds,
while it is slight, where I laid down rules to be observed by men in
health, troubled with a weakness in any part. What remedies also are
proper, when the pain is attended with a fever, has been shewn in that
place, where the cure of fevers was considered. Now I shall treat of
the rest.
That, which is acute, and that, which rises to an unusual height, and
that, which proceeds from some sudden cause, and though not mortal, yet
is very violent, demands venesection for the first step in the cure.
But unless the pain be intolerable, that is needless. And it is better
to abstain from food; if possible, from drink too; if not, to drink
water. If the pain continues the following day, to give a clyster, to
procure sneezings, to take nothing but water: for this discipline often
removes it in a day or two, especially if the origin be from wine, or
crudity.
But if these methods afford small relief, it is proper to clip the hair
close to the skin: then it must be considered, what was the cause of
the pain. If heat, it is expedient to pour a great quantity of cold
water over the head, to apply a concave sponge frequently dipped in
cold water and squeezed, to anoint with rose-oil and vinegar, or rather
to apply sordid wool dipped in these, or some other cooling cataplasms.
But if cold has brought on the disorder, it is proper to pour upon the
head sea water, or at least salt water warm, or a decoction of laurel;
then to rub the head briskly; next to embrocate it with warm oil, and
to cover it. Some even bind it up; others clap on cervicalia(5) and
cloaths, and thus are relieved; others are assisted by hot cataplasms.
And therefore, where the cause is not known, it is proper to try,
whether cooling things, or heating give most relief, and to use those,
which upon experiment shall be found best.
But if the cause cannot be discovered, it is proper to pour over the
head first warm water, as has been prescribed, or salt water, or a
decoction of laurel, then cold vinegar and water. The following methods
are of general use in all inveterate pains of the head: to excite
sneezings, to rub the lower parts briskly, to use gargarisms of such
things as promote saliva, to apply cucurbitals to the temples and back
of the head, to sollicit an hæmorrhage from the nose, to vellicate the
temples now and then with resin, and by applying mustard to ulcerate
those parts, that are affected, first putting linen below, that it may
not corrode too severely, or to make ulcers where the pain is, by hot
irons, to eat always moderately, and drink water; when the pain is
abated, to go into the bath, there to pour over the head first a great
quantity of hot water, and then cold. If the pain is wholly removed, to
return even to the use of wine; but ever after to drink water before
any thing else.
That kind is different, where a humour is collected within the head.
In this it is necessary to clip to the skin; then to apply mustard, so
as to ulcerate it; if that does not prove effectual, the knife must
be made use of. The management must be so far the same with dropsical
cases, that the patient must be exercised, sweated, briskly rubbed, and
take such food and drink, as are powerful diureticks.
[Sidenote: _Of the cynicus spasmus._]
There is a distemper incident to the face, which the Greeks call
cynicus spasmus[CE]. It comes on an acute fever. The mouth is turned
aside with a kind of grin, and therefore it is nothing else than a
distortion of the mouth. There is also a frequent change of colour in
the face and the whole body, and a great propensity to sleep.
[CE] κυνικὸς σπασμὸς.
It is very proper to let blood in this disorder. If it is not removed
by this, to give a clyster. If it does not yield even to that, to
vomit by white hellebore. Besides it is necessary to avoid the heat of
the sun, fatigue, and wine. But if it is not cured by these methods,
running must be used, and gentle and long friction upon that part,
which is diseased; in the other parts shorter, but brisk. It does
service also to procure sneezings, to shave the head, and to pour upon
it hot, either sea water, or at least salt water, with sulphur added
to it: after this bathing, to rub again, to chew mustard, and at the
same time to apply cerate to the parts of the face that are affected,
and to the sound parts mustard, till it corrode them. The most proper
diet is of the middle kind.
[Sidenote: _Of a palsy of the tongue._]
But if the tongue be paralytick, which sometimes happens of itself,
sometimes is occasioned by distemper, so that the pronunciation is
indistinct; it is necessary to use a gargarism of a decoction of thyme,
or hyssop, or catmint; to drink water; to rub briskly the head, mouth,
and the parts under the chin, and the neck; to rub the tongue itself
with laser; to chew the most acrid things, such as mustard, garlick,
onion; to make strong efforts to articulate words clearly; to take
exercise, keeping in the breath; to pour cold water upon the head
often; sometimes to eat plentifully of radishes, and then to vomit.
[Sidenote: _Of a catarrh and gravedo._]
A humour distils from the head sometimes into the nose, which is a
slight disorder; sometimes upon the fauces, which is worse; sometimes
even upon the lungs, which is worst of all. If it have fallen upon
the nose, a thin rheum flows from the nostrils, the head is slightly
pained, a weight is felt in it, and there are frequent sneezings. If
upon the fauces, it irritates them, and raises a slight cough. If upon
the lungs, beside the sneezings and cough, there is also a weight in
the head, lassitude, thirst, heat, and bilious urine.
Another (though not very different) disorder is a gravedo. This
obstructs the nostrils, blunts the voice, raises a dry cough: at the
same time the saliva is salt, there is a sounding in the ears, the
veins of the head move, and the urine is turbid. All these disorders
Hippocrates calls coryzæ[CF]. I observe that this is now by the
Greeks appropriated to the gravedo: and catarrhs are called by them
catastagmi[CG]. These are common, and of short continuance; but if they
be neglected, are usually lasting. None of them is dangerous, but such
as ulcerate the lungs.
[CF] κορύζαι.
[CG] κατασταγμοὶ.
When we perceive any such symptoms, we ought immediately to avoid the
heat of the sun, the bath, and venery(6). And at the same time
nevertheless unction may be used, and the ordinary diet. The patient
should take a straight, but not too quick walk; and after it the head
and face must be rubbed above fifty times. And it seldom happens,
if we have restricted ourselves for two days or three at most, that
the disorder is not mitigated. When it is abated, if in the catarrh
the phlegm turns thicker, or in a gravedo, if the nostrils are more
open(7), the bath is to be used, and the face and head fomented
plentifully first with hot water, and then with egelid; after that,
the patient may eat heartily and drink wine. But if on the fourth day
the phlegm is equally thin, or the nostrils appear equally obstructed,
austere Arminæan wine(8) is to be taken; then again for two days
successively water; after which the person may return to the bath, and
his usual way of living.
Neither even on these days, in which some things are to be refrained,
is it proper to live like sick people; but in all other respects the
same liberties may be taken as in health, except by one, who uses to
be long and severely afflicted with these disorders; for such a person
requires a management somewhat nicer. Therefore if the defluxion be
upon his nose or fauces, besides what I mentioned before, he ought
immediately in the first days of his indisposition to walk much, to
rub the inferior parts briskly, the friction must be more gentle upon
the thorax, and gentler still upon the head, the ordinary diet must be
diminished to half the quantity, eggs must be used, starch, and such
like things, which generate a thicker phlegm; thirst, as much as he
can bear, must be one part of the cure. When by these means one has
been rendered fit for the bath, and has used it, a small fish, or flesh
is to be added to his diet; with this caution however, that he do not
immediately take his ordinary quantity of victuals. Pure wine must be
used pretty plentifully.
But if it distils also upon the lungs, there is a much greater
necessity for walking and friction, still observing the same rules in
diet. If these have not the desired effect, he must use the more acrid
kinds, indulge sleep more, and abstain from all business, sometimes try
the bath, but not soon.
In a gravedo it is necessary for the first day to rest, neither to eat
nor drink, to cover the head, and put wool round the throat; the day
following to rise, to abstain long from drinking, or if he is obliged
to do it, not to take above a hemina of water; on the third day to
take a little soft bread with a small fish or some light flesh, and to
drink water. If a person should not be able to forbear eating heartily,
he must vomit: when he comes into the bath, he is to foment his head
and face plentifully with warm water, till he sweat, then return to
the use of wine. After which it can scarcely happen, that the same
indisposition will continue. But if it remain, use must be made of
cold, dry, and light food, as little moisture as possible, friction
and exercise being still continued, which are necessary in every
indisposition of this nature.
CHAP. III.
OF THE DISEASES OF THE NECK, AND THEIR CURE.
From the head we proceed to the neck, which is liable to very severe
diseases. Nor is there a more troublesome or more acute distemper than
that, which by a kind of spasm of the nerves draws sometimes the head
to the shoulders, sometimes the chin to the breast, sometimes stretches
the neck _and holds it_ straight and immoveable. The first the Greeks
call opisthotonus[CH], the second emprosthotonus[CI], and the last
tetanus[CJ], although some with less accuracy make use of these names
indiscriminately. They often kill within four days: if the patients
have escaped that time, they are out of danger.
[CH] ὀπισθότονος.
[CI] ἐμπροσθότονος.
[CJ] τέτανος.
All these are cured by the same method; so far physicians agree. But
Asclepiades believed, that blood should be let: some again affirmed
that ought by all means to be avoided: for this reason, that the body
then stood most in need of heat; and that this resides in the blood of
the veins. This indeed is false. For it is not the nature of the blood
to be peculiarly hot; but amongst the several things, which compose the
human body, it most quickly grows either hot or cold. Whether or no it
be proper to make this discharge, may be understood from the general
directions, which were given about bleeding. But it is evidently
proper to give castor, and with it pepper or laser. Then a moist and
hot fomentation is needful. Therefore most physicians pour warm water
frequently upon the neck. That relieves for the present; but renders
the nerves more liable to cold, which is to be particularly avoided.
It is more proper then first to anoint the neck over with liquid
cerate(9): next to apply ox-bladders or bottles filled with hot oil,
or a hot cataplasm made of meal, or pepper bruised with a fig. But it
is most suitable to foment with moist salt; the manner of doing which I
have already shewn. When any of these has been done, it is fit to bring
the patient to the fire, or if it be the summer-time to the sun; and to
rub his neck, and shoulders, and spine with old oil, which is fittest
for that purpose; if that cannot be had, with Syrian(10); if that
cannot be got neither, with the oldest fat.
As friction is serviceable to all the vertebræ, so it is particularly
to those of the neck. Wherefore day and night, but at proper intervals,
this remedy must be used. When it is intermitted, some heating malagma
must be applied. And cold is of all things to be avoided. And upon
that account there ought to be a constant fire in the chamber, where
the patient is nursed, and especially in the morning before day-light,
when the cold is most intense. Neither will it be improper to keep
the head close clipped, and to moisten it with hot ointment of iris,
or the cyprine, and to keep it covered with a cap; sometimes to dip
the whole body in warm oil, or in a warm decoction of fenugreek, with
the addition of a third part of oil. A clyster also often relaxes the
superior parts.
But if notwithstanding the pain has grown more severe, cucurbitals are
to be applied to the neck, and an incision made in the skin. Eschars
are to be made either by irons, or mustard. When the pain has abated,
and the neck has begun to move, we may know, that the disease yields to
the remedies. But all food that requires chewing must be long avoided.
Gruels must be used, also sorbile eggs, or broth made of chickens, or
some other tender flesh. If this has succeeded, and the neck shall
appear to be entirely well, we must begin with pulse or intrita well
moistened. But the patient may sooner venture to chew bread than taste
wine; for the use of this is very dangerous, and therefore to be
deferred for a longer time.
CHAP. IV.
OF THE DISEASES IN THE FAUCES, AND THEIR CURE.
As the former kind of distemper afflicts the whole neck, so there is
another common one equally dangerous and acute, the seat of which is
in the fauces. Our authors call it angina: amongst the Greeks the name
varies according to the species. For sometimes there appears neither
any redness nor tumour; but the body is dry, the breath is fetched with
difficulty, the limbs are relaxed. This they call [CK]synanche(11).
Sometimes the tongue and fauces are red and swelled, the voice is
stopped, the eyes are turned, the face is pale, and there is a
hiccough. That is called quasi synanche[CL]. These symptoms are common
to both: the patient is not able to swallow either food or drink;
his breathing is obstructed. It is more slight, when there is only a
swelling and redness, and the rest of the symptoms do not follow. That
they call parasynanche[CM].
[CK] συνάγχη.
[CL] ὡς συνάγχη.
[CM] παρασυνάγχη.
Whatever species it be, if the patient’s strength will allow, blood
must be let, although there is not a plethora; the next thing is to
give a clyster. A cucurbital also is properly applied below the chin,
and about the fauces, in order to evacuate the suffocating matter.
Then there is a necessity for moist fomentations. For dry ones cut
the breath. Therefore it is fit to apply sponges, which are better
dipped now and then in warm oil, than in warm water. And it is of
great efficacy in this case too, to put on salt in warm bags. Then it
is convenient to make a decoction of hyssop, or cat mint, or thyme,
or wormwood, or even bran, or dry figs, in hydromel, and use it as a
gargarism; after that to touch the palate either with ox-gall, or the
medicine, which is composed of mulberries. Fine flour of pepper is also
proper to sprinkle upon it.
If from these things there is little benefit, the last remedy is to
make pretty deep incisions under the jaws above the neck, and in the
palate about the uvula, or to open the veins, that lie under the
tongue, that the distemper may be discharged through these wounds. If
this method don’t relieve the patient, we may be assured, that the
distemper has got the better of him. But if the disorder is mitigated
by them, and his throat is capable of admitting meat and drink, health
will be easily recovered again. And sometimes nature assists too, if
the disorder passes from a more contracted place to a larger. For this
reason, when a redness and swelling begins in the præcordia, it is a
sign that the malady has begun to leave the throat.
Whatever has relieved it, he must begin with a moist diet, and
especially hydromel; then take soft food, and not acrid, till the
fauces return to their former soundness. It is a vulgar opinion,
that if a person eats a young swallow, he will be in no danger of an
angina for the whole year: and that if it be preserved in salt, to
burn it, and powder the coal of it, and give it to drink in hydromel,
does service in this distemper. And as this is confidently reported
by men of good credit among the common people, and the practice can
be attended with no danger, although I have not read of it in medical
treatises, yet I thought fit to give it a place in this work.
[Sidenote: _Of a difficulty of breathing._]
There is also a disorder about the fauces, which amongst the Greeks has
different names, according to its different degrees. The whole consists
in a difficulty of breathing: but while it is moderate, and does not
wholly suffocate, it is called dyspnœa[CN]; when it is more severe,
that the patient cannot breath without a noise, and quick fetches,
asthma[CO]; when the difficulty is so great, that respiration cannot
be performed, unless the neck be kept erect, orthopnœa[CP]. The first
of these may be of long continuance without endangering life: the two
following are commonly acute. These symptoms are common to them all,
that by the straitness of the passage, through which the breath comes,
a wheezing is occasioned; there is a pain in the breast and præcordia,
sometimes also in the shoulders, and that goes and comes; besides these
there is a slight cough.
[CN] δύσπνοια.
[CO] ̃ἀσθμα.
[CP] ὀρθόπνοια.
Now the remedy, unless there be some contra-indication, is letting
of blood. Nor is that sufficient; but goat’s milk must be given warm
to the patient fasting, and if he has no fever, his belly must be
opened(12); and sometimes purged; and sometimes a clyster must be
given, by which means the body being extenuated, the patient begins to
breathe more freely. The head also ought to be placed high on the bed,
and the thorax assisted with fomentations, and hot cataplasms, either
dry or moist; and after that a malagma applied, or a cerate of the
cyprine ointment, or that of iris. Then the patient must drink fasting
either hydromel, or a decoction of hyssop, or bruised caper-roots
in water. It is proper also to give nitre, or cresses, or garlick,
toasted, and then ground and mixed with honey: _another medicine is
thus prepared_, honey, galbanum, resin, and turpentine are boiled up
together: and when they have come to a consistence, the bigness of
a bean is put every day in the mouth, and suffered to lie under the
tongue, till it be dissolved: or p. *. & a quadrans of crude sulphur,
and p. *. of southernwood are powdered, and mixed in a cyathus of wine,
and that is supped warm. And it is not an idle opinion, that a fox’s
liver dried ought to be beat, and the powder of it sprinkled upon the
drink; or that the lungs of the same animal should be eaten roasted as
soon as possible after he is killed, but nothing of iron _used in the
dressing_. Besides these, gruels and light food must be used, sometimes
also small austere wine, and sometimes a vomit taken. Whatever is
diuretic, is also good; but nothing more so, than walking slowly almost
to lassitude, much friction, especially of the lower parts, either in
the sun or at the fire, and both by the patient himself and by others,
till he sweat.
[Sidenote: _Of an ulcer in the fauces._]
In the internal part of the fauces there sometimes happens an
exulceration. In this case most people make use of hot cataplasms
externally, and moist fomentations. They advise also the warm vapour to
be received by the mouth: by which, others say these parts are rendered
softer, and more fit to afford entertainment to the disorder, that
already possesses them. But if the distemper can be prevented by these
methods, those remedies are safe: if there is reason to fear _it is
already begun_, they are improper. It is undoubtedly dangerous to rub
the fauces, for it ulcerates them. Neither are diuretics good: because
as they pass, they may possibly attenuate the phlegm of the part
affected, which it is better to repel.
Asclepiades, to whom we are indebted for many useful discoveries, in
which I have also followed him, recommends the sipping of very strong
vinegar, and asserts, that this without any danger suppresses the
ulcers. That may possibly prevent a flux of blood, but cannot heal
the ulcers. A more proper application is lycium(13), which the same
author also equally approves; or the juice of leek, or horehound,
or sweet almonds rubbed with tragacanth, and mixed with passum, or
lint-seed bruised, and mixed with sweet wine. The exercise also of
walking and running is necessary. And smart friction is to be used from
the breast downwards to all the inferior parts.
The food ought to be neither too acrid, nor rough: honey, lentils,
tragum, milk, ptisan, fat flesh, and especially leeks, and whatever is
mixed with the latter. The drink ought to be as little as possible,
water may be given, either pure, or boiled to a decoction with a quince
or dates. Also mild gargarisms: but if these are not successful,
repellent ones are good.
This disease is not acute, and yet may not continue long: but requires
a speedy cure, lest it turn very severe and tedious.
[Sidenote: _Of a cough._]
A cough, which is contracted in many different ways, is generally a
troublesome concomitant of an exulceration of the fauces; and in this
case, when the fauces are cured, the cough ceases. Yet it is sometimes
found by itself without any other distemper: and when it becomes
inveterate, it is hardly possible to remove it entirely. And sometimes
it is dry, sometimes it either generates or discharges phlegm.
In this it is proper to drink hyssop every other day; to keep in the
breath and run, but by no means in dusty places; and to read aloud,
which at first is obstructed by the cough, but afterwards overcomes it;
then to walk; then to use also those exercises that employ the hands,
and to rub the breast for a long time: after these to eat three ounces
of the mellowest figs stewed over the fire.
Besides if it be moist, strong frictions are good with some heating
medicines, the head being briskly rubbed at the same time; also
cucurbitals used to the breast, mustard applied to the external part of
the fauces, till it be a little ulcerated; the drink may be prepared
from mint, and sweet almonds, and starch; and beginning with dry bread
he may proceed to any other light food.
But if it be a dry cough, when it is most severe, taking a cyathus of
austere wine relieves; provided that be not oftener done than three or
four times after proper intervals. It is likewise necessary to swallow
a little of the best laser, to take the juice of leeks or horehound, to
lick squils, to sup vinegar of squills, or at least sharp vinegar, or
two cyathi of wine with a clove of bruised garlick infused in it.
In every cough it does service to take journies, long voyages, and to
live near the sea, and to swim. The diet must be sometimes soft, as
mallows and nettles; sometimes acrid, as milk boiled with garlick;
gruels, to which laser has been added, or such as have had leeks boiled
in them, till they have lost all their verdure. A sorbile egg also with
an addition of sulphur may be supped; for drink warm water may be taken
first, then alternately, some days water, and other days wine.
[Sidenote: _Of a spitting of blood._]
A spitting of blood may strike a greater terror. But that sometimes
is less, and sometimes more dangerous. For it issues sometimes from
the gums, sometimes from the mouth; and indeed from the latter very
plentifully at times, but without a cough, without an ulcer, or any
distemper of the gums, and without expectorating any thing; but breaks
out from the mouth in the same manner, as from the nose. And sometimes
pure blood is discharged, at other times something like water, in which
fresh meat has been washed. Sometimes it comes from the upper part
of the fauces, which may happen by means of an exulceration in that
part; or when it is not ulcerated, either from the mouth of some vein
opened, or tubercles rising there, and discharging the blood. When
this is the case, neither meat nor drink do harm, nor is any thing
expectorated, as from an ulcer. But sometimes, when the throat and
wind-pipe are ulcerated, a frequent cough forces out blood too. Neither
is it uncommon for it to come either from the lungs, or the breast,
or the side, or the liver. Women, whose menses are suppressed, often
have these spittings. And medical writers say, that blood is discharged
either by the erosion, or the rupture of some part, or the dilatation
of the mouth of some vein. The first they call diabrosis[CQ], the
second rhegmochasmus[CR], the third anastomosis[CS]. The last does
least hurt; the first is most dangerous. And it often happens, that the
blood is followed by pus.
[CQ] διάβρωσις.
[CR] ῥηγμοχασμὸς.
[CS] ἀναστόμωσις.
Now sometimes stopping the blood is alone sufficient to effect a cure.
But if ulcers have followed, if pus, if there be a cough, diseases
are formed, which differ in nature and danger according to the parts
they possess. If blood only is discharged, both the remedy is easier,
and the termination of the distemper quicker. And we ought not to be
ignorant, that a moderate discharge of blood, is not hurtful to those,
who are accustomed to hæmorrhages, or such, whose spine or hips are
pained, or to any after violent walking or running, provided there
be no fever: and that passing off in the urine, it removes even the
lassitude. And that it is not terrible in the case of a person, who has
fallen from a height, if nothing else appears uncommon in his urine.
That neither is a vomiting of blood dangerous, although it return,
if opportunity has been allowed to strengthen and fill up the body
beforehand: and in general that no such discharge can hurt, when it
happens in a strong body, and is neither excessive, nor raises a cough,
nor heat. These observations are universal. Now I shall return to those
particular places, which I have mentioned.
If it comes from the gums, it is sufficient to chew purslane; if from
the mouth, to hold pure wine in it; if that is not effectual, vinegar.
If notwithstanding these it breaks out with violence, because it may
waste a person, it is most proper to divert its force by applying a
cucurbital to the back of the head, and making an incision in the skin;
if this happens to a woman, whose menses are stopped, to apply the
cucurbital to her groin, with scarification.
But if it has proceeded from the fauces, or the more internal parts,
there is more to be feared, and greater care must be taken in the
cure. Blood must be let: and if notwithstanding that, it breaks
out from the mouth, the operation must be repeated a second, and a
third time, and every day a little taken away: the patient ought
immediately to sup either vinegar, or the juice of plantain, or leek
with frankincense(14): and some sordid wool dipped in vinegar
and squeezed, should be applied externally upon the place, which
is diseased, and it must be cooled now and then with a sponge.
Erasistratus made many ligatures in the legs, and thighs, and arms of
such patients. Asclepiades was so far from thinking this useful, that
he even judged it hurtful. But a number of experiments gives proof of
its often answering very well.
Nevertheless there is not a necessity for making ligatures in many
places: but it is sufficient to do it below the groin, and above the
ancles, and near the top of the shoulders, and fore arms. Then if
the patient have a fever, gruel must be given; and for drink some
astringent decoction. But if there is no fever, either washed alica,
or bread dipped in cold water, and a soft egg too may be given; and
for drink either what was above-mentioned, or sweet wine, or cold
water. But in the allowance of drink we must remember, that thirst is
serviceable in this disorder.
Besides these, rest, security from apprehensions, and silence are
necessary. The patient’s head, when he lies, should also be high, and
it is proper to clip it close. The face is to be often bathed with cold
water. But wine, the bath, venery, oil amongst meat, all acrid things,
warm fomentations, a hot and close room, many cloaths thrown upon the
body, are all prejudicial; also frictions, unless when bleedings have
entirely ceased. Then indeed he may begin with the arms and legs, but
not touch the chest. In this case he should reside near the sea-coast
in the winter time, and in the inland places in the summer.
CHAP. V.
OF THE DISORDERS OF THE STOMACH, AND THEIR CURE.
The stomach(15) is below the fauces; to this many tedious disorders
are incident. For sometimes a great heat affects it, sometimes a
flatulency, or an inflammation, or an exulceration; at other times
phlegm or bile attacks it. But the most frequent disease is a
relaxation: nor is there any thing from which the stomach either
suffers more itself, or more affects the whole frame.
As its disorders are different, so are the remedies. Where it is
distressed with heat, it must be embrocated now and then with vinegar
and rose oil, and a powder(16) with oil applied, and such cataplasms
as at the same time both repel and soften. Cold water may be given to
drink, unless there be some particular reason against it.
When there is a flatulency, the application of cucurbitals does
service, and there is no necessity for scarification. Dry and warm
fomentations, but not very strong, are serviceable. Abstinence must
be enjoined at times. To drink wormwood, or hyssop, or rue fasting
is good. Exercise must be used, at first gentle, and afterwards
stronger; especially such as may move the superior parts, which kind
is most proper in all disorders of the stomach. Exercise should be
followed by unction and friction; also the bath sometimes, but seldom,
and sometimes clysters; after these warm food, and not flatulent;
and in the same manner warm drink, first water, afterwards when the
inflation has subsided, austere wine. This rule must be laid down in
all distempers of the stomach, that by whatever means any patient has
been recovered, he must pursue the same method when he is well: for his
weakness returns, unless health be preserved by the same regimen, by
which it was restored.
But if there be any inflammation, which is commonly followed by a
swelling and pain, the chief remedies are, rest, and abstinence,
sulphurated wool(17) applied round it, the use of wormwood fasting.
If there is a burning heat in the stomach, it must be embrocated
now and then with vinegar and rose-oil; and then food must be taken
sparingly; and the external applications must be such, as both repel
and soften; then withdrawing these, warm cataplasms of meal must be
used, to discuss the remains of it; a clyster must be given now and
then; exercise must be used, and a fuller diet.
But if the stomach is infested with an ulcer, the same course almost
must be pursued, as has been prescribed in ulcerated fauces. Exercise
and friction of the lower parts must be practised. Light and glutinous
food must be used, but not to satiety. Every thing acrid and acid is to
be avoided. If there is no fever, sweet wine may be used, or if that
inflates, at least mild; but neither very cold, nor too hot.
If the stomach is loaded with phlegm, a vomit is necessary, sometimes
fasting, sometimes after meat. Exercise, gestation, sailing, friction,
are good. Nothing is to be eaten or drunk, but what is warm; only
avoiding such things, as usually generate phlegm.
It is a more troublesome disorder, where the stomach is vitiated with
bile. Those that are thus affected, usually at the interval of some
days throw it up, and indeed, which is worst of all, of a black colour.
It is proper to give such patients clysters, and potions of wormwood;
gestation, and sailing are necessary, and vomiting by sea sickness,
if it can be procured; crudity must be avoided; food used easy of
concoction, and not ungrateful to the stomach, and austere wine.
The most common and worst disorder of the stomach is a relaxation,
that is, when it is not capable of retaining food, and the body ceases
to be nourished, and thus is wasted by a consumption. The bath is
very hurtful in this species. Reading, and exercising of the superior
parts are necessary, also unctions and frictions; then to have cold
water poured all over the body, and to swim in cold water, and to
lay the stomach itself under canals, and more especially that part
below the shoulders, which is opposite to the stomach; to stand in
cold and medicinal springs is a salutary practice, such as those of
Cutiliæ(18) and Subruinæ; food is also to be used cold, and such
rather, as is of difficult concoction than what is easily corrupted:
for this reason most people, that can concoct nothing else, concoct
beef. Whence we may infer, that neither birds, nor venison, nor fish
ought to be given, except the harder kinds. Cold wine indeed is fittest
to drink, or at least the strong well warmed, particularly the Rhetic
or Allobrogic(19), or any other, which is both austere, and seasoned
with resin; if that is not to be had, the roughest possible, and
especially Signine(20).
If the food does not stay upon the stomach, water is to be drunk, and
a plentiful vomiting procured; and food must be given a second time,
and then cucurbitals are to be applied two fingers breadth below the
stomach, and kept there for two or three hours. If there is both a
vomiting and pain at the same time, sordid wool, or sponge dipped in
vinegar, or a cooling cataplasm, must be applied to the stomach. The
arms and legs must be rubbed briskly, but not long, and heated.
If the pain is more severe, the cupping must be performed four fingers
below the præcordia; bread dipped in cold vinegar and water must be
given immediately; if it has not staid, then after the vomiting,
some light thing not ungrateful to the stomach; if even that is not
retained, a cyathus of wine every hour, till the stomach be settled.
The juice of radishes is also a powerful medicine; but a stronger is
the juice of the acid pomegranate, with an equal quantity of the juice
of the sweet pomegranate, and an addition also of the juice of endive
and mint, but the least proportion of this; with which it is very
proper to mix as much cold water, as equals the quantity of them all
together. For that is more efficacious for composing the stomach than
wine. A vomiting, which comes of itself, is to be stopped, although
there be a nausea.
But if the food has grown sour or putrid within the stomach, both which
accidents are known by the eructations, it must be evacuated; and the
stomach must be immediately recruited by taking the same kind of food,
that I have just mentioned. When the present danger is removed, we must
return to those things which have been prescribed before.
CHAP. VI.
OF PAINS OF THE SIDES, AND THEIR CURE.
The stomach is surrounded by the sides; and in these there happen
sometimes violent pains. They arise either from cold, or a blow,
or from excessive running, or from a distemper. But sometimes the
disorder goes no farther than a pain; which is sometimes slowly, and
sometimes quickly removed. At other times it grows extremely dangerous;
and there arises an acute distemper, which by the Greeks is called
pleuriticus[CT]. To this pain of the side is added a fever and cough:
and by the last is expectorated, if the distemper be tolerable phlegm;
if severe, blood. Sometimes also the cough is dry, and brings up
nothing, and this is worse than the first, but more tolerable than the
second.
[CT] πλευριτικὸς. Our author uses here the masculine adjective to
the Latin word _morbus_.
Now the cure of a violent and recent pain is letting of blood. But
if the case is more slight or of a longer standing, that remedy in
the first is needless, and for the other is too late; and recourse
must be had to cupping, first making an incision in the skin. Mustard
with vinegar is also proper to apply upon the breast, till it produce
ulcuscles and pimples; and after that, a medicine which can derive the
humour thither. Besides these it is fit first to put sulphurated wool
round the side; and then when the inflammation has a little abated, to
make use of dry and warm fomentations. From these a transition is made
to malagmas.
If an inveterate pain still continues, in the last place it is
discussed by the application of resin. Warm food and drink must be
used, and cold avoided. In the mean time, it is not amiss to rub the
extremities with oil and sulphur: if the cough has abated to read
softly: and by that time to take both acrid food and stronger wine.
Such then are the prescriptions of the physicians. But without these
it is said, that our peasants find it sufficient for their cure to
drink germander in water.
These rules are common in every pain of the side: the cure is more
difficult, if the distemper has grown acute. In such a case, besides
what has been already directed, these cautions are to be observed: that
the food be extremely thin and mild, especially gruel, and particularly
that, which is made of ptisan; or chicken broth with leeks, and that is
not to be given till the third day, and with this condition then, that
the strength will admit of it: and for the drink a decoction of hyssop,
or rue in hydromel. Now the seasons for giving these will appear from
the consideration of the fevers increasing or abating, so that they be
given in the greatest remission. At the same time however we should
know, that in a cough of this kind we are not to allow the fauces to be
dry. For often, where there is nothing to be expectorated, it continues
and suffocates: for which reason I said, that a cough, which evacuates
nothing, was still worse than one, which brought up phlegm. But the
distemper itself in this case will not allow wine, which we prescribed
before: instead of it the cream of ptisan is to be used.
As the patient is to be supported in the violence of the distemper by
these things; so when it has abated a little, a fuller diet and also
some wine may be allowed; provided nothing be given, which may either
refrigerate the body, or irritate the fauces. If the cough remains
upon the recovery, it will be proper to intermit for one day, and the
day after to take a little more wine with meat. But if the cough still
prevails, it will not be amiss, as above directed, to drink some cyathi
of wine. But in this kind of disorder sweet wine, or at least mild is
more proper. If it grows inveterate, the body must be strengthened by a
robust diet.
CHAP. VII.
OF A PERIPNEUMONY, AND ITS CURE.
From the frame of the body we must proceed to the bowels; and first
of all to the lungs. Whence a violent and acute distemper arises,
which the Greeks call peripneumonia[CU]. The nature of it is this. The
whole lungs are affected. And their disorder is followed by a cough
bringing up bile, or pus, a weight of the præcordia and the whole
breast, difficulty of breathing, violent fevers, continual watching,
prostration of appetite, and a consumption. This kind of distemper is
attended with more danger than pain.
[CU] περιπνευμονία.
It is fit, if the strength will admit of it, to let blood: if not,
to make use of dry cupping to the præcordia; and if the patient can
endure it, by gestation to dissipate; if he cannot bear that, to move
him gently within the house; to give him in drink hyssop boiled with a
dry fig; or a decoction of hyssop or rue in hydromel; to use friction
longest upon the shoulders, a little shorter on the arms, and feet, and
legs, gentle over the lungs, and to do this twice every day.
As to diet, he ought never to have salt things, nor acrid, nor bitters,
nor astringents; but what is of the milder kind. Therefore at the
beginning is to be given gruel either of ptisan, or alica, or rice,
in which recent fat has been boiled; along with it a sorbile egg,
pine-nuts, bread with honey, or washed alica with hydromel. After that,
not only pure water must be allowed to drink, but hydromel too egelid;
or if it be the summer time, even cold; unless there be some particular
reason against it. It is sufficient to give these every other day, when
the distemper is increasing.
When it ceases to increase, as much as the circumstances will allow,
he must abstain from every thing, except egelid water. If the strength
fails, it must be supported by hydromel. And against the pains the
application of hot fomentations is good, or such things as both repel
and soften. It does good also to lay salt ground fine upon the breast,
mixed with cerat; because it corrodes the skin gently, and thus diverts
the course of the matter, which oppresses the lungs. Some malagmas too
of such things as make a derivation are useful. And it is not improper,
during the violence of the distemper, to keep the windows close upon
the patient: when it has a little abated, three or four times a day
to open them a little and let in fresh air. Then when he begins to
recover, for several days to abstain from wine: to use gestation and
friction; to add to the gruels and former diet, amongst the pot-herbs
leeks; of flesh, the heels, and trotters; and small fish; so that for a
long time nothing else be taken, but what is soft and mild.
CHAP. VIII.
OF THE DISEASE OF THE LIVER, AND ITS CURE.
The distemper of another bowel, that is the liver, in like manner
happens to be sometimes long and sometimes acute. The Greeks call
it hepaticus[CV]. There is a violent pain to the right below the
præcordia; and the same reaches to the right side, and to the clavicle,
and the shoulder of the same side: sometimes also the right hand is
benumbed, and there is a strong shuddering. When it is severe, bile
is vomited; sometimes the hiccough almost suffocates. And these are
its symptoms, when it is acute. But it is chronical, when there is a
suppuration in the liver; and the pain sometimes ceases, at other times
increases; on the right side the præcordia are hard and swelled; after
eating, the difficulty of breathing is increased. There is also a sort
of paralytic relaxation of the jaws. When the disorder has continued
long, the belly, and legs, and feet swell; the breast, and arms, and
the parts about both clavicles are emaciated.
[CV] ἡπατικὸς the adjective is used here in the same manner, as
pleuriticus before.
In the beginning, the best thing is to let blood: then the belly
must be opened; if that cannot be done otherwise, by means of black
hellebore. Cataplasms are to be applied externally; first such as may
repel, then hot ones, which can discuss; to these it is proper to add
iris, or wormwood; after them a malagma. The diet should be gruels, and
all the food should be warm, not very nourishing, and generally such
as is proper in a peripneumony; and those besides that are diuretic,
and such drink as will promote the same end. Thyme is good in this
distemper, savory, hyssop, catmint, sweet marjoram, sesamum(21),
bay-berries, pine-flowers, blood herb, mint, the pulp of a quince, the
fresh and raw liver of a pigeon. Of these some may be eaten alone, and
others added to the gruel, or the drinks, but in small quantities;
and it is not improper to swallow every day a catapotium composed of
powdered wormwood, honey, and pepper. But all cold things must be
refrained, for nothing hurts the liver more. The extremities must be
rubbed. All labour and violent motion avoided: even the breath must not
be long kept in. Anger, flutter, lifting any thing weighty, throwing,
running are hurtful. Pouring water plentifully upon the body does good,
if it be the winter time, hot; if the summer, tepid; also plentiful
unction, and sweating in the bath.
If the liver is oppressed with a vomica, the same method must be
followed as in other internal suppurations. Some even make an incision
over it(22), and cauterize the vomica itself.
CHAP. IX.
OF THE DISORDER OF THE SPLEEN, AND ITS CURE.
But when the spleen is affected, it swells, and together with it the
left side, which is both hard and resists pressure; and the belly is
tense: there is some swelling also in the legs. Ulcers either do not
heal at all, or at least scarcely cicatrize. In walking briskly or
running, there is a pain, and some difficulty.
This malady is increased by rest. Therefore there is a necessity for
exercise and labour: care being taken however that these be not carried
too far, lest they produce a fever. Unction and friction, and sweatings
are necessary. Every thing sweet is hurtful; also milk, and cheese.
Acids are most agreeable; therefore it is good to sup sharp vinegar
alone, and more especially that, which is tinctured with squills. Salt
fish is to be eaten, or olives in hard brine; lettuce in vinegar;
endive also, and betes in the same manner; and mustard, wild radish,
and parsnips: of animal food the heels, and cheeks, lean birds, and
venison of the same kind. A decoction of wormwood in water may be
given for drink fasting: but after meat the water, in which a smith has
often extinguished hot iron, for this very powerfully contracts the
spleen: the discovery of which property we owe to an observation made
upon animals bred in the houses of smiths, that they have very small
spleens. Small and austere wine may also be given; and every thing in
food or drink, which is diuretic: of great efficacy for that purpose is
trefoil seed, or cummin, or smallage, or serpyllum, or cytisus(23),
or thyme, or hyssop, or savory: for these seem very proper to promote a
discharge of the humour from it. It is good also to eat of the spleen
of beef: and rocket and cresses are remarkable for attenuating the
spleen. There must be some external application to ease the pain. Such
is composed from a kind of acorns(24) used by the Unguentarii, which
the Greeks call myrobalani[CW]: or the seeds of lint, and cresses mixed
with wine and oil: also of green cypress and dry figs: or of mustard
and a fourth part of the suet of a goat’s kidneys, and this is rubbed
in the sun and applied immediately. And the caper too is fit for this
disorder in many forms; for it may both be eaten itself with meat, and
its pickle with vinegar supped. Moreover the root powdered or its bark
with bran, or the caper itself powdered, and mixed with honey, may be
applied externally. There are also malagmas calculated for this purpose.
[CW] μυροβάλανοι.
CHAP. X.
OF THE DISEASES OF THE KIDNEYS, AND THEIR CURE.
But where the kidneys are affected, the disorder continues long. It
is worse if attended with a frequent bilious vomiting. It is proper
to rest; to lie soft; to open the belly; and even to give a clyster
if it will not do without it; to sit down often in warm water; to
take neither meat nor drink cold; to abstain from every thing salt,
acrimonious, acid, and fruit of the apple kind; to drink freely; to
add sometimes to the meat, and sometimes to the drink, pepper, leeks,
ferula(25), white poppies, which usually cause a great discharge of
urine from the kidneys.
If they be ulcerated, and the ulcers are to be cleansed, the remedy is
sixty seeds of cucumber blanched, fifteen kernels of the wild pine, as
much anise as can be held betwixt three fingers, a little saffron; all
these powdered, and divided into two draughts of mulse.
If the pain only is to be relieved, _the medicine is_ thirty seeds
of cucumber, and twenty of the kernels mentioned before, five sweet
almonds, a little saffron powdered, and given to drink with milk. And
besides these it is proper to apply some malagmas; especially such as
are fit for drawing out moisture.
CHAP. XI.
OF THE CHOLERA, AND ITS CURE.
From the bowels we proceed to the intestines, which are obnoxious both
to acute and chronic distempers. And first of all we shall make mention
of the cholera; because that seems at once to affect equally the
stomach and intestines. For at the same time there is both a purging
and vomiting: besides these, there are flatulencies, the intestines are
racked, bile is forced both upwards and downwards, first resembling
water, then as if fresh meat had been washed in it, sometimes white,
sometimes black, or variously coloured. Upon this account the Greeks
gave this distemper the name of cholera[CX]. And besides what we have
taken notice of already, the legs and hands too are often contracted,
thirst torments, and there are faintings. Where all these concur, it is
not to be wondered, if the patient die suddenly. And nevertheless there
is no distemper obviated with less trouble.
[CX] χολέρα.
Wherefore upon the first appearance of these symptoms it is proper to
drink plenty of tepid water and to vomit. That scarce ever fails to
vomit: but although it miscarries in that, yet it is of use to mix
new matter with the corrupted; and it is a step in the recovery, if
the vomiting be stopped. If that happens, all drink must immediately
be abstained from. But if there be bloody stools, it is fit to bathe
the stomach with something cold, or if the belly be pained, with the
same egelid, the belly itself being assisted by medicines moderately
warm. But if the vomiting, and purging, and thirst, all at once torment
greatly, and what is vomited is yet somewhat crude, it is not a proper
time to give wine: water must be given, and that not cold, but rather
egelid. And penny-royal with vinegar must be applied to the nostrils,
or polenta sprinkled with wine, or mint, or what is _comfortable or
refreshing_ to nature(26).
But when the crudity is removed, then there is more apprehension of the
person fainting. Wherefore at such time recourse must be had to wine:
which ought to be small, aromatic, and mixed with cold water, either
with the addition of polenta, or a piece of bread, which also it is
proper to eat: and as often as the stomach or belly has discharged, so
often to recruit the strength by these means. Erasistratus directed
to mix at first three or five drops of wine with every draught, and
then to add more wine by degrees. He was in the right, if he gave wine
from the beginning, and then found reason to fear a crudity: but if he
imagined a great weakness could be relieved by three drops of wine, he
was mistaken.
But if the patient be empty, and his legs contracted, wormwood must be
given to drink now and then. If the extremities be cold, they must be
anointed with hot oil, with the addition of a little wax; and cherished
with hot fomentations. If even by these relief has not been procured,
a cucurbital must be applied externally over the stomach itself, or
mustard put upon it. When that is composed, it is proper for him to
sleep; and on the day following to abstain from drinking; on the third
day to go into the bath; to recruit himself gradually by food; and
sleep, if he can rest easily; and to avoid fatigue and colds. If after
the suppression of the cholera a feverishness remains, it is necessary
to give a clyster, then to take food and wine. Now this distemper is
both acute, and so much seated betwixt the intestines and the stomach,
that it is hard to say, to which it peculiarly belongs.
CHAP. XII.
OF THE COELIAC DISTEMPER OF THE STOMACH, AND ITS CURE.
At the lower orifice of the stomach is seated a distemper, which is
usually long, called cœliacus[CY] by the Greeks. In this the abdomen
grows hard, and is pained; there is no passage by stool, and not so
much as wind can escape; the extremities grow cold; and there is a
difficulty in breathing.
[CY] κοιλιακὸς.
It is most proper in the beginning to apply warm cataplasms over all
the belly to ease the pain; after meat to vomit, and thus to empty the
belly; then on the following days to apply cucurbitals (without making
any incision) to the belly and hips: to loosen the belly itself by
giving milk and salt wine cold; green figs also, if it be the season
for them; with this caution however, that neither the allowance of food
nor drink be given all at once, but gradually. Wherefore at intervals
it is sufficient to take two or three cyathi, and food in proportion to
this. And a cyathus of milk mixed with an equal quantity of water, and
so given, does very well. Warm and acrid food is proper; so that even
bruised garlic with milk is no bad mixture.
In a little time the case requires gestation, and especially sailing;
to be rubbed three or four times a day with oil and nitre together; to
have warm water poured on after meat; then to apply mustard to all the
parts of the body, except the head, till they be corroded and grow red;
and more especially if the body be firm and strong. Then there must be
a gradual change to such things as bind the belly. Strong roasted flesh
is to be given, and such as is not easily corrupted: boiled rain water
may be given to drink, to the quantity of two or three cyathi at a time.
If the disorder be of long standing, it is proper to swallow the bulk
of a pepper-corn of the best laser; and every other day to drink wine
or water, at times to sup single cyathi of wine, taking food between;
to give a clyster of rain-water egelid; and more especially if the pain
continues in the lower parts.
CHAP. XIII.
OF THE DISTEMPER OF THE SMALL GUT, AND ITS CURE.
To the intestines themselves two distempers are peculiar; one of
which is in the small, and the other in the large gut. The first is
acute: the other may continue long. Diodes the Carystian called the
distemper of the small intestine chordapsus[CZ], that of the larger he
named ileus[DA]. But I observe, that most people now call the first
ileus, and the other colicus[DB]. Now the first occasions a pain,
sometimes above, sometimes below the navel. In either place there is
an inflammation: neither the excrements nor wind can pass downwards.
If the upper part is affected, the food, if the lower, the excrements
are returned by the mouth: in either case there is danger; which is
increased, if the vomiting be bilious, fetid, or various, or black.
[CZ] χόρδαψος.
[DA] εἰλεὸς.
[DB] κολικὸς.
The cure is letting of blood; or applying cucurbitals in several
places, but not to make incisions of the skin every where; for that
is sufficient in two or three places: from the rest it suffices to
evacuate air. Then it is proper to observe, where the seat of the
disorder is; for there is commonly a swelling over it. And if it be
above the navel, a clyster signifies nothing: if it is below, it
is most proper, in the opinion of Erasistratus, to give clysters
sometimes; and this remedy is often of very great service in these
parts. The liquor proper for this is strained cream of ptisan, with
the addition of oil and honey without any thing else. If there is
no swelling, it is most proper to apply the two hands to the top of
the belly, and to bring them down gradually; for thus the seat of
the disorder will be discovered, as it will necessarily resist the
pressure: and from thence it may be determined, whether it is fit to
use clysters or not.
The following remedies are general: to apply hot cataplasms from the
breasts as far as the groin and spine, and to change them often; to
rub the legs and arms; to dip the patient all over in warm oil. If the
pain does not abate, to give even a clyster of three or four cyathi
of warm oil. When by these means we have procured a passage for the
wind downward, to give tepid mulse to drink, but in small quantity,
for before great care must be taken that he drink nothing: if that has
succeeded well, to add gruel.
When the pain and feverishness have ceased, then we may venture upon
a fuller diet; but neither flatulent nor strong, lest the intestines
yet weak be hurt. Nothing should be drunk but pure water; for every
thing either vinous or acid is prejudicial in this distemper. And even
afterwards it is proper to avoid the bath, walking, gestation, and
other motions of the body: for the disease is apt to return upon slight
occasions; and cold, or any violent motion, before the intestines have
fully recovered their strength, brings it back again.
CHAP. XIV.
OF THE DISEASE OF THE LARGE INTESTINE, AND ITS CURE.
That distemper, which is seated in the large intestine, principally
affects that part, where I mentioned the cæcum to be situated. There
is a violent inflation; vehement pains, especially on the right side:
the intestine seems to be inverted, which almost forces out the wind.
In most people it comes after colds and crudity, then ceases; and while
they live, it often returns, and torments, but does not shorten life.
When this pain has begun, it is proper to apply dry and warm
fomentations, but first of all mild, and then stronger; and at the same
time by friction to make a derivation of the matter to the extremities,
that is, the legs and arms: if it is not removed, to make use of dry
cupping, where the pain is. There is also a medicine calculated for
this distemper, which is called colicon[DC]. Cassius claimed the glory
of this invention. It has the best effect given by way of potion; but
even externally applied by dispersing the wind it eases the pain.
Neither food nor drink should be given, till the pain be over.
The regimen for such patients I have already mentioned(27). The
composition, which is called colicon, consists of the following
ingredients: of costus, anise, castor, each p. * iii. parsley, p. *
iv. long pepper and round, each p. * v. tears of poppy, round cyperus,
myrrh, nard, of each p. * vi. these are incorporated in honey. Now this
may be both swallowed alone, and taken with warm water.
CHAP. XV.
OF A DYSENTERY, AND ITS CURE.
The next disorder of the intestines to this is by us called tormina,
and by the Greeks dysenteria[DD]. The intestines are ulcerated within;
blood flows from them; and together with that either excrements, which
are always liquid, or something mucous are discharged; sometimes along
with it, something fleshy is excerned. There is a frequent desire of
going to stool, and a pain in the anus: with this pain a very small
quantity is excreted; and even by that the pain is increased; and after
some time it abates, and there is a small interval of ease; sleep is
interrupted; a slight fever comes on; and when this distemper grows
inveterate, it either kills a man in time, or though it terminates at
last, torments him long.
[DC] κολικὸν.
[DD] δυσεντερία.
The first rule to be observed, is to rest; for all kinds of agitation
ulcerate: then to sup a cyathus of wine fasting, with the bruised root
of cinquefoil; to apply restringent cataplasms over the belly, which
is not expedient in the abovementioned disorders of this part; and as
often as he has gone to stool, to wash his lower parts with a warm
decoction of vervains; to eat purslane, either boiled or preserved in
strong brine; to take such food and drink as bind the belly.
If the distemper is of longer standing, it is fit to administer a tepid
injection of the cream of ptisan or milk, or melted fat, or deer’s
marrow, or oil, or butter with rose oil, or the raw whites of eggs with
the same, or a decoction of lintseed; or if there is no sleep, the
yolks with a decoction of rose leaves: for these ease the pain, and
render the ulcers milder, and are especially useful, if the disorder be
also attended with a nausea. Themison asserts, that the roughest brine
should be used in the same manner.
The food ought to be such, as is gently astringent to the belly. But
diureticks, if they have their natural effect, are useful by making a
derivation of the humour: if they do not gain that point, they increase
the malady; therefore they must not be administered, but to such, as
they usually affect in that way easily. If there be a fever, pure warm
water must be given to drink, or such as has an astringent quality:
if that is not to be got, light, austere wine. If for several days
these remedies have done no good, and the distemper is now inveterate,
drinking of water pretty cold binds the ulcers, and begins a recovery.
But when the belly is once bound, they must immediately return to warm
drink.
Sometimes also there happens to be a discharge of putrid sanies, which
has an intolerable stench: and sometimes pure blood comes away. In
the first of these cases, the belly should be washed with hydromel;
after that the injections above prescribed must be used. And a piece
of minium(28) powdered with a hemina of salt, is powerful against a
gangrene of the intestines: or they may be mixed with water, and given
for a clyster. But if pure blood is evacuated, the food and drink ought
to be astringent.
CHAP. XVI.
OF A LIENTERY, AND ITS CURE.
From a dysentery sometimes proceeds a lientery, in which the intestines
can retain nothing, and whatever is taken they presently pass
unconcocted. This sometimes is tedious, and sometimes carries off
people quickly.
Now in this disorder it is proper to administer astringents, to enable
the intestines to retain. Wherefore mustard should be applied over the
breast; and when the skin is ulcerated, a malagma to discharge the
humour: and let the patient sit down in a decoction of the vervains;
and take such food and drink as bind the belly, and have cold water
poured over him.
Care should be taken, however, that upon the application of all these
remedies at once, there do not arise a malady on the contrary extreme
by means of immoderate flatulencies. Wherefore the intestines will
require to be strengthened gradually by the daily addition of somewhat.
And as in every flux of the belly, so in this, it is particularly
necessary to go to stool not as often as there is a motion, but as
often as there is an absolute necessity, that this very delay may bring
the intestines to a habit of bearing their burden.
There is another direction, which belongs equally to all similar
disorders, to be principally regarded in this; that since most of the
things proper for the disorder are disagreeable to the palate, such as
plantain, and bramble berries, and whatever is mixed with pomegranate
bark, such of these are to be chosen as the patient prefers. Then if
he has an aversion to them all, let something less beneficial, but
more grateful, be given at times to excite his appetite. Exercise
and friction are necessary also in this distemper: and with these,
according to Hippocrates, the heat of the sun, the fire, the bath, and
vomiting, even by white hellebore, if the other means for that purpose
prove unsuccessful.
CHAP. XVII.
OF WORMS IN THE BELLY, AND THEIR CURE.
Worms too sometimes infest the belly; and they are sometimes discharged
downwards, at other times, which is more disagreeable, from the mouth:
and sometimes we observe them to be broad, which are the worst kind,
and sometimes round.
If they are broad, a decoction of lupines, or mulberry bark in water
may be given to drink: or either hyssop, or an acetabulum of pepper
powdered, and a scammony with water. Or let the patient on one day,
after eating plentifully of garlick, vomit; and the day following take
a handful of the small stalks of the pomegranate, and boil these,
after bruising them, in three sextarii of water, till a third part
remains; let him add to this a little nitre, and drink it fasting: then
after the interval of three hours let him take two draughts of this
decoction, or the same with the addition of hard brine; then go to
stool, having hot water in a vessel below him.
If again they are round, which chiefly molest children, both the same
medicines may be given, and something more gentle, as the seed of
nettles powdered, or of cabbage, or cummin with water, or mint with the
same, or a decoction of wormwood, or hyssop in hydromel, or the seed
of cresses powdered with vinegar. It is good also to eat lupines, and
garlick, or to have clysters of oil administered.
CHAP. XVIII.
OF A TENESMUS, AND ITS CURE.
There is also another distemper, which is more mild than any I have
been treating of, called by the Greeks tenesmus[DE]. This ought to
be ranked neither with the acute nor the chronic disorders, since it
may be easily removed, and by itself never proves mortal. In this, as
well as in a dysentery, there is a frequent motion to stool; and equal
pain, when any thing is excreted. Something like to phlegm and mucus
is discharged, sometimes too, slightly tinctured with blood; but with
these is sometimes mixed what has been duly concocted from the food.
[DE] τεινεσμὸς.
It is proper to sit down in warm water; to apply something to the anus
itself pretty often. For which purpose many medicines are suitable:
butter with oil of roses; acacia dissolved in vinegar; that plaister,
which the Greeks call tetrapharmacum(29), melted with rose oil;
alum wrapped in wool, and thus applied; and the same injections which
relieve in the dysentery; the same decoction of vervains to foment the
lower parts. Every other day, water and light austere wine are to be
drunk alternately. The drink ought to be egelid, and nearer to cold:
the diet of the same nature as we have directed for a dysentery.
CHAP. XIX.
OF A SIMPLE PURGING, AND ITS CURE.
A purging, while recent, is still a more gentle distemper, in which the
discharge is both liquid, and more frequent than ordinary. In this the
pain is sometimes tolerable, at other times very severe; and that shews
a greater violence of the disease. But for the belly to be loose for
one day is often salutary; and even for several days, provided there be
no fever, and it cease in seven days. For thus the body is cleansed;
and what would have hurt internally, is advantageously evacuated.
But the continuance of it is dangerous; for sometimes it brings on a
dysentery, and febriculas, and wastes the strength.
It is sufficient to rest the first day; and not to stop the flux of
the belly. If it has ceased spontaneously, to make use of the bath, to
take a little food: if it continues, to abstain, not only from food,
but from drink also. On the day following, if the belly still be loose,
to continue at rest; and take a very little astringent food. On the
third day to go into the bath; to rub every part of the body briskly,
except the belly; to expose the loins and shoulders to the heat of the
fire; to take food, but such as is astringent to the belly; a little
wine undiluted. If on the day following the purging shall continue, to
eat more, but likewise to vomit. Upon the whole, to struggle against it
by thirst, fasting, and vomiting, till it ceases: for it is scarcely
possible, that after this care the belly should not be bound.
There is another method, when one has a mind to stop the flux, to
take supper, and then to vomit; on the day after, to rest in bed; to
be anointed in the evening, but gently; then to eat half a pound of
bread in neat Aminaean wine; next, something roasted, and especially
a bird; and afterwards to drink the same wine mixed with rain water;
and to continue in this course till the fifth day, and vomit again.
Asclepiades, contrary to former authors, affirmed, that the drink ought
always to be cold, and indeed as cold as possible. My opinion is, that
every one may determine by his own experience, whether he should use it
hot or cold.
But it sometimes happens, that this disorder, neglected for several
days, may be more difficult to cure; it is proper to begin with a
vomit; then on the evening of the following day, to be anointed in a
tepid place; to eat moderately, and drink wine undiluted and as rough
as can be got; to keep rue with cerate applied over the belly. And in
this state of the body, neither walking nor friction are proper: riding
in a chariot is good, on horseback much better; for nothing strengthens
the intestines more.
If medicines are to be made use of, those composed of the apple kind
are most suitable. At the time of vintage, pears and crab apples
are to be thrown into a large vessel; if these cannot be had, green
tarentine pears, or signine, the apples called scandiana or amerina, or
pears called myrrhapia(30); and to these quinces must be added, and
pomegranates with their bark, service fruit, and, which are more used,
the torminalia, and let these take up the third part of the jar; after
that it must be filled with must, and boiled till the whole contents
being dissolved unite into one mass. This is not unpleasant to the
taste; and whenever the case requires it, taken moderately, without
any prejudice to the stomach it binds the belly: it is sufficient to
take two or three spoonfuls in one day. Another stronger medicine is,
to gather myrtle berries, and press the wine from them, to boil it to
the tenth part, and sup a cyathus of that. The third, which may be got
at any time, is to scoop a pomegranate, and taking out all the seeds,
to put in again the membranes, that were betwixt them; then to drop in
raw eggs, and mix them up with a small wooden stirrer; then to put the
shell over the fire, which does not burn, while there is any moisture
within; when it begins to grow dry, it is proper to remove it, and
taking out the contents with a spoon, to eat them. This acquires great
efficacy by the addition of some other things: therefore it is even
put into pepper wine, and mixed with salt, and pepper, and eaten with
these: and pulse may be taken also boiled with some old honeycomb. And
lentils boiled with pomegranate bark, and bramble tops boiled in water,
and eaten with oil and vinegar, are efficacious: as also to drink the
decoction either of dates, or quinces, or dry service fruit, or bramble
berries; and I mean this kind of liquor, whenever I direct such drink
to be given as is astringent. A hemina of wheat also is boiled in
austere Aminaean wine; and the wheat is given to a person fasting and
thirsty, and after that the wine is supped: this may justly be ranked
amongst the most powerful medicines. And the signine wine is given also
to drink, or resinated austere, or any other austere kind. And the
pomegranate is bruised with its shells and seeds, and is mixed with
such wine; and a person either sups this alone, or drinks it mixed. But
the use of medicines is needless, unless where the disorder is violent.
CHAP. XX.
OF THE DISEASES OF THE WOMB, AND THEIR CURE.
From the womb in women proceeds a violent distemper; and next to the
stomach, this part both suffers most sensibly itself, and most affects
the rest of the body. Sometimes it destroys the senses, so as to
occasion their falling as in an epilepsy: but with this difference,
that the eyes are not turned, nor is there any discharge of froth,
nor convulsions: there is only a profound sleep. In some women this
distemper returns frequently, and attends them during the whole course
of their lives.
When it attacks, if there be sufficient strength, bleeding relieves:
if there is not, yet cucurbitals must be applied to both sides of the
groin. If the patient lies long in this state, or used to do so, it is
proper to hold to the nostrils the extinguished wick of a lamp, or some
other of these things I have mentioned of a remarkably bad smell, in
order to rouse the woman. The same purpose is obtained by the pouring
on of cold water. And rue bruised small with honey is good, or cerate
of cyprine oil, or any other hot and moist cataplasm, applied from the
pudenda up to the pubes. In the mean time, the hips and hams ought also
to be rubbed.
After this, when she returns to herself, she must be forbid wine for a
whole year, even although the disorder do not return. Friction must be
practised every day over the whole body, but chiefly on the belly and
hams. Food of the middle kind must be given: mustard be applied to the
lower belly every third or fourth day, till the skin grow red.
If the hardness continue(31), nightshade dipt in milk, and then
rubbed small, seems to be a proper emollient, and white wax and deers
marrow with iris ointment, or beef suet, or goat’s, mixed with rose
oil. In drink must be given either castor, or git, or dill. If she is
not in good habit, she may be purged with the cyperus. If the womb
is ulcerated, a cerate may be made of rose oil, also fresh hogs lard
mixed with whites of eggs may be applied: or the white of an egg mixed
with rose oil, with the addition of some powder of roses to help the
consistence. But when the womb is pained, it ought to be fumigated with
sulphur.
But if an excessive discharge hurts a woman, the remedy is to make an
incision in the skin, and apply cucurbitals either to the groin or
below the breasts. If the discharge is malignant,(32) restringents
must be used. This intention is answered by white olives, black poppies
taken with honey, and gum liquified, together with the powdered seed
of smallage, and given in a cyathus of passum.
Besides these, in all disorders of the womb, such drink is proper as is
made of the aromaticks, that is, spikenard, saffron, cinnamon, cassia,
and the like. The mastich tree boiled to a decoction has the same
effects. But if the pain be intolerable, and blood is discharged, even
bleeding is proper; or at least the application of cucurbitals to the
hips, after making an incision in the skin.
[Sidenote: _Of an excessive discharge of urine._]
But when urine is made beyond the measure of what is drunk, and coming
away without pain emaciates, and creates danger, if it be limpid, there
is a necessity for exercise and friction, especially in the sun, or
at the fire. The bath ought to be seldom used, and the stay in it but
short; the food astringent; the wine austere and undiluted, in summer
cold, in winter egelid, but as little as possible. The belly should be
either opened by a clyster, or purged with milk. If the urine is thick,
both the exercise and friction ought to be more violent; the stay in
the bath longer; the food tender; wine as above directed: in both
cases, every thing that provokes urine must be avoided.
CHAP. XXI.
OF AN EXCESSIVE DISCHARGE OF SEMEN, AND ITS CURE.
There is also a distemper about the parts of generation, an excessive
profusion of semen, which without venery or dreams, runs off in such
quantities, that in time it destroys a man by a consumption.
In this disorder brisk frictions, pouring water over the body, and
swimming in water extremely cold are salutary: no food nor drink but
what is taken cold. It is proper also to avoid crudities, and every
thing flatulent; and to take nothing that seems to generate semen: such
are siligo, fine flour of wheat, eggs, alica, starch, all glutinous
flesh, pepper, rocket, bulbous roots, pine nuts. And it is not improper
to foment the lower parts with a decoction of the astringent vervains,
and to apply a cataplasm composed of the same to the lower belly and
groin; and especially rue with vinegar(33); and the person should be
cautious not to sleep supine.
CHAP. XXII.
OF THE DISEASE OF THE HIPS, AND ITS CURE.
It remains that I come to the extremities, which are connected together
by articulations. I shall begin with the hips. In these a violent pain
arises, which often weakens, and some people it never leaves: and
for this reason that species is most difficult to cure, which after
long diseases turns upon this part with a pernicious force: and as it
relieves other parts, so it takes a fast hold of this, which it affects.
Fomentations of hot water must be used first; then warm cataplasms. The
applications, which appear to be most useful in this case, are the bark
of capers cut small and mixed with barley-meal, or with a fig boiled
in water; or the meal of darnel boiled with diluted wine, and mixed
with dry lees. It is more convenient to apply these malagmas in the
night-time, because they are apt to grow cold. The root of elicampane
also bruised, and after boiled with austere wine, and spread all over
the hip is amongst the most powerful remedies. If these do not discuss
the malady, hot and moist salt must be made use of.
If the pain is not removed by this method neither, or a swelling
comes on, the skin must be cut and cucurbitals applied; urine must be
promoted; and if the belly be bound a clyster must be given. The last
remedy, which is also of great efficacy in disorders of the womb, is to
make ulcers in the skin with hot irons in three or four places above
the hip. To make use of friction too, chiefly in the sun, and several
times in one day: that this hurtful collection of humours may be more
easily discussed. The hips themselves may be rubbed, if there be no
ulcer; if there is, the other parts of the body. Now since an ulcer
is frequently to be made with hot iron, that noxious matter may be
evacuated, this is always to be observed, that ulcers of this kind be
not healed, as soon as may be; but kept open, till the distemper, which
we propose to cure by them ceases.
CHAP. XXIII.
OF A PAIN IN THE KNEES, AND ITS CURE.
The knees are next to the hips, in which there sometimes happens to be
a pain. The cure consists in the same cataplasms and cupping: which
are the remedies also when any pain arises in the shoulders, or the
other joints. It is most hurtful of all things for one, whose knees are
pained, to ride on horseback. Now all pains of this kind, when they
have continued long, are scarcely cured without the use of the actual
cautery.
CHAP. XXIV.
OF THE DISEASES IN THE JOINTS OF THE HANDS AND FEET, AND THEIR CURE.
In the hands and feet the diseases of the joints are more frequent, and
continue longer. Such as happen to gouty people in these places, seldom
disturb either eunuchs, or boys before coition, or women unless their
menses be suppressed.
When they begin to feel them, blood must be let. For this done
immediately at the beginning often procures good health for a whole
year, sometimes for life. Some too by cleansing themselves thoroughly
by drinking asses milk, have prevented its ever returning; Others
by abstaining from wine, mulse and venery for a year, have rendered
themselves secure from it for their whole life. And this method is to
be pursued after the first attack of the pain, although it has ceased.
But if the fits of it are grown customary, one may indeed be more
secure at such times as the pain has remitted: but more care ought to
be taken at such seasons, as it returns(34), which happens commonly
in the spring or autumn.
Now when the pain is not violent, the patient ought to use gestation
in the morning; then to be carried, or to exercise himself by walking
gently, and if the gout be in the foot, at small intervals alternately
sometimes to sit, sometimes to walk; next before he takes food, without
bathing to be rubbed gently in a warm place, to sweat, and have egelid
water poured over him; after that to take food of the middle kind,
making use at times of diuretics; and whenever he turns plethoric to
vomit.
When the pain is very violent, it makes a difference, whether there
be no swelling, or a tumour with heat, or a swelling already grown
callous. For if there is no tumour, hot fomentations are required. It
is proper to heat sea-water, or strong brine, then to pour it into a
bason, and when the patient can bear it, to put his feet into it, and
spread his gown over them, and cover them beside with cloaths, pouring
in gradually at the edge of the vessel some of the same liquor, that
the heat within may not decrease; and then in the night-time to apply
heating cataplasms, and especially the root of marshmallows boiled in
wine. But if there be a swelling and heat, coolers are more proper, and
it is fit to keep the joints in the coldest water; but neither every
day, nor long at a time, lest the nerves be indurated. And a cooling
cataplasm must be applied: nor must even that be continued long; but a
change must be made to those things, which are repellent, and at the
same time emollient.
If the pain be more severe, the bark of poppies must be boiled in
wine, and mixed with cerate made of rose-oil: or equal quantities of
wax and hogs lard must be melted together, then wine mixed with them;
and whenever an application of this medicine has grown hot, it must be
removed, and another put on immediately.
But if the tumours have grown callous, and are painful, they are
relieved by the application of a sponge squeezed now and then out of
oil, or vinegar, or cold water; or by equal parts of pitch, wax and
alum mixed together. There are also several malagmas proper for the
hands and feet. But if the pain will allow nothing to be laid on, it is
fit to foment the part, which is not swelled, with a sponge dipped in
a warm decoction of poppy-bark, or the roots of wild cucumber; then to
put over the joints saffron with the juice of poppies and ewes milk.
But if there is a swelling, it ought to be fomented with an egelid
decoction of mastic-tree, or any other of the restringent vervains;
and be covered with a medicine composed of bitter almonds powdered,
and vinegar; or ceruss with an addition of the juice of the wall-herb
bruised. The stone also, which eats flesh, by the Greeks called
[DF]sarcophagus(35), cut into such a form as to receive the feet,
usually relieves their pain, when they are put into it and kept there.
Of this they make sepulchres in Assus. And the Asian stone(36) also
has its merit for giving ease.
[DF] σαρκοφάγος.
When the pain and inflammation have remitted (which happens within
thirty days, unless the patient has been faulty) moderate exercises,
abstinence, gentle unctions must be used, the joints being at the same
time rubbed with an acopon(37), or liquid cerate of cyprine oil.
Riding is hurtful, to those that have the gout in their feet.
Those, who have stated returns of this pain, before them ought both
by a strict regimen to take care to prevent the redundancy of hurtful
matter in the body, and to use frequent vomiting, and if there is
reason to apprehend a present plethora, either clysters, or purging by
milk. Which Erasistratus declared against, when the feet were gouty;
lest the course of the humours downward should occasion a redundancy in
the feet: though it is evident in every purgation, that not only the
superior parts, but the inferior also are emptied.
CHAP. XXV.
OF THE TREATMENT OF PATIENTS RECOVERING.
From whatever distemper a person is recovering, if he gathers
strength slowly, he ought to awake at day-light, nevertheless to
lie still in bed; about the third hour to rub his body gently with
his hands anointed. Then to amuse himself by walking as long as he
finds it agreeable, laying aside all attention to business; then to
use gestation for a long time, much friction; to change often his
situation, air, and food. When he has drunk wine for three or four
days, for one or even two to interpose water. For by these methods he
shall both escape those distempers, that bring on a consumption, and
may quickly recover his strength. But when he is entirely recovered,
it will be dangerous for him to change his course suddenly, and turn
irregular. Therefore he ought by slow degrees to lay aside these
restraints, and change to the way of life most agreeable to his
humour(38).
A. CORNELIUS CELSUS
OF
MEDICINE.
_BOOK V._
PREFACE.
Having gone through those disorders of the body, which are principally
relieved by diet, we must now proceed to that branch of physic, which
depends more upon medicines. The ancient authors put great confidence
in them; so did Erasistratus, and those, who stiled themselves
empiricks. Their efficacy was still more extolled by Herophilus and his
followers; insomuch that they attempted to cure no distemper without
them. They have written a great deal too concerning the virtues of
medicines: such are the treatises of Zeno, or Andreas, or Apollonius,
who was sirnamed Mus. Not without reason Asclepiades in a great
measure laid aside the use of them: and because almost all medicines
offend the stomach, and afford bad juices, he chose to apply all his
care to the management of the diet. But though this be more useful in
most distempers, yet many disorders are incident to our bodies, which
cannot be totally removed without medicines. It is fit to observe in
the first place, that all the branches of medicine are so connected
together, that they cannot be entirely separated; but each derives its
appellation from that, which is principally made use of in it. And
therefore as that, which cures by diet, sometimes employs medicines; so
the other, which chiefly works by medicines, ought also to take in the
diet, which is of great service in all disorders of the body. But since
all medicines have some peculiar powers, and often give relief single,
often mixed, it seems not improper first of all to mention both their
names and virtues, and the compositions of them; that our work may be
shortened, when we come to the curative part.
CHAP. I.
MEDICINES FOR STOPPING BLOOD.
A bleeding is stopped by copperas, which the Greeks call
chalcanthus[DG], chalcitis(1), acacia, lycium with water,
frankincense, aloes, gum(2), calcined lead(3), leeks, blood herb,
either Cimolian, or potter’s chalk, misy(4), cold water, wine,
vinegar, allum(5), melinum(6), scales both of iron(7) and copper;
and of this last there are two species, the one of common copper, the
other of red copper.
[DG] χάλκανθος.
CHAP. II.
AGGLUTINANTS AND RESTRINGENTS.
A wound is agglutinated by myrrh, frankincense, gum, especially
acanthine, fleawort, tragacanth, cardamom, bulbusses, lintseed,
cresses, white of an egg, glue, isinglass, the white vine(8), snails
bruised with their shells, boiled honey, sponge squeezed out of cold
water or wine or vinegar; or sordid wool dipped in the same, if the
wound be slight; also cobwebs.
Both scissile alum, which is called schiston[DH] and the liquid are
restringent, also melinum, orpiment, verdigrease, chalcitis, copperas.
[DH] σχιστὸν.
CHAP. III.
MEDICINES FOR PROMOTING A SUPPURATION.
Maturating and suppurating medicines are nard, myrrh, costus, balsam,
galbanum, propolis(9), storax, both the soot of frankincense(10)
and its bark, bitumen, pitch, sulphur, resin, suet, fat, and oil.
CHAP. IV.
MEDICINES FOR OPENING WOUNDS.
Wounds are opened like mouths in bodies, which in Greek is called
anastomoun[DI], by cinnamon, balsam, panaces, long cyperus,
penny-royal, white violet flowers, bdellium, galbanum, turpentine
and pine resin, propolis, old oil, pepper, pellitory, ground pine,
stavesacre, sulphur, alum, seed of rue.
[DI] ἀναστομο̃υν. This word Celsus here translates literally _to
open like a mouth_.
CHAP. V.
CLEANSERS.
Cleansers are verdigrease, orpiment, which by the Greeks is called
arsenicon[DJ] (this in all respects has the same properties with
sandarach(11), but is stronger) copper scales, pumice, iris, balsam,
storax, frankincense, incense bark, both pine and turpentine resin
liquid, flower of the wild vine, lizard’s dung, blood of a pigeon,
and ring-dove, and swallow, ammoniacum, bdellium (which has the same
virtues with the ammoniacum, but is not so strong) southern-wood, dry
figs, gnidian berry(12), shavings of ivory, omphacium(13), radish,
the coagulum of blood, but especially that of a hare (which has the
same properties of others, but in this case is more efficacious)
ox gall, raw yolk of an egg, hartshorn, glue, crude honey, misy,
chalcitis, saffron, stavesacre, litharge, galls, copper scales(14),
blood-stone, minium, costus, sulphur, crude pitch, suet, fat, oil, rue,
leeks, lentils, vetches.
[DJ] ἀρσενικὸν.
CHAP. VI.
CORRODING MEDICINES.
Corrosives are liquid alum, but more especially the round, verdigrease,
chalcitis, misy, copper scales, especially of the red kind, calcined
copper(15), sandarach, minium from Sinope, cassia, balsam, myrrh,
incense bark, galbanum, liquid turpentine resin, both kinds of
pepper, but chiefly the round, cardamom, orpiment, lime, nitre, and
aphronitre(16), seed of smallage, narcissus-root, omphacium, bastard
sponge, oil of bitter almonds, garlic, crude honey, wine, mastich-tree,
iron scales, ox-gall, scammony, stavesacre, cinnamon, storax, seed of
rue, resin, seed of narcissus, salt, bitter almonds, as well as their
oil, copperas, chrysocolla(17), calcined shells.
CHAP. VII.
EATING MEDICINES.
The medicines, which eat flesh, are the juice of acacia, ebony,
verdigrease, copper scales, chrysocolla, Cyprus ashes(18), nitre,
cadmia(19), litharge, hypocistis(20), diphryges(21), salt,
orpiment, sulphur, rocket, sandarach, salamander(22), bastard sponge,
flour of copper(23), chalcitis, copperas, ochre, lime, vinegar,
galls, alum, milk of the wild fig-tree, or of sea spurge, which by the
Greeks is called tithymallus[DK], animal gall, soot of frankincense,
spodium(24), lentil, honey, olive-leaves, horehound, blood-stone, and
the Phrygian(25), and Asian, and Scissile(26) stones, misy, wine,
and vinegar(27).
[DK] τιθύμαλλος.
CHAP. VIII.
CAUSTICS.
Caustics are orpiment, copperas, chalcitis, misy, verdigrease, lime,
burned paper(28), salt, copper scales, burned lees, myrrh, dung of
a lizard, and pigeon, and ring-dove, and swallow, pepper, gnidian
berry, garlick, diphryges, both the milks mentioned in the last
chapter, hellebore both white and black, cantharides, coral, pellitory,
frankincense, salamander, rocket, sandarach, stavesacre, chrysocolla,
ochre, scissile alum, sheep’s dung, flower of wild vine.
CHAP. IX.
MEDICINES FOR FORMING CRUSTS UPON ULCERS.
The same medicines form crusts upon ulcers, as if they were burnt by
fire, but particularly chalcitis, especially if it be calcined, flower
of copper, verdigrease, orpiment, misy, and the efficacy of the last is
increased by calcination.
CHAP. X.
RESOLVENTS FOR CRUSTS.
The crusts (eschars) of ulcers are resolved by wheat meal with rue or
leeks or lentils, with the addition of some honey.
CHAP. XI.
DISCUTIENTS.
For discussing any collections, which have been formed in any part
of the body, the following things are very powerful, southernwood,
elicampane, sweet marjoram, white violet, honey, lilies,
sansucus(29), cyperus, milk, mellilot, serpyllum, cypress, cedar,
iris, purple violet, narcissus, roses, saffron, white horehound,
long rooted cyperus, nard, cinnamon, cassia, ammoniacum, wax, resin,
stavesacre, litharge, storax, dry figs, goat’s marjoram, seeds of
lint, and of narcissus, bitumen, the dust of the gymnasium, the
pyrites-stone, or mill-stone, raw yolks of eggs, bitter almonds, and
sulphur.
CHAP. XII.
EVACUATING AND DRAWING MEDICINES.
Evacuant and drawing are labdanum, round alum, ebony, lintseed,
omphacium, gall, chalcites, bdellium, turpentine and pine resin,
propolis, dry figs boiled, pigeon’s dung, pumice, meal of darnel, green
figs boiled in water, elaterium, bay-berries, nitre, and salt.
CHAP. XIII.
LENIENTS.
Lenients for what is exasperated are spodium, ebony, gum, white of
eggs, milk, tragacanth.
CHAP. XIV.
INCARNING MEDICINES.
Pine resin, attic ochre, honey, asteriace(30), wax, and butter,
incarn and fill up ulcers.
CHAP. XV.
EMOLLIENTS.
Emollients are, calcined copper, Eretrian earth(31), nitre,
poppy-tears(32), ammoniacum, bdellium, wax, suet, fat, oil, dry
figs, sesamum, mellilot, the root and seed of narcissus, rose-leaves,
coagulum, yolk of egg raw, bitter almonds, all marrow, antimony(33),
pitch, boiled snails, hemlock-seed, dross of lead(34), by the Greeks
called scoria molybdou[DL], panaces, cardamom, galbanum, resin,
stavesacre, storax, iris, balsam, dust of the gymnasium, sulphur,
butter, rue.
[DL] σκορία μολύβδου.
CHAP. XVI.
CLEANSERS OF THE SKIN.
The skin is cleansed by honey, for which purpose it is more effectual
when mixed with galls, or vetches, or lentils, or horehound, or iris,
or rue, or nitre, or verdigrease.
CHAP. XVII.
OF THE MIXTURE OF SIMPLES; AND OF THE PROPORTION OF THE WEIGHTS.
Having mentioned the virtues of the simples, we are next to shew in
what manner they are to be mixed, and what compositions are made from
them. Now they are mixed variously, and there is no certain method for
it, since of similar ingredients some are taken away, and others are
added; and though the very same simples are all used, the proportion
of their weights may be changed. And therefore though the number of
medicinal simples be not so very great, there are innumerable kinds
of mixtures; which it would be needless to enumerate, though it were
possible: both because the same effects are found within the compass
of a few compositions; and because it is easy for any person, who
is acquainted with their virtues, to change them. I shall therefore
confine myself to the most esteemed. Now in this book I shall give an
account of those, which may either have been wanted in the preceding,
or are employed in the cures, which I am to treat of, only throwing
together these compositions, which are of more general use. Such as
are accommodated to one particular disorder, or even to a few, I will
insert in their proper places.
But before I proceed, I would have it understood, that in an ounce
is contained the weight of seven denarii. Next, that I divide each
denarius into six parts, that is sextantes, so that I have the same
quantity in the sextans of a denarius, that the Greeks have in their
obolus[DM]. That being reduced to our weights makes a little more than
half a scruple.
[DM] ὀβολὸς.
[Sidenote: _Of the difference betwixt malagmas, plaisters, and
troches._]
Now malagmas, and plaisters, and troches, which the Greeks call
trochischi[DN], though in many things they are the same, differ in
this, that malagmas are chiefly made from flowers, and even their
stalks, plaisters and troches are more generally composed of some
metallic ingredients. Then malagmas being beat up are abundantly soft:
for they are applied, where the skin is unbroken: but those things, of
which plaisters and troches are made, are carefully powdered; lest they
hurt wounds, when they are laid on. Betwixt a plaister and a troche
there is this difference, that a plaister admits of something melted:
in a troche there are only dry medicines united by some liquid. Again,
a plaister is made in this manner: The dry medicines are powdered by
themselves: when they are mixed, vinegar is dropped into them, or any
other liquor belonging to the composition, that is not greasy; and they
are again rubbed with that. Those things, that are capable of being
melted, are melted altogether at the fire; and if any oil is to be in
the mixture, it is then poured in. Sometimes too, some one of the dry
ingredients is first boiled with oil. When these things are finished,
which ought to be done separately, the whole is mixed together into one
mass. But the way of making troches is this: The dry medicines being
powdered are formed into one body with a liquor not greasy, such as
wine or vinegar, and again after being brought to a consistence, grow
dry: and when they are to be used, are diluted by a liquor of the same
kind. _There is also a difference in the manner of using these_: for a
plaister is simply applied, a troche is rubbed on, or else mixed with
something softer than itself, or with cerate.
[DN] τροχίσχοι.
CHAP. XVIII.
OF MALAGMAS.
[Sidenote: _1. A cooling malagma for the hot gout._]
These particulars being premised, I shall first subjoin malagmas,
which are commonly contrived not with an intention to cool, but to
heat. There is one however, which is cooling, adapted to the hot gout
in the feet. It contains of galls both unripe, and otherwise, of
coriander-seed, hemlock, poppy-tears, gum, of each an acetabulum, of
washed cerate, which the Greeks call peplumenon[DO], half a pound.
[DO] πεπλυμένον.
The other malagmas are mostly heating. But some of them discuss matter,
others draw it out, which are called epispastica[DP]: most of them are
adapted to particular parts of the body.
[DP] ἐπισπαστικὰ.
[Sidenote: _2. A drawing malagma._]
If matter(35) is to be drawn out, as in a dropsical case, pleurisy,
a beginning abscess, and even a moderate suppuration, that is proper,
which consists of dry resin, nitre, ammoniacum, galbanum, each p. *.
wax, p. *. Or that, which contains rasile verdigrease, frankincense,
each p. ii. *. Sal ammoniac p. vi. *. copper scales, wax, each p. viii.
*. dry resin p. xii. *. and vinegar a cyathus. The same end is obtained
by the meal of cummin-seed with struthium(36) and honey p. ii. *.
[Sidenote: _3. Malagma for the liver._]
If the liver is pained, the proper malagma is that, which contains
balsam-tears p. xii. *. costus, cinnamon, cassia bark, myrrh, saffron,
round cyperus, balsam-seed, Illyrian iris, cardamom, amomum, nard, of
each p. xvi. *. To these is added nard ointment(37), till it be of
the consistence of cerate. And this must be used, while it is recent:
but if it be to be kept for some time, turpentine resin p. xvi. *. wax
p. x. *. must be beat up with mild wine, and mixed with it.
[Sidenote: _4. Malagma for the spleen._]
But if the spleen is pained, the bark of that acorn, which the Greeks
call myrobalanus, and nitre are beat together in equal quantities, and
are sprinkled over with the sharpest vinegar: when it comes to the
consistence of cerate, it is spread upon a linen cloth first moistened
in cold water, and thus applied, and over it is laid barley meal; but
it ought not to lie there above six hours, lest it waste the spleen;
and it is better to do it twice or thrice.
[Sidenote: _5. Lysias’s malagma for several parts._]
Lysias composed a malagma, at once calculated for the liver, and
spleen, and for abscesses, and the scrophula, and parotid swellings,
and the joints, and heels suppurating, or otherwise painful, likewise
to assist the concoction of the stomach, of the following materials:
opopanax, galbanum, resin, of each p. ii. *. ammoniacum, bdellium, wax,
beef suet, dry iris p. iv. *. with an acetabulum of cachrys(38) and
forty grains of pepper: which being powdered are brought to a proper
consistence by iris ointment.
[Sidenote: _6. Apollophanes’s malagma._]
The composition of Apollophanes is calculated for pains of the sides.
It consists of turpentine resin, soot of frankincense, each p. iv.
*. bdellium, ammoniacum, iris, suet from the kidneys either of veal
or a goat, viscum(39), each p. iv. *. Now this relieves all pains,
mollifies what is hard, and is moderately heating.
[Sidenote: _7. Andreas’s malagma._]
The malagma of Andreas also has the same effect; it likewise relaxes,
draws out humour, maturates pus, and when that is ripe, it breaks the
skin, and brings it to cicatrize. It does good applied either to small
or large abscesses; also to pained joints, hips, and feet: it restores
too any part, that has been damaged by bruises; softens hard and
inflated præcordia; extracts bones; and in fine is efficacious in every
case, where heat can be of service. It contains wax p. xi. *. viscum,
sycaminum (which others call sycamore) tears, each p. i. *. pepper both
round and long, ammoniacum thymiama(40), bdellium, Illyrium iris,
cardamom, xylobalsam, male frankincense, myrrh, dry resin, each p. x.
*. pellitory, gnidian berries, aphronitre, sal ammoniac, root of Cretan
birthwort, root of wild cucumber, liquid resin of turpentine, of each
p. xx. *. to these is added a sufficient quantity of iris ointment to
soften and reduce them to a proper consistence.
[Sidenote: _8. Malagma for Polyarchus._]
The principal composition for relaxing what is bound, softening what
is hard, and discussing any collection, is that, which is ascribed
to Polyarchus. It contains of long cyperus, cardamom, soot of
frankincense, amomum, wax, liquid resin, equal parts.
[Sidenote: _9. Malagma of Nileus._]
There is another by Nileus for the same purposes: of crocomagma(41),
which is, as it were, the refuse of saffron p. iv. *. ammoniacum
thymiama, wax, each p. xxx. *. the two first of these are rubbed down
with vinegar, the wax is melted with oil of roses, and then the whole
is mixed together.
[Sidenote: _10. Moschus’s emollient malagma._]
The malagma, that passes under the name of Moschus, has only the
property of softening what is hard. It contains of galbanum one ounce,
soot of frankincense p. iii. *. wax, ammoniacum thymiama, each a
triens, dry pitch p. ii. *. vinegar three heminae.
[Sidenote: _11. Medus’s discutient malagma._]
Medus’s malagma is used to discuss any collection. This contains wax p.
iii. *. panaces 1/2 p. *. copper scales, round alum, scissile alum, of
each p. i. *. calcined lead p. i. *. and 1/2.
[Sidenote: _12. Panthemus’s malagma._]
Panthemus for the same intention made use of lime 1/2 p. *. mustard
powdered, fenugreek, alum, each p. i. *. beef suet p. ii. *. and 1/2.
[Sidenote: _13. Andreas’s malagma for the scrophula._]
For the scrophula I find many malagmas. I believe indeed, that the
more malignant that distemper is, and the more difficult to discuss,
the greater number of remedies have been tried; which have succeeded
variously in different persons. Andreas is the author of the following
mixture: Nettle-seed p. i. *. round pepper, bdellium, galbanum,
ammoniacum thymiama, dry resin, of each p. iv. *. liquid resin, wax,
pellitory, long pepper, sea spurge-seed, crude sulphur, which is called
apyron[DQ], equal parts.
[DQ] ἄπυρον, that has not passed the fire.
[Sidenote: _14. Mico’s for the same._]
Mico’s malagma is this: of dry lees, vinegar, aphronitre, sal ammoniac,
mustard, cardamom, wild cucumber-root, resin, each p. iv. *. which are
beat up with mild wine.
[Sidenote: _15. Three others._]
A more expeditious for the same purpose is that, which contains of
viscum, cat’s dung, resin, crude sulphur, equal parts. And another,
in which are of sulphur p. i. *. pyrites-stone p. iv. *. of cummin an
acetabulum. Likewise that, which consists of one part of pyrites, two
of sulphur, and three of turpentine resin.
[Sidenote: _16. Malagma of an Arabian for the scrophula, &c._]
There is a malagma of a certain Arabian for the scrophula, and
rising tubercles, which are called phymata, which discusses them. It
contains myrrh, sal ammoniac, frankincense, resin both liquid and dry,
crocomagma, wax, of each p. i. *. the pyrites-stone p. iv. *. to which
some add sulphur p. ii. *.
[Sidenote: _17. Another for the same._]
There is another of service in the scrophula, and in those tubercles,
which are with difficulty brought to maturate; and in those, that are
called carcinodea[DR], which consists of these things: sulphur p. ii.
*. nitre p. iv. *. myrrh p. vi. *. soot frankincense 1/2 p. *. sal
ammoniac p. iii. *. wax p. i. *.
[DR] χαρχινωδὴ, cancerous.
[Sidenote: _18. Protarchus’s malagma._]
Protarchus for parotid swellings, and those tubercles, which are called
melicerides[DS], that is, honey-combs, or phymata, and for malignant
ulcers, made this mixture: of pumice, liquid pine resin, soot of
frankincense, aphronitre, iris, each p. viii. *. with wax p. ix. *. and
to these he added a cyathus and half of oil.
[DS] μιλιχηρίδες.
[Sidenote: _19. Malagma for a panus, &c._]
But against the panus upon its first appearance, which the Greeks call
phygethlon[DT], and any tubercle, which is called phyma, a mixture is
made of attic ochre, with two parts of flour, and to these, while they
are beat up, honey is now and then dropped in, till it acquire the
consistence of a malagma.
[DT] φύγεθλον.
[Sidenote: _20. A malagma against all phymata._]
That also discusses all the tubercles, that have the name of phyma,
which contains of lime, aphronitre, round pepper, each p. i. *.
galbanum p. ii. *. salt p. iv. *. which are incorporated with cerate
made of rose-oil.
[Sidenote: _21. Malagma for beginning abscesses._]
That malagma suppresses all beginning abscesses, which is composed of
galbanum, bruised beans, each p. i. *. myrrh, frankincense, bark of
caper-root, each p. iv. *. And the murex burnt, and reduced to a fine
powder, dropping in now and then a little vinegar, powerfully discusses
all beginning abscesses.
[Sidenote: _22. Malagma for blood._]
But if in such tumours, too great a quantity of blood is extravasated,
it is proper to use an application, which is also efficacious against
tubercles. It has the following ingredients: bdellium, storax,
ammoniacum, galbanum, pine resin both dry and liquid. Also mastich,
frankincense, iris, of each p. ii. *.
[Sidenote: _23. Malagma for cancers, &c._]
Cancers and tubercles are in a good measure eased by this composition:
galbanum, viscum, ammoniacum, turpentine resin, each p. i. *. beef suet
1/2 p. *. burned lees as great a proportion as may be, without making
it drier than a malagma ought to be.
[Sidenote: _24. Malagma for the face._]
But if there be a contusion in the face and a livor from an
extravasation of blood, the following composition, applied night and
day, removes it. Birthwort, thapsia(42), of each p. ii. *. bdellium,
storax, ammoniacum thymiama, galbanum, dry resin, and liquid, resin of
the mastich-tree, male frankincense, Illyrian iris, wax, of each p. iv.
*. The application of a bean also will do good in the same case.
[Sidenote: _25. Opening malagmas._]
There are also some malagmas, which by the Greeks are called
anastomotica[DU], because they have the power of opening. Such is that,
which is composed of the following things: long pepper, aphronitre, of
each p. ii. *. hedge mustard p. iv. *. which are mixed with honey: they
are also proper for opening scrophulous tumours. Of the same kind with
this, but stronger, is that, which contains lime p. iv. *. pepper six
grains, nitre, wax, of each p. x. *. honey p. iii. *. and a hemina of
oil.
[DU] ἀναστομωτικὰ.
[Sidenote: _26. Mico’s relaxing, &c. malagma._]
There is one of Mico’s, which is relaxing, opening, and cleansing. It
contains of bastard sponge, sulphur, nitre, pumice, equal parts; to
these is added of pitch and wax a sufficient quantity to make it the
consistence of cerate.
[Sidenote: _27. Aristogenes’s malagma for the bones, &c._]
Aristogenes’s malagma for the bones consists of these ingredients:
of sulphur p. i. *. turpentine resin, aphronitre, and the pulp of a
squil, washed lead(43), each p. ii. *. soot of frankincense p. viii.
*. the mellowest dry figs, beef suet, each p. viii. *. wax p. xii. *.
Macedonian iris p. vi. *. sesamum toasted and acetabulum. And this
malagma is very agreeable to the nerves and joints.
[Sidenote: _28. Euthycleus’s malagma for the joints, &c._]
That, which was invented by Euthycleus, is proper for the joints, and
for all pains, particularly in the bladder, and any contraction of
the joints from a recent cicatrix, which the Greeks call anchyla[DV].
It contains soot of frankincense an acetabulum, the same quantity of
resin, galbanum without its stalks an ounce and half, ammoniacum,
bdellium, of each p. *. wax 1/2 p. *----There is also another, which
consists of iris, ammoniacum, galbanum, nitre, each p. xiv. *. liquid
resin p. vi. *. wax p. xvi. *.
[DV] ἀγκύλη.
[Sidenote: _29. Sosagoras’s for the same._]
Sosagoras’s malagma for pains of the joints: of calcined lead,
poppy-tears, bark of henbane, storax, hog’s fennel, suet, resin, and
wax, equal parts.
[Sidenote: _30. Chrysippus’s._]
Chrysippus also composed one: of liquid resin, sandarach, pepper, each
p. xii. * to these a little wax is added.
[Sidenote: _31. Ctesiphon’s._]
Ctesiphon’s: of Cretan wax, turpentine resin, the reddest nitre, each
1/2 p. *. three cyathi of oil. But the nitre is first rubbed for three
days with water dropped in upon it, and boiled with a sextarius of it,
till all the moisture be consumed.----This composition is also good
for parotids, tubercles, and the scrophula, and for softening every
collection of humour.
[Sidenote: _32. For the joints._]
To the joints one may properly apply a part of a dry fig mixed with
cat-mint; or staveacre without the seeds, with penny-royal.
[Sidenote: _33. Ariston’s for the gout in the feet._]
The same composition is useful for the gout in the foot. But for that
ailment Ariston has also composed one, containing of nard, cinnamon,
cassia, chamaeleon, round cyperus, each p. viii. *. goat’s suet melted
in iris ointment p. xx. *. iris p. i. *. which ought to lie in the
strongest vinegar for twenty days. The same also discusses recent
tubercles, and all pains.
[Sidenote: _34. Theoxenus’s for pained feet._]
But for pains of the feet Theoxenus mixed, of kidney suet a third part,
of salt two parts, and applied them spread upon a piece of leather;
then put over it ammoniacum thymiama dissolved in vinegar.
[Sidenote: _35. Numenius’s for the gout, &c._]
But Numenius mollified the gout in the feet, and other indurated joints
with the following composition: southernwood, dry roses, poppy-tears,
of each p. iii. *. turpentine resin p. iv. *. frankincense, aphronitre,
each p. viii. * iris, birthwort, each p. xii. *. wax p. iii. * to these
is added one cyathus of cedria(44), three cyathi of laurel oil(45),
and a sextarius of bitter oil.
[Sidenote: _36. Dexius’s malagma for a callus, &c._]
For a callus formed upon the joints, Dexius directed the following
application: of lime, p. iv. *. ceruss, p. viii. *. pine resin xx.
*. pepper thirty grains, wax p. ii. *. And while these are beat up a
hemina of mild wine is poured in.
CHAP. XIX.
OF PLAISTERS.
Of plaisters there are none more useful, than those, which are
immediately applied to bloody wounds; the Greeks call them enaima[DW].
For these repel an inflammation, unless it be excited by something very
violent, and even then they diminish its force, and agglutinate wounds,
which are not inflamed, and cicatrize them. They consist of medicines
not fat, and therefore by the Greeks are called alipaina[DX].
[DW] ἔναιμα.
[DX] ἀλίπαινα.
[Sidenote: _1. Barbarium plaister._]
The best of these plaisters is that, which is called barbarum. It
contains of rasile verdigrease(46) p. xii. *. litharge p. xx. *.
alum, dry pitch, dry pine resin, each p. i. *. to which is added of oil
and vinegar each a hemina.
[Sidenote: _2. The choacon._]
There is another for the same, which is called choacon; it contains of
litharge p. x. *. dry resin as much. But the litharge is first boiled
in three heminæ of oil. The colour of both these plaisters is black,
which generally results from pitch and resin, as the blackest is from
bitumen; from verdigrease, or scales of copper, green; from minium,
red; from ceruss, white.
[Sidenote: _3. The basilicon._]
There are a very few compositions, in which the variety of the mixture
causes some different appearance; therefore that also is black, which
is called basilicon. It contains of opopanax p. i. *. galbanum p. ii.
*. pitch and resin, of each p. x. *. half a cyathus of oil.
[Sidenote: _4. The smaragdine._]
But that, which is very green, is called smaragdine, in which there are
of pine resin. p. iii. *. wax p. i. *. verdigrease 1/2 p. *. flour of
frankincense p. ii. *. as much oil and vinegar, with which _last_ the
flour and verdigrease are united.
[Sidenote: _5. The rufum._]
There is also one of a reddish colour, which seems to bring wounds to
cicatrize quickly: it consists of frankincense p. i. *. resin p. ii.
*. copper scales p. iii. *. litharge p. xx. *. wax p. c. *. of oil a
hemina.
[Sidenote: _6. The paracolleticon._]
Besides, there is another, which from agglutinating is called
paracolleticon[DY] It contains bitumen, scissile alum, p. iv. *.
litharge p. iv. *. and a hemina of old oil.
[DY] παρακολλητικὸν.
[Sidenote: _7. Philotas’s cephalic plaister._]
Besides these there are some of the same kind, which, because they
are particularly adapted to fractures of the skull, are by the Greeks
called cephalica[DZ]. Philotas’s composition contains of Eretrian
earth, chalcitis, each p. iv. *. myrrh, calcined copper, each p. x.
*. isinglass p. vi. *. rasile verdigrease, round alum, crude misy,
birthwort, each p. viii. *. copper scales p. xx. *. male frankincense
p. ii. *. wax p. i. *. rose and bitter oil three cyathi, and a
sufficient quantity of vinegar for rubbing down all the dry ingredients.
[DZ] κηφαλικὰ.
[Sidenote: _8. A green one._]
There is another for the same purpose green; which consists of calcined
copper, copper scales, myrrh, isinglass, each p. vi. *. crude misy,
rasile verdigrease, birthwort, round alum, each p. viii. *. wax p. vi.
*. a hemina of oil, and of vinegar a sufficient quantity.
[Sidenote: _9. The tetrapharmacum._]
For promoting a suppuration there is nothing better than that, which is
very quickly prepared, and by the Greeks is called tetrapharmacum[EA].
It contains equal parts of wax, pitch, resin, and beef suet; if the
last cannot be had, veal suet.
[EA] τετραφάρμακον, or consisting of four medicines.
[Sidenote: _10. Ennea pharmacum._]
There is another for the same intention, which is called ennea
pharmacum[EB], which cleanses more; it consists of nine ingredients,
wax, honey, suet, resin, myrrh, rose oil, marrow either of a deer or
calf, or beef, or œsypum(47), and butter. These also are mixed in
equal quantities.
[EB] ἐννεαφάρμακον, of nine medicines.
But there are some plaisters, that answer both these intentions at
once; which, unless the case requires distinct applications for each,
are preferable; otherwise they are worse, and never to be made use of,
but either when both intentions are proposed together, or when, though
the plaisters are wanted singly, they are not to be had by themselves.
But where there is choice, they are to be rejected, and such only
applied as are peculiarly suited to the end to be obtained. For example
I will mention two.
[Sidenote: _11. Attallum plaister._]
There is then the Attalum plaister for wounds: which contains of copper
scales p. vii. *. soot of frankincense p. xv. *. ammoniacum as much,
liquid turpentine resin p. xxv. *. beef suet the same quantity, three
heminæ of vinegar, a sextarius of oil.
[Sidenote: _12. Judæus’s plaister._]
But amongst those, which are proper for a fractured skull, some use
that, which is said to be invented by Judæus. It consists of the
following ingredients: salt p. iv. *. red copper scales, calcined
copper, each p. xii. *. ammoniacum thymiama, soot of frankincense, dry
resin, each p. vi. *. Colophonian resin, wax, veal suet cured, each p.
xx. *. a cyathus and half of vinegar is added, and less than a cyathus
of oil. What the Greeks call tetherapeumena[EC], we call curata,
_cured_; when for instance from the suet all the little membranes are
carefully taken away, and so in any other medicine.
[EC] τεθεραπευμένα.
[Sidenote: _13. Diadaphnidon._]
There are also some plaisters greatly celebrated for drawing, which
are likewise distinguished by the name of epispastica[ED]. Such as is
that, which because bay-berries are among the ingredients, is called
diadaphnidon[EE]. In it there is turpentine resin p. x. *. nitre, wax,
dry pitch, bay-berries, each p. xx. *. and a little oil. Now as often
as I shall mention a berry or a nut, or any thing of that nature,
it will be proper to know, that before it be weighed, the exterior,
pellicle is to be taken from it.
[ED] ἐπισπαστικὰ.
[EE] διὰ δαφνίδων.
[Sidenote: _14. Another._]
There is another of the same name, which is also for promoting a
suppuration. Of veal suet, ammoniacum thymiama, pitch, wax, nitre,
bay-berries, dry resin, birthwort, pellitory, of each equal parts.
[Sidenote: _15. Philocrates’s._]
Besides these there is one of Philocrates: which contains sal ammoniac
p. vii. *. birthwort p. viii. *. wax, turpentine resin, soot of
frankincense, each p. xv. *. litharge p. xxxii. *. To these, that it
may serve also for promoting a suppuration, are added iris p. iii. *.
galbanum p. vi. *.
[Sidenote: _16. Rhypodes._]
However that is best for drawing, which from its resemblance to sordes,
the Greeks call rhypodes[EF]. It contains myrrh, saffron, iris,
propolis, bdellium, the heads of pomegranates, scissile and round
alum, misy, chalcitis, boiled copperas(48), opopanax, sal ammoniac,
viscum, each p. iv. *. birthwort p. viii. *. copper scales p. xvi. *.
turpentine resin p. lxxv. *. wax, and suet, either beef or goat’s, each
p. c. *.
[EF] ῥυπω̃δες.
[Sidenote: _17. Hecatæus’s._]
Hecatæus also is the author of a plaister of the same kind, which is
thus composed: galbanum p. ii. *. soot of frankincense p. iv. *. pitch
p. v. *. wax and turpentine resin, each p. viii. *. with these a little
iris ointment is mixed.
[Sidenote: _18. The green Alexandrian._]
The green Alexandrian drawing plaister is efficacious for the same
purpose. It contains scissile alum p. viii. *. sal ammoniac p. vii. *.
copper scales p. xvi. *. myrrh, frankincense, each p. xviii. *. wax
p. cl. *. colophonian or pine resin p. cxc. *. a hemina of oil, and a
sextarius of vinegar.
[Sidenote: _19. An eating plaister._]
Some plaisters are eating, which the Greeks call septica[EG], such as
is that, which contains turpentine resin, soot of frankincense, of each
p. ii. *. copper scales p. i. *. labdanum p. ii. * the same quantity of
alum, litharge p. iv. *.
[EG] σηπτικὰ.
[Sidenote: _20. Another for eating, &c._]
This plaister also eats away flesh vehemently, and even dissolves
the bones, and keeps down fungous flesh. It contains litharge,
copper scales, of each an ounce; nitre that has not felt the fire,
Asian stone, birthwort, of each a sextans, wax, turpentine resin,
frankincense, old oil, copperas, sal ammoniac, 1/2 p. rasile
verdigrease p. bessis, of squill vinegar a hemina, and a like quantity
of Aminæan wine.
[Sidenote: _21. Diogenes’s black plaister._]
There are also some calculated against bites; such as the black one of
Diogenes: which contains of bitumen, wax, dry pine resin, each p. xx.
*. litharge p. c. *. of oil a sextarius. Or that, which consists of
copper scales p. iv. *. ceruss and rasile verdigrease each p. viii. *.
ammoniacum p. xii. *. wax, pine resin, each p. xxv. *. litharge p. c.
*. of oil a sextarius. Or that, which is composed of copper scales p.
xiv. *. galbanum p. vi. *. ceruss and rasile verdigrease, each p. viii.
*. ammoniacum p. xii. *. wax, pine resin, of each p. lv. *. with these
the litharge is boiled.
[Sidenote: _22. Red Ephesian plaister._]
There is a red plaister of the same virtues, which is called Ephesian.
It contains turpentine resin p. ii. *. galbanum p. iv. *. Sinopian
minium p, vi. *. soot of frankincense p. vi. *. wax p. viii. *.
litharge, p. lvi. *. old oil a hemina.
[Sidenote: _23. Another._]
Likewise that which consists of the following materials; copper scales,
soot of frankincense, of each p. iv *. galbanum p. vi. *. sal ammoniac
p. xii. z. *. wax p. xxv. *. with three heminæ of oil. These also are
proper applications for other recent wounds.
[Sidenote: _24. A white lenient plaister._]
There are also white lenient plaisters, by the Greeks, _from their
colour_, called leuca[EH], generally calculated for slight wounds, and
especially those of old men: such as is that, which contains of ceruss
p. lii. *. veal suet cured and wax, each p. lviii. *. three heminæ of
oil, with which the ceruss is boiled up.
[EH] λευκὰ.
[Sidenote: _25. Elephantine plaister._]
Another, which consists of ceruss p. xx. *. wax p. lv. *. a hemina of
oil, and a sextarius of water. Now as often as these are added, to
ceruss or litharge, we may take it for granted, that they are to be
boiled with them. This last composition is very white, and therefore it
is called elephantine.
[Sidenote: _26. A lenient plaister._]
There are also some lenient plaisters, which the Greeks commonly call
lipara[EI], as that which contains minium p. iv.*. litharge, p. xxv. *.
wax and hog’s lard, each p. xxxv. *. and the yolks of four eggs.
[EI] λιπαρὰ.
[Sidenote: _27. Another._]
Another composition of the same kind: wax, turpentine resin, of each
p. v. *. ceruss p. viii. *. litharge, dross of lead (scoria molybdi
the Greeks call it) each p. x. *. cicine(49) and myrtle oil, each the
third part of a hemina.
[Sidenote: _28. Archagathus’s._]
Another, which is said to be invented by Archagathus: burnt misy,
calcined copper, each p. iv. *. burnt(50) ceruss p. viii. *.
turpentine resin p. x. *. litharge p. vi. *.
[Sidenote: _29. Another for the same purpose._]
For the same purpose: litharge, wax, hog’s lard, of each p. xxvii. *.
boiled yolks of eggs, with a hemina of rose oil. Or this composition:
cerate made of myrtle oil three parts, hog’s lard a fourth part, a
little lead dross. Or the following composition; of litharge half a
pound boiled with a hemina of oil, and a like quantity of sea water,
till it cease to bubble, with the addition of a little wax. Or this:
equal parts of wax, suet, antimony, litharge, and ceruss.
CHAP. XX.
OF TROCHES.
[Sidenote: _1. Troche for agglutinating._]
Troches also have different virtues. For there are some adapted to
agglutinate and heal recent wounds: such is that, which contains
chalcitis, misy, aphro-nitre, flower of copper, galls, scissile alum
moderately burnt, of each p. i. *. calcined copper, the heads of
pomegranates, each p. iii. *. This should be diluted with vinegar, and
so laid on, when a wound is to be agglutinated. But if it be a nervous
or muscular part, it is better to mix it with cerate, so as to have a
ninth part of the latter with eight of the other.
[Sidenote: _2. Another._]
Another for the same purpose. It consists of the following materials:
bitumen, scissile alum, of each p. i. *. calcined copper p. iv. *.
litharge p. xi. *. and a sextarius of oil.
[Sidenote: _3. The sphragis of Polybus._]
But that of Polybus(51) is by far the most celebrated: it is called
sphragis[EJ]. Which contains of scissile alum p. iv. *. copperas p. ii.
*. myrrh p. v. *. aloes a like quantity; the heads of pomegranates, ox
gall, each p. vi. *. which being rubbed together, are incorporated with
austere wine.
[EJ] σφραγὶς.
[Sidenote: _4. Troche for foul ulcers._]
For foul ulcers, and blackness in the ears, nose, obscene parts, and
inflammation in any of these places: of chrysocolla p. i. *. copperas,
scissile alum, each p. ii. *. bark of winter cherry p. iv. *. minium p.
vi. *. litharge p. xii. *. ceruss p. xvi. *. these are compounded with
vinegar, and diluted when used.
[Sidenote: _5. Andro’s troche._]
Andro’s is for an inflamed uvula, for foulness in the obscene parts,
or gangrenes in the same; of galls, copperas, myrrh, each p. i. *.
birthwort, scissile alum, each p. ii. *. heads of pomegranates p. xxv.
*. compounded with passum, and when they are to be used, diluted with
vinegar or wine, according as the disorder, which is to be cured, is
more or less violent.
[Sidenote: _6. A troche for fissures of the anus, &c._]
For fissures in the anus, or an effusion of blood from the hæmorrhoidal
veins, or a gangrene, the following is of peculiar efficacy; of
verdigrease p. ii. *. myrrh p. iv. *. gum p. viii. *. frankincense p.
xii. *. antimony, poppy tears, acacia, each p. xvi. *. which are both
rubbed down with wine, and when used, diluted with the same liquor.
[Sidenote: _7. Troche for expelling a stone from the bladder._]
This composition seems proper to expel a stone out of the bladder along
with the urine: equal parts of cassia, saffron, myrrh, costus, nard,
cinnamon, liquorice root, balsam, hypericum are powdered; then mild
wine is dropped in, and the troches are formed. Each may contain p. i.
*. and one of these may be swallowed every day in the morning fasting.
CHAP. XXI.
OF PESSARIES.
These three kinds of compositions, that is, malagmas, plaisters, and
troches, are extensive and various in their uses. But there are other
things also useful: as those, which are applied below to females: the
Greeks call them pessi[EK]. The manner of them is this: the composition
is received in soft wool, and this wool put into the vagina.
[EK] πεσσοὶ.
[Sidenote: _1. Pessary for evacuating blood._]
For evacuating blood, to two of the small kind of figs called
cauneæ(52) is added nitre p. i. *. Or the seed of garlick
is powdered, and a little myrrh added and mixed with susine
ointment(53). Or the pulp of a wild cucumber is diluted in woman’s
milk.
[Sidenote: _2. For softening the womb._]
To soften the womb, the yolk of an egg, and fenugreek, and rose oil,
and saffron are mixed together. Or of elaterium p. iii. *. as much
salt, and stavesacre p. vi. *. are incorporated with honey.
[Sidenote: _3. Boethus’s for the same._]
There is another invented by Boethus, which contains saffron,
turpentine resin, each p. iv. *. myrrh p. iii. *. rose oil p. i. *.
veal suet p. iii. *. wax p. ii. *. mixed together.
[Sidenote: _4. Numenius’s for an inflammation._]
The best composition against an inflammation of the womb, is that of
Numenius, which contains saffron p. iii. *. wax p. i. *. butter p.
viii. *. goose fat p. xii. *. two boiled yolks of eggs, with less than
a cyathus of rose oil.
[Sidenote: _5. For expelling a dead fœtus._]
If a fœtus has died within the womb, that it may be the more easily
expelled, the bark of pomegranates must be rubbed down with water, and
then made use of.
[Sidenote: _6. For hysterick fits._]
If a woman from an hysterick disorder is subject to fits, snails
together with their shells must be burnt and powdered, and then honey
added to them.
[Sidenote: _7. For conception._]
If a woman does not conceive(54), lions fat must be softened with
rose oil.
CHAP. XXII.
MEDICINES USED EITHER IN A DRY FORM, OR MIXED WITH LIQUIDS.
[Sidenote: _1. Powder for fungous flesh._]
There are some mixtures of medicines made use of dry without being
brought to any consistence, which we sprinkle on, or mix with some
liquid, and lay them on. Such as that for eating down fungous flesh,
which contains of copper scales, soot of frankincense, each p. i. *.
verdigrease p. ii. *. Now this same composition with honey cleanses
ulcers; and with wax fills them up. Also, if misy, galls, and cadmia
be mixed in equal proportions, they consume the flesh; and these may
either be sprinkled on dry(55), or brought to a consistence and
spread on.
[Sidenote: _2. For restraining putrid flesh._]
Honey mixed either with lentils, or with horehound, or with olive
leaves first boiled in wine, restrains putrid flesh, and does not
suffer it to spread, and is gently corrosive. Also mellilot boiled in
mulse, and then rubbed small. Or lime with cerate. Or bitter almonds
with a third part of their quantity of garlick, and a little saffron
added to them. Or that, which contains litharge p. vi. *. burnt ox
horn p. xii. *. myrtle oil and wine, each three cyathi. Or that, which
consists of the following things: the flowers of pomegranate, copperas,
aloes, of each p. ii. *. scissile allum, frankincense, each p. iv.
*. galls p. viii. *. birthwort p. x. *. The following is stronger,
and even caustic; orpiment with chalcitis, and either nitre, or lime,
or burnt paper. Also salt with vinegar. Or that composition, which
contains chalcitis, pomegranate tops, aloes of each p. ii. *. scissile
alum, frankincense, each p. iv. *. galls p. viii. *. birthwort p.
x. *. and a sufficient quantity of honey to bring them to a proper
consistence. Or cantharides, sulphur, of each p. i. *. darnel p.
iii. *. with the addition of as much liquid pitch as will keep them
together. Or even chalcitis mixed with resin and rue: or diphryges with
the same resin; or stavesacre with liquid pitch. There is the same
property in burnt lees of wine, and equal parts of lime and nitre. Or
scissile alum p. i. *. frankincense, sandarach, nitre, each p. i. *.
galls p. viii. *. birthwort p. x. *. and a sufficient quantity of honey.
[Sidenote: _3. Hera’s composition._]
There is also a composition of Hera’s, which contains myrrh, chalcitis
of each p. ii. *. aloes, frankincense, scissile alum, each p. iv. *.
birthwort, unripe galls, each p. viii.*. pomegranate bark powdered p.
xx. *.
[Sidenote: _4. Judæus’s._]
There is likewise one by Judæus: in which are two parts of lime, and a
third of the reddest nitre; which are mixed with the urine of a young
boy, till they be of the consistence of strigment. But the part, upon
which this is spread, must be moistened now and then.
[Sidenote: _5. Jollas’s._]
But Jollas mixed of burnt paper, sandarach, each p. i. *. lime p. ii.
*. and the same quantity of orpiment.
[Sidenote: _6. For an hæmorrhage._]
[Sidenote: _7. For cicatrizing ulcers._]
But if there is blood discharged from that membrane, which covers the
brain, the yolk of an egg ought to be burnt, powdered, and sprinkled
upon it. If the hæmorrhage is from any other part, orpiment, copper
scales, of each p. i. *. sandarach p. ii. *. burnt marble(56) p. iv.
*. ought to be sprinkled on. The same things also resist a gangrene. To
bring on a cicatrix, copper scales, soot of frankincense, of each p.
ii. *. lime p. iv. *. p. The same mixture also keeps down fungous flesh.
[Sidenote: _8. Timæus’s for the ignis sacer._]
Timæus made use of the following composition for the ignis sacer(57)
and a gangrene; of myrrh p. ii. *. frankincense, copperas, each p. iii.
*. sandarach, orpiment, copper scales, each p. iv. *. galls p. vi. *.
burnt ceruss p. viii. *. These have the same effect whether sprinkled
on dry, or mixed with honey.
[Sidenote: _Sternutatory medicines._]
Sneezings are excited by putting into the nose either white hellebore,
or struthium. Or this mixture: of pepper, white hellebore each p. iii.
*. castor p. i. *. aphronitre p. ii. *. struthium p. iii. *.
[Sidenote: _Gargarisms._]
Gargarisms are used either to alleviate, or to repel, or to evacuate.
Milk cream of ptisan, or bran, are lenients. A decoction either of
lentils, or roses, or brambles, or quinces, or dates, are repellent.
Mustard and pepper are evacuants.
CHAP. XXIII.
OF ANTIDOTES, AND THEIR USES.
Antidotes, though seldom wanted, are sometimes extremely necessary,
because they relieve in the most dangerous cases. They are properly
exhibited, when bodies are bruised either by blows, or by falling from
a height, or in pains of the bowels, sides, fauces, and more internal
parts. But their principal use is against poisons either injected into
our bodies by bites, or received with meat or drink.
[Sidenote: _1. Antidote._]
There is one, which contains poppy tears p. *. z. acorum,
malobathrum(58) p. v. *. Illyrian iris, gum, of each p. ii. *.
anise p. iii. *. Gallican nard, dry rose leaves, cardamom, each p.
iv. *. parsley p. *. iii. z. trefoil p. v. *. black cassia(59),
silis, bdellium, balsam fruit, white poppy seed, each p. *. z. storax
p. *. v. z. myrrh, opopanax, Syrian nard, male frankincense, juice
of hypocistis, each p. vi. *. castor p. vi. *. costus, white pepper,
galbanum, turpentine resin, saffron, flower of round cyperus, each p.
vi. *. z. liquorice p. viii. *. z. these are incorporated with honey or
passum.
[Sidenote: _2. Antidote called ambrosia._]
Another antidote, which Zopyrus is said to have compounded for king
Ptolemy, and called it ambrosia, consists of the following things:
costus, male frankincense, of each p. v. *. white pepper p. *. z.
flower of round cyperus p. ii. *. cinnamon p. iii. *. black cassia p.
iv. *. Cilician saffron p. *. iv. z. the myrrh called stacte(60) p.
v. *. Indian nard p. *. v. z. which being powdered separately, are
incorporated with boiled honey: then when it is used, the bigness of an
Egyptian bean must be diluted in a draught of wine.
[Sidenote: _3. Mithridates’s antidote._]
But the most celebrated is that of Mithridates: by taking which every
day, this king is said to have rendered his body secure against the
danger or poisons. It contains the following things: of costus p. *.
z. acorus p. v. *. hystericum, cummin, sagapenum, juice of acacia,
Illyrian iris, cardamom, each p. ii. * anise p. iii. * Gallican nard,
gentian-root, dry rose leaves, each p. iv. *. poppy tears, parsley,
each p. *. iv. z. cassia, siler, darnel, long pepper, each p. vi. *.
storax p. *. v. z. castor, frankincense, juice of hypocistis, myrrh,
opopanax, each p. vi. *. malobathrum leaves p. vi. *. flower of round
cyperus, turpentine resin, galbanum, seed of Cretan carrot, each p.
*. v. z. nard, opobalsam, each p. *. vi. z. treacle mustard p. *. vi.
pontic root(61) p. vii. *. saffron, ginger, cinnamon, each p. *.
viii. These are powdered and mixed with honey, and against poison the
bigness of a sweet almond is given in wine. In other disorders of the
body, according to their violence, either the bigness of an Egyptian
bean, or a vetch, will be sufficient.
CHAP. XXIV.
OF ACOPA.
[Sidenote: _Acopon for the nerves._]
Acopa(62) are useful to the nerves. Such is that, which contains
flower of round cyperus p. *. ii. z. z. costus, long cyperus, bay
berries, ammoniacum, cardamom, each p. *. iv. z. myrrh, calcined
copper, each p. vii. *. Illyrian iris, wax, each p. iv. *. Alexandrian
reed, round cyperus, calambac wood, xylo-balsam, each p. xviii. *. suet
p. i. *. iris ointment a cyathus.
[Sidenote: _Another called elæodes._]
There is another, which they call elæodes[EL]; it is made in this
manner: of wax p. *. z. oil a like quantity, and of turpentine resin
the bulk of a walnut; these are boiled together: then being poured into
a mortar, are rubbed, and an acetabulum of the best honey is gradually
dropped into it, then three cyathi of iris ointment and of rose oil.
[EL] ἐλαιω̃̃δες.
[Sidenote: _Of enchrista. One for cleansing and filling ulcers._]
The Greeks call liquids, that are daubed on, by the name of
enchrista[EM]. Such as is that for cleansing and incarning ulcers,
especially amongst nerves. It consists of a mixture of equal parts
of butter, veal marrow, veal suet, goose fat, wax, honey, turpentine
resin, rose and cicine oil. These are all melted separately, then
mixed while they are liquid, and afterwards rubbed together. And this
composition is indeed more cleansing: but it would be more emollient,
if instead of the rose oil, that of cyprus be infused.
[EM] ἔγχριστα.
[Sidenote: _For the ignis sacer._]
For the ignis sacer: of litharge p. vi. *. ox-horn burnt p. ii. *.
these are beat up together, and there is added alternately wine, and
myrtle wine, till three cyathi of each be used.
CHAP. XXV.
OF CATAPOTIA.
[Sidenote: _1. Anodyne catapotium for concoction._]
There are catapotia of various kinds, and composed for different
intentions. They call those anodyna[EN], which mitigate pain by sleep:
which it is not fit to use, unless there be a very great necessity. For
they consist of medicines strong and ungrateful to the stomach. Yet
that even promotes concoction, which contains poppy tears, galbanum,
of each p. i. *. myrrh, castor, pepper, each p. ii. Of these it is
sufficient to swallow the bigness of a vetch.
[EN] ἀνώδυνα.
[Sidenote: _2. Another stronger._]
Another, which is more powerful to promote sleep, but worse for the
stomach, consists of the following ingredients. Of mandrake p. *. z.
seeds of smallage and henbane, each p. iv. *. which are rubbed down
with wine. The same quantity of this, as was directed of the other, is
a plentiful dose.
[Sidenote: _3. A quieting catapotium for pains of the head, &c._]
If there be pains of the head, or ulcers, or a lippitude, or tooth-ach,
or difficulty of breathing, or pains of the intestines, or inflammation
of the womb, or the hip, or a pain in the liver, spleen, or side, or if
a woman falls into hysterick fits, and loses her speech, a catapotium
of the following kind removes the pain by sleep. Sil(63), acorum,
seed of wild rue, each p. ii. *. castor, cinnamon, each p. ii. *.
poppy-tears, root of panaces, dry mandrake fruit, flower of round
cyperus, of each p. ii. *. pepper lvi. grains. These being powdered
separately, are again all rubbed together, dropping in now and then
passum, till they acquire the consistence of sordes. A little of this
is either swallowed, or diluted in water, and given to drink.
[Sidenote: _4. Another of more general use._]
Moreover a handful of wild poppy, when it is just ripe for gathering
the tear, is put into a vessel, and upon it is infused a sufficient
quantity of water to cover it, and thus it is boiled. When this handful
has been well boiled, let it be squeezed and thrown away; and with the
liquor let an equal quantity of passum be mixed, and let them boil
together, till it be as thick as sordes. When it has cooled, it is made
into catapotia of the bigness of our bean, which have an extensive use.
For they both procure sleep, either taken alone, or given in water,
and with the addition of a little juice of rue and passum mitigate
ear-aches: and dissolved in wine they stop a dysentery: and mixed with
cerate made of rose oil, to which a little saffron is added, they
restrain an inflammation of the womb. And spread upon the forehead with
water, they stop the flux of gum to the eyes.
[Sidenote: _5. For a pain of the womb._]
Again, if a pain of the womb prevent sleep, a mixture is made of
saffron p. ii. *. anise, myrrh, each p. i. *. poppy tears p. iv. *.
hemlock seed p. viii. *. and these incorporated with old wine, and the
bigness of a lupin is diluted with three cyathi of water. But this is
dangerous to give in a fever.
[Sidenote: _6. Catapotium for healing the liver._]
For healing the liver, of nitre p. *. z. saffron, myrrh, Gallican nard,
each p. i. *. are mixed with honey, and the bigness of an Egyptian bean
serves for a dose.
[Sidenote: _7. For pains in the sides._]
For removing pains of the sides, equal parts of pepper, birthwort,
nard, and myrrh are mixed together.
[Sidenote: _8. Of the thorax._]
For pains of the thorax, of nard p. i. *. frankincense, cassia, each
p. iii. *. myrrh, cinnamon, each p. vi. *. saffron p. viii. turpentine
resin a quadrans, honey three heminæ.
[Sidenote: _9. Athenio’s for a cough._]
For a cough is that of Athenio: of myrrh, pepper, each p. i. *. castor,
poppy tears, each p. i. *. which are bruised separately, and afterwards
mixed, and two catapotia of the bulk of our bean are given in the
morning, and two, when the patient is going to sleep at night.
[Sidenote: _10. Heraclides’s anodyne catapotium for a cough._]
But if a cough prevents sleep, that of Heraclides the Tarentine is
calculated for both disorders: of saffron p. i. *. cinnamon, castor,
poppy tears, each p. i. *. myrrh, long pepper, costus, galbanum, each
p. *. z.
[Sidenote: _11. Catapotium for foul ulcers in the fauces._]
But if ulcers in the fauces of patients labouring under a cough require
to be cleansed, of panaces, myrrh, turpentine resin, each p. v. *.
galbanum p. *. z. hyssop p. *. z. are to be rubbed together, and to
these a hemina of honey is added, and as much as can be taken upon the
finger must be swallowed.
[Sidenote: _12. The colice of Cassius._]
The colice of Cassius consists of the following ingredients: of
saffron, anise, castor, each p. iii. *. parsley p. iv. *. pepper both
long and round, each p. v. *. poppy-tears, round cyperus, myrrh, nard,
each p. vi. *. which are incorporated with honey. And this may be both
swallowed alone, and taken in warm water.
[Sidenote: _13. For expelling a dead fœtus._]
A draught of water mixed with sal ammoniac p. i. *. or dittany of Crete
p. i. *. expels a dead fœtus or the secundines.
[Sidenote: _14. To forward labour._]
To women in labour hedge mustard ought to be given in tepid wine, when
they are fasting.
[Sidenote: _15. For the voice._]
The voice is assisted by p. i. *. of frankincense given in two cyathi
of wine.
[Sidenote: _16. For a dysury._]
Against a difficulty of urine: of long pepper, castor, myrrh, galbanum,
poppy tears, saffron, costus, each one ounce, storax, turpentine resin,
of each a sextans, wormwood, honey, a cyathus. Of these the bigness of
an Egyptian bean ought to be given in the morning, and after supper.
[Sidenote: _17. The composition of arteriace._]
Arteriace is made in this manner: of cassia, iris, cinnamon, nard,
myrrh, frankincense, each p. i. *. saffron, p. i. *. pepper thirty
grains, are boiled in three sextarii of passum, till they acquire the
consistence of honey. Or saffron, myrrh, frankincense, of each p. i.
*. are mixed with the same quantity of passum, and boiled in the same
manner. Or three heminæ of the same passum are boiled, till a drop of
it grows hard; and p. i. *. of powdered cassia is added to it.
CHAP. XXVI.
OF FIVE DIFFERENT KINDS OF DISORDERS INCIDENT TO THE BODY; AND OF THE
NATURE, SYMPTOMS, AND CURE OF WOUNDS.
Having explained the virtues of medicines, I shall next consider five
different kinds of disorders, to which the body is incident. When it is
hurt externally, as in wounds. When any part is corrupted internally,
as in a gangrene. When any thing grows within some part, as the stone
in the bladder. When any part is preternaturally enlarged, as a vein,
which swelling is called a varix. Lastly, when somewhat is deficient,
or maimed. In some of these medicines, in others manual operations
are most useful. Deferring the consideration of the disorders, which
chiefly require manual operations, I shall now treat of such, as stand
mostly in need of medicines. And I shall divide this part of medicine
in the same manner as the former, and first speak of those, which may
happen in any part of the body; next of these, which attack certain
parts. I shall begin with wounds.
[Sidenote: _Rules for the conduct of the physician._]
Now a physician should above all things know, what are incurable, what
difficult to cure, and what more easy. For it is the part of a prudent
man first, not to undertake one, whose case is desperate, lest he
appear to have killed him, whom his own destiny has destroyed. Next,
in a case of great danger, but not quite desperate, to discover to the
friends of the patient, that it is a matter of difficulty: that if the
malady should prevail against the art, he may neither seem to have
been ignorant himself, nor to have deceived them. But as this is the
proper conduct for a prudent person, so on the contrary it is the part
of a quack to exaggerate a small matter, that he may appear to have
performed the greater cure. Where a case is easy, it is reasonable that
the physician by a free declaration of its easiness be obliged to the
greater diligence and circumspection; that what is in itself small may
not by his negligence become more considerable.
[Sidenote: _Incurable wounds._]
A person cannot be preserved, when the basis of the brain, or the
heart, or the gullet, or the portæ of the liver, or the spinal marrow
is wounded; or when the middle of the lungs, or the jejunum, or smaller
intestine, or stomach, or kidneys are wounded; or when the large veins
or arteries about the throat are cut through.
[Sidenote: _Wounds difficult to cure._]
The cure is difficult in such as are wounded either in any part of the
lungs, or the thick part of the liver, or the membrane that contains
the brain, or in the spleen, or womb, or bladder, or any intestine, or
the diaphragm. Such also are in a very dangerous situation, in whom the
point of a weapon has penetrated as far as the large blood vessels,
that lie deep in the arm-pits and hams. And all wounds are dangerous,
wherever there are large blood-vessels, because they may exhaust a
person by the profusion of blood. And this happens not only in the
arm-pits and hams, but likewise in the veins, which go to the anus and
testicles. Besides these, any wound in the arm-pits, or the inside
of the thighs, or in any cavity, or between the fingers(15)is bad.
Also by which a muscle, or nerve, or artery, or membrane, or bone, or
cartilage, is hurt.
[Sidenote: _Safe wounds._]
A wound in the flesh is safest of all, and these again from their
situation are either worse or better. But a wound when large is
dangerous from its size.
[Sidenote: _The nature and figure of wounds._]
The nature of the wound also and its figure make some difference; for
when a part is both cut and bruised, it is worse than when it is only
cut asunder; so that it is better to be wounded by a sharp weapon, than
a blunt one. And that wound is worse, out of which any substance is
cut, or where the flesh is carried off on one part, and hangs on the
other. In general, those wounds are the worst, that are crooked: and
those safest that are of a straight direction. And then, the nearer the
wound approaches to the first or second of these forms, it is more or
less dangerous.
[Sidenote: _Consideration of the age, constitution, and season._]
Moreover the age, constitution, the way of life _of the patient_,
and the season of the year, are of some importance: for a boy or a
youth recovers more easily than one that is older; the strong than
the infirm; one, that is neither too slender nor too plethoric, than
one, that is on either of these extremes; one of a sound than one of
a corrupt habit; one, that takes exercise, than an indolent person;
the sober and temperate than one given to wine and venery. Again, the
most convenient season of the year for curing a wound is the spring; or
at least when it is neither hot nor cold: for both excessive heat and
intense cold are prejudicial to wounds; but most of all an alternate
change of these: and for that reason the autumn is very hurtful.
[Sidenote: _Of wounds of the internal parts._]
Most wounds are exposed to our view: but there are some, of which we
judge from the situation of the parts, which we explained elsewhere,
when we demonstrated the position of the internal parts. Nevertheless,
because some of these lie superficial, and it makes a difference,
whether a wound be in the surface, or has penetrated deeper; it is
necessary to mention the appearances, by which we may know what is
hurt within; and from which we are either to hope or despair.
[Sidenote: _Symptoms of the heart being wounded._]
When the heart is wounded, there is a great effusion of blood, the
pulse is languid, the skin very pale, cold sweats with a bad smell
come on, the same as in sickness: the extremities grow cold, and death
quickly follows.
[Sidenote: _Of the lungs._]
When the lungs are wounded, there is a difficulty of breathing; frothy
blood is discharged from the mouth, and red blood from the wound; also
along with the latter the air issues with a noise; the patient has an
inclination to lie upon the wound; some start up without any reason.
Many when they are lying upon the wound, are able to speak: if upon
another part, they lose that faculty.
[Sidenote: _Of the liver._]
The symptoms of a wounded liver are these: there is a great effusion of
blood under the right side of the præcordia; the præcordia are drawn
backward towards the spine; there is a pleasure in lying upon the
belly; there are prickings and pains reaching as far as the clavicle
and the broad bone of the shoulder, that is joined to it; to these
there is sometimes added also a bilious vomiting.
[Sidenote: _Of the kidneys._]
When the kidneys are wounded, the pain reaches to the groin and
testicles; the urine is made with difficulty; and it is either bloody,
or grumous blood is voided.
[Sidenote: _Of the spleen._]
But when the spleen is wounded, black blood issues out from the left
side; the præcordia and stomach on the same side grow hard; a great
thirst ensues; and a pain strikes up to the clavicle, as when the liver
is wounded.
[Sidenote: _Of the womb._]
But when the womb is wounded, there is a pain in the groin, and hips,
and inside of the thighs; the blood is partly discharged by the wound,
partly by the vagina; and a bilious vomiting follows. Some women lose
their speech; some are delirious; others sensible, but complain, that
they are tormented with a pain of their nerves and eyes: and when
dying, have the same symptoms, as attend a wounded heart.
[Sidenote: _Of the brain or its membrane._]
If the brain or its membrane has received a wound, blood is discharged
by the nose, in some also by the ears and generally a bilious vomiting
follows. The senses of some are impaired, and they do not perceive when
they are called upon: the countenance of others is fierce; and their
eyes roll different ways, as in a palsy; and commonly on the third or
fifth day a delirium comes on. Many are likewise convulsed. Before
death most of them tear the bandages, with which their head is bound
up, and expose the naked wound to the cold.
[Sidenote: _Of the gullet._]
When the gullet is wounded, a hiccough and bilious vomiting follow; if
any meat or drink has been taken, it is quickly returned; the pulse
grows languid; thin sweats come on, in which the extremities grow cold.
[Sidenote: _Of the stomach and jejunum, and other intestines._]
The signs of a wound in the jejunum and stomach are the same; for
the food and drink pass through the wound: the præcordia grow hard;
sometimes bile is vomited. Only it must be observed, that the jejunum
is situated lower than the stomach. When the other intestines are
wounded, they emit either excrement, or its smell.
[Sidenote: _Of the spinal marrow._]
When the spinal marrow is cut through, there follows either a palsy or
convulsions; the patient becomes insensible; and after some time, the
lower parts discharge involuntarily either seed, or urine, or excrement.
[Sidenote: _Of the diaphragm._]
But if the diaphragm is wounded, the præcordia are drawn upward; there
is a pain in the spine, an oppression of the breath, and a discharge of
frothy blood.
[Sidenote: _Of the bladder._]
When the bladder is wounded, the groin is pained, there is a tension of
the parts immediately above the pubes; instead of urine comes blood;
and the urine is discharged at the wound; the stomach is affected, so
that the patients either vomit bile, or have a hiccough; a coldness
seizes them, and after that death.
[Sidenote: _Of the discharge from wounds and ulcers._]
[Sidenote: _Blood, sanies, and pus._]
[Sidenote: _Ichor._]
[Sidenote: _Melicera._]
[Sidenote: _Elæodes._]
These things being known, there still remain some other particulars to
be observed relating to the wounds and ulcers, which we are to treat
of. From wounds then and ulcers are discharged blood, sanies, and pus.
Blood is known to every one. Sanies is thinner than blood, unequally
thick, glutinous, and coloured. Pus is very thick and white, also more
glutinous than either blood or sanies. Now blood is discharged from a
recent wound, or one that is just healing: sanies appears betwixt these
times: pus in an ulcer beginning to heal. Further, both sanies and pus
are distinguished into several species by Greek names; for there is
one kind of sanies, which is called ichor[EO], another melicera[EP].
There is also a species of pus called elæodes[EQ]. Ichor is thin, of
a whitish colour, and proceeds from a bad ulcer, and especially where
a nerve has been hurt, and an inflammation has followed. Melicera is
thicker, more glutinous, whitish, and somewhat resembling white honey:
this also is discharged from malignant ulcers, where the nerves about
the joints are hurt; and amongst the joints principally from the knees.
Elæodes is thin, whitish, somewhat unctuous, in colour and fatness not
unlike to white oil; and appears in large ulcers, that are healing. Now
blood is bad that is either too thin or too thick, in colour either
livid or black; or mixed with phlegm, or of various colours: the best
is warm, red, moderately thick, and not glutinous. Therefore from the
first the cure of a wound, which has yielded good blood, is more easy
and quick: and afterwards there is more hope of those, from which the
several discharges have been of the best kind. Sanies then is bad,
where it is in great quantity, over thin, livid, or pale, or black,
or glutinous, or fetid, or such as corrodes the ulcer itself and the
adjacent skin. It is better, when the quantity is small, indifferently
thick, of a reddish colour, or inclining to white. Ichor again is the
worst, that is plentiful, thick, inclining to a livid or pale colour,
glutinous, black, hot, fetid. It is more tolerable, if inclining to
white, and when in all other respects it is the reverse of the former.
But melicera is bad, when it is in great quantity, and very thick;
better, when thinner, and less in quantity. Pus is the best amongst
these. But even that too is bad, when it is copious, thin, diluted;
and the more so, if it be such from the beginning; also if in colour
it resemble serum, if it be pale, or livid, or feculent; moreover if
it be fetid; unless the smell arises from the nature of the particular
part, where the ulcer is. The less there is of it, and the thicker,
and whiter, so much the better; and also if it be smooth, if it have
no smell, if it be homogeneous. In quantity, however, it ought to
correspond both with the size and age of the wound: for a greater
quantity is discharged naturally from a larger one; and more before the
inflammation is removed, than afterwards. Elæodes also when plentiful,
and containing but little fat, is bad: but the less there is of it, and
the more oily so much the better.
[EO] ἰχὼρ.
[EP] μελίκηρα.
[EQ] ἐλαιω̃δες.
[Sidenote: _Cure of a hæmorrhage from a wound._]
These things being considered, when any person is wounded, that can
be cured, two things are immediately to be regarded: that he do not
perish either by a hæmorrhage, or an inflammation. If we are afraid of
a hæmorrhage (which may be known from the situation of the wound and
its largeness, and from the force of the stream of blood) the wound
is to be filled with dry lint, and over it a sponge squeezed out of
cold water must be applied, and pressed down with the hand. If this
does not stop the blood, the lint is to be frequently changed: and if
it have not strength enough dry, it must be moistened with vinegar.
This is very powerful in stopping blood: and therefore some people
pour it into the wound. But here again it is to be feared, that the
matter being too forcibly retained there, may afterwards raise a great
inflammation. Which is the reason why neither corroding medicines,
nor such as are caustic, and therefore forming a slough, are to be
used, although most of these stop blood: but if recourse is ever had
to them, such ought rather to be employed, as are the mildest in their
operation. But if even these do not prevail against the hæmorrhage,
the vessels, which discharge the blood are to be taken hold of, and
tied in two places about the wounded part, and cut through, that they
may both unite together, and nevertheless have their orifices closed.
When the circumstances do not even allow of this measure, they may
be cauterized with a hot iron. And in this case too, when there is a
considerable hæmorrhage from a part, where there is neither nerve, nor
muscle, in the forehead for instance, or upper part of the head, it is
very proper to apply a cupping vessel to the opposite part, that the
current of blood may be diverted thither.
[Sidenote: _Cure of the inflammation in wounds._]
These then are the remedies against a haemorrhage: but for an
inflammation the flux of blood itself is the cure. This may be
apprehended, when either a bone has been hurt, or a nerve, or a
cartilage, or a muscle, or when the haemorrhage has been too small in
proportion to the size of the wound. Therefore when any thing of this
kind happens, it will not be proper to stop the blood quickly, but to
suffer it to flow as long as it is safe; insomuch that if the discharge
has appeared small, it ought also to be taken from the arm; especially
if the patient be young and robust, and used to exercise; much more,
if he was intoxicated before he received the wound. And if a muscle
shall appear to be wounded, it must be cut through: for when it is only
divided in part, it is mortal; cut quite through it admits of a cure.
[Sidenote: _The agglutination of wounds._]
The blood then being either stopped, when the haemorrhage is excessive,
or _more_ taken away _by phlebotomy_ when too small, it is far the best
method to agglutinate the wound. Now this may be done, either when it
is in the skin, or even in the flesh, if nothing else is hurt. It may
be done, where the flesh is hanging down in one part, and adhering
in another; provided however it be still sound, and nourished by its
continuity with the body.
In wounds to be agglutinated there is a double method of cure. For if
the wound be in a soft place, it ought to be sewed: and especially, if
the extremity of the ear, or the lower part of the nose be cut, or the
forehead, or the cheek, or the eye-brow, or the lip, or the skin about
the throat, or the belly. But if the wound is in the flesh, and gapes,
and its lips cannot be easily brought together, a suture is improper:
and in this case fibulæ(64) are to be put on (the Greeks call them
ancteres[ER]) to draw the lips a little closer; that the cicatrix may
be the less broad after the cure.
[ER] ἀγκτη̃ρες.
Hence now it may be collected, whether a wound, in which the flesh
is in one part depending, and in another adhering, if it is not yet
corrupted, requires a suture, or a fibula. But neither of them ought
to be applied before the wound be cleansed within, lest any concreted
blood be left there. For that turns to pus, raises an inflammation, and
prevents the wound from being agglutinated. Even the lint, that is put
into it to stop the bleeding, must not be left there; for that also
inflames.
It will be necessary to take up with the needle, or the fibula, not
only the skin, but also some of the flesh below it, that it may adhere
the more strongly, and not break away the skin. Both of them are best
done with soft thread(65), not too much twisted, that it may be the
less uneasy to the part. Neither of them are to be applied at too great
distances, nor too frequently: if at too great distances they will not
hold; if too frequently they are very hurtful; because the oftener
the needle has passed, and the more places are gauled by the fibula,
so much the greater will the inflammation be; and especially in the
summer-time. Neither of them requires any force; but the operation is
only so far useful, as the skin follows the hand as it were of its
own accord. Now the fibula commonly allows a wound to be broader: a
suture joins its lips, but these should not touch one another in every
part; that if any humour be collected within, there may be a passage
for it to escape. But if a wound admits of neither of these, it ought
nevertheless to be cleansed.
In the next place, upon every wound should be applied first a sponge
squeezed out of vinegar: if any patient is not able to bear the
strength of vinegar, wine must be made use of: a slight wound is helped
by laying on a sponge squeezed even out of cold water. But in whatever
way it is put on, it does good no longer than it is moist: therefore
it must not be suffered to dry. A wound may be cured without foreign,
scarce, and compound medicines. But if one has not confidence in that
method, he ought to apply a medicine, that is composed, without suet,
of those things, which I mentioned to be proper for bloody wounds; and
particularly if it be in the flesh, the barbarum: if it be a nerve,
or cartilage, or any of the prominent parts, as the ears, or lips, the
sphragis of Polybus. The green Alexandrian also is fit for the nerves;
and for the prominent parts that, which the Greeks call rhuptousa[ES].
[ES] ῥύπτουσα.--Our author has not mentioned this plaister before, at
least not under the same name.
It is common also, where there is a contusion, for the skin to be
a little broken. When this happens, it is not improper to make a
larger opening with a knife; unless there be muscles and nerves near
to it, which it is not fit to cut. When it is sufficiently opened, a
medicine must be applied. But if the bruised part cannot admit the
opening, though too small, to be enlarged, upon account of nerves or
muscles, such applications are to be used, as may draw out the humour
gently; and of that kind the fittest for the present purpose is the
composition, which I said was called rhypodes. It is not improper
also, wherever there is a severe wound, after applying(66) what is
agreeable to it; to cover the whole with sordid wool moistened with
vinegar and oil; or if the part be soft, a mild restringent cataplasm;
if nervous, or muscular, an emollient.
[Sidenote: _The proper bandages for wounds._]
For binding up a wound a linen roller is most convenient: and this
ought to be bandages for so broad, that a single application of it may
not only cover the wound, but take in a little on each side of it. If
the flesh has shrunk away more on one side, it is better to begin the
rolling from thence; if equally on both sides, it ought to lay hold of
the lips transversely; or if the nature of the wound does not admit of
that, the middle of it is first put on, that it may be drawn afterwards
both ways. Now it is to be bound on in such a manner, that it may both
hold, and not be over tight. When it does not hold, it slides off; and
that, which is over tight, hazards a gangrene. In the winter-time the
roller ought to be carried round oftener; in the summer, no more than
necessity requires. Then the extremity of it is to be sewed to the
lower part of the bandage. For a knot hurts a wound, unless it be at a
distance from it.
Moreover every person ought to know, that the viscera, which I
mentioned before, require a particular method of cure. For the external
wound is to be cured either by a suture, or some other method. In the
bowels nothing is to be touched, unless some bit in the extremity of
the liver, or spleen, or lungs be hanging out, which may be cut away.
Otherwise the internal wound is to be cured by the diet and medicines,
which I mentioned in the former book as agreeable to each viscus.
[Sidenote: _Directions for the patient’s diet._]
These steps being taken on the first day, the patient must be put to
bed: and if the wound be severe, he ought to abstain from food, as
much as his strength will permit, before the inflammation comes on;
to satisfy his thirst with warm water, or if it be in summer, and he
have neither fever nor pain, the water may be cold. However no rule
is so constant, but that a regard must always be had to the strength
of the patient; so that his weakness may render it necessary to take
food immediately, but such as is thin, and in small quantity, just
sufficient to support him. And many sinking under a hæmorrhage, before
any thing else be done, are even to be refreshed with wine; which is
otherwise very prejudicial to a wound.
[Sidenote: _Good and bad symptoms in wounds._]
It is dangerous for a wound to swell too much: not to swell at all is
extremely dangerous. The first is a sign of a violent inflammation;
the other of a mortification. If the patient be sensible, and no fever
has come on, we may at once conclude, that the wound will be soon
healed: and even a fever ought not to alarm us, if in a large wound it
continue, while the inflammation subsists; it is bad, when it either
supervenes to a slight wound, or lasts longer than the inflammation,
or brings on a delirium; or if it does not remove a tetanus, or
convulsion, that arose from the wound. Also an involuntary bilious
vomiting coming on either immediately after the wound is received,
or while the inflammation continues, is a bad symptom in those only,
whose nerves, or nervous parts are wounded. However to take a vomit is
not hurtful; especially in those, who have been accustomed to it; but
neither immediately after meat, nor when the inflammation has begun,
nor when the wound is in the superior parts.
[Sidenote: _Dressings for wounds._]
The wound being kept thus for two days, on third it must be opened,
and the sanies must be wiped off with cold water, and the same kind
of dressings put on. On the fifth day it will be easy to judge to
what height the inflammation is to rise. On which day the wound must
be uncovered again, and its colour observed. And if it be livid, or
pale, or variegated, or black, we may be sure it is a bad wound: and
whensoever this appearance is observed, it may alarm us. It is best for
a wound to be white, or ruddy. Also a hard, thick, and painful skin
denotes danger. It is a good sign, when this is free from pain, thin
and soft. But if the wound is closed, or there be a slight swelling,
the same application must be used as at first.
If the inflammation is violent, with no hopes of an agglutination,
and does not yield, the use of warm water too is necessary, that it
may dissipate the matter, and soften the hardness, and promote a
suppuration. It must be of such a degree of warmth, as to be agreeable
to the hand; and be continued so long, till it appear to have
diminished in some measure the swelling, and restored a more natural
heat to the ulcer. After this fomentation, if the wound does not gape
much, a plaister should be applied immediately, and if it be a large
wound, the tetrapharmacum would be best; in the joints, fingers, or
cartilaginous parts, the rhypodes. But if it gapes pretty much, that
same plaister must be softened with ointment of iris, and lint spread
with it must be laid over the wound; then the plaister applied above,
and over that sordid wool; and the rollers must be also less tight than
at first.
[Sidenote: _Peculiar directions for wounds in the joints._]
But there are some peculiarities to be attended to in the joints. If
the nerves, which secure them, are cut through, a weakness of that part
follows. If that is uncertain, and the wound is from a sharp weapon,
and that in a transverse direction, it is more easy to cure: and if it
be from a blunt and heavy one, the figure of it makes no difference:
but it must be observed whether the pus comes from above or below the
joint. If it come from under it, and continue a long time white and
thick, it is probable that a nerve is cut through, and the more so, the
greater the pains and inflammations are, and the sooner they began. But
although the nerve be not cut through, yet if a hard tumour continue
round it long, the ulcer of necessity must be tedious, and even when
that is healed, the tumour will remain; and it will be a considerable
time before that limb recover its power either of extension or
contraction. And it is longer before it can be extended, when the cure
has been conducted with the joint bent, than it is before one can be
bent, which we have kept straight. The limb, that is wounded, ought to
be placed also in a certain position: if it is to be agglutinated, it
must be laid high; if it is inflamed, so as to incline to neither side;
if the pus has begun to flow, it must be kept in a depending posture.
Rest too is an excellent remedy. Motion and walking are prejudicial,
except to people in health: however, less dangerous to such as are
wounded in the head or arms, than those, that are wounded in the lower
parts. And walking is least of all proper, when the hurt is in the
thigh, or the leg, or the foot. The place, where the patient lies,
ought to be warm. Bathing also, while the wound is not clean, is
extremely bad: for that renders it both tumid and foul; from whence the
transition to a gangrene is common. Gentle friction is good; but in
those parts, that are at a great distance from the wound.
[Sidenote: _Deterging of wounds._]
After the inflammation is gone, the wound must be deterged. That end
is best obtained by lint dipt in honey; and over that must be applied
either the tetrapharmacum plaister, or the enneapharmacum. Now that
ulcer is clean, which appears red, and is neither too dry nor too
moist. But any ulcer that is deprived of its sensibility, or whose
feeling is unnaturally exquisite, or that is either too dry or too
moist, or that is either whitish or livid, or black, that ulcer is not
clean.
[Sidenote: _Incarning of wounds._]
After a wound is deterged, it must next be incarned; and for that
purpose warm water is so far necessary, as to remove the sanies. The
use of sordid wool is improper; it is better to cover it with such as
has been washed. And there are also some medicines, which conduce to
the filling up of the wound; therefore it is not amiss to make use
of them: such as butter with oil of roses, and a small proportion of
honey; or the plaister tetrapharmacum with the same proportion of
honey, or with the oil of roses; or lint dipped in oil of roses. But
the bath used sparingly is more efficacious; and food of a good juice,
avoiding every thing acrid. When they are almost filled up, birds and
venison and boiled pork may be given. Wine is always hurtful, while
there is a fever or inflammation; and indeed, till it be cicatrized,
if either nerves or muscles are wounded; or even the flesh, if it be
deep. But if the wound is of the safer kind, and only superficial,
wine not very old, given in moderate quantities however, may promote
the incarnation. If any thing is to be softened, which is necessary in
nervous and muscular parts, cerate must also be laid upon the wound.
But if fungous flesh has grown upon it, dry lint restrains it gently;
copper scales more powerfully. If the quantity to be taken away be more
considerable, things still stronger must be applied to eat down the
flesh. After these a cicatrix is very well formed by lycium diluted in
passum or milk; or dry lint laid on alone is still more efficacious.
[Sidenote: _Bad consequences from unsuccessful cures._]
This then is the process of a successful cure. But at times things will
happen to take a dangerous turn. For sometimes the ulcer grows ancient,
a callosity comes over it, and its lips are thick, and of a livid
colour: after which, whatever medicine is applied, does little good;
and this generally happens to an ulcer negligently treated.
Sometimes from an excessive inflammation, or violent heats, or
excessive cold, or too tight bandages, or the old age or bad habit of
the patient, a gangrene seizes upon it. This kind of disorder by the
Greeks is divided into several species, for which we have no terms in
our language. Now every gangrene not only corrupts that, which it has
seized upon, but also spreads. But then the distinction is to be made
between the species by different symptoms. For sometimes beyond the
inflammation a redness surrounds the ulcer, and spreads with pain; the
Greeks call it erysipelas[ET].; sometimes the ulcer is black, because
the flesh of it is corrupted, and the blackness is greatly increased
as the putrefaction goes on, when the wound is moist, and from the
black ulcer is discharged a pale fetid liquor, and the flesh within is
corrupted(67): sometimes also the nerves and membranes are dissolved,
and a probe put in descends either laterally or downwards; sometimes
the bone is affected with that disorder: and sometimes there follows
what the Greeks call gangræna[EU].
[ET] ἐρυσίπελας.
[EU] γάγγραινα.
The former kinds happen in any part of the body: the last mentioned
about the extremities, that is, the nails, the armpits, or groin; and
generally in old people, or in such as are in a bad habit of body. The
flesh of such an ulcer is either black or livid, but dry and withered,
and the contiguous skin is for the most part covered with pustules of
a dark brown colour; then the next to that is either pale or livid,
and commonly of an æruginous colour, and void of sensation; the skin
a little farther off(68) is inflamed. And all these spread at once;
the ulcer into the pustulous part; the pustules to the part that is
pale or livid; the paleness or livor to that which is inflamed; and the
inflammation proceeds to that which is sound. In the mean time an acute
fever comes on, and a vehement thirst; some are also delirious; others,
though they be sensible, stammer, and with great difficulty can make
their meaning understood; the stomach begins to be affected; the breath
itself acquires a fetid smell. Now this disorder in the beginning
admits of a cure; but when it is thoroughly rooted, it is incurable;
and most of them die with a cold sweat.
[Sidenote: _The cure of an old ulcer._]
These are the dangers, to which wounds are liable. But when the ulcer
is old, it must be cut round with a knife, and its lips cut off, and
whatever beyond them is livid, must likewise be scarified. If there be
a small varix within, which prevents its healing, that also must be cut
out. Afterwards when blood has been discharged, and a new face thus
given to the wound, the same method of cure must be pursued, which has
been directed for recent wounds. If any person does not chuse to make
use of a knife, the plaister, which is composed of labdanum, may incarn
it, and when the ulcer has been eaten down by that, a plaister, which
brings on a cicatrix.
[Sidenote: _Of an erysipelas._]
Now that, which I said has the name of an erysipelas, is not only
consequent upon a wound, but often happens without it, and is sometimes
very dangerous; especially if its seat be about the neck or head.
It is proper, if the strength will admit, to bleed; then to apply at
once repellents and coolers, and particularly cerus with the juice of
nightshade, or cimolian chalk with rain water; or meal made into a
paste with the same water, with the addition of cypress, or if it be in
a tender part, with lentils. Whatever is applied, must be covered with
a beet leaf, and upon that must be laid a linen cloth dipped in cold
water. If coolers alone do little service, the following mixture must
be made; of sulphur p. i. *. ceruss, saffron, each p. x. *. and these
to be rubbed down with wine, and spread over the part: or if the place
is not tender, leaves of nightshade powdered must be mixed with hog’s
lard, and applied spread upon linen.
But if there be a blackness, which does not yet spread, such
applications must be used, as will gently eat away the putrid flesh;
and the ulcer being thus cleansed, must be dressed in the same manner
as others. If it be more putrid, and already begins to advance and
spread, there is a necessity for stronger corrosives. If even these
do not overcome it, the part must be cauterized, till no moisture
flow from it; for whatever is sound, is dry when it is burnt. After
the burning of a putrid ulcer, such applications must be used, as
may separate the sloughs from the quick part; the Greeks call them
apescharotica[EV]. When they have fallen off, the ulcer must be
cleansed, particularly with honey and resin; but it may be cleansed
also by those things with which purulent ulcers are dressed, and healed
up by the like methods.
[EV] ἀπεσχαρωτικὰ.
[Sidenote: _Of a gangrene._]
It is not very difficult to cure a gangrene, if it has not got full
possession, but is only beginning, especially in a young person: and
easier still, if the muscles are sound; or if the nerves are either
untouched, or but slightly affected; and no large joint laid bare; or
there be but little flesh in that part, and consequently not much to
putrify, and if the disorder is confined to one place, which chiefly
happens in a finger. In such a case the first thing to be done, if the
strength will allow, is to let blood: after that, to cut through to the
sound flesh, whatever is dry, which by a kind of tension is uneasy to
the contiguous parts.
While the disorder is spreading, no suppurating medicines are to be
applied; and for that reason not so much as warm water. Ponderous
medicines also, although they be repellent, are hurtful; but the
lightest of that nature are required; and over the parts, which are
inflamed, coolers must be applied. If the disease is not stopped by
these, so much as is betwixt the sound and corrupted parts, ought to be
cauterized.
And in this case particularly help must be sought not from medicines
alone, but from a due regimen: for this disease never appears but in
a corrupt and vitiated habit. Wherefore in the first place, unless
weakness forbid, the patient must live abstemiously: and then for food
and drink must be given what will bind the belly, and consequently
the body also; but these must be of a light nature. Afterwards if
the disorder stop, the same applications must be used as have been
prescribed in a putrid ulcer. And then also a fuller diet may be
allowed of the middle class: only such however as tends to dry the
belly and the whole body; and the drink must be cold rain water.
The bath, unless we are confident of a cure, is hurtful; for the
ulcer softened by that means is quickly affected again with the same
disorder. But sometimes it happens, that all these remedies do no
service, and notwithstanding all their force, the gangrene spreads. In
which case the miserable but sole remedy is to cut off that limb, which
is perishing by degrees, to save the rest of the body.
[Sidenote: _The cure of more slight wounds._]
This then is the method of treating the most severe wounds. But even
such are not to be neglected, where the skin is entire, but the flesh
within(69) is bruised; or where any thing is razed or rubbed off the
surface; or when a splinter is fixed into the flesh; or when a wound,
though small, has penetrated deep.
In the first case it is a very proper remedy to boil pomegranate bark
in wine, and bruising the inner part of it, to mix it with a cerate of
the oil of roses, which is to be laid upon the part; then where the
skin is razed, to cover it with a mild medicine, such as the lipara[EW].
[EW] λιπαρὰ.
Upon the part, that has its surface razed and rubbed off, the
tetrapharmacum plaister must be applied, and the quantity of food
diminished, and wine denied. Nor should such a hurt be looked upon as
contemptible, because the wound is not deep: for from such accidents
gangrenes often arise. But if it be slight and of small extent, the
mild medicine abovementioned may be sufficient for the cure.
A splinter, if possible, must be extracted either by the hand or
by an instrument: if it has either broke or penetrated deeper than
to admit of this, it must be drawn out by a medicine. Now the best
application for that purpose is the root of a reed; which if tender,
must be immediately bruised; if grown hard, it may be first boiled in
mulse: to this honey must always be added; or birthwort with honey must
be applied. The worst splinter is that of a reed, on account of its
asperity: the fern is also equally hurtful: but it has been found by
experience, that each of these bruised and applied is a cure for the
other. Every medicine, that has the faculty of drawing, has the same
effect in all splinters. The same kind of medicine is also finest for
deep and small wounds: the plaister of Philocrates is best adapted to
the former, that of Hecatæus to the latter case.
[Sidenote: _Of cicatrizing ulcers._]
In any wound, when we are to form the cicatrix (which is necessary
after the ulcers are thoroughly cleansed and incarned) in the first
place lint dipped in cold water must be applied, while the growth of
flesh is encouraged; afterwards when that is to be restrained, it
must be put on dry, till a cicatrix be formed; then white lead ought
to be bound over it, which both compresses the cicatrix, and gives
it a colour resembling the sound part of the body. The root of wild
cucumber has the same effect. Also the composition, which contains of
elaterium p. i. *. litharge p. ii. *. myrobalans p. iv. *. to which is
added turpentine resin, till the whole be brought to the consistence
of a plaister. But black cicatrices are gently cleansed by a mixture
of equal parts of verdigrease, and washed lead, and the same resin
boiled, whether the cicatrix be anointed with this, which may be
practised in the face, or it be applied like a plaister, which is more
convenient in other parts of the body.
But if the cicatrix is either protuberant or hollow, it is ridiculous,
merely in regard to the appearance to submit a second time to the pain
and trouble of a cure; otherwise both cases might be remedied. For
either of these cicatrices may be converted into a wound by the knife.
If one rather chuses a medicine, the same purpose is answered by those
compositions, which eat down flesh. When the skin is taken off, upon
the prominent one must be applied eating medicines, upon the hollow one
such as tend to fill up, till both these kinds of ulcers be brought to
the level of the sound skin, and then they may be cicatrized.
CHAP. XXVII.
OF WOUNDS CAUSED BY BITES; POISONS TAKEN INTERNALLY; AND BURNS.
I have treated of those wounds, which are most commonly inflicted
by weapons. It follows, that I speak concerning those, which are
occasioned by the bite, sometimes of a man, sometimes of an ape, often
of a dog, sometimes of wild beasts, or other animals, or serpents. Now
almost all bites(70) are in some degree venomous.
Therefore if the wound be severe, a cupping vessel must be applied;
if slight, a plaister must be immediately put on, particularly that
of Diogenes; if that is not to be had, any of those, which I have
prescribed against bites; if these are not to be got, the green
Alexandrian; if that is not at hand neither, any of those, which are
not greasy, that are calculated for recent wounds. Salt is also a
remedy for them, and particularly for the bite of a dog, if it be
applied dry, and the part be chaffed with two fingers; for it brings
out the sanies. It is also of use to bind salt fish over such a wound.
[Sidenote: _The bite of a mad dog._]
If the dog was mad, it is more especially necessary to extract the
poison by cupping. After that, if the part is neither nervous nor
muscular, the wound must be cauterized. If it cannot be cauterized,
it is proper for the patient to be bled. Then upon the wound, after
burning, must be applied what is proper for other cauterized ulcers.
Such as have not been cauterized must be treated with those medicines,
that powerfully corrode the flesh. After which the wound must be filled
up, and healed by no other than the common method already laid down.
Some presently after the bite of a mad dog order such a patient into
the bath, and allow him to sweat there as long as he is able, with the
wound bare, that the poison may the more readily be discharged; then
they refresh him with plenty of strong wine, which is an antidote to
all poisons. And when this method has been pursued for three days, the
patient is thought out of danger.
But it is usual for such a wound, if not effectually treated, to
produce a fear of water. The Greeks call it hydrophobia[EX]: a most
miserable kind of disease, in which the patient is tormented at once
with thirst, and a dread of water. When this happens, there is very
little hope left. But yet there is one remedy: to throw the patient
unawares suddenly into a pond, and if he cannot swim, to suffer him to
sink sometimes, and thus drink, and sometimes to lift up his head; if
he can swim, to keep him down at times, that even against his will he
may be satiated with water: for thus at once both the thirst and dread
of water is removed. But this practice is attended with another danger,
which is, that a weak body fatigued in cold water, may be destroyed by
a convulsion. To prevent which, from the pond he must immediately be
put into warm oil. An antidote (particularly that which I mentioned
first, or in its stead another) if the patient is not possessed with
the horror of water, may be given to drink in water; if he be offended
with its bitterness, honey must be added; but if that disease has
already come on, it may be taken in the form of catapotia.
[EX] ὑδροφοβία.
[Sidenote: _Of the bites of serpents in general._]
The bites of serpents do not require a very different treatment:
although in this the ancients varied greatly; in so much that they
prescribed as many distinct methods as there were kinds of snakes; in
which too they differed widely from each other. But generally the same
remedies have the best success in all of them. Wherefore in the first
place the limb must be tied above the wound; but not too tight, lest
it become torpid. Then the poison must be extracted. This is best done
by cupping. Neither is it improper to cut round the wound first with a
knife, that the more of the blood already vitiated may be extracted.
If a cupping vessel cannot be had (which can scarcely happen) then any
other similar vessel will do, which will serve the same purpose. If
none such can be got, a person must be employed to suck the wound.
Nor indeed have those, that are called Psylli(71), any peculiar
skill, but a boldness confirmed purely by custom. For the poison of
a serpent, as also some of those, which hunters make use of, and
especially in Gaul(72), are not hurtful, taken in by the mouth, but
injected by a wound: and for that reason even a snake itself is safely
eaten: its bite is mortal, and when it is in a state of stupidity
(which dealers in legerdemain can produce by the force of some drugs)
if one puts his finger into its mouth, and is not bit, he receives
no hurt from the saliva. Therefore any person that, like a Psyllus,
shall suck the wound, will both be safe himself, and save the patient.
In the mean time he ought to attend to this first, that he have no
ulcer either in his gums, or palate, or any other part of his mouth.
Afterwards the patient must be laid in a warm place, in such a posture,
that the part, which is wounded, may be in a depending posture.
If no body can be got to suck the wound, nor a cupping vessel is at
hand, the patient ought to sup goose or veal broth, till he vomit. A
chicken must also be cut through the middle alive, and immediately
applied warm over the wound, with the internal part next the body.
The same effect is produced by a kid, or a lamb cut up, and the warm
flesh immediately laid upon the wound, and by the plaisters, that have
been mentioned before: the most proper of which is the Ephesian, or
that, which follows it. To take some antidote too immediately, is a
powerful protection against the danger. But if that cannot be had,
it is necessary to sup a little pure wine with pepper, or any thing
else, which serves to excite heat, and does not suffer the humour to
coagulate within. For the greatest part of poisons kills by cold. All
diuretics too, because they attenuate the humour, are useful.
[Sidenote: _Of the bite of an aspis._]
The former remedies are general, and good against bites: but experience
itself has taught us, that a person, who has been bit by an aspis,
ought rather to drink vinegar. Which is said to have been discovered
by the case of a certain boy, who, when he had been wounded by one,
and partly from the wound itself, and partly from the excessive heat
of the weather, was tormented with thirst, and the country being dry,
could find no other liquor, drank off vinegar, which he chanced to have
by him, and was cured. The reason of the effect in my opinion is, that
vinegar, though it refrigerate, yet has a faculty of dissipating at the
same time. Whence it happens, that earth sprinkled with it rises in a
froth. From the same virtue therefore it is very probable, that the
fluids of the human body beginning to be coagulated are dissipated by
it, and health thereby restored.
[Sidenote: _Of the scorpion._]
Against the poison of some other serpents also peculiar remedies are
well known. For the scorpion is a most excellent remedy against itself.
Some drink it bruised with wine. Some apply it in the same form to the
wound. Others laying it upon live coals fumigate the wound with it,
keeping a cloth all round it, that the smoke may not escape; and then
bind it on when burnt to a coal. Now it is proper to drink in wine
the seed, or at least the leaves of turnsole (which the Greeks call
heliotropium[EY].) And over the wound it is fit to apply bran with
vinegar, or wild rue, or salt toasted with honey. But I have known
physicians, who have done nothing else to people stung by a scorpion,
but bled them in the arm.
[EY] ἡλιοτρόπιον.
For the sting of a scorpion also, and a spider, garlick mixed with rue,
and rubbed down with oil, is a proper application.
[Sidenote: _Of the cerastes, dipsas, and hæmorrhois._]
For a wound given by a cerastes(73), or dipsas(74), or hæmorrhois(75),
the remedy is dried asphodel, about the bigness of an Egyptian bean,
with the addition of a little rue given in drink, and divided into
two doses. Trefoil also and horse-mint, and panaces with vinegar are
equally good. Also costus, and cassia, and cinnamon are proper to take
in drink.
[Sidenote: _Of a chersydrus._]
Against the wound of a chersydrus(76), panaces or laser, or each
scruples p. ii. *. Or the juice of a leek is to be taken with a hemina
of wine, and savory eaten plentifully. And let goat’s dung boiled in
vinegar be laid upon the wound; or barley meal in the same manner with
vinegar; or rue, or cat-mint, powdered with salt and mixed with honey.
And this is equally efficacious against the bite of a cerastes.
[Sidenote: _Of a phalangium._]
When a phalangium(77) has given a wound, beside the chirurgical part
of the cure, the patient should be frequently plunged into the warm
bath, and an equal quantity of myrrh and stavesacre is to be given in a
hemina of passum; or radish-seed, or darnel-root with wine; let there
be also applied to the wound bran boiled with vinegar, and he must be
ordered to continue quiet.
[Sidenote: _Of Italian snakes._]
But the kinds of serpents mentioned hitherto are foreign, and much more
dangerous than ours; especially those, which are in very hot countries.
Italy and the colder climates, besides that they are more healthful in
other respects, have the advantage in this, that they produce snakes
less formidable. Their bites are well enough cured by the herb betony,
or bindweed, or centory, or agrimony, or germander, or burdock, or
pastinaca fish(78), either singly, or any two of them taken together
powdered, and thus given to drink in wine, and also applied upon the
wound. It is necessary to observe, that the bite of every serpent is
more hurtful, when either the animal or the wounded person is fasting,
and therefore they are most pernicious when they are hatching; and it
is adviseable, when any one is apprehensive of meeting serpents, not to
go out, before he has taken some food.
[Sidenote: _Of poisons._]
It is not so easy to relieve those, who have swallowed poison, either
in their food or drink. In the first place, because they do not
perceive it immediately, as those do, who are bit by a snake; and
therefore cannot instantly apply the remedy. In the next place, because
the hurt does not begin in the skin, but in the internal parts. However
it is best, as soon as one discovers it, immediately to drink largely
of oil, and to vomit. And then, when he has emptied his praecordia, to
take an antidote in his drink; if that is not to be got, pure wine.
[Sidenote: _Remedies against cantharides._]
Nevertheless there are some peculiar remedies against certain
poisons, and chiefly of the milder kind. For if any person has drunk
cantharides, he ought to take panaces bruised with milk, or galbanum,
with the addition of wine, or milk by itself.
[Sidenote: _Against hemlock._]
If hemlock, let the patient drink as much hot pure wine with rue as he
can; then he must be forced to vomit; after that, laser with wine must
be given; and, if he be free of a fever, he must be put into the warm
bath; if not, be anointed with warm ingremedies. After these, rest is
necessary for him.
[Sidenote: _Henbane._]
If henbane, hot mulse must be drunk, or any kind of milk, but more
particularly asses milk.
[Sidenote: _Ceruss._]
If ceruss, the juice of mallows, or of a bruised walnut with wine are
most serviceable.
[Sidenote: _A leech._]
If one happens to swallow a leech in drinking, vinegar with salt must
be given. If milk has curdled in the stomach, either passum, or laser
with vinegar.
[Sidenote: _Poisonous mushrooms._]
If a person has eaten poisonous mushrooms, let him take radish
either out of vinegar and water, or salt and vinegar. These may both
be distinguished from the good by their form, and also be rendered
innocent by the manner of dressing. For they are perfectly freed from
all noxious qualities, by boiling them in oil, or with a twig of a
pear-tree.
[Sidenote: _Of burns._]
Burns are also to be reckoned amongst the effects of external violence.
The plan laid down, therefore, seems to oblige me to speak of them
in this place. They are best cured by the leaves either of lilly, or
hound’s-tongue, or betes boiled in wine and oil. Any of these presently
applied heals them.
But the method of cure may also be divided into those things, which
being gently eating and repellent, at first both prevent pustules, and
excoriate the part; and those, which being lenient, restore the part
to its soundness. Of the former is the meal of lentils with honey,
or myrrh with wine; or Cimolian chalk, powdered with the bark of
frankincense, and worked up to a paste with water, and when it is to be
used, diluted with vinegar. Of the second class any of the lipara. But
the most suitable is that, which contains the dross of lead, or yolks
of eggs.
Another way also of treating burns is, while the inflammation
continues, to apply to them lentils with honey; when that is gone off,
meal with rue, or leeks, or horehound, till the crusts fall off, then
vetches with honey, or iris, or turpentine resin, till the ulcer be
clean; last of all, dry lint.
CHAP. XXVIII.
OF EXTERNAL DISORDERS PROCEEDING FROM AN INTERNAL CAUSE, AND THEIR CURE.
[Sidenote: _Of a carbuncle._]
From external injuries, we proceed to disorders which have an internal
origin, when some part of the body is corrupted. Amongst these none is
worse than a carbuncle. The marks of it are these. There is a redness,
and above that pustules rise, not very high, mostly black, sometimes
inclining to a livid colour, or pale. There seems to be sanies in them;
below, the colour is black. The flesh is parched, and harder than it
ought to be naturally. And about it, there is a sort of crust; which is
surrounded with an inflammation. Neither can the skin be lifted up in
that place, but is, as it were, bound down to the flesh below. There
is a propensity to sleep. Sometimes a shuddering, or fever comes on,
or both. And this disease shoots out roots, as it were, below, and
spreads, sometimes quickly, sometimes more slowly. At the surface also
it spreads and grows white; then becomes livid; and all round it small
pustules break out. And if it happen to be near the gullet or fauces,
it often stops the breath suddenly.
Nothing is better than to sear it immediately. Neither is that painful,
for it has no feeling, because such flesh is mortified. And the burning
should be continued, till there is a sense of pain on every side. After
this, the ulcer is to be cured in the same manner, as other burns.
For by eating medicines is produced an eschar, which being entirely
separated from the quick flesh, draws with it whatever was corrupted;
and the sinus, by this time clean, may be dressed with incarning
medicines. But if the disorder be in the surface of the skin, medicines
barely eating, or at most caustic, may be sufficient. The violence of
the cure is to be proportioned to the malady. Whatever medicine is
applied, if it has the desired effect, will immediately separate the
corrupted part from the quick.
And we may generally be confident of success, if the corrupted flesh
falls off, wherever such medicine eats down; if that does not happen,
and the medicine is overcome by the disease, an immediate recourse
must be had to the actual cautery. But in such a case, the patient
must abstain from food and wine. It is also proper to drink water
plentifully. And these directions are to be observed more strictly, if
a febricula be added to the other complaints.
[Sidenote: _Of a Cancer._]
There is not so great danger of a cancer[EZ], unless it be irritated by
the imprudence of the physician. This disease generally happens in the
superior parts, about the face, the nose, ears, lips, and breasts of
women. It also rises from the liver, or spleen. About the place there
are pricking pains; it is immoveable, and unequally swelled; it is also
sometimes insensible. Around it the veins are inflated, and tortuous;
and either pale or livid; in some also, they are concealed from view.
Touching the part gives pain to some, to others none. Sometimes it is
harder, or softer, than it ought naturally to be, without any ulcer; at
other times, all other circumstances being as above described, there
is likewise an ulcer. Sometimes it has no peculiar characteristic to
distinguish it; at other times it resembles those which the Greeks call
condylomata[FA], but has an asperity and magnitude peculiar to itself.
And its colour is red, or resembling that of a lentil. Neither is it
safe to cut it; for immediately there follows either a palsy, or a
convulsion. Often when a person receives a blow upon it, he loses his
speech and faints. In some also if the tumour itself be compressed,
the contiguous parts grow tense and swell. Now this is a very bad
kind(79). Its general progress is this; first appears what the Greeks
call a cacoethes[FB], then it becomes a carcinoma, without an ulcer.
From that an ulcer; and from an ulcer a thymium.
[EZ] καρκίνωμα.
[FA] κονδυλώματα.
[FB] κακόηθες.
None of these can be removed but the cacoethes(80); the rest are
irritated by every method of cure; and the more violent the operations
are, the more angry they grow. Some have made use of caustic medicines;
others of the actual cautery; others cut them out with a knife. Nor
was any person ever relieved by medicine; but after cauterizing, the
tumours have been quickened in their progress, and increased till
they proved mortal; when they have been cut out, and cicatrized, they
have, notwithstanding, returned, and occasioned death. Whereas, at the
same time, most people, by using no violent methods to attempt the
extirpation of the disease, but only applying mild medicines, to sooth
it, protract their lives, notwithstanding the disorder, to an extreme
old age. But no body can pretend to distinguish a cacoethes, which is
curable, from a carcinoma, which is not, otherwise than by time and
experiments.
Therefore, so soon as this disease is perceived, caustic medicines
ought to be applied; if the disorder is alleviated, and its symptoms
grow milder, we may proceed both to incision and the actual cautery;
if it is immediately irritated, we may conclude, that it is already a
carcinoma; and every thing acrid and severe is to be taken away. But
if the part is hard, without any ulcer, it is sufficient to apply a
very mellow fig, or the plaister called rhypodes. If there is an ulcer,
but not rising _above the surface of the skin_, the cerate of rose oil
is to be put on, with the addition of a powdered shell, with smith’s
forge water. If it grows fungous, copper scales (which is the gentlest
caustic) must be tried, till there is no rising above the other parts;
provided still that it does not exasperate; if it does, we ought to be
content with the same cerate.
[Sidenote: _Of a therioma._]
There is also an ulcer, which the Greeks call therioma[FC]. This both
comes of itself, and sometimes is consequent upon an ulcer produced
from another cause. The colour is either livid or black; the smell
is bad; it discharges copiously a humour like mucus; it is sensible
neither of the touch, nor of medicine; and is only disturbed by
itching. About it there is a pain and inflammation. Sometimes also a
fever comes on. Sometimes there is a haemorrhage from the ulcer, and
this disorder spreads, by which all the symptoms often increase. From
these proceeds the ulcer which the Greeks call herpes esthiomenos[FD],
_voracious herpes_; because by spreading quickly, and penetrating
even to the bones, it devours the body. The surface of this ulcer
is unequal, resembling dirt; and there is in it a great quantity of
glutinous humour, an intolerable smell, and an inflammation more
violent, than is found in an ulcer of that size. Both of them, as
indeed all the kinds of gangrenes, happen chiefly to old people, or
those, who are in a bad habit of body.
[FC] θηρίωμα.
[FD] ἕρπης ἐσθιόμενος.
The manner of curing both is the same; but the greater disease requires
the sharper remedy. And the regimen must first be regulated; the
patient must rest in his bed, for some days abstain from food, drink
water very plentifully, and have a clyster given him. Then, when the
inflammation is gone, let him take food of a good juice(81), avoiding
every thing acrid; he may drink as much as he will, provided he be
content in the day-time with water but at supper, he may also drink
some rough wine. But the abstinence should not be equally severe in a
herpes, and a therioma. This then is the regimen necessary.
Externally upon the ulcer, must be sprinkled powder of dry aloes, and
if that does but little service, chalcitis. But if any nerve, by the
flesh being destroyed, be laid bare, it must be covered first with
linen, lest it be burnt by that medicine. If there is need of remedies
still more powerful, we must make use of those compositions, that
cauterize more strongly. Now when any medicine is sprinkled on, it
ought to be done by the broad end of a probe(82). Over it should be
applied either lint with honey, or olive leaves boiled in wine, or
horehound: and these must be covered with linen dipped in cold water,
and then well squeezed. And all round, where there is a tumour from the
inflammation, repellent cataplasms must be applied. If by these methods
it grows no better, the place ought to be cauterized with a _hot_ iron;
the nerves that are in view being first covered. By what has been said
on other occasions, it will be clear enough to any body, that a part,
which is burned either by medicines or the actual cautery, must first
be cleansed, and then filled up.
[Sidenote: _Of the ignis sacer._]
The ignis sacer ought also to be numbered amongst bad ulcers. There
are two species of it. The one is of a colour inclining to ruddy, or
a mixture of red and pale, and the surface is roughened by contiguous
pustules, of which no one is bigger than another, but they are very
numerous, and exceeding small. In these there is almost always pus, and
often a redness attended with heat; and that spreads, sometimes when
the part first affected is healing, sometimes when it is ulcerated,
in which case, the pustules breaking, one continued ulcer is formed,
discharging a humour, which seems to be betwixt sanies and pus. It
attacks chiefly the breast, or sides, or extremities, and particularly
the soles of the feet. The other kind comes with an ulceration in the
surface of the skin, but without going deep, broad, inclining to a
livid colour, but unequal; and the middle part of it heals, while the
extremities spread; and often that, which seemed to be sound, ulcerates
again. But the skin round about it, which is to receive the disease,
grows tumid, and hardish, and the colour of it is a blackish red. And
this disease too generally attacks old people, or those, that are in a
bad habit, but chiefly in their legs.
Now every ignis sacer, though it be the least dangerous of those
disorders, which have the disposition to spread, yet is, I had almost
said, the hardest to cure of them all. The most effectual remedy is a
fever for one day, which consumes the noxious humour. The thicker and
whiter the pus is, so much the less is the danger. It does good also
to excoriate the part below the ulcer by scourging, that the more
pus may be evacuated, and the matter drawn out, which corrupts the
flesh there. But notwithstanding if a slight fever comes on, there is
a necessity for abstinence, lying a-bed, and clysters. In every ignis
sacer, neither mild and glutinous food, nor salt and acrid are proper;
but what is betwixt these: such as unleavened bread, fish, kid, birds,
and except the wild boar, almost all venison. If there is no febricula,
both gestation and walking are serviceable, and rough wine, and the
bath; and in this disorder, as well as that mentioned before, the drink
ought to be more plentiful than the food.
As for the ulcers themselves, if their progress be moderate, they
must be fomented with hot water; if more rapid, with hot wine. Next
wherever there are any pustules, they must be opened with a needle.
Then such applications used, as may consume the putrid flesh. When the
inflammation is removed, and the ulcer cleansed, a lenient medicine
ought to be applied. In the second species, quinces boiled in wine
and bruised may do good; as likewise the plaister of Hera, or the
tetrapharmacum, with the addition of a fifth part of frankincense;
likewise black ivy boiled in a rough wine, and if the disorder spread
fast, nothing is more efficacious. When the ulcer, which I observed to
be in the surface of the skin, is cleansed, the same lenient medicines
are sufficient to the cure.
[Sidenote: _Of the Chironian ulcer._]
The ulcer named Chironian(83) is large, and has hard, callous, and
swelled lips. A sanies is discharged not copious, but thin; the smell
is bad. There is no inflammation either in the ulcer or in the tumour
about it. The pain is tolerable. It does not spread, and therefore is
not dangerous; but it does not easily heal. Sometimes a thin cicatrix
comes on, and then breaks again, and the ulcer is renewed. It occurs
chiefly in the feet and legs.
The application to it ought to contain both something lenient, and
something strong, and repellent. Such as the following composition made
for the purpose: of copper scales, calcined lead washed, each p. vi.
*. cadmia, wax, each p. viii. *. oil of roses a sufficient quantity to
soften the wax with the other ingredients.
[Sidenote: _Of ulcers occasioned by cold._]
There is a kind of ulcer occasioned by the cold of the winter. It is
most common in children, chiefly in their feet and toes, sometimes
also in their hands. There is a redness with a moderate inflammation.
Sometimes pustules break out, which are followed by an ulceration.
The pain is not great, the itching greater. Sometimes a humour is
discharged, but in small quantity, which seems to resemble either pus
or sanies.
In the first place it must be fomented plentifully with a hot decoction
of turnips, or if these are not to be had, some of the repellent
vervains. If it is not yet ulcerated, copper, as hot as a person is
able to bear it, must be applied. When it is already ulcerated, allum,
powdered with an equal quantity of frankincense, ought to be put to it,
with the addition of wine; or pomegranate bark boiled in water, then
beat. If the surface of the skin be excoriated, in that case lenient
medicines succeed best.
[Sidenote: _Of the scrophula._]
The scrophula is a tumour, in which there are formed some concretions
of pus and blood, resembling small glands. These are extremely
troublesome to physicians, because they both generate fevers, and never
maturate kindly; and whether they be cured by incision or medicines,
for the most part they rise again close to the cicatrices; which they
are much more ready to do, after being treated with medicines; and what
is more, they are of long continuance. They grow chiefly in the neck;
but also in the armpits, the groin and the sides. Meges the surgeon
assures us, that he has met with them in the breasts of women too.
For these reasons, it is proper to give internally white hellebore, and
that even frequently, till they be discussed; and externally to apply
medicines which may either draw out the humour, or discuss it; such as
have been mentioned before. Some also make use of caustics, which eat
down and constringe the part with an eschar; and then treat it like an
ulcer. Whatever method of cure be pursued, when the ulcer is clean, the
body must be exercised and nourished, till it come to a cicatrix. These
are the methods prescribed by physicians(84): but the experience of
some peasants has discovered, that eating a snake cures a scrophulous
patient.
[Sidenote: _Of a furuncle._]
A furuncle is an acute tubercle, attended with inflammation and pain;
and especially when it is just turning to pus. When this is opened,
and the pus is discharged, part of the flesh below appears converted
into pus, part corrupted, of a whitish colour, and reddish; which some
call the ventricle of the furuncle. There is no danger in it, though no
means be used for its cure, for it maturates of itself, and breaks. But
the pain makes a medicine, that can hasten the cure, eligible.
The proper medicine for it is galbanum, but other things have also been
mentioned before. If none of these can be had, the first application
ought to be a plaister not greasy, to repel it; then if that has not
succeeded, something to promote a suppuration. If that cannot be got,
either resin or leaven(85). When the pus is squeezed out, no further
cure is necessary.
[Sidenote: _Of phymata._]
The name of phyma is given to a tubercle resembling a furuncle, but
rounder, and flatter in the surface, and often larger. For a furuncle
seldom rises to the bulk of half an egg, and never exceeds it: a phyma
is commonly of greater extent; but the inflammation and pain in it
are less. When it is broken, the pus appears in the same manner; no
ventricle is found here, as in the furuncle; but all the corrupted
flesh is turned into pus. Now this grows more frequently in children,
and is more easily cured; in young men it occurs more seldom, and is
more difficult to cure: when age has given firmness to the body, it
does not appear at all. The proper medicines for discussing it have
been mentioned before.
[Sidenote: _Of a phygethlon._]
A phygethlon is a low, but broad tumour, in which there is something
like to a pustule. The pain and tension are violent, and greater than
in proportion to the size of the tumour; sometimes also attended with
a slight fever. It ripens slowly, and no great part of it is converted
into pus. It is formed chiefly either in the neck, or in the armpits,
or the groin. From its figure our authors call it panus(86). The
proper medicine for this also we have pointed out before.
[Sidenote: _Of abscesses._]
But though all the foregoing are nothing else but small abscesses,
yet a larger collection, that tends entirely to suppuration,
appropriates to itself the general name of abscess. And this collection
happens generally after fevers or pains of some particular parts,
and especially after pains in the belly. It commonly shews itself
externally, for it sometimes swells to a pretty large compass, like
the phyma, and is red and hot, and in a little time contracts a
hardness. It is more troublesome as it advances, and occasions thirst
and watchfulness. But sometimes there is none of these appearances in
the skin; and more especially when the suppuration is pretty deep; but
inward prickings are felt, attended with thirst and watchfulness. It is
more kindly when it does not become hard of a sudden; and when, though
it be ruddy, yet it is changing to a white colour. Which symptoms occur
when the suppuration is beginning; for the swelling and redness comes
on long before.
If the abscess be forming in any of the nobler parts, the accession
of matter there must be prevented by cataplasms, which are at the
same time repellent and cooling; such as I have mentioned under the
erysipelas and elsewhere. If it is grown pretty hard, we must have
recourse to discutients and resolvents; such as a dry fig bruised, or
lees of wine mixed with cerate, made up with hog’s lard; or the root of
wild cucumber, with the addition of two parts of meal, first boiled in
mulse. We may also mix equal parts of ammoniacum, galbanum, propolis,
viscum, adding of myrrh not half the quantity of any of the other
ingredients: and the plaisters and malagmas I have mentioned before,
have the same effect.
What is not discussed by these, must necessarily maturate. And to
hasten this, must be applied barley meal mixed with water; to which
also it will be proper to add some herbs. The same applications(87)
are fit for the lesser abscesses too, whose names and properties I have
recited above. The general method of cure is the same in them all; and
only differs in the degree. Now that tumour is crude, in which there
appears a strong pulsation of the arteries, a weight, heat, tension,
pain, redness, and hardness; and if the abscess be large, a shuddering,
as also a slight fever continues; and the suppuration being pretty deep
and concealed, instead of the marks, which otherwise shew themselves
in the skin, there are prickings. When these have abated, and the part
begins to itch, and either becomes somewhat livid or whitish, the
suppuration, is perfected. And when it either breaks of itself, or is
opened by medicines, or by incision, the pus ought to be discharged.
And if it happens in the armpits or groin, it must be dressed without
lint. In other parts too, if it is narrow at the bottom, if the
suppuration has been moderate, if it has not penetrated deep, if there
is no fever, if the patient be strong, lint is equally needless. In
other circumstances it ought to be used, sparingly however, and not
unless the wound be large. It does well to spread honey upon the lint;
or without it, to apply lentils with honey, or pomegranate bark boiled
with wine. And these things are proper both alone and mixed.
If any parts round it should be too hard, to soften them may be applied
either mallows beat, or fenugreek, or lintseed boiled in passum. And
then whatever is to be applied, ought to be secured not by a tight,
but an easy bandage. Every body ought to know, that in this kind of
disorder cerate may be used. What else belongs to the cleansing of the
ulcer, filling it up, and bringing on a cicatrix, and equally relates
to wounds, has been already pointed out.
[Sidenote: _Of fistulas._]
But sometimes from abscesses of this kind and other ulcers, arise
fistulas. That is the name of a deep, narrow and callous ulcer. It
occurs almost in every part of the body; and it has some peculiarities
in each place. I shall first treat of the general properties. There
are then several kinds of fistulas; for some are short, others deeper;
some point inward in a straight line; others, and by far the greatest
part, are transverse; some are simple, others are double, or triple,
which beginning from one orifice, branch out within, into three or
more sinuses; some straight, others bent and tortuous; some end in the
flesh, others penetrate to bones or a cartilage; or where neither of
these lies beyond them, reach to the more internal parts; some again
are easily cured, others with difficulty, and some are even found
incurable.
The cure of a simple and recent fistula in the flesh is easy. It is an
advantage to it, if the person be young, and the constitution firm:
the contrary are very unfavourable circumstances; as also if the
fistula has injured a bone, or cartilage, or nerve, or muscles; if it
have seized upon a joint, or has penetrated either to the bladder, or
the lungs, or to the womb, or to the large veins or arteries, or to
the jaw-bones, throat, stomach, or thorax. When it points towards the
intestines too, it is always dangerous, and often mortal. In these
cases it greatly increases the malady, if the patient be either sick,
or old, or of a bad habit.
First of all, it is proper to put a probe into the fistula, that we
may find its direction and depth: and at the same time whether it
be altogether moist, or drier than it should be, which appears upon
drawing out the probe. It may also be determined, whether the bone be
affected or not; and if the fistula has penetrated there, how far it
has injured it. For if that part is soft, which is touched by the end
of the probe, the disorder is confined to the flesh; if it resists
more, it has made way to the bone. And again, if the probe slides,
there is no caries begun: if it does not slip out(88) of the point
where it is placed, the caries is begun, but is slight yet: if it feels
unequal also, and rough, the bone is very much corroded. The situation
itself shews when there is a cartilage below; and that the fistula has
reached it, appears by its resistance.
Now from these circumstances may be learnt the seats and extents of
fistulas, and what parts they have damaged. From the quantity of
the pus it may be known, whether they be simple, or divided into
more parts. If more of that comes away, than can issue from a single
cavity, it is evident there are more sinuses. And as flesh, nerves,
and some nervous substances, such as the greatest part of the coats
and membranes are, commonly lie together, the nature of the pus will
discover whether the several sinuses have eaten through these different
sorts of bodies. For from flesh a smooth and white pus is discharged
pretty copiously; from a nervous place the discharge is of the same
colour indeed, but thinner, and less in quantity; from a nerve fat
and not unlike to oil. Lastly, the posture of the body also discovers
whether the fistulas have penetrated into several parts, because often,
when one lies down with his body and limb in a different position, the
pus begins to flow again, which had before stopped, and shews not only
that there is another sinus, from whence it descends, but also that it
proceeds in a different direction.
If it be confined to the flesh, and is recent and simple, neither
consisting of sinuses, nor having a large cavity: also if it be not
in a joint, but in a part, which is immoveable by itself, and is never
put in motion but with the whole body, a plaister for recent wounds
will be sufficient, if that contain either salt, or allum, or copper
scales, or verdigrease, or any of the metallic substances. And of this
a collyrium(89) ought to be made, at the one end smaller, and at
the other somewhat thicker. And this ought to be introduced with the
small end foremost into the fistula, till pure blood begins to appear.
This is universal in the application of all collyriums for fistulas.
And then the same plaister is to be put over it spread upon linen; and
above that must be applied a sponge first dipt in vinegar; and it is
sufficient to open the dressings on the fifth day. Such diet must be
used, as I have recommended for generating flesh.
But if the fistula is at a distance from the præcordia, it is necessary
for the patient now and then to eat radishes fasting and then to vomit.
When the fistula by time becomes callous (and it is impossible to
be mistaken in a callosity, because it is hard, and either white or
pale) then there is a necessity for stronger medicines. Such as that
composition, which contains of poppy tears p. i. *. gum p. iii. *.
cadmia p. iv. *. copperas p. viii. *. these are incorporated with
water, and made into a collyrium. Or that, which consists of galls
p. i. *. verdigrease, sandarach, Egyptian allum, each p. i. *.
calcined copperas p. ii. *. Or that, which is composed of chalcitis
and stone-lime, to which is added of orpiment less by one half than
each of the other ingredients; and these are mixed up with boiled
honey. The most expeditious is the prescription of Meges: to reduce to
powder of rasile verdigrease p. ii. *. then to dissolve in vinegar, of
ammoniacum thymiama p. ii. *. and with this to bring the verdigrease to
a consistence: and this is one of the choicest medicines. But though
the foregoing compositions are the most efficacious, yet if these are
not to be had, it is easy to destroy the callosity by some caustic
medicines: and it is sufficient to arm with these a twisted paper reed,
or some part of a penecillum, formed after the manner of a collyrium.
Squills also boiled, and mixed with lime consume a callus.
If the fistula happen to be pretty long, and transverse, after
introducing a probe, it is very proper to make an incision over against
its origin, and to put in any collyrium you chuse.
But if we judge the fistula to have two or more sinuses, provided it
be short and confined to the flesh, we ought not to make use of a
collyrium, which may cure one part, and not touch the rest; but the
same medicines dry are to be put into a writing reed, which being
applied to the orifice, the medicines must be blown into the fistula.
Or the same things may be dissolved in wine; or if the fistula be
somewhat foul, in mulse; if somewhat, callous, in vinegar; and
whatever is injected, must be infused in this liquid form. Coolers
and repellents must be applied above; for generally the parts about a
fistula are a little inflamed. Neither is it improper, when one has
removed the dressings, before he make another injection, to wash the
fistula by means of a syringe; if there be much matter, with wine; if
the callosity be pretty hard, with vinegar; if it is already cleansing,
with mulse, or a decoction of vetches in water, with a little honey
added to it. It commonly happens that the membrane, which is betwixt
the orifice and the sound flesh, being overcome by so many medicines,
casts off, and the ulcer is clean below. Whenever this happens,
agglutinants are to be applied, and especially spunge armed with boiled
honey. I know it is a practice approved of by many in this case, to
have lint rolled up into the form of a collyrium, and dipt in honey,
introduced for incarning. But this method more quickly agglutinates,
than incarns. And there is no fear, that clean flesh brought into
contact with clean flesh can fail to unite, especially when medicines
proper for that purpose are made use of; since often an ulceration of
the fingers, unless great care is taken to prevent it, will join them
together in the healing.
[Sidenote: _Of the cerion ulcer._]
There is also a kind of ulcer, which from its resemblance to a
honeycomb, by the Greeks is called cerium[FE]. And of this there are
two species: the one is of a whitish colour, and like to a furuncle,
but larger, and attended with great pain. When it maturates, it has
openings, through which is discharged a glutinous and purulent matter;
nevertheless it does not come to a due ripeness. If it be divided by
incision, there appears to be a great deal more corruption within, than
in a furuncle, and it reaches deeper. It seldom occurs but amongst the
hair of the head.
[FE] κηρίον.
The other is less, and eminent upon the top of the head, hard, broad,
of a pale green colour, and more ulcerated; for there are openings
at the roots of each of the hairs, through which issues a glutinous,
palish humour, in consistence like honey, or viscum, or sometimes oil;
and if an incision be made upon it, the flesh within appears green.
There is a great pain and inflammation, insomuch that they often bring
on an acute fever.
To that kind, which has fewer openings, it is proper to apply dry figs,
and lintseed boiled in mulse, and drawing plaisters and malagmas, or
the medicines, of that quality above recited.
Upon the other, the same medicines, likewise meal boiled in mulse, and
half the quantity of turpentine resin added to it; and a fig boiled in
mulse; to which a little powdered hyssop is added; likewise a fourth
part of stavesacre added to the fig. But if medicines do but little
service in either kind, the whole ulcer must be cut out to the sound
flesh. When the ulcer is taken away, medicines must be applied over the
wound; first such as promote pus, next detergents, then such as incarn.
[Sidenote: _Of the acrochordon, acrothymium, myrmecia, and the clavus._]
There are also some resembling warts, which have different names, as
they are different disorders. The Greeks call that an acrochordon[FF],
where a substance pretty hard is collected within the skin, which
sometimes is rough, and of the same colour with the adjacent parts;
near the skin it is narrow, and broader above. This is small, rarely
exceeding the size of a bean. They are hardly found to grow single;
generally a number together, and chiefly in children. They sometimes
suddenly disappear, sometimes they excite a moderate inflammation. Some
are also converted into pus.
[FF] ἀκροχορδὼν.
That is called acrothymium[FG], which rises like a small wart above
the flesh, broader at the skin, smaller above, hardish and very
rough upon the top, where in colour it resembles thyme, whence it has
its name; and it is easily divided there, and made bloody; sometimes
it discharges some blood; and is generally about the bigness of an
Egyptian bean, seldom larger, sometimes very small. Sometimes only one,
at other times more grow in the palms of the hands, and soles of the
feet; they are worst in the private parts, and aptest to bleed there.
[FG] ἀκροθύμιον.
Those called myrmecia[FH] are lower and harder than an acrothymium, fix
their roots deeper, and occasion a greater pain; below they are broad,
and above small, and less blood comes from them: in size they scarce
ever exceed a lupine. These likewise grow either in the palms of the
hands, or lower parts of the feet.
[FH] μυρμήκια.
The clavus grows elsewhere sometimes, but chiefly in the feet, and
principally form a contusion, though sometimes from other causes; and
it gives pain, if not at other times, at least when one is walking.
Of these the acrochordon, and the acrothymium often terminate of
themselves, and the more readily, the less they are. Myrmecia and
clavi are scarce ever removed without medicine. If the acrochordon be
cut off, it leaves no root, and for reason does not grow again. When
the acrothymium and clavus are cut off, a small roundish root grows,
which descends deep into the flesh, and that being left, they sprout up
again. The myrmecia adhere by very broad roots, and therefore cannot
be taken off without a great ulceration. It is very proper to pare the
clavus now and then: for thus without any violence it grows soft: but
if a little blood be let out, it often dies away. It is also removed,
if one cleans it round, and then applies to it resin mixed with a
little of the powder of a milstone. But the other kinds are to be eaten
away by medicines. For the two first, that which is made from the lees
of wine; for the myrmecia the most proper is that, which consists of
alum and sandarach. But the contiguous parts ought to be covered with
leaves, lest they also be corroded; and after that a lentil must be
applied. A fig also boiled in water destroys an acrothymium.
[Sidenote: _Of pustules._]
Pustules break out chiefly in the spring season. Of these there are
several kinds. For sometimes there is a certain asperity over the whole
body, or a part, resembling those pustules, which are occasioned by a
nettle, or from sweat; the Greeks call them exanthemata[FI]. And they
are sometimes red, at other times of the same colour with the skin.
Sometimes a great many grow resembling vari, sometimes larger. The
pustules are livid or pale, or black, or otherwise different from the
natural colour; and there is a humour contained in them. When they are
broke, the flesh below appears as it were ulcerated. By the Greeks they
are called phlyctænæ helcodes[FJ]. They arise either from cold, or from
fire, or from medicines.
[FI] ἐξανθήματα.
[FJ] φλύκταιναι ἑλκώδεις.
The phlyzacium[FK] is a pustule somewhat harder, of a whitish colour,
and sharp pointed. What is squeezed from it is moist. The pustules
sometimes turn to small ulcers, either dry or moist; and sometimes
attended only with an itching, at other times with an inflammation
and pain: pus or sanies issues from them, or both. And this occurs
in children chiefly; seldom in the trunk of the body; often in the
extremities.
[FK] φλυζάκιον.
The worst kind of pustule is that, which is called epinyctis[FL]. Its
colour either inclines to livid, or is a dark brown, or white. There
is a violent inflammation round it; and when it is opened, a mucous
ulceration is found within, in colour resembling its humour. The pain
of this is greater than in proportion to its bulk; for it is not
larger than a bean. And this likewise grows in the extremities, and
generally in the night-time: whence the Greeks have given it the name
of epinyctis.
[FL] ἐπινυκτὶς.
Now in the cure of all pustules, the first thing is to walk much, and
to take exercise: if that cannot be complied with, to use gestation.
The second rule is, to lessen the quantity of food; to abstain from
every thing acrid and extenuating. And nurses ought to observe the
same rules, if their sucking child is thus affected. Besides these,
one, that can bear it, if the pustules be small, ought to sweat in
the bagnio; and at the same time to sprinkle nitre over them; and
to anoint the part with a mixture of wine and oil; then to go into
the bath. If no benefit accrues from these, or if the pustules be of
a larger kind, a lentil must be applied, and when the surface of the
skin is taken off, we must have recourse to lenient medicines. After
the lentil, the epinyctis is to be treated with blood-herb, or green
coriander.
The ulcers formed from pustules are cured by litharge mixed with
fenugreek seed; and in compounding them, rose oil, or juice of endive,
are used alternately, till the mixture have the consistence of honey.
The proper composition for those pustules, which attack, infants, is of
that stone, which the Greeks call pyrites p. viii. *. with fifty bitter
almonds, and an addition of three cyathi of oil. But the pustules ought
to be first rubbed with ceruss, and then anointed with this.
[Sidenote: _Of the scabies._]
The scabies is a hardness of the skin, of a muddy colour, from whence
pustules arise, some of them moist, others dry; from some of them
issues a sanies; and in these there follows a continued itching
ulceration, which in certain cases spreads very fast. In some people
it goes entirely off, in others it returns at a certain season of
the year; the greater its asperity, and the more it itches, the more
difficult it is to cure. And therefore this species of it the Greeks
call agria[FM], that is, cruel.
[FM] ἀγρία.
In this also the same diet is necessary, as above prescribed. The
medicine proper for this in its beginning, consists of spodium,
saffron, verdigrease, each p. i. *. white pepper, verjuice, each p.
i. *. cadmia p. viii. *. But where there is already an ulceration,
that, which is composed of sulphur p. i. *. wax p. iv. *. liquid pitch
a hemina, two sextarii of oil. These must be boiled together to the
consistence of honey. There is also another, which is said to have
been invented by Protarchus. It contains a sextarius of lupine meal,
four cyathi of nitre, a hemina of liquid pitch, half a pound of liquid
resin, and three cyathi of vinegar. It is also proper to mix saffron,
lycium, verdigrease, myrrh, ashes, in equal quantities, and boil them
in passum. This heals every kind of scabies. And if there be nothing
else at hand, lees of oil boiled to a third part, or sulphur mixed with
liquid pitch, as I prescribed for cattle, relieve men also labouring
under the scabies.
[Sidenote: _Of the impetigo._]
Of the impetigo there are four species. The least malignant is that,
which resembles the scabies. For it is red, hardish, ulcerated,
and corrosive. But it differs widely from that, which is more
ulcerated(90), and has pustules like to vari; and there appear to be
in it somewhat like air bubbles, from which, after a time, something
like scales come off; and this is more certain in its returns.
The second kind is worse, and is not unlike the papula, but of greater
asperity and a more ruddy colour, having various figures; scales fall
off from the surface of the skin, there is a greater erosion, it
spreads more quickly, and broader, and both comes and goes at more
certain intervals than the former. It is called the red.
The third kind is still worse. For it is both thicker and harder,
and more swelled; it causes fissures in the surface of the skin, and
corrodes more vehemently. This also is scaly, but black; it spreads
wide(91), and does not stay long at a time; but is less uncertain as
to its periods of coming and going; and is not to be entirely removed.
This has the epithet of the black.
There is a fourth kind absolutely incurable, very different from the
rest in colour. For it is whitish, and resembling a recent cicatrix; it
has scales of a pale colour, some whitish, others resembling a lentil;
which being taken off, blood sometimes follows. Otherwise the humour of
it is white, the skin is hard and chopped, and it spreads wider.
All these kinds happen chiefly in the feet and hands; and they also
infest the nails. There is no medicine more efficacious than that I
mentioned for the scabies, which bears the name of Protarchus. Serapion
made use of the following composition, nitre p. ii. *. sulphur p. iv.
*. incorporated with plenty of resin.
[Sidenote: _Of the papula._]
There are two species of the papula. One is, where the skin is made
rough by very small pustules, and is both red, and gently corroded; in
the midst of them is a space somewhat smoother; it spreads slowly. And
this disorder is of a round form in its beginning, and proceeds in the
same manner circularly.
The second, the Greeks call agria: which has a similar appearance,
but the skin is more unequal and ulcerated, and it corrodes more
vehemently, is redder, and sometimes also loosens the hairs.
That which is less round, heals with greater difficulty; and unless it
be cured, it turns to an impetigo. But a slight papula, if it be rubbed
every day with fasting spittle, will heal. The greater kind is very
well cured by feverfew rubbed over it. But for the compound medicines,
that same prescription abovementioned of Protarchus is so much the more
powerful here, as the distemper is less. There is another of Mico’s for
the same purpose; of red nitre, frankincense, each p. i. *. cantharides
cleansed p. ii. *. crude sulphur a like quantity, liquid turpentine
resin p. xx. *. meal of darnel three sextantes, three cyathi of git,
and one sextans of crude pitch.
[Sidenote: _Of the vitiligo._]
The vitiligo also, though of itself not dangerous, yet is both nasty,
and proceeds from a bad habit of body. There are three species of it.
It is called alphos[FN], when it is white; it is commonly a little
rough, and not continued, but appears like drops dispersed here and
there. Sometimes it spreads wider, leaving some, places between free.
The melas[FO] differs from that in colour, being black, and like a
shadow. In other respects it is the same. The leuce[FP] has some
resemblance to the alphos, but is whiter, and penetrates deeper;
and has white downy hairs in it. All these spread; but in some more
quickly, in others slower. The alphos and melas come and go in some
people without any regularity. The leuce does not easily quit a person
it has once seized.
[FN] ἄλφος.
[FO] μέλας.
[FP] λεύκη.
The two first are not very difficult to cure; the last scarce ever
heals; and though the disorder be in some degree mitigated, yet the
natural colour is never fully restored. Whether any of these be curable
or not, is easily known from an experiment. For the skin should be cut,
or pricked with a needle. If blood issues, which generally happens in
the two former, there is room for a remedy; if a white humour starts,
it will not admit of a cure. And therefore it should not he meddled
with.
To the curable kinds must be applied lentils mixed with sulphur and
frankincense, the lentils being bruised and dipped in vinegar. Another
composition for the same purpose is that, which goes under the name of
Irenæus. Bastard spunge, nitre, cummin, dry fig-leaves, of each equal
parts, are bruised with the addition of vinegar. With this the part
affected is anointed in the sun; and in a little time, it is washed
off, lest it corrode too much. Some following the practice of Mico,
anoint the alphi with the following medicine; they mix of sulphur p.
ii. *. nitre p. iv. *. dry myrrh powdered an acetabulum; then in the
bath sprinkle upon the vitiligo bean flour, and afterwards put the
other over it. Those which I called melanes, are cured by the following
things beat up together; bastard spunge, frankincense, barley, and
beans; these are sprinkled upon them without oil in the bagnio, before
a sweat comes on, and then that species of vitiligo comes off by
rubbing.
A. CORNELIUS CELSUS
OF
MEDICINE.
_BOOK VI._
CHAP. I.
Having done with the disorders, which break out in any part of the body
indifferently, and require the assistance of medicines; I shall now
proceed to those, that are confined to particular parts, beginning with
the head.
[Sidenote: _Of hairs falling off the head._]
When the hairs of the head fall off, the principal remedy is frequent
shaving: though labdanum mixed with oil, conduces also towards keeping
them on. I here speak of the hair, which falls off after an illness.
For no remedy whatever can prevent the heads of some people from
becoming bald by age.
CHAP. II.
OF A PORRIGO.
We call that disorder a porrigo, _scurf_, when certain small scales
arise amongst the hair, and are loosened from the skin; they are
sometimes moist, much more frequently dry. It happens sometimes
without any ulcer, sometimes in a part that is ulcerated, and is
sometimes attended with a bad smell, sometimes with none. It usually
occurs in the hair of the head, more rarely in the beard, sometimes
also in the eye-brows. And as it never comes without some antecedent
disorder in the body, so it is not altogether useless. For when the
head is free from disorders, then it does not appear: when there is
any disorder there, it is more expedient, _in such a case_, that the
surface of the skin should be here and there corrupted, than that the
noxious matter should be turned in upon a more noble part.
It is more proper then to cleanse it by frequent combing, than to repel
it entirely. But if that method makes it more offensive (which may
happen by the excessive discharge of humour, and more so, if the humour
be fetid) the head is to be shaved often; and treated with some gentle
repellents, such as nitre with vinegar, or labdanum with myrtle oil,
and wine, or myrobalans with wine. If these have little effect, we may
use some of the more powerful ones; but, at the same time, we should be
aware, that this practice is hurtful, when the disorder is recent.
CHAP. III.
OF THE SYCOSIS.
There is an ulcer, which from its resemblance to a fig, by the Greeks,
is called sycosis[FQ], because flesh sprouts up from it. And this is
the general name. Under it are included two species. The one is a hard
and round ulcer; the other is moist and unequal in its surface. From
the hard one the discharge is very small and glutinous; from the moist,
it is in greater quantity and fetid. Both kinds occur in the parts
covered with hair: but that which is callous and round, most frequently
in the beard; the other, which is moist, chiefly in the hair of the
head.
[FQ] σύκωσις.
To both of them it is proper to apply elaterium, or lintseed powdered,
and made into a paste with water, or a fig boiled in water, or the
tetrapharmacum plaister softened with vinegar. Eretrian earth also
liquified with vinegar is proper to lay upon them.
CHAP. IV.
OF AREAE.
There are two kinds of areae. Both of them agree in this, that the
surface of the skin mortifying, the hairs first decay, and then fall
off; and if the part is wounded, thin and fetid blood is discharged;
and both kinds increase in some people quickly, in others slowly. It is
then worst, when it has rendered the skin thick and fat, and entirely
smooth. That, which is called alopecia[FR], spreads in no certain form.
It is found both in the hair of the head, and in the beard. But that,
which from its likeness to a serpent is called ophiasis[FS], begins at
the hinder part of the head; its breadth not exceeding two fingers; it
creeps with two heads to the ears; in some, even to the forehead, till
the two heads are joined in the fore part. The former species happens
at any age; the latter commonly to infants. The first hardly ever
terminates without medicine; the other often goes away of itself.
[FR] ἀλωπεκία.
[FS] ὀφίασις.
Some scarify these kinds of areae gently with a knife. Others anoint
them with escharotic medicines mixed with oil; and especially burnt
paper. Others apply turpentine resin with thapsia. But nothing is
better than daily shaving with a razor; because, when the cuticula is
gradually cut off, the small roots of the hairs are laid bare. Nor
should this be given over, till it appears, that the hair grows thick.
It is sufficient to rub the part, that is frequently shaved, with
copperas.
CHAP. V.
OF VARI, LENTICULAE, AND EPHELIDES.
It is almost a folly to cure vari, lenticulae, and ephelides: but
it is impossible to prevent women from being nice in what regards
their beauty. Of these disorders, which I have just mentioned, vari
and lenticulae are universally known; however, that species is more
rare, which the Greeks call phacia[FT], though that is only of a more
ruddy colour, and more unequal surface than the common lenticula. The
ephelis[FU] is unknown to most people; and is nothing else than a
certain ill coloured asperity and hardness. The others are peculiar to
the face; the lenticulae sometimes appear in other parts, of which I
did not think it worth while to treat separately elsewhere.
[FT] φακία.
[FU] ἐφηλὶς.
But vari are well cured by the application of resin mixed with an equal
quantity of scissile alum, and a little honey. Equal quantities of
galbanum and nitre, beat up with vinegar to the consistence of honey,
remove a lenticula. The part is to be rubbed with these, and after an
interval of several hours, washed clean in the morning, and gently
anointed with oil.
An ephelis is cured by resin, with the addition of a third part of
fossile salt and a little honey. And for all these disorders, and
likewise for giving a proper colour to cicatrices, that composition
is good, which is said to be invented by Tryphon the father. In it
there are equal parts of myrobalans crocomagma, the bluish Cimolian
chalk(92), bitter almonds, flour of barley, and vetches, white
struthium, seed of mellilot: all these are powdered and brought to
a consistence with the bitterest honey, and being rubbed on in the
evening, are always washed off in the morning.
CHAP. VI.
OF THE DISORDERS OF THE EYES.
The foregoing are indispositions of small account. But our eyes are
exposed to grievous and various maladies. And because they contribute
so large a share both to the conveniency and pleasure of life, they
deserve our utmost care to preserve them.
Presently after the appearance of a lippitude, there are certain
indications, from which we may form a presage of the event. For, if
a discharge of tears, and a tumour, and a thick gum too(2) have
commenced at once; if that gum is mixed with tears, and the tears are
not hot, also if the gum is white and soft, and the tumour not hard,
there is no danger of the disorder continuing long. But if the tears
are copious, and hot, the gum little in quantity, the tumour small, and
these are confined to one eye; the case will prove tedious, but without
danger. And this species of lippitude is not at all painful; but is
hardly ever removed before the twentieth day; sometimes it continues
for two months, and sometimes not so long.
If the gum begins to be white and soft, and is mixed with tears, or
both these have attacked the two eyes at once; the lippitude may be
of shorter continuance, but there is a danger of ulcers. Now a dry
and parched gum occasions pain, but terminates sooner; unless it have
produced some ulcer.
A large tumour, if it be without pain, and dry, is void of all danger;
if it be dry, but attended with pain, it commonly ulcerates; and
sometimes, from this case it happens, that the eye-lid is agglutinated
to the eye. There is room also to fear an ulceration in the eye-lids or
the pupil, when besides great pain, there is a discharge of salt and
hot tears; or even when after the tumour is removed, the tears flow for
a long time mixed with the gum.
It is worse still, where the gum is pale or livid, the tears are
scalding, or in great quantity, the head hot, and the pain reaches
from the temples to the eyes, also if the person is distressed with
wakefulness in the night; for in such circumstances, generally the eye
bursts, when it were to be wished, it would only ulcerate. A slight
fever is of service to an eye that bursts inwardly. If it breaks and
is protruded externally, the case admits of no remedy. If from a black
colour, some part of it has become whitish, it continues long. But if
it be rough and thick, even after the cure, it leaves some mark.
Hippocrates, the most ancient author we have, has observed in his
writings, that the eyes are cured by bleeding, by medicines, the bath,
fomentations, and drinking of wine. But he has not explained the proper
time for these, and the reasons for their use; in which the principal
part of medicine consists. There is also much benefit received from
abstinence and clysters.
They are sometimes seized with an inflammation; in which they are
at once pained and swelled; and there follows a discharge of gum;
sometimes more, sometimes less plentiful, or acrid. In such a case,
the principal remedies are rest and abstinence. Wherefore, for the
first day, the patient ought to lie in a dark place, and even refrain
from speaking; to take no food at all; if he can command himself, not
so much as water; if he cannot do that, at least as little of it as
possible.
But if the pains are severe, blood must be taken away, and preferably
on the second day; but if the case be urgent, on the first; especially
if the veins in the forehead swell, the patient be strong, and there
is a redundancy of matter: but if the illness be less severe, it calls
for a milder cure. It is not necessary to give a clyster, till the
second or third day. But a small inflammation requires neither of these
remedies; and it is sufficient to rest and fast.
Nevertheless, long fasting is not proper in lippitudes, lest it render
the gum more fetid and acrid; but on the second day, some of the
gentlest of those things, that generate a thicker phlegm(3), ought
to be given, such as sorbile eggs; if the disorder be but slight,
pulticula, or bread sopped in milk. On the following days, as much
as the inflammation decreases, so much may the quantity of food be
increased; but of the same kind; so that above all, nothing salt, or
acrid, or extenuating be taken; and nothing be used for drink but
water. And with respect to diet, such a regimen is highly necessary.
Now on the first day of the distemper, it is proper to mix p. i. *. of
saffron, and p. ii. *. of the finest, whitest flour, with the white of
an egg to the consistence of honey; and to spread this upon a piece of
linen, and apply it to the forehead, that by compressing the veins,
it may restrain the violent flux of gum. If saffron cannot be had,
frankincense has the same effect. It makes no difference whether it be
spread upon a bit of linen, or wool. The eyes ought to be anointed with
the following composition: as much saffron as can be held with three
fingers, myrrh, the bigness of a bean, of poppy tears, the bigness of a
lentil, are rubbed down together with passum, and daubed over the eyes
with a probe. Another for the same purpose consists of myrrh, p. i. *.
mandrake juice p. ii. *. poppy tears p. ii. *. rose leaves, hemlock
seed, each p. iii. *. acacia p. iv. *. gum p. viii. *. And these are
applied in the day time; but in the night, for promoting rest, it is
not improper to lay on the crumb of white bread mixed up with wine. For
that both restrains the flux of gum, and if any tears are discharged,
it absorbs them, and does not suffer the eyes to be glued up.
If the pain of the eyes be so great as to make this application uneasy
and too hard, both the white and yolk of an egg must be dropped into a
cup, and a little mulse added to them, and these mixed with the finger;
when they are incorporated, soft wool combed, ought to be dipped in
it, and saturated with it, and applied over the eyes. This is light,
and by cooling restrains the gum; besides, it does not grow dry, nor
suffer the eye to be glued. Barley-meal also boiled and mixed with a
boiled quince is a proper application. And it is no absurd practice to
use rather a pencillum squeezed out of water, if the disorder be less
severe, if more so, out of vinegar and water. The former applications
are to be bound on with a roller, lest they fall off in the time of
sleep: but it is sufficient to lay the pencillum on the eyes; both
because it can be conveniently replaced by the patient himself, and
because, when it has grown dry, it must be moistened again. If the
disorder is so great as to prevent sleep for a long time, some of
the medicines are to be given, which the Greeks call anodyne: and
for a boy, the bigness of a vetch is a sufficient dose; for a man,
the bigness of a bean. On the first day, it is not fit to inject any
thing into the eye, unless the inflammation be very great: for the
gum is often rather invited than diminished by that means. But on the
second day, even in a severe lippitude, it is proper to relieve by
the injection of medicines, when either the patient has been bled, or
a clyster has been given; or it appears, that neither of these was
necessary.
There are many collyriums proper for this purpose, invented by
different authors; and new ones may still be made; since lenient and
gently repelling medicines may be easily mixed in various proportions.
I shall mention the most celebrated of them.
[Sidenote: _Philon’s collyrium._]
The collyrium of Philon contains of washed ceruss, spodium, gum, each
p. i. *. poppy tears toasted p. i. *. It is fit to know, that all the
ingredients must first be powdered separately, after that mixed and
beat up again, dropping in from time to time, either water or some
other liquid. Gum, as it possesses some other qualities, so has this
peculiar effect upon collyriums, that when they have been long made,
and are grown dry, they continue firmly united, and are not friable.
[Sidenote: _Dionysius’s._]
Dionysius’s collyrium: of poppy tears toasted till tender p. i. *.
toasted frankincense, gum, each p. ii. *. spodium p. iv. *.
[Sidenote: _Cleon’s._]
Cleon’s is a very famous one: of poppy tears toasted p. i. *. saffron
p. i. *. gum p. *. v. to these, while they are powdered, is added juice
of roses. Another, by the same, stronger; of iron scales, which is
called stomoma[FV] p. i. *. saffron p. ii. *. spodium p. iv. *. lead,
both washed and calcined p. i. *. and the same quantity of gum. There
is still another of the same author’s, chiefly useful where there is
a great flux of gum: of castor p. *. i. aloes p. *. i. myrrh p. *.
ii. prepared cadmia p. viii. *. a like quantity of antimony, juice of
acacia p. xii. *. the mixture may be kept in a small box. But Theodotus
added to this composition toasted poppy tears p. *. i. copper calcined
and washed p. ii. *. date kernels toasted p. x. *. gum p. xii. *.
[FV] στόμωμα.
[Sidenote: _The acharistum of Theodotus._]
But Theodotus’s own, which by some is called acharistum[FW], is thus
made: of castor, Indian nard, each p. i. *. lycium p. *. poppy tears
the same quantity; myrrh p. ii. *. saffron, washed ceruss, aloes, each
p. iii. *. cadmia botryitis washed, calcined copper, each p. viii. *.
gum p. xviii. *. juice of acacia, p. xx. *. antimony the same quantity;
to these is added rain water.
[FW] ἀχάριστον.
[Sidenote: _The cythion, or tephrion._]
Besides these, amongst the most common collyriums is that, which some
call cythion, others from its ash colour, teprion. It contains of
starch, tragacanth, acacia juice, gum, each p. i. *. poppy tears p. ii.
*. washed ceruss p. iv. *. washed litharge p. viii. *. these in the
same manner are beat up with rain water.
[Sidenote: _The trygodes of Euelpides._]
Euelpides, who was the greatest oculist in our age, made use of one,
which he had composed himself, and called it trygodes. It contains of
castor p. ii. *. lycium, nard, poppy tears, each p. i. *. saffron,
myrrh, aloes, each p. iv. *. calcined copper p. viii. *. cadmia and
antimony, each p. xii. *. acacia juice p. xxvi. *. gum the same
quantity.
The more violent any inflammation is, so much the more it requires to
be alleviated by medicines, with the addition either of the white of an
egg, or breast milk. But if neither a physician nor a medicine can be
got, it mitigates the disorder to infuse either of these into the eyes
by a penecillum made for the purpose. But when relief is obtained, and
the flux of gum stops, the slight relics of the disorder, that might
perhaps otherwise continue, are discussed by bathing and drinking wine.
Therefore the patient ought to bathe moderately, being first rubbed
over with old oil, and longer in his legs and thighs than the rest of
his body; and to foment his eyes with plenty of warm water; next to
have warm water first, and afterwards water with the cold just taken
off, poured over his head; after bathing, he must guard against being
exposed to cold, or wind. After this, his diet ought to be somewhat
fuller than formerly(4); but he should abstain from all extenuants
of phlegm: the wine he drinks should be mild, inclining to rough, of
a moderate age; and in this he ought neither to indulge to excess, nor
be too sparing, that the former extreme may not occasion crudity, but
that by a just quantity sleep may be procured, and the acrimony lurking
within may be sheathed. But if a person in the bath has felt more
uneasiness in his eyes than he did before (which usually happens to
those, who have made too much haste to get into it, while the flux of
gum still continued) he ought to come out immediately; to drink no wine
that day; and eat even less than he did the day before. Afterwards,
as soon as the discharge of gum is sufficiently stopt, he must return
again to the use of the bath.
Nevertheless, it sometimes happens, from some unfavourable circumstance
either in the weather, or habit of the patient, that for several days
neither the pain, nor the inflammation, and least of all, the discharge
of gum ceases. When this is the case, and time itself has brought
the disorder to a full maturity for it, relief is to be sought from
the same remedies, that is, the bath and wine. For though they are
hurtful, while these complaints are recent, because they may irritate
and inflame them; yet in the inveterate, which have not yielded to any
other remedies, they are commonly very efficacious. For in this, as
well as in other cases, when seemingly proper medicines have been tried
in vain, those of a contrary nature give relief. But it is expedient
for the patient, in the first place, to have his hair clipped close
to the skin; next, to foment his head and eyes in the bath, very
plentifully, with warm water; then to wipe both with a penecillum, and
anoint his head with ointment of iris; to lie in bed, till all the
heat acquired in the bath is gone off, and the sweat cease, which was
necessarily collected in his head. Then he should make use of the same
kind of food and wine above recommended, the latter undiluted; and
cover his head, and continue at rest. For after these, either a sound
sleep, or a sweat, or a purging, often puts an end to the discharge
of gum. If the disorder abates (which sometimes does not happen soon)
the same course ought to be pursued for several days, till the cure
be completed. If, on these days, he has no stool, a clyster must be
injected for relieving the superior parts.
But sometimes a great inflammation arises, and of so violent a nature,
that it propels the eyes from their cavity. The Greeks call this
proptosis[FX], because the eyes fall forward. It is plain such patients
require bleeding, if their strength will admit of it: if that cannot be
done, a clyster is necessary, and long fasting. The mildest medicines
are required _in this case_. Therefore, some use the first of Cleon’s
two collyriums mentioned above. But that of Nileus is the best, and all
authors agree to give it the preference to any other.
[FX] πρόπτωσις.
[Sidenote: _Nileus’s collyrium._]
It is this: Indian nard, poppy tears, of each p. *. gum p. i. *.
saffron p. ii. *. fresh rose leaves, p. iv. *. which are brought to a
consistence, either by rain water, or light wine, inclining to rough.
And it is not improper to boil pomegranate bark, or melilot, in wines,
then to bruise it; or to mix black myrrh with rose leaves; or henbane
leaves boiled with the white of an egg; or meal, with acacia juice,
or passum, or mulse. And if poppy leaves too be added, they will be
somewhat more efficacious. When some one of these is prepared, the eyes
ought to be fomented with a penecillum squeezed out of a warm decoction
of myrtle or rose leaves in water; after that, the medicine is to be
applied. Besides, the skin in the back of the head is to be cut, and a
cupping vessel applied to it.
If, by these means, the eye is not restored to its place, but
continues prominent as before, we may conclude the eye-sight is gone;
and that the eye will next grow hard, or be converted into pus. If
the suppuration appears in that angle, which is next the temple, an
incision must be made in the eye, that vent being given to the matter,
the inflammation and pain may cease, and the coats _of the eye_ fall
inward, so that the face may be less disfigured afterwards. And then
must be used, either the same collyriums with milk, or an egg; or else
saffron mixed with the white of an egg. But if it has grown hard, and
is mortified, without turning to pus, so much of it must be scooped
out, as to prevent a shocking projection; which must be done thus. The
external coat must be laid hold of with a hook, and below that the
incision made with a knife; then these medicines are to be injected,
till the pain be entirely gone. The same medicines are also necessary
for an eye, that is first protruded, and afterwards bursts in several
places.
[Sidenote: _Of carbuncles of the eyes._]
It is not uncommon for carbuncles to proceed from an inflammation,
sometimes in the eyes themselves, sometimes in their lids; and in the
last, they are sometimes in the inside, at other times on the outside.
In this case, a clyster must be given; the quantity of food lessened;
milk allowed for drink; that the offending acrimony may be sheathed.
As to cataplasms and medicines, we must use such as have been proposed
against inflammations. And here also the collyrium of Nileus is the
best. But if the carbuncle be on the external part of the eye-lid,
lintseed boiled in mulse is the most proper for a cataplasm; or if that
is not to be had, wheat meal boiled in the same manner.
[Sidenote: _Of pustules of the eyes._]
Sometimes pustules also proceed from inflammations. If this happens in
the beginning of the inflammation, the former directions about bleeding
and rest are even to be more punctually observed; if later than to
admit of bleeding, yet a clyster must be given. If for any reasons that
likewise is impracticable, at least the proper diet must be used. In
this case too, the mild medicines are necessary; such as that of Nileus
or Cleon.
[Sidenote: _Collyrium of Philes._]
The collyrium which takes its name from Philes, is also suited to this
disorder. For it contains of myrrh, poppy tears, each p. i. *. washed
lead, Samian earth, which is called after, tragacanth, each p. iv. *.
burnt antimony(5), starch, each p. vi. *. washed spodium, washed
ceruss, each p. viii. *, which are incorporated with rain water. This
collyrium is used mixed either with an egg, or milk.
From pustules sometimes are generated ulcers; and these, when recent,
are to be dressed with the like lenient medicines, and mostly the same
as I have prescribed above for pustules. There is also a particular
application for them, which is called dialibanou[FY]. It contains of
copper calcined and washed, poppy tears toasted, each p. i. *. spodium
washed, frankincense, antimony calcined and washed, myrrh and gum, each
p. ii. *.
[FY] διὰ λιβάνου.
[Sidenote: _Wasting of the eyes._]
It happens likewise, that the eyes, either one or both, become less
than they ought to be naturally. And this is caused by an acrid flux of
gum in a lippitude, also by continual weeping, and wounds badly cured.
In such cases, the same mild medicines with breast milk are to be used;
and such food as most nourishes and fills the body; and the patient
must carefully avoid whatever occasions weeping, and all the anxiety of
domestic affairs: and if any misfortune happens likely to disturb him,
it must be concealed from his knowledge: acrid medicines and acrid food
hurt by occasioning tears, as much as any other way.
[Sidenote: _Lice in the eye-lids._]
There is a peculiar kind of disorder, in which lice are generated
amongst the hair of the eye lids. This the Greeks call phthiriasis[FZ].
Which arising from a bad habit of body, seldom stops there; but
generally after some time there follows a smart flux of gum; and the
eyes themselves being greatly ulcerated, it even destroys the sight.
[FZ] φθειρίασις.
Such patients must be purged by clysters; the hair of their head
clipped close to the skin, and the head rubbed for a long time
every day fasting. They must diligently practise walking, and other
exercises; gargle with a decoction of catmint and a mellow fig in
mulse; foment the head often in the bath with plenty of warm water;
avoid acrid food; use good milk and wine, and also drink more freely
than they eat. Medicines too are to be given internally, of a mild
nature, that they may not generate any acrid gum; and others externally
applied to kill the lice, and prevent the production of more. For this
purpose, of aphronitre p. i. *. sandarach p. i. *. stavesacre p. i. *.
are powdered together, and then equal quantities of old oil and vinegar
are added, till the whole come to the consistence of honey.
Thus much of those distempers of the eyes, which are cured by mild
medicines. There are besides these, other kinds, which require a
different treatment, commonly proceeding from inflammations, but
continuing even after they
[Sidenote: _Collyrium of Andreas._]
are gone. And in the first place, a flux of thin gum continues in
some. To such patients clysters should be given, and their quantity of
food diminished. Neither is it improper to anoint the forehead with
the composition of Andreas: which consists of gum p. i. *. ceruss,
antimony, each p. ii. *. litharge boiled and washed p. iv. *. the
litharge is boiled in rain water; and the dry medicines are rubbed with
the juice of myrtle. These being spread upon the forehead, a cataplasm
of meal is also to be applied over it, made into a paste with cold
water, and with the addition either of acacia juice or cypress. It is
proper also to make an incision on the top of the head, and apply a
cupping vessel there; or to bleed at the temples. The eye ought to be
anointed with that composition, which contains of copper scales, poppy
tears, each p. *. hartshorn calcined and washed, washed lead, gum, each
p. iv. *. frankincense p. xii. *. Now this collyrium, because horn is
one of the ingredients, is called diaceratos[GA]. As often as I do not
subjoin what kind of moisture is to be added, I would be understood to
intend water.
[GA] διὰ κέρατος.
[Sidenote: _The memigmenon of Euelpides._]
For the same purpose is that of Euelpides, which he called
memigmenon[GB]. In it there are poppy tears and white pepper, of
each an ounce, gum a pound, calcined copper p. i. *. During this
course, with some intervals, the bath and wine are serviceable. And as
extenuating food must be avoided by all that labour under a lippitude;
so particularly by those that have for a long time a flux of thin
humour. But if they be surfeited with such food as generates a thicker
phlegm, as is most common in this kind of diet, they must have recourse
to that, which because it binds the belly, constringes the body too.
[GB] μεμιγμένον.
But ulcers, that do not go off with the inflammation, generally either
grow fungous, or foul, or at least inveterate. Their excrescences are
best suppressed by the collyrium called memigmenon. The foul ones are
deterged both by the same, and by that, which is called smilion.
[Sidenote: _Smilion._]
This contains of verdigrease p. vi. *. gum the same quantity,
ammoniacum, minium from Sinope, each p. xvi. *. these are rubbed down
by some with water, by others, to make them stronger, with vinegar.
[Sidenote: _Phynon of Euelpides._]
That of Euelpides, which he called phynon, is also suitable to this
case; of saffron p. i. *. poppy tears, gum, each p. ii. *. copper
calcined and washed, myrrh, each p. iv. *. white pepper p. vi. *. But
the application of this must be preceded by an ointment.
[Sidenote: _Sphærion of the same author._]
The collyrium of the same author, to which he gave the name of
sphærion, is of like virtue; of bloodstone washed p. ii. *. pepper six
grains, cadmia washed, myrrh, poppy tears, each p. iii. *. saffron p.
iv. *. gum p. viii. *. which are rubbed down with Aminæan wine.
[Sidenote: _A liquid medicine by the same._]
He likewise compounded a liquid medicine for the same purpose, in
which were the following things; of verdigrease p. *. minium calcined,
copperas, cinnamon, each p. iii. *. saffron, nard, poppy tears, each p.
i. *. myrrh p. ii. *. calcined copper p. iii. *. aromatick ashes p. iv.
*. pepper fifteen grains. These are rubbed with a rough wine, and then
boiled with three heminæ of passum, till the whole unites. And this
medicine becomes more efficacious by keeping.
For filling the cavities of ulcers _of the eyes_, the best of all those
we have mentioned are the sphærion and the collyrium of Philes. The
same sphærion is an excellent medicine for inveterate ulcers, and such
as can scarcely be brought to cicatrize.
[Sidenote: _Hermon’s._]
There is also a collyrium, which though it be serviceable in many
cases, yet seems to be most efficacious in these ulcers. It is said to
be invented by Hermon. It contains of long pepper p. i. *. z. *. white
pepper p. *. cinnamon, costus, each p. i. *. copperas, nard, cassia,
castor, each p. ii. *. galls p. v. *. myrrh, saffron, frankincense,
lycium, ceruss, each p. viii. *. poppy tears p. xii. *. aloes, calcined
copper, cadmia, each p. xvi. *. acacia, antimony, gum, each p. xxv. *.
[Sidenote: _Asclepias._]
[Sidenote: _Canopite._]
[Sidenote: _Pyxinum of Euelpides._]
Cicatrices formed from ulcers are liable to two defects; of being
either concave, or protuberant. If they be concave, they may be filled
by the sphærion collyrium; or that called asclepias. This consists of
poppy tears p. ii. *. sagapenum, opopanax, each p. iii. *. verdigrease
p. iv. *. gum p. viii. *. pepper p. xii. *. cadmia washed, ceruss, each
p. xvi. *. But if the cicatrices are thick, they are rendered thin
by the smilion, or canopite collyrium, which last contains cinnamon,
acacia, of each p. i. *. cadmia washed, saffron, myrrh, poppy tears,
gum, each p. ii. *. white pepper, frankincense, each p. iii. *.
calcined copper p. ix. *. with rain water. Or the pyxinum of Euelpides,
which consists of the following ingredients; of fossile salt p. iv.
*. ammoniacum thymiama p. viii. *. poppy tears p. xiii. *. ceruss p.
xv. *. white pepper, Cilician saffron, each p. lii. gum p. xiii. *.
cadmia washed p. ix. *. Yet the composition, which contains gum p. iii.
*. verdigrease p. i. *. crocomagma p. iv. *. seems to be the best for
removing a cicatrix.
There is also another kind of inflammation, in which if the patient’s
eyes swell, and are distended with pain, it is necessary to bleed in
the forehead; and to foment the head and eyes plentifully with hot
water; to gargle with lentils, or cream of figs; to anoint with the
acrid medicines mentioned above; particularly that, which is called
sphærion, and which has blood-stone in it. And others are useful too,
which are calculated to lessen the roughness; of which I am going to
speak.
This commonly follows an inflammation of the eyes; sometimes it is
more violent, at other times more slight. Sometimes too a roughness
occasions a lippitude, and that again increases the roughness, and in
some is short, in others it continues long, and so as to be hardly ever
cured.
In this kind of disorder some scrape the thick and hard eye-lids
both with a fig-leaf and a specillum asperatum(6), and sometimes
with a knife; and turning them up, they rub them every day with
medicines. Which ought not to be practised, unless in a considerable
and inveterate roughness, nor that often. For the same end is better
obtained by a suitable regimen and proper medicines. Therefore we shall
use exercises and the bath more frequently: and foment the eye-lids
with plenty of warm water. The food must be acrid and extenuating.
[Sidenote: _Cæsarian._]
The medicine, which is called Cæsarian, contains of copperas p. i.
*. misy p. *. white pepper p. v. *. poppy tears, gum, each p. ii. *.
cadmia washed p. iii. *. antimony p. vi. *. And this collyrium is
allowed to be a good remedy against every kind of disorder in the eyes,
except those, that are treated by mild medicines.
[Sidenote: _Hierax’s._]
That also, which is called Hierax’s, is powerful against a roughness.
It consists of myrrh p. *. ammoniacum thymiama p. ii. *. rasile
verdigrease p. iv. *. with rain water. For the same purpose that
also is proper, which is called canopite, and the smilion, and the
pyxinum, and the sphærion. But if compound medicines are not at hand, a
roughness may be easily enough cured by goat’s gall or the best honey.
[Sidenote: _Dry lippitude._]
There is likewise a kind of dry lippitude, which the Greeks call
xerophthalmia[GC]. In this the eyes neither swell, nor run, but are
only red, and heavy with some pain, which is commonly slight, also an
itching, and the eye-lids without any hardness stick together in the
night-time by means of a very troublesome gum: and the less violent in
its degree this species is, so much the longer does it continue.
[GC] ξηροφθαλμία.
In this disorder it is necessary to walk much, to take much exercise,
to bathe often, and sweat in the bagnio, to use much friction. The
proper diet is neither such as is filling, nor over acrid, but the
middle kind betwixt these. In the morning, when it is evident that the
concoction is completed, it is not improper to gargle with mustard, and
alter that to rub the head and face a considerable time.
[Sidenote: _Rhinion._]
The collyrium best adapted to this case is that called rhinion. Which
contains of myrrh p. i. *. poppy tears, acacia juice, pepper, gum, each
p. i. *. blood-stone, Phrygian stone, lycium, scissile stone, each p.
i. *. calcined copper p. iv. *. The pyxinum also is suitable for the
same purpose.
[Sidenote: _Basilicon of Euelpides._]
But if the eyes be scabrous, which mostly happens in the angles, the
rhinion mentioned already may be serviceable. For the same purpose
that may be useful, which contains, of rasile verdigrease, long pepper,
poppy tears each p. ii. *. white pepper, gum, each p. iv. *. cadmia
washed, ceruss, each p. vi. *. However, there is none better than that
of Euelpides, which he called basilicon. It contains of poppy tears,
ceruss, Asian stone, each p. ii. *. gum p. xiii. *. white pepper p. iv.
*. saffron p. vi. *. psoricum(7) p. xiii. *. Now there is no simple,
which by itself is called psoricum; but a certain quantity of chalcitis
and a little more than half its quantity of cadmia are rubbed together
with vinegar; and this being put into an earthen vessel, and covered
over with fig leaves, is deposited under ground for twenty days, and
being taken up again it is powdered, and thus is called psoricum. The
basilicon collyrium too is generally allowed to be proper for all
disorders of the eyes, that are not treated by mild medicines.
But when compound medicines are not to be had, both honey and wine
mitigates an asperity in the angles. These and a dry lippitude too are
relieved by an application of bread, softened with wine, over the eyes.
For since there is generally a humour, which exasperates sometimes the
eye itself, sometimes the angles, or eyelids; by this application, if
any humour is discharged, it is drawn away, and if it happens to be
lodged near, is repelled.
[Sidenote: _Of a dimness of the eyes._]
A dimness comes upon the eyes, sometimes from a lippitude, at other
times even without that, from old age, or weakness. If the disorder
proceeds from the relics of a lippitude, the collyrium called asclepias
is serviceable. Likewise that, which is composed of crocomagma.
The collyrium which is called diacrocou[GD] is composed peculiarly for
this. It contains of pepper p. i. *. Cilician saffron, poppy tears,
ceruss, each p. ii. *. psoricum, gum, each p. iv. *.
[GD] διὰ κρόκου.
But if it arises from old age, or weakness, it may be proper to anoint
with the best honey, and cyprine and old oil. But it is most expedient
to mix together one part of balsam, and two of old, or cyprine oil,
and three parts of the most pungent honey. The medicines prescribed
above for a dimness _from a lippitude_, and those mentioned before for
diminishing cicatrices, are useful in this case too.
Whoever is troubled with a dimness must walk much, use exercise,
frequent bathing, at which time the whole body must be rubbed, but
principally the head, with iris ointment till it sweat; after that it
must be veiled, and not uncovered, till after he has got home, and
the sweat and heat have ceased. Then he must keep to an acrid and
extenuating diet; and after the interval of some days use a gargarism
of mustard.
[Sidenote: _Of a cataract._]
A suffusion also, which the Greeks call hypochysis[GE], sometimes
obstructs the pupil of the eye, where vision is performed. If this
disorder be inveterate, it requires an operation to remove it. At the
beginning sometimes it is discussed by certain methods adapted to the
case. It is expedient to bleed in the forehead, or nose; to cauterize
the veins in the temples; by the use of gargarisms to evacuate phlegm;
to use fumigations; to anoint the eyes with acrid medicines. The best
diet is such as extenuates phlegm.
[GE] ὑπόχυσις.
[Sidenote: _A palsy of the eyes._]
Nor is a palsy of the eyes (which the Greeks call paralysis) to be
cured by any different diet, or different medicines, so that it is
needless to do more than describe the distemper. It happens then
sometimes in one eye, sometimes in both, either from a blow, or from
an epilepsy, or spasms, where the eye itself is strongly convulsed, so
that it can neither be directed to any particular object, nor be kept
fixed; but moves to and fro involuntarily; and therefore cannot see any
thing distinctly.
[Sidenote: _Of a mydriasis._]
What the Greeks call a mydriasis[GF] is not very different from this
distemper. The pupil is dilated, the sight grows dull, and almost dim.
This kind of weakness is extremely difficult to remove. Against both
disorders, that is, the palsy and mydriasis, we must use the same
remedies as have been prescribed in the dimness of the eyes, with a few
alterations; thus for the head, to the iris oil must be added sometimes
vinegar, sometimes nitre; it is sufficient to anoint the eyes with
honey. In the latter disorder some have made use of hot waters(8),
and been relieved; others without any apparent cause have suddenly lost
their sight. Some of these, after continuing blind for some time, from
a sudden purging have recovered their sight: whence it seems the less
improper, both when the disorder is recent, and when it is of some
standing, to procure stools by medicines, in order to force all the
noxious matter into the lower parts.
[GF] μυδρίασις.
[Sidenote: _A weakness of the eyes._]
Besides these, there is a kind of weakness of the eyes, in which
patients see well enough in the day-time, but not at all in the night:
which never happens to a woman, when her menstrual discharge is
regular. But persons labouring under this disorder ought to be anointed
with the blood of a liver (particularly the liver of a he-goat; if
that cannot be had, of a she-goat) that drops from it while roasting;
and they ought to eat the liver itself. They may nevertheless not
improperly make use of the same medicines, that extenuate either
cicatrices, or an asperity. Some powder the seed of purslane, and add
honey to it, till the mixture be of such a consistence, as not to
drop off a probe, and anoint with that. They must also use exercises,
bathing, frictions.
[Sidenote: _Of external hurts in the eyes._]
These disorders all arise from internal causes. But externally the eye
may be hurt by a blow, so as to become bloodshot. There is nothing
more proper for this case than anointing with the blood of a pigeon,
or ringdove, or swallow. Nor is this practice without reason; since
the sight of these birds being hurt by some accident, in a little time
is restored, and that of the swallow soonest; which gave rise to the
fable, that their parents perform by an herb the cure, which is really
the work of nature. Their blood therefore is a very proper remedy for
our eyes in external hurts, in these different degrees of efficacy;
the blood of a swallow is best, next to that of a ringdove; that of a
pigeon is least medicinal both to itself and us.
Over an eye that has received a blow, in order to assuage the
inflammation, it is also proper to apply cataplasms. Now sal ammoniac,
or any other, ought to be very finely powdered, oil being dropped in by
degrees, till it acquire the consistence of strigment. Then this is to
be mixed with barley-meal boiled in mulse. Upon a review of all the
cures published, even by physicians, it is easy to see, that there is
hardly one of the abovementioned disorders of the eyes, which may not
be sometimes removed by very simple and obvious remedies.
CHAP. VII.
OF THE DISEASES OF THE EARS.
Thus far we have recited those disorders of the eyes, in which
medicines are most efficacious; we must now proceed to the ears; the
part, which nature has bestowed upon us next in usefulness to the eyes.
But in these the danger is much greater. For the mischief arising
from the distempers of the eyes is confined to themselves; whereas
inflammations and pains of the ears sometimes occasion madness and
death: which makes it the more necessary to administer speedy relief in
their beginnings, to prevent any greater danger.
Wherefore, when a person first feels a pain, he ought to fast, and
observe a strict regimen; the day following, if the disorder increases,
to clip the hair of his head, and anoint it all over with ointment of
iris warm, and to cover it. But a violent pain attended with a fever,
and watching, requires also bleeding. If particular circumstances
prevent that, the body must be kept open. Hot cataplasms too,
frequently changed, are serviceable; either of the meal of fenugreek,
or lint-seed, or any other, boiled in mulse. Spunges also squeezed out
of hot water are proper to apply now and then. When the pain is eased,
cerate made either of iris or cyprine oil ought to be put round it. In
some, however, that which is made of oil of roses, succeeds better. If
a violent inflammation prevents sleep entirely, to the cataplasm ought
to be added half its quantity of poppy heads toasted and powdered; and
then these may be boiled together in passum, or mulse. It is proper too
to infuse some medicine into the ear: which ought always to be made
tepid first, and is most conveniently dropped in by a strigil(9).
When the ear is filled, soft wool is to be put into it to keep the
liquor from returning. And these are general remedies.
Now the medicines _for injection_ are the juice of roses, and the
roots of reeds, and oil, in which worms have been boiled, and the
liquor of bitter almonds, or that, which is pressed from a peach
kernel. The compositions for alleviating the inflammation and pain are
generally these; of castor, poppy tears, equal quantities powdered,
and afterwards mixed with passum. Or equal quantities of poppy
tears, saffron, and myrrh are beat, rose oil and passum being added
alternately. Or the bitter part of an Egyptian bean is powdered, and
rose oil added to it: with which some also mix a little myrrh, or
poppy tears, or frankincense with breast milk, or the juice of bitter
almonds with rose oil. Or castor, myrrh, and poppy tears in equal
quantities, with passum. Or of saffron p. i. *. myrrh, scissile allum,
each p. iii. *. and in powdering these, three cyathi of passum are to
be gradually mixed with them, and less than a cyathus of honey. This is
one of the principal remedies. Or poppy tears with vinegar. We may also
use Themison’s composition, which consists of castor, opopanax, poppy
tears with vinegar, each p. ii. *. aphronitre p. iv. *. which being
powdered are incorporated with passum, till they be of the consistence
of cerate; and so laid by. When they are wanted for use, the medicine
is again rubbed down by a pistil, with the addition of passum. This is
a constant rule, whenever a medicine is too thick for dropping into the
ear, that liquor must be added, with which it ought to be compounded,
till it be sufficiently fluid.
[Sidenote: _Of pus in the ears._]
But if there is pus in the ears, it is proper to infuse lycium by
itself; or ointment of iris; or juice of leek, with honey; or juice of
centory with passum; or juice of a pomegranate warmed in its own shell,
with the addition of a small proportion of myrrh. A proper mixture
is also made of the myrrh called stacte p. i. *. the same quantity
of saffron, twenty five bitter almonds, a cyathus and half of honey;
which being rubbed together, are to be warmed in a pomegranate shell,
when they are to be used. Those medicines, which are compounded for an
ulcerated mouth, are equally sanative to ulcers of the ears. If these
be of pretty long standing, and there is a great discharge of sanies,
the proper composition is that generally ascribed to Erasistratus. It
contains of pepper, saffron, each p. i. *. myrrh, misy calcined, each
p. ii. *. calcined copper p. ii. *. These are rubbed down with wine;
when they are grown dry, three heminae of passum are added, and they
are boiled together. When they are to be used, honey and wine are added
to them. There is also a medicine of Ptolemaeus the surgeon; which
contains mastich, galls, of each p. i. *. omphacium p. i. *. juice of
the pomegranate. That of Menophilus is very efficacious, which consists
of the following things; of long pepper p. i. *. castor p. ii. *.
myrrh, saffron, poppy tears, Syrian nard, frankincense, pomegranate
bark, the inner part of an Egyptian bean, bitter almonds, the best
honey, each p. iv. *. When they are powdered, the sharpest vinegar is
added, till the whole be of the consistence of passum. There is also
a composition of Crato’s; of cinnamon, cassia, each p. i. *. nard,
lycium, myrrh, each p. i. *. aloes p. ii. *. honey, three cyathi, wine
a sextarius. Of these the lycium is boiled with the wine; after that
mixed with the other ingredients. But if the quantity of pus be great,
and there is a bad smell; of rasile verdigrease, frankincense, each p.
ii. *. honey, two cyathi, of vinegar four, are boiled all together.
When the composition is to be used, it is mixed with sweet wine.
Or scissile allum, poppy tears, juice of acacia are mixed in equal
quantities, and to these is added juice of henbane less than half the
quantity of any of the other ingredients; and these being powdered are
diluted with wine. The juice of henbane too by itself is pretty good.
Asclepiades compounded a general remedy against all disorders of the
ears, which is now approved by experience. In it there are of cinnamon,
cassia, each p. i. *. flowers of round cyperus, castor, white pepper,
and long, amomum, myrobalans, each two scruples, male frankincense,
Syrian nard, fat myrrh, saffron, aphronitre, each p. ii. *. Which
being powdered separately, and afterwards mixed, are rubbed down with
vinegar; and being thus preserved are diluted with vinegar when used.
In the same manner, the sphragis of Polybus liquified with sweet wine,
is a general remedy for disorders in the ears; which composition is
contained in the former book.
But if sanies is discharged, and there is a tumour, it is not improper
to wash it with diluted wine by a syringe; and then to infuse rough
wine mixed with oil of roses, and the addition of a little spodium, or
lycium with milk, or the juice of the blood herb, with oil of roses, or
juice of pomegranate with a very small proportion of myrrh.
If there are also foul ulcers, it is better to wash them with mulse;
and after that, some one of the compositions mentioned above, that
contains honey, is infused. If the pus flows more plentifully, in
that case, the hair of the head is to be clipped close, and plenty of
warm water poured over it; also gargarisms must be used, and walking
to lassitude, with a sparing diet. If blood likewise appears from the
ulcers, lycium with milk ought to be infused; or a decoction of roses
in water; with the addition of the juice either of blood herb, or
acacia.
But if a fungus has grown upon the ulcers, which is fetid, and
discharges blood, it ought to be washed with tepid water; and after
that, the composition infused, which is made of frankincense,
verdigrease, vinegar, and honey; or honey boiled with verdigrease.
Copper scales too with sandarach, powdered, is proper to be dropped in
by a pipe.
[Sidenote: _Of worms in the ears._]
When worms are generated there, if they be within reach, they must be
drawn out with a specillum oricularium(10), if farther in, they must
be killed by medicines; and means used to prevent the breeding of more.
White hellebore powdered with vinegar, answers both these intentions.
The ear ought to be washed also with a decoction of horehound in wine.
Thus, the worms being killed slide down into the entrance of the ear,
from whence they may be taken out with very great ease.
[Sidenote: _Obstructions in the ears._]
If the orifice of the ear be straitened, and a thick sanies is
contained within, the best honey ought to be put into it. If that does
little good, to a cyathus and half of the best honey must be added of
rasile verdigrease p. ii. *. which are to be boiled together, and made
use of. Iris also with honey is good for the same purpose. Likewise of
honey and oil of roses two scruples. Also of galbanum p. ii. *. myrrh
with honey, and ox-gall, each p. ii. *. wine a sufficient quantity to
dilute the myrrh.
[Sidenote: _Dulness of hearing._]
When a person grows dull of hearing, (which most commonly happens after
long pains of the head) in the first place, it is proper to inspect the
ear itself. For there will appear either a crust, such as grows upon
ulcers, or a collection of the cerumen. If there is a crust, either
warm oil must be infused, or verdigrease with honey, or juice of leek,
or a little nitre with mulse. And when this crust falls forward, it
must be washed with tepid water, that after it has fairly disengaged
itself it may be the easier pulled out by the specillum oricularium.
If there be cerumen, and this is soft, it must be taken out with the
same instrument. But if it be hard, vinegar, and a little nitre with it
must be injected; and when it is softened, the ear should be washed in
the same manner, and cleansed. And if a heaviness of the head remain,
the hair must be clipped, and the head gently rubbed, but a long time,
with the oil of iris or laurel, and with either of these may be mixed
a little vinegar: then the patient must take a long walk, and after
anointing, foment the head gently with warm water; and make use of
food of the weakest and middle class, and more especially take diluted
drinks; sometimes use gargarisms. Into the ear must be infused castor,
with vinegar and laurel oil, and the juice of radish rind, or the juice
of wild cucumber, with the addition of rose leaves powdered. The juice
also of unripe grapes infused with oil of roses, is pretty good against
a deafness.
[Sidenote: _Of a noise in the ears._]
The disorder is of a different nature, where there is a noise within
the ears themselves: and this prevents them from receiving an external
sound. This is slightest, when it proceeds from a gravedo; worse,
when it is occasioned by a distemper or inveterate pains of the head;
worst of all, when it is the harbinger of some violent disease, and
particularly of an epilepsy. If it happens from a gravedo, the ear
ought to be cleansed, and the patient hold in his breath, till some
frothy moisture issue from it. If, from a distemper, or pain of the
head, the same rules _as prescribed in a dulness of hearing_, must
be practised with regard to exercise, friction, pouring on of cold
water, and the use of gargarisms; no food but such as extenuates must
be used; juice of radish, with oil of roses, or with the juice of the
root of wild cucumber, must be infused into the ear, or castor with
vinegar and laurel oil. Hellebore is also rubbed with vinegar, then
incorporated with boiled honey, and being made into a collyrium, is
introduced into the ear. If it has begun without these, and therefore
gives reason to fear the approach of some terrible disease, castor
ought to be infused into the ear with vinegar, or oil, either of iris
or laurel; or together with the last, castor and the juice of bitter
almonds; or myrrh and nitre with oil of roses and vinegar. But a proper
diet is more serviceable in this case too. And the same rules are to
be observed, which I prescribed above, even with greater exactness;
besides which, the patient must refrain from wine, till the noise cease.
But if, at the same time, there are both a noise and an inflammation,
it is sufficient to inject laurel oil, or that, which is expressed from
bitter almonds; with which, some mix either castor or myrrh.
[Sidenote: _Of extraneous bodies in the ears._]
It sometimes happens too, that something falls into the ear, as a
small stone, or some animal. If a flea has got into it, a little wool
must be pressed in; and if it comes upon that, it is drawn out along
with it. If it has not followed it, or it be any other animal, a probe
wrapt in wool must be dipped in the most adhesive resin, particularly
turpentine, and this is to be introduced into the ear, and turned round
there: for it will certainly catch hold of it, and bring it away. But
if it be any lifeless thing, it must be drawn out by the specillum
oricularium, or a blunt hook, but little bent. If these means do not
succeed, it may be drawn out by resin, in the same manner as directed
in the preceding case. Sternutatories also are very proper to force it
out, or water strongly injected by a syringe. _The following method is
also practised in this case_; a board is laid down(11), supported in
the middle, with both ends hanging over, and the patient is tied upon
that, lying on that side, the ear of which is affected, so that he does
not reach over the board; then the end of the board, where his feet
are, must be struck with a hammer, and thus by shaking the ear, what is
within it drops out.
CHAP. VIII.
OF THE DISEASES OF THE NOSE.
Ulcers in the nostrils must be fomented with the steam of hot water.
This is done both by applying a squeezed sponge, and putting under the
nostrils a narrow-mouthed vessel filled with hot water. After this
fomentation, the ulcers are to be anointed either with dross of lead,
or ceruss, or litharge. When a person powders any of these, he may add,
while they are rubbed, alternately, wine and myrtle oil, till he make
it of the consistence of honey. But if these ulcers be near the mouth,
and have several crusts, and a fetid smell, which kind the Greeks call
ozaena[GG], we may take it for granted, that it is hardly possible to
cure that disease. Nevertheless, the following things may be tried;
to clip the hair of the head close to the skin, and daily to rub it
briskly, and pour plenty of warm water over it; to walk much; to eat
sparingly, and such food as is neither acrid nor of the strongest kind.
Then to put into the nostril honey, with a very little turpentine resin
(which is done by a probe, wrapt up in wool) and let this moisture
be drawn in by the breath, till the taste of it be perceived in the
mouth. For by these means, the crusts are loosened, which ought then
to be discharged by sneezing. The ulcers being thus cleansed must be
fumigated with the vapour of hot water; afterwards should be applied,
either lycium diluted with wine, or the lees of oil, or omphacium, or
juice of mint, or of horehound; or copperas that has been burnt white,
and then powdered; or the pulp of a squill bruised; to any of these
honey may be added, of which in the other mixtures there ought to be
only a very small part; with the copperas so much as to make it liquid;
but with the squill a considerable quantity; then the end of a probe
must be wrapped in wool, and dipped in the medicine; and by that the
ulcers are to be incarned. And further, a piece of lint is to be rolled
up in an oblong form, and dipped in the same medicine, which is to be
introduced into the nostril, and loosely tied at the lower part. This
ought to be done twice a day, in the winter and spring, and thrice in
the summer and autumn.
[GG] ὄζαινα.
[Sidenote: _Of fleshy caruncles in the nostrils._]
Sometimes in the nostrils there grow caruncles resembling womens’
nipples, and these adhere to its extremities, where it is
cartilaginous. These ought to be treated with escharotic medicines;
by which they are certainly consumed. A polypus[GH] is a caruncle
sometimes white, sometimes inclining to a red colour, which sticks
to the bones of the nostrils; and sometimes spreading towards the
lips, it fills the nostril, at other times reaching backward through
the opening, by which the breath passes from the nose to the fauces,
increases so much, that it may be seen behind the uvula; and almost
suffocates the patient, especially when the south or east wind blows.
It is generally soft, seldom hard; and the latter obstructs the breath
more, dilates the nostrils, and is commonly of the cancerous nature,
and therefore ought not to be touched. The other kind is generally
cured by cutting; sometimes, however, it withers, if by means of lint
or a pencillum, that composition be thrust up into the nose, which
contains of Sinopian minium, chalcitis, lime, sandarach, each p. i. *.
copperas p. ii. *.
[GH] πολύπους.
CHAP. IX.
OF THE TOOTHACH.
In the toothach, a disorder, that may justly be ranked even amongst
the greatest torments, the use of wine must be entirely forbid; and at
first a total abstinence from food must be observed; afterwards it may
be taken sparingly, but soft, lest the teeth be irritated by chewing.
Then externally, by means of a sponge, the steam of hot water is to be
applied, and a cerate made of cyprine, or iris oil spread upon wool,
and the head must also be covered. But if the pain be more severe, a
clyster is useful, with hot cataplasms applied to the cheek, as also
some medicinal hot liquor held in the mouth, and frequently changed.
For which purpose is used a decoction of cinquefoil root in diluted
wine; and henbane root, either in vinegar and water, or diluted wine,
with the addition of a little salt to either of them; and poppy heads
not over dry, and mandrake root prepared in the same manner. But in
these three, care must be taken not to swallow what is in the mouth.
The bark of the root of white poplar, boiled in diluted wine, does very
well for this purpose; or hartshorn shavings in vinegar, and catmint
with teda(12), and a mellow fig; also a mellow fig, either in mulse
or in vinegar and honey, and when the fig is dissolved by boiling,
the liquor is strained. A probe also wrapt up in wool is dipped into
hot oil; and used to touch the tooth itself. Moreover, something like
cataplasms are put into the tooth. For which end the inner part of
the shell of an acid and dry pomegranate is powdered, with an equal
quantity of galls and pine bark, and with these is mixed minium;
which being powdered, are brought to a consistence with rain water;
or panaces, poppy tears, hog’s fennel, stavesacre without its seeds,
powdered in equal proportions; or three parts of galbanum, and a fourth
of poppy tears. Whatever is applied to the teeth, a cerate, such as
is directed above, ought, nevertheless, to be kept upon the cheek,
and covered with wool. Some also bruise and spread upon linen, myrrh,
cardamoms, of each p. i. *. saffron, pellitory, figs, pepper, each p.
iv. *. mustard p. viii. *. and apply this to the arm of that side,
where the painful tooth is; if it be in the upper jaw, in the part
next the scapula; if in the lower, on that next the breast; and this
relieves the pain; and when it has given ease, it must be immediately
taken away.
Now if the tooth be spoilt, we need not be hasty in extracting it,
unless there be a necessity for it; but in such a case, to all the
fomentations directed before, must be added some stronger compositions
to ease the pain. Such as is that, which contains of poppy tears p.
i. *. pepper p. ii. *. sory(13) p. x. *. these are powdered and
mixed up with galbanum, and put round the affected tooth; or that of
Menemachus principally for double teeth, in which are of saffron p. i.
*. cardamoms, soot of frankincense, figs, pepper, pellitory, each p.
iv. *. mustard p. viii. *. Some mix of pellitory, pepper, elaterium,
each p. i. *. scissile allum, poppy tears, stavesacre, crude sulphur,
bitumen, bay-berries, mustard, of each p. ii. *. But if the pain make
it necessary to take it out, a pepper corn stript of its bark, and in
the same manner an ivy berry put into its opening, splits the tooth,
so that it comes away in scales. The prickle of the planus fish also
(which we call pastinaca, the Greeks trygon) is toasted, then powdered,
and mixed with resin, which being put round the tooth loosens it.
Scissile alum likewise put into the opening disposes the tooth to
come away. But it is more expedient to wrap this in a little wool,
and then put it in: because in that way it both preserves the tooth,
and eases the pain. These are the prescriptions of physicians; but
the experience of our peasants has discovered, that for the toothach
the herb horsemint ought to be pulled up by the roots, and put into a
bason, and water infused upon it, and that the patient should sit down
close by it, covered all over with clothes; and then red hot flints are
to be thrown into the bason, so as to be covered with the water, and
the patient with his mouth open must receive the vapour, close wrapt up
as before directed. For both a plentiful sweat follows, and a continued
stream of rheum runs from the mouth, which secures health for a pretty
long time, and frequently for a whole year.
CHAP. X.
OF THE DISEASES OF THE TONSILS.
If the tonsils swell from an inflammation without an ulcer, the
head must be covered as in the last disorder, and the part fomented
externally with the vapour of hot water; the patient must walk much;
lie in bed with his head raised; and use gargarisms of the repellent
medicines. The liquorice root too bruised, and boiled in passum or
mulse, has the same effect. And it is not amiss to touch them gently
with some medicines, which are made in this manner: the juice is
squeezed from a sweet pomegranate, and a sextarius of this is boiled
over a gentle fire to the consistence of honey; then saffron, myrrh,
scissile alum, of each p. ii. *. are powdered separately, and to these
are added gradually two cyathi of mild wine, of honey one; after that,
they are mixed with the first mentioned juice; and again gently boiled;
or a sextarius of the same juice is boiled in the same way, and the
following things powdered in like manner are added to it; of nard p.
*. omphacium p. i. *. cinnamon, myrrh, cassia, each p. i. *. And these
same compositions are proper both for purulent ears and nostrils. The
food in this disorder also ought to be mild, lest it exasperate the
inflammation.
But if the inflammation is so great as to obstruct the breath, the
patient must rest in bed, abstain from eating, and take nothing else
but warm water: a clyster must also be given, and a gargarism used
of figs and mulse; and the part touched with honey and omphacium.
Externally the hot vapour must be applied, but for a longer time, till
they suppurate and break of themselves. If pus is contained within, and
the tumours do not break, they must be cut. Afterwards the patient must
gargle with warm mulse.
But if with an inconsiderable swelling there is an ulceration, for a
gargarism there must be added to the cream of bran a little honey,
and the ulcers are to be anointed with the following medicines: three
cyathi of the sweetest passum are boiled into one; then is added of
frankincense p. i. *. saffron, myrrh, each p. *. and the whole is set
upon the fire again, till it boil. When the ulcers are clean, he must
gargle with the same cream of bran, or with milk. And in this case also
a mild diet is necessary; to which may be added sweet wine.
CHAP. XI.
OF ULCERS OF THE MOUTH.
Ulcers of the mouth, if they be attended with an inflammation, and
are foul and red, are best treated by the medicines prepared from
pomegranates mentioned before. And a repellent cream, with the addition
of a little honey, is to be held in the mouth often; the patient must
walk, and avoid all acrid food. When the ulcers begin to be clean,
a mild liquor, and sometimes the best water is to be kept in the
mouth: and the use of wine undiluted does service, also a fuller diet,
provided it be not at all acrid. The ulcers ought to be sprinkled with
scissile allum, and a little more than half its quantity of unripe
galls.
If they are already covered with crusts, such as we find in burns, the
compositions which the Greeks call antherae[GI] are to be applied.
These contain of long cyperus, myrrh, sandarach, allum, equal parts;
or, of saffron, myrrh, each p. ii. *. iris, scissile allum, sandarach,
each p. iv. *. long cyperus p. viii. *. Or, of galls, myrrh, each
p. ii. *. scissile allum p. ii. *. rose leaves, p. iv. *. But some
mix together of saffron p. *. scissile allum, myrrh, each p. i. *.
sandarach p. ii. *. long cyperus p. iv. *. The former are sprinkled on
dry; the last is applied with honey; and not only to these ulcers, but
to the tonsils also.
[GI] ἀθηραὶι.
But those ulcers, which the Greek call aphthae, are by far the most
dangerous; that is, in children; for they often kill them: in men
and women there is not the same danger. They begin at the gums, next
possess the palate, and the whole mouth; then descend to the uvula
and fauces. When these are affected, it is not easy for the child
to recover. And the case is more deplorable, if the infant is yet
sucking; because it is more difficult to apply any remedy. But in the
first place the nurse must be obliged to exercise by walking and such
employments as move the superior parts; she must be sent to the bath,
and ordered to pour warm water there over her breasts; next, her food
must be mild, and such as is not easily corrupted; and if the child
have a fever, she must drink water; if not, diluted wine. And if the
nurse is costive, she must have a clyster; if phlegm collects in her
mouth, a vomit. Then _for the infant_, the ulcers must be anointed
with honey, to which is added that kind of rhus(14), which is called
Syrian, or bitter almonds; or with a mixture of dry rose leaves, pine
kernels, and mint incorporated with honey; or that medicine may be
used, which is made up with mulberries; the juice of which is boiled in
the same manner as that of the pomegranate to the consistence of honey;
and in the same way, saffron, myrrh, allum, wine and honey are mixed
with it. Nor is any thing to be given, which may provoke the discharge
of humour. If the child is come to more strength, he ought to gargle
with such mixtures, as have been mentioned before. And if the milder
medicines do but little service here, such are to be used, as by their
caustic quality may cover the ulcers with crusts. The scissile allum is
powerful, or chalcitis, or copperas. Fasting too, in as great a degree
as the patient can bear, does service. The food ought to be mild;
however to cleanse the ulcers, it is proper to give sometimes cheese
spread with honey.
CHAP. XII.
OF ULCERS OF THE TONGUE.
Ulcers of the tongue require no other medicines than those, that have
been laid down in the former part of the last chapter. But such as
arise upon the side of it continue longest. And it is necessary to
inspect whether some tooth opposite to it is not too sharp, which often
prevents an ulcer in that part from healing, and for that reason must
be filed.
CHAP. XIII.
OF PARULIDES AND ULCERS IN THE GUMS.
Some painful tubercles also grow sometimes in the gums, near the teeth;
the Greeks call them parulides[GJ]. It is proper at the beginning, to
rub these gently with powdered salt, or with a mixture of fossile salt
calcined, and cypress and catmint; then to wash the mouth with the
cream of lentils, withal holding the mouth open, till the phlegm is
sufficiently discharged. In a greater inflammation the same medicines
are to be used, as were directed before, for ulcers of the mouth; and
a little soft lint is to be rolled up in one of those compositions,
which I said were called antherae, and that must be put betwixt the
tooth and the gum. But if the tumour be too hard to admit of that, the
steam of hot water, by means of a spunge, must be used externally,
and cerate applied. If a suppuration appears, the steam must be used
longer; and a hot decoction of figs in mulse, must also be held in
the mouth. And the tubercle must be cut before it be quite ripe, lest
the pus, by continuing there too long hurt the bone. If the tumour be
pretty large, it is better to cut it out entirely, so that the tooth
may be freed on both sides. When the pus is discharged, if the wound be
slight, it is sufficient to hold warm water in the mouth, and to foment
externally with the same vapour; if it be larger, to make use of the
cream of lentils, and the same medicines, by which other ulcers in the
mouth are cured.
[GJ] παρουλίδες.
Other ulcers, likewise, frequently arise in the gums, which are
relieved in the same manner, as those in the other parts of the mouth.
However, it is highly proper to chew privet, and hold the juice of it
in the mouth. It sometimes happens, too, that from an ulcer in the gum,
whether it be a parulis or not, pus is discharged for a long time, when
a tooth is either rotten, or broke, or the bone otherwise spoilt; and
that commonly proceeds from a fistula. When this is the case, the part
must be opened, and the tooth extracted; if there be any exfoliation,
it must be taken out; if any part of it is spoilt, it must be scraped.
After which, the same methods must be taken, as were prescribed before
in the cure of other ulcers. But if the gums leave the teeth, the same
antherae are helpful. It does good also to chew pears or apples not
very ripe, and to keep their juice in the mouth. And mild vinegar held
in the mouth may have the same effect.
CHAP. XIV.
OF AN INFLAMMATION OF THE UVULA.
A violent inflammation of the uvula may justly excite our fears.
Therefore, in this case, abstinence is necessary, and it is proper
to bleed; and if there is any good reason against that, a clyster is
serviceable. Besides, the head must be covered, and kept pretty high;
next, a decoction of bramble and lentils in water, must be used as a
gargarism; and the uvula itself be touched with honey, mixed either
with omphacium, or galls, or scissile allum. The medicine also, which
is called andronium is suitable to this case. It consists of scissile
allum, scales of red copper, copperas, galls, myrrh, and misy; which
are powdered separately, and being mixed, they are again rubbed with
the addition of rough wine, to the consistence of honey. It does great
service also to apply to the uvula the juice of celandine, by means
of a spoon. When the uvula is moistened with any of these, a great
quantity of phlegm runs out; and when that ceases, the patient must
gargle with hot wine.
But if the inflammation be slight, it is sufficient to powder laser,
and add to it cold water, and to put this water into a spoon, and
hold it below the uvula. And when it is not much swelled, cold water
alone, used in the same way, constringes it. The patient must also
use a gargarism of water, either with laser, or without it. But the
chirurgical cure for a lengthened uvula I shall describe afterwards.
CHAP. XV.
OF A GANGRENE OF THE MOUTH.
If a gangrene seizes ulcers of the mouth, it is to be considered in the
first place, whether the body be in a bad habit: if it be, that must
be rectified; and then we may proceed to the cure of the ulcers. But
if that disorder be on the surface, it does well enough to sprinkle
a dry anthera upon the ulcer, if moist: if it be somewhat dry, it
must be laid on with a small portion of honey: if a little deeper,
two parts of burnt paper, and one of orpiment: if the disorder is of
a considerable depth, three parts of burnt paper, and a fourth of
orpiment, or equal parts of salt and iris both toasted; or equal parts
of chalcitis, lime, and orpiment. But it is necessary to dip lint in
rose oil, and apply over that escharotic medicines, to prevent their
hurting the sound contiguous part. Some also throw in so much toasted
salt into a hemina of strong vinegar, till it will dissolve no more;
next, they boil away this vinegar till the remainder be dry; and powder
the salt, and sprinkle it on the ulcers. Now, as often as a medicine is
applied, both before and after, the mouth must be washed, either with
cream of lentils, or a decoction of vetches, or olives, or vervains in
water; and with any of these must be mixed a little honey. Vinegar of
squills, also held in the mouth, has no small efficacy against these
ulcers; and vinegar mixed again with the salt, boiled in vinegar, as
before directed. But when either of these is used, it must be kept in
the mouth a long time together, and be repeated twice or thrice in a
day, as the malady is more or less severe. And if the patient be a
child, a probe must be wrapped in wool, and dipped into a medicine, and
held upon the ulcer; lest for want of thought, he should swallow the
escharotics. But if there be a pain in the gums, and some of the teeth
be loosened, they ought to be pulled out: for they very much obstruct
the cure. If medicines do no service, the ulcers will require to be
cauterized: which, however, is not necessary in the lips, because it is
more convenient to cut them out. And both that which is cauterized, and
that which is cut out, are equally incapable of being filled up without
the manual operation. Now the bones of the gums, which have but little
life in them, when once stripped by burning, continue bare ever after:
for the flesh never grows again there. Upon the burnt places, however,
lentils must be applied, till they recover their soundness, as far as
the case will admit.
CHAP. XVI.
OF PAROTID SWELLINGS.
These are the disorders in the head, which generally require the help
of medicines, but under the ears, it is common for parotides[GK] to
arise; sometimes in health, when an inflammation commences there;
sometimes after long fevers, when the violence of the disease settles
in that part. This is a kind of abscess: and therefore requires no
peculiar method of cure. This one caution, however, is necessary, that
if the swelling came without any preceding distemper, repellents should
first of all be tried: if the disorder proceeds from any illness, that
method is hurtful; and it is more expedient to have it maturated and
opened as soon as possible.
[GK] παρωτίδες.
CHAP. XVII.
OF A PROMINENT NAVEL.
In the case of a prominent navel, to prevent the necessity of any
chirurgical operation, trial must first be made of abstinence, and a
clyster must be given; over the navel may be applied that composition,
which consists of hemlock and soot, each p. i. *. ceruss washed, p. iv.
*. lead washed p. viii. *. with two eggs; to which is likewise added
the juice of night-shade. This ought to lie on for a pretty long time;
and, in the mean while, the patient is to be restrained from motion,
use a spare diet, and avoid every thing flatulent.
CHAP. XVIII.
OF THE DISEASES OF THE PRIVATE PARTS.
The next disorders we are to treat of, are those of the private parts.
The names of which amongst the Greeks are both more tolerable, and
already established by custom; since they are of common use in almost
every book and discourse of physicians: with us the terms are more
indecent, and have had no sanction from the conversation of modest
men to qualify their coarseness. This makes it difficult to treat of
them so, as at once to preserve a delicacy of expression, and deliver
plainly the precepts of the art. Nevertheless this circumstance ought
not to deter me from writing. In the first place, because it is my
intention to comprehend every thing, that I have learned to be useful;
in the next place, because every body should know how to cure those
disorders, which we are so unwilling to expose to another.
Therefore, if the penis be swelled from an inflammation, and the
prepuce cannot either be drawn back, or brought forward again, the
part must be fomented plentifully with warm water. And when the glans
is covered, warm water must also be injected by a syringe, betwixt it
and the skin. If the skin, mollified and extenuated by this means, can
be drawn back, the subsequent part of the cure is more easy; if the
swelling prevails _against this remedy_, lentils, or horehound, or
olive leaves boiled in wine must be applied, and to any of these, while
it is rubbed, a little honey is added; and the penis is to be tied up
to the belly; which is necessary in the cure of all its disorders; and
the patient ought to confine himself to a strict regimen, and abstain
from eating, and relieve his thirst by nothing but water. The day
following, the fomentation of water must be applied in the same way,
and trial made, even with some degree of violence, to pull back the
prepuce; if it will not give way, the surface of it must be slightly
cut with a knife. For when the sanies is discharged, the part will be
extenuated, and the prepuce more easily drawn back.
Whether it has yielded to the latter method, or has never resisted,
ulcers will be found, either in the inner part(15) of the prepuce, or
in the glans, or in the penis beyond that; which must, of necessity,
be either clean and dry, or humid and purulent. If they be dry, they
must be first fomented with hot water; then lycium, with wine applied,
or oil lees boiled with the same, or rose oil with butter. If there is
a thin humour in them, they must be washed with wine; then a little
honey and oil of roses with butter, and a fourth part of turpentine
resin must be used. But if pus is discharged from them, first of all
they ought to be washed with warm mulse; after which is applied of
pepper p. i. *. myrrh p. ii. *. saffron, calcined milsy, each p. ii.
*. which are boiled with a rough wine, to the consistence of honey.
The same composition is also proper for the tonsils, a moist uvula,
and ulcers of the nostrils and mouth. Another for the same purpose: of
pepper p. i. *. myrrh p. i. *. saffron p. ii *. milsy p. i. *. calcined
copper p. ii. *. which are first rubbed down with a rough wine, then
when they have grown dry, they are again rubbed with three cyathi of
passum, and boiled to the consistence of viscum. Verdigrease too, with
boiled honey, and those compositions, which were mentioned before, for
ulcers of the mouth, cure these. But the composition of Erasistratus,
or Crato, is a proper application for purulent ulcers of the parts of
generation. Olive leaves also are boiled in nine cyathi of wine(16),
and to these are added of scissile allum p. iv. *. lycium p. viii. *.
honey a cyathus and half; and if the quantity of pus be pretty great,
this medicine is diluted with honey; if small, with wine. This is a
constant rule; after dressing, while the inflammation continues, to
apply over it such a cataplasm, as before directed, and to dress the
ulcers every day in the same manner. But if pus begins to be discharged
in a great quantity, and is fetid, the _ulcer_ ought to be washed with
cream of lentils, with the addition of a little honey, or a decoction
of olive, or mastich leaves; or a decoction of horehound used in the
like manner with honey. And the same dressings must be applied; or else
omphacium with honey; or that composition for the ears, which is made
of verdigrease and honey; or the composition of Andron; or an anthera,
with the addition of a little honey. Some dress all the ulcers, which
we have yet mentioned, with lycium and wine.
If the ulcer increases in breadth and deepness, it ought to be washed
in the same manner; and either verdigrease, or omphacium with honey,
applied; or Andron’s composition; or of horehound, myrrh, saffron,
scissile alum calcined, dry rose leaves, galls, each p. i. *. Sinopian
minium, p. ii. *. which are first powdered separately; then mixed and
rubbed together in honey, till they acquire the consistence of liquid
cerate; after which they are boiled in a copper vessel, gently, so as
not to boil over; when the drops of it grow hard, the vessel is taken
off the fire; and this medicine, as occasion requires, is softened,
either with honey or wine. The same composition, by itself, is also
good for fistulas.
Sometimes too, the ulcer penetrates to the nerves; and there is a
plentiful discharge of humour, and thin sanies and fetid, of no
consistence, but like water, in which recent flesh has been washed;
there are pains and prickings in the parts. Although this be of the
purulent kind, yet it must be cured by mild medicines; such as the
tetrapharmacum plaister, liquified with rose oil, and mixed with a
little frankincense; or that, which is made of butter, rose oil, resin,
and honey, already mentioned. Above all, this ulcer is to be fomented
with abundance of warm water, and covered, and not exposed to the cold.
Sometimes also, by these ulcers, the penis under the skin is so
consumed, that the glans falls off. In which case, the prepuce itself
must be taken off by circumcision. And it is a general rule, whenever
the glans, or any part of the penis falls off, or is cut off, that the
skin be kept from falling in contact and uniting with the ulcer(17),
so that it cannot be drawn back afterwards, and perhaps may even
obstruct the urinary passage.
Tubercles likewise, which the Greeks call phymata, arise about the
glans; which are cauterized either by medicines, or the actual cautery;
and when the sloughs cast off, copper scales are sprinkled upon them,
to prevent any thing growing there again.
[Sidenote: _Of a gangrene._]
In what we have hitherto described there is still no gangrene; to
which, as in the other parts, so more especially here, ulcers are
liable. It begins with a blackness. If this seizes the prepuce, a
probe must be immediately put under it, and an incision made; then the
extremities are to be laid hold of with a vulsella(18), and whatever
is corrupted must be cut away, and even some of the sound part taken
off, and the place cauterized. Whenever any part is burned, the next
step is to apply lentils; afterwards, when the sloughs have cast off,
the cure is the same with that of common ulcers.
But if a gangrene has seized the penis itself, some of the escharotic
medicines must be sprinkled upon it, chiefly that, which is composed
of lime, chalcitis, and orpiment. If medicines fail of success, here
also whatever is corrupted is to be cut out with a knife, in such a
manner as that some of the sound part be taken with it. This rule is as
universal as the former, when a gangrened part is cut away, that the
wound must be cauterized. But if either by means of medicines, or the
actual cautery, the sloughs have grown callous, there is great danger,
that when they cast off, a profusion of blood from the penis may
follow. Therefore long rest is necessary, and keeping the body almost
immoveable, till the sloughs be gently loosened from it in proper time.
But if a person either wittingly, or inadvertently, by walking too soon
has separated the sloughs, and there ensues a hæmorrhage, cold water
must be applied. If that does not prevail, recourse must be had to
those medicines, which stop blood. If even these do not relieve, the
part must be cauterized carefully and cautiously; and not afterwards
exposed to the same danger by any motion whatsoever.
[Sidenote: _Of a phagedaena._]
Sometimes also in the same place there happens that kind of gangrene,
which the Greeks call phagedæna[GL]. In which no time is to be lost,
but the same remedies must be immediately applied; and if these are not
successful, it must be burnt by the actual cautery. There is likewise
a certain blackness, which gives no pain, but spreads, and if we do
not resist it, it makes its way to the bladder; and cannot be cured
afterwards. But if it be at the end of the glans near the urinary pipe,
a small probe should be introduced into that first, to prevent its
closing; and then the actual cautery must be applied to the ulcer. But
if it has penetrated deep, whatever is tainted must be cut off. For the
rest, it must have the same treatment with other gangrenes.
[GL] φαγέδαινα.
[Sidenote: _A callosity or carbuncle._]
There is likewise sometimes a callous excrescence from the penis, which
is almost void of all sensation, and ought to be cut out. A carbuncle,
as soon as it appears there, must be washed by means of a syringe; then
it must be cauterized too with medicines, particularly chalcitis with
honey, or verdigrease with boiled honey, or sheep’s dung toasted and
powdered with honey. When it falls off, liquid medicines must be used,
which are composed for the lips of ulcers.
[Sidenote: _Diseases of the testicles._]
If any inflammation begins in the testicles without a blow, blood must
be taken from the ancle; the patient must abstain from eating; that
composition must be applied, which consists of bean meal boiled in
mulse, then mixed with powdered cummin, and worked up to a consistence
with honey; or powdered cummin with cerate made of rose oil; or
lintseed toasted, powdered, and boiled in mulse; or wheat meal boiled
in mulse with cypress; or lily root bruised. But if the testicles are
grown hard, lint or fenugreek seed, boiled in mulse, should be applied;
or cerate made of cyprine oil; or fine flour rubbed with wine and the
addition of a little saffron. If the hardness be already of pretty long
standing, the root of wild cucumber boiled in mulse and then bruised
does a great deal of service.
If they are swelled from a blow, it is necessary to let blood, and more
so if they are livid besides; and either of these compositions made
with cummin above mentioned must be applied; or that composition, which
contains of nitre calcined p. i. *. pine resin, cummin, each p. ii. *.
stavesacre without the seeds p. iv. *. honey, a sufficient quantity
to bring them to a consistence. But if from the blow the testicle
ceases to receive nourishment, there is generally a collection of pus
at the same time, and there is no other remedy for it, than by making
an incision in the scrotum, to discharge the pus, and extirpate the
testicle itself.
[Sidenote: _Diseases of the anus. Rhagadia._]
The anus too is liable to many and very tedious disorders; and these
are cured by methods not very different from one another. In the first
place it is a common ailment here, that the skin is chopped, and that
in several places: the Greeks call it rhagadia[GM]. When this is
recent, the patient ought to rest, and sit down in hot water. Pigeons
eggs are also to be boiled, and when they are hard, the shells taken
off, after that one of them ought to lie in water well heated, while
the part is fomented with the other warm; and thus each of them must be
used alternately for some time. Then the tetrapharmacum or the rhypodes
must be softened with rose oil; or recent œsypum mixed with liquid
cerate made of rose oil; or to the same liquid cerate must be added
washed lead; or myrrh to turpentine resin; or old oil to litharge: and
the part anointed with any of these. If the part affected be external,
and not concealed within, a piece of lint dipped in the same medicine
ought to be applied to it, and whatever is laid first on, must be
covered with cerate. In this case neither acrid food, nor austere, nor
binding must be used; nothing even dried is good, unless the quantity
be very small. Liquid, mild, fat and glutinous food is better. There is
no reason to refrain from the use of mild wine.
[GM] ῥαγάδια.
[Sidenote: _Of condylomata._]
A condyloma is a tubercle, which commonly proceeds from some
inflammation. When it appears, the directions must be observed, which
were just now given, with regard to rest, meat, and drink. It is
proper to foment this tubercle with eggs, as in the other case. But
the patient should first sit down in a decoction of repellent vervains
in water; then it is fit to apply lentils with a small proportion of
honey, mellilot boiled with wine, and bramble leaves bruised with
cerate made of rose oil; and with the same cerate either a quince
bruised, or the inner part of pomegranate bark boiled in wine; and
chalcitis burnt, and powdered, then mixed with œsypum and rose oil;
and some of that composition, which contains of frankincense p. i. *.
scissile alum p. ii. *. ceruss p. iii. *. litharge p. v. *. to these,
while they are powdered, is instilled alternately oil of roses and
wine. The bandage for that part is a square piece of linen or woollen
cloth, which at two of its corners has two loops, and at the other as
many fillets; and when it is put under the patient, the loops being
turned toward the belly, the two fillets from behind are put through
them, and when drawn tight, the right one must be extended to the left,
and that on the left to the right, and lastly both being brought round
are tied in a knot over the belly. But if the condyloma be inveterate,
and is grown hard, and does not give way to these methods, it may be
cauterized by a medicine, which consists of the following ingredients;
of verdigrease p. ii. *. myrrh p. iv. *. gum p. viii. *. frankincense
p. xii. *. antimony, poppy tears, acacia, each p. xvi. *. with which
medicine some chuse to renew those ulcers of which I was lately
treating. If this has no effect upon the condyloma, even stronger
caustics may be used. When the tumour is consumed, we must change to
the mild applications.
[Sidenote: _Of the hemorrhoids._]
The third disease of the anus is when the orifices of the
_hemorrhoidal_ veins grow turgid, and shoot out something like
small heads, which often discharge blood; the Greeks call them the
hæmorrhoides[GN]. And this frequently happens to women in the mouth
of the womb. And it is not safe to stop it in some people, who are
not weakened by the discharge of blood: for this serves for a drain,
and is not a disease. And therefore some that have been cured, as the
blood had no exit, have been seized with sudden and very dangerous
distempers, from the matter settling upon the præcordia and bowels.
But a man that feels bad effects from this discharge, ought to sit
down in a decoction of vervains; and to apply principally pomegranate
bark powdered, with dry rose leaves; and some of those things, which
stop blood. An inflammation sometimes comes on, especially when hard
excrements hurt the part. Then the patient must sit down in pure water,
and foment the part with eggs, and apply the yolks with rose leaves
beat up with passum; and if the disorder be within, this must be put
to it with the finger; if without, it must be applied spread upon a
cloth. Those medicines too, which are calculated for recent fissures,
are suitable here. And the same diet must be used in this, as in the
former cases. If these methods give but little relief, it is usual by
the application of caustic medicines to consume these small heads. But
if they be inveterate, by the direction of Dionysius, sandarach is to
be sprinkled upon them; after that the following composition must be
applied: of copper scales, orpiment, each p. v. *. stone lime p. viii.
*. the next day, they must be punctured with a needle. By cauterizing
these small heads a cicatrix is formed(19), which prevents the
effusion of blood. But whenever this is stopped, to avoid any dangerous
consequence from the suppression, the matter must be dissipated by
much exercise; and besides both men, and such women, whose menstrual
discharge is stopped, ought sometimes to be bled in the arm.
[GN] αἱμοῤῥοἱδες.
[Sidenote: _Of a prolapsus of the anus or womb._]
But if the anus itself, or the mouth of the womb fall down (for that
sometimes happens) it ought to be considered whether the part, which is
protruded, be clean, or covered with a mucous humour. If it be clean,
the patient ought to sit down in salt water, or a decoction of vervains
or of pomegranate bark in water: but if moist, it must be washed with
a rough wine, and rubbed with burnt lees of wine. When it has been
treated in either way, it must be replaced; and an application made of
bruised plantain, or willow leaves boiled in vinegar; over that, linen
and wool: these must be tied on, and the legs bound close together.
[Sidenote: _Of a fungous ulcer._]
There sometimes appears an ulcer in the same part resembling a
mushroom. This, if it be the winter-time, must be fomented with water
just warm; if any other season, with cold; afterwards it must be
sprinkled on copper scales, and over that cerate applied made of myrtle
oil, with the addition of a little scales, soot, and lime. If it is
not removed in this method, it must be consumed either by stronger
medicines(20) or the actual cautery.
CHAP. XIX.
OF ULCERS IN THE FINGERS.
The best cure for ulcers of long standing in the fingers is either
lycium or lees of oil boiled; to either of which wine is added. A
caruncle here also sometimes recedes from the nails with great pain;
the Greeks call it pterygion[GO]. It is proper to dissolve as much
round Melian alum in water, as to make it of the consistence of honey;
then to pour into it the same quantity of honey as there was of alum,
and to stir it with a spatula, till it becomes of a saffron colour,
and rub that over it; some people for the same purpose chuse to mix
equal quantities of dry alum and honey, and boil them together to the
due consistence. If they are not extirpated by this method, they must
be cut off; then the fingers must be fomented with a decoction of
vervains, and a medicine applied over them compounded thus; chalcitis,
pomegranate bark, and copper scales are incorporated with a mellow
fig gently boiled, and honey; or equal quantities of burnt paper,
orpiment, and crude sulphur are mixed with cerate made of myrtle oil;
or of rasile verdigrease p. i. *. copper scales p. ii. *. are brought
to a consistence with a cyathus of honey; or equal parts of stone lime,
chalcitis, and orpiment are mixed together. Which ever of these is
applied, it must be covered with a linen cloth dipped in water. On the
third day, the finger must be opened, and what is dry, must be cut away
as before, and the like dressing applied. If it does not yield to this
method, it must be cleansed with a knife, and burnt with small irons,
and cured like other burns.
[GO] πτερύγιον.
But where the nails are scabrous, they ought to be opened round, where
they are joined to the flesh; then some of the following composition
must be applied over them; of sandarach, sulphur, each p. ii. *. nitre,
orpiment, each p. iv. *. liquid resin p. viii. *. And this is to be
taken off on the third day. This medicine causes the spoiled nails to
fall off and better to grow in their place.
A. CORNELIUS CELSUS
OF
MEDICINE.
_BOOK VII._
PREFACE.
That surgery makes the third part of medicine, is both universally
known, and has been already observed. This does not indeed discard
medicines, and a proper regimen; but yet the principal part is
accomplished by the hand. And the effect of this is the most evident
of all the parts of medicine. For as fortune contributes a good deal
to the cure of distempers, and the same things are often salutary,
often fruitless; it may be doubted, whether the recovery be owing
to physic, or the constitution. In those diseases also, in which
we chiefly make use of medicines, although their success be pretty
evident, nevertheless it is plain, that health is both sought for
by their means in vain, and often restored without them. As may be
observed with regard to the eyes, which after having long suffered from
the applications of physicians, sometimes recover of themselves. But
in surgery it is manifest that the success, though it may be somewhat
promoted by other means, is chiefly to be ascribed to this. Now this
branch, though it be the most ancient, yet has been more cultivated
by Hippocrates the father of all medicine, than by his predecessors.
Afterwards being separated from the other parts, it began to have its
peculiar professors, and received considerable improvements in Egypt,
as well as elsewhere, principally from Philoxenus, who has treated of
this part fully, and with great accuracy, in several volumes. Gorgias
also, and Sostratus, the two Herons, and the two Apollonii, and
Ammonius Alexandrinus, and many other celebrated men, have each of them
made some discoveries. And at Rome too professors of no small note,
and particularly of late Tryphon the father, and Euelpistus the son of
Phleges, and Meges the most learned of them all, as appears from his
writings, by altering some things for the better have made considerable
additions to this art.
A surgeon ought to be young, or at most but middle aged, to have a
strong and steady hand, never subject to tremble, and be no less
dexterous with his left than his right hand; to have a quick and clear
sight; to be bold, and so far void of pity, that he may have only in
view the cure of him, whom he has taken in hand, and not in compassion
to cries either make more haste than the case requires, or his cut less
than is necessary; but to do all, as if he was not moved by the shrieks
of his patient.
Now it may be asked what peculiarly belongs to this branch: because
surgeons assume to themselves the curing of many wounds and ulcers,
which I have treated of elsewhere. I can very well suppose the same
person capable of performing all these: and since they are divided, I
esteem him most, whose skill is most extensive. For my part, I have
left to this branch those cases, in which the physician(1) makes
wound, where he does not find one; and those wounds and ulcers, in
which I believe manual operation to be more useful than medicines;
lastly whatever relates to the bones. Which things I shall consider
in order, and deferring the bones to another book, I shall in this
explain the two former; so treating first of these, which are found
indifferently in every part of the body, I shall proceed to those, that
fall upon particular parts.
CHAP. I.
OF CONTUSIONS.
Contusions, in whatever part of the body they are, ought as soon as
possible to be treated in this manner; the skin of the part, where the
pain is, must be cut in several places, and the _grumous_ blood issuing
from them must be wiped away with the back of the knife. If it is not
taken in time, and there is a redness, so much of the skin as is red
_must be cut_; if there is a tumour too, wherever that extends, the
same remedy is still the best. Then repellents are to be applied over
it; and particularly sordid wool squeezed out of vinegar and oil. But
if the hurt be more slight, the same applications without an incision
may perform the cure. And if nothing else is at hand, ashes, especially
of burnt twigs; if they are not to be got, any other ashes mixed up
with vinegar, or even with water.
CHAP. II.
OF THE OPERATIONS NECESSARY IN SUPPURATED TUMOURS.
The foregoing case is easily managed. But there is more trouble
with those tumours, that come from an internal cause, and tend to
suppuration. That all these are kinds of abscesses, I have elsewhere
shewn, and treated of the medicines proper for them: it now remains,
that I mention the manual operations necessary for their cure.
Wherefore it is requisite, before they grow hard, to cut the skin,
and apply a cupping vessel to evacuate any bad and corrupted matter
which may have been collected there: and this may be repeated a second
and third time, till all the symptoms of an inflammation be gone.
Nevertheless, it is not right to trust(2) entirely to the cupping
vessel.
Sometimes also it happens, though rarely, that a collection of pus
is inclosed in a covering of its own: the ancients called this a
coat. Meges, because every coat is nervous, affirmed a nerve was not
generated in a disorder, which destroyed the flesh, but that the pus
being lodged below for a long time, was surrounded with a callosity.
This however has not the least relation to the method of cure; because
the same course, that ought to be pursued if it be a coat, is also
necessary if it be a callosity. And though it should be a callosity,
yet as it invelops something, there is no reason against calling it
a coat. And then again, it is not uncommon for this to be found even
before the suppuration is formed(3), and therefore what is below it
cannot be extracted by a cupping vessel. But this is easily discovered,
when the application of that instrument has made no change. Therefore,
where-ever that happens, or when there is already a hardness, nothing
is to be expected from this remedy: but as I have directed elsewhere,
either the afflux of matter to the part must be diverted, or it must
be discussed, or brought to a perfect suppuration. If either of the
former has taken place, nothing further is necessary. If the pus has
been maturated, in the armpits and groin an incision is rarely to be
made: likewise where-ever the abscess is but small; also where-ever
the malady is in the surface of the skin, or even in the flesh; unless
the weakness of the patient obliges us to lose no time. And it is
sufficient by cataplasms to assist the pus to make its own way. For
the part, that has not been touched by an instrument, is generally
free from a scar. If the malady lies deeper, it ought to be considered
whether the part be nervous or not. For if it be nervous, it should
be opened by the actual cautery; the reason of which is, that a small
wound may keep open longer for evacuating the pus, and the cicatrix
afterwards may be small. But if there be nerves near it, the actual
cautery is improper, lest convulsions follow, which may debilitate(4)
the limb; yet the assistance of the knife is necessary. The others may
be opened before they be quite mature: but amongst tendons the utmost
ripeness is to be waited for, that the skin may be thin, and the pus
brought close to it, that it may be the sooner found. And some again
require a wound(5) in a straight direction, as those in the flesh:
but others render the skin extremely thin; and in such the whole
surface of it above the pus must be cut away. Now in all cases where
the knife is used, care must be taken, that the wounds be as small
and as few in number as possible: with this caution, however, that we
do all the case requires, both with regard to size and number: for
larger cavities require broader incisions; sometimes even in two or
three different directions. And we must endeavour that the deepest
part of the sinus shall have a free discharge, lest any of the humour
settle within, which by corroding the contiguous parts yet sound, may
make sinuses there. Cases also sometimes occur, in which the skin
must be taken off to a more considerable breadth. For when after long
distempers, the habit of the whole body has been vitiated, and the
sinus is enlarged to a great compass, and the skin is pale; we may
take it for granted that it is already mortified, and will be useless:
therefore it is more proper to cut it off: and especially if this
happen about the larger joints, and the patient has been troubled with
a purging while he was confined to his bed, and he gains no flesh by
the nourishment he takes. But the excision should be made in the form
of a myrtle leaf, that it may heal the more easily. And this rule must
constantly be observed, whenever a physician upon any account cuts away
the skin. After the pus is discharged, in the armpits and groin there
is no need of lint, but a sponge squeezed out of wine must be laid on.
In the other parts, if lint is equally needless, a little honey must
be infused to cleanse it; then agglutinants are to be applied: if lint
be necessary, over it also in like manner ought to be laid a sponge
squeezed out of wine in the same way. When lint is necessary, and when
not, has been determined elsewhere. The other directions are to be
observed when the suppurated tumour is cut, which I gave for one, that
has been broke by medicines.
CHAP. III.
OF THE GOOD OR BAD SYMPTOMS OF SUPPURATIONS.
It is soon known from the nature of the symptoms, how a cure advances,
and what event is to be hoped or feared: and these are commonly the
same with what have been laid down in wounds. For they are good signs
to sleep, to breathe easily, not to be troubled with thirst, not to
loathe food, if there has been a slight fever, to be free of it:
also that the pus be white, smooth, and not fetid. The bad signs are
wakefulness, difficulty in breathing, thirst, loathing of food, a
fever, and the pus black, or feculent, and fetid: also a hemorrhage
in the process of the cure; or if before the cavity is filled up
with flesh, the lips become callous, and the flesh there be dull of
sensation, and spongy. But for a person to faint either in the dressing
or afterwards, is worst of all. Moreover, if the fever cease suddenly,
before the suppuration is begun, or if it continue after the discharge
of the pus, these are just grounds for fear. There is room to fear
also, if the wound is not sensible of corrosive medicines. But whatever
symptoms shall happen to arise, it is the part of a physician to
endeavour the recovery of his patient. Therefore, as often as he shall
open a wound, he ought to wash it, if it seems necessary to repel the
humour, with a mixture of wine and rain water, or with a decoction of
lentils in water: if it needs cleansing, with mulse; and to apply the
same dressings again. When the humour shall appear to be stopt, and the
ulcer clean, it will be convenient to promote the growth of the flesh,
and dress the ulcer with equal parts of wine and honey, and apply a
sponge dipt in wine and oil of roses, which things are incarning. A
proper regimen however, as I have observed elsewhere, is more effectual
for this purpose: that is, when the fever is removed, and the appetite
restored, bathing now and then, daily but mild gestation, and such
kinds of food and drink as are of the most nourishing nature. All which
rules also hold with regard to an abscess, that has been broken by
medicines. But because it is hardly possible to cure a large tumour
without the knife, the mention of these has been reserved to this place.
CHAP. IV.
OF FISTULAS.
With regard to fistulas, if they penetrate pretty deep, so that a
collyrium cannot reach the bottom of them, if they are tortuous, or
consist of several sinuses, operations are more useful than medicines;
and those, that run in a transverse direction below the skin, give less
trouble than such as go directly inward. Therefore, if the fistula
be transverse under the skin, a probe ought to be introduced, and an
incision made upon that. If it be tortuous, its windings are to be
followed by the probe and knife. And the same course must be taken, if
several of them appear like rivulets _uniting their streams_. When we
have reached to the end of the fistula, all the callosity must be cut
out, and fibulae applied to it with medicines to agglutinate. But if it
points directly inward, when its direction is found by a probe, that
sinus must be cut out: then a fibula put upon the lips of the skin,
and agglutinating medicines laid over it; or if the ulcer be very foul
(which sometimes happens from a carious bone) when that also is cured,
medicines to promote a digestion.
[Sidenote: _Of fistulas amongst the ribs._]
It is common for fistulas to extend beneath the ribs. When this case
occurs, the rib in that part must be cut through on both sides, and
taken out, lest any thing corrupt be left within. It is usual for them
also, when they have got through the ribs, to penetrate the transverse
septum, that divides the intestines from the superior viscera. Which
circumstance may be known, both from the situation, and from the
violence of the pain, and because sometimes the air comes out with the
matter, as it were bubbling, and particularly when the patient keeps
in his breath. For this case there is no remedy. In the other kinds
about the ribs, which are curable, greasy medicines are hurtful, and
_therefore_ we should use such as are adapted to wounds: but the best
application is dry lint, or if any thing requires to be cleansed, the
same dipped in honey.
[Sidenote: _Of fistulas in the belly._]
There is no bone within the skin of the belly; but fistulas in that
part are extremely dangerous; insomuch that Sostratus believed them
incurable. That they are not always so, experience has shewn. And
indeed, which may seem very wonderful, a fistula opposite to the
liver and spleen, and stomach, is more safe than one opposite to the
intestines: not that the thing is of its own nature more pernicious
there, but because it exposes to a danger of another kind. The reason
of which fact some authors have but little understood, though their
experience convinced them of this difficulty. For the belly itself is
often wounded by a weapon, and the intestines, that have fallen out,
are replaced, and the wound united by sutures: the manner of doing
which I shall point out presently. Therefore, when a small fistula
has even penetrated the abdomen, it may be cut out, and the lips of
it joined by a suture. But if the fistula spreads wider within, upon
its being cut out, it must necessarily leave a pretty large vacuity,
which cannot be sewed up without great violence; especially on the
internal side, where there is a kind of membrane, which the Greeks call
peritonaeum, that surrounds the abdomen. Therefore, as soon as a person
begins to walk or move, the suture breaks, and the intestines are let
loose, so that the patient must perish. But the case is not always
desperate; and therefore, we must attempt the cure of smaller fistulas
there.
[Sidenote: _Of fistulas in the anus._]
Fistulas in the anus require a particular treatment. A probe being
put into them, an incision must be made in the skin at its further
end: then the probe must be drawn out at the new orifice with a thread
following it, which was put through an eye made in the other end for
the purpose. There the thread must be taken hold of, and tied to the
other end, that it may gently take hold of the skin above the fistula:
and the thread should be made of crude lint(6), double or triple,
and so twisted as to make one string. In the mean time the patient
may go about his business, walk, bathe, and eat, just as if he were
in the most perfect health. Only loosing this knot(7) twice a day,
the string must be drawn in such a manner, that the part, which was
above, may then be within the fistula. And the thread must not be
suffered to rot, but every third day, the knot must be untied, and at
its one end must be fixed a fresh ligature, which when the old one is
drawn out, must be left in the fistula with a like knot. For thus it
gradually cuts the skin that is above the fistula: and, at the same
time, the part that has been eat through by the thread, heals; whilst
the remainder, which is pinched by the thread, continues to be cut by
it. This method of cure is long, but is attended with no pain.
Those, that are for making quick dispatch, ought to tie the skin
tight with the string, that it may be the sooner cut; and at night to
introduce some small slips of a penecillum, that the skin may be made
thin by the same means that it is distended; however this occasions
pain. The dispatch, as well as the pain, is increased, if both the
string and the penecillum be turned with some one of those medicines,
which I mentioned, for consuming a callosity. It may happen, however,
that the use of the knife may be necessary, even in this part, if the
fistula points inward, or consists of several sinuses. Wherefore in
these kinds, the probe must be introduced, and the skin must be cut
in two lines, so that betwixt them a very small habenula may be cut
out(8), to prevent the lips from uniting presently; and that room
may be left for pledgits of lint, as few of which as possible ought
to be laid on; and the same course must be pursued as was directed in
abscesses. But if, from one orifice, there shall be several sinuses,
that sinus, that runs straight, must be opened with a knife, and the
others, that branch from it, which will then appear, must be tied with
a ligature. If any one penetrate so deeply, that an instrument cannot
be safely used, a collyrium must be put in.
The food, in all these cases, whether the treatment be by an operation,
or by medicines, ought to be moist; the quantity of drink pretty
liberal, and for a long time water. And when the flesh begins to sprout
up, then indeed the bath may be used, but sparingly, and such food as
plumps the body.
CHAP. V.
OF EXTRACTING WEAPONS OUT OF THE BODY.
Weapons, that lodge in the body, are very often troublesome to extract.
For there are some difficulties, which arise from their different
forms; others from the situation of the parts, into which they have
penetrated. Now every weapon is extracted, either on that side, where
it entered, or on that, to which it points. In the first case it
returns by the way itself made: in the other, it receives one from the
knife; for the flesh is cut directly upon the point of the weapon.
If the weapon does not lie deep, but is in the surface of the flesh,
or at least has not past through large veins and nervous parts, the
best method is to pull it out by the way it entered. But if the space,
through which the weapon must return, be greater than that, which is to
be laid open, and it has already past through veins and nerves, it is
more expedient to open what remains, and extract it that way; for it is
both nearer at hand, and is drawn out with more safety. And in one of
the larger limbs, if the point of the weapon has past beyond the middle
of it, it will heal the more readily for being open quite through, as
the remedies will act at both extremities of the wound. But if the
weapon is to be brought back the same way, the wound must be enlarged,
that it may move the more easily, and occasion the less inflammation;
which will be considerable, if the body be lacerated by the weapon as
it returns. And in like manner, if an opening be made on the opposite
part, it ought to be so large, as not to be increased afterwards by
the weapon passing through it. In either case, the greatest caution
must be used not to cut a tendon, or a large vein, or an artery. When
any of these are exposed, it must be laid hold of with a blunt hook,
and drawn aside from the knife. When an incision is made large enough,
the weapon must be taken out: then also the same method, and the same
precaution are to be used, lest any of the abovementioned parts should
be injured, which lie under the weapon, that is to be extracted.
[Sidenote: _Of arrows._]
The foregoing directions are general: besides which, there are some
particular rules for the several kinds of weapons, which I shall
immediately subjoin. Nothing is so easily lodged in the body as an
arrow, and it goes to the greatest depth. The reasons are, both that it
moves with great force, and because it is small. Therefore, it must be
extracted more frequently on the opposite part, than on that by which
it entered, and especially because it is generally surrounded with
beards, which lacerate more, if they be drawn backward than forward.
But an orifice being made on the opposite part, the flesh ought to
be opened by an instrument made in the form of the Greek letter ν;
and when the point appears, if the shaft adheres to it, it must be
pushed forward, till it can be taken hold of at the opposite part, and
extracted. If that is already broke off, and only the iron head is
within, the point must be taken hold of by the fingers, or a forceps,
and thus pulled out. And there is no other method of extracting it,
when it is thought adviseable to pull it out by the orifice it entered
at: for after the wound is enlarged, either the shaft, if that be
lodged within, must be pulled out; or if that be not there, the iron
itself. But if the beards are visible, and they are short and small,
they ought to be broke off with a forceps, and the weapon, when freed
of them, to be brought out; if they are larger and stronger, they must
be covered with writing reeds split, to prevent their lacerating any
part, and thus pulled out. This is the method observed in extracting
arrows.
[Sidenote: _Of broad weapons._]
But if a person has a broad weapon lodged within his flesh, it is not
proper to draw it out at the opposite part, lest we add another great
wound to the large one already made. It must therefore be pulled out
with a certain kind of iron instrument, which the Greeks call the
graphiscus of Diocles[GP], because it was invented by Diocles, whom I
have already taken notice of among the ancient and greatest physicians.
This is a plate of iron, or sometimes of copper, at the one end,
having two claws turned downwards on each side; the other perforated
and folded back on each side; bent a little at that extremity, which
has the claws; and likewise on the other, which is perforated. This
is introduced transversely, hard by the weapon; and then, when it
has reached its point, it is turned a little, that it may receive
the weapon into the perforation. When the point is in the hole, the
operator, clapping two of his fingers to the claws at the other end,
draws out at once his instrument and the weapon.
[GP] γραφίσκος Διοκλέους.
[Sidenote: _Of leaden bullets, &c._]
A third kind of weapon, which requires sometimes to be pulled out, is
a leaden bullet, or a stone, or some such thing, which having broke
through the skin, is entirely lodged within. In all these cases, the
wound must be enlarged, and what is within must be extracted by a
forceps the way it entered.
But there is an additional difficulty attending every wound, where the
weapon is either fixed in a bone, or has sunk into an articulation
between two bones. If, in a bone, the weapon must be moved to and fro,
till the part, which gripes the point, gives way, and then the weapon
must be extracted, either with the hand, or a forceps. Which is also
the method of extracting the teeth. And it is very rare that the weapon
does not follow in this way. But if it still remains, it may be forced
out with some kind of instrument. The last resource, when it is not
extracted, is to make a perforation near it by a terebra, and from that
opening, to cut the bone in the form of the letter v, opposite to the
weapon, in such a manner, that the opening of the lines be directed
towards the weapon; when this is done, it must necessarily give way,
and be easily taken out.
If it has made its way into an articulation between two bones, the two
limbs must be bound up with rollers and straps, and by means of these
drawn contrary ways, to stretch the tendons: which being extended,
will leave a larger space between the bones, so that the weapon may
be extracted without difficulty. Care must be taken, as I observed
in other cases, in its extraction, that no nerve, vein, or artery be
wounded by the weapon, whilst it is extracting, _which is to be guarded
against_ by the method mentioned before.
[Sidenote: _Of poisonous weapons._]
But if a person be wounded by a poisoned weapon, all that is above
mentioned being, if possible, still more expeditiously executed, he
must also be treated in the method prescribed for one that has drunk
poison, or been bit by a serpent. The treatment of the wound itself,
after the extraction of the weapon, is the same as if nothing had been
lodged there; of which I have said enough elsewhere.
CHAP. VI.
OF A GANGLION, MELICERIS, ATHEROMA, STEATOMA, AND OTHER TUBERCLES OF
THE HEAD.
These are cases that occur in any part of the body indifferently: the
rest have certain seats, which I am going to speak of, beginning with
those in the head. In this a great number and variety of tubercles
rise, called ganglia[GQ] melicerides[GR], atheromata[GS]; there are
some other kinds, to which authors give different names; to which I
shall also add steatomata[GT]: which though they often arise in the
neck, and in the armpits, and sides, I have not mentioned separately;
since all of them differ but little, and neither are threatening, nor
require any different treatment from each other. Now all these rise
from a very small beginning, and increase gradually for a long time,
and are inclosed each in a coat of its own. Some of them are hard, and
resist pressure, others are soft and yielding; some of them are bald
in a part, others remain covered with hair, and are commonly without
pain. What their contents are, though it may be pretty well guessed
at, yet cannot be certainly known, till they be taken out. However,
generally in these that resist, there are found either some stony
substance, or a number of hairs concreted together: but in those that
yield, something resembling honey, or thin pulticula, or the scrapings
of cartilage, or insensible or bloody flesh; and these are commonly
of different colours. And for the most part ganglia are elastic: the
atheroma contains a liquor like thin pulticula: the meliceris a more
liquid one, which therefore fluctuates upon being pressed: there is
a fat substance in the steatoma, and that generally has the largest
circumference, and so relaxes the whole surface of the skin above it,
as to make it slide backward and forward; whereas, in the rest, it is
more bound. It is proper first to shave them all if they be covered
with hair, and then to cut them through the middle, that whatever was
collected within may be evacuated. But the coat of the steatoma must
also be cut; because it is not easily separated from the skin and
subjacent flesh. In the others the coat is to be preserved entire: and
immediately, when it appears white and tense, it must be separated by
the handle of the knife from the skin and flesh, and taken out together
with its contents. If, however, it should happen, that the lower side
of the coat adheres to a muscle, lest that be wounded, the upper side
must be taken away, and the lower left in its place. When the whole
is extracted, the lips must be brought together, and a fibula put
upon them, and over that an agglutinating medicine. When either the
whole coat, or any part of it is left behind, medicines to promote a
digestion must be applied.
[GQ] γάγγλια.
[GR] μελικηρίδες.
[GS] ἀθερώματα.
[GT] στεατώματα.
CHAP. VII.
OF THE DISEASES OF THE EYES, WHICH ARE CURED BY MANUAL OPERATIONS.
But as the foregoing disorders do not differ much either in their
nature, or method of cure, so these in the eyes, which require manual
operations, are both different in their kinds, and require different
methods of cure.
[Sidenote: _Of vesicles in the upper eye-lids._]
In the upper eye-lids then it is common for fat and heavy vesicles to
rise, which scarcely allow the eye to be raised, and occasion gentle,
but constant fluxes of gum in the eyes. And they commonly happen to
children. _In this case_, it is necessary to compress the eye with
two fingers, and thus stretching the skin, to cut with the knife in a
transverse line, with a very light hand, in such a manner as not to
wound the vesicle, and so that it may pass out when a way is made for
it; then to catch hold of it with the fingers, and pull it out: for it
easily separates. After this the part ought to be anointed over with
any of these collyriums, that are used in lippitudes; by which means it
is covered with a cicatrix in a very few days. It is more troublesome,
when the vesicle is cut: for it discharges its humour, and cannot be
laid hold of after, because of its smallness. If that accident should
happen, one of the medicines that promotes a digestion, may be laid on.
[Sidenote: _Of a crithe._]
In the eye-lid, likewise, above the lashes, there grows a small
tubercle, which from its resemblance to a barley-corn, is, by the
Greeks, called crithe[GU]. It is contained in a coat, and seldom
maturates. Upon this should be applied hot bread, or wax heated now and
then, provided the degree of heat be no more, than the part can easily
bear: for by this method it is often discussed, sometimes maturated. If
pus appear, it ought to be divided by a knife, and the contained humour
squeezed out: and to be afterwards treated with the same warmth, and
anointed, till it recover a sound state.
[GU] κριθὴ.
[Sidenote: _Of chalazia._]
Other tubercles not unlike this, grow in the eye-lids; but however not
of the same form, and also moveable, when they are impelled this way or
that by the finger: which because of their resemblance to hail-stones,
the Greeks call chalazia[GV]. These ought to be cut on the external
side, if they be immediately under the skin; on the internal, if they
lie below the cartilage; after that, they must be separated by the
handle of the knife from the sound parts. And if the wound be on the
internal side, it must be anointed at first with mild, and afterwards
more acrid medicines; if, on the external, an agglutinating plaister
must be applied over it.
[GV] χαλάζια.
[Sidenote: _Of the unguis._]
The unguis, called by the Greeks, pterygium[GW], is a small nervous
membrane, which arising from the angle of the eye, sometimes reaches to
the pupil, and obstructs the sight. It oftener begins from the angle,
near the nose, sometimes too from that towards the temples. It is no
difficult matter to discuss this, when recent, by the medicines, which
lessen cicatrices in the eyes. If it be of long standing, and has
acquired some thickness, it ought to be cut out. After an abstinence
of one day, the patient must be placed in a seat, either with his
face opposite to the physician, or with his back to him, in such a
manner, that he may recline his head upon his breast. Some, if the
disease be in the left eye, chuse to have him set with his face to
the physician; if in the right, in the reclined posture. One eye-lid
ought to be opened by an assistant, and the other by the physician.
If the physician face him, he must take hold of the lower one; if he
be reclined, the upper one. Then the physician is to fix under the
extremity of the unguis, a small sharp hook, with its point turned a
little inward; and to let go the eye-lid, which is then to be held
by an assistant, and taking hold of the hook, he is to lift up the
unguis, and pass a needle through, drawing a thread after it; then to
lay aside the needle, and take hold of the ends of the thread, and by
them raising up the unguis, if it adheres any where to the eye, to
separate it by the handle of the knife, till he come to the angle; then
alternately sometimes to slacken, sometimes to draw it, that so both
its origin and the extremity of the angle may be found. For there is a
double danger attends it; either lest some part of the unguis be left,
which being ulcerated is hardly ever cured, or lest the caruncle be
cut away from the angle; for if the unguis be drawn away with too much
force, that also follows, and comes away. If it is torn off, an orifice
is opened, through which afterwards a humour always descends, which
the Greeks call rhyas[GX]. The true termination then of the angle must
be found out. When that plainly appears, the knife is to be used, the
unguis not being too straight drawn; and then this small membrane is
to be cut out in such a manner, that no part of the angle be wounded.
Afterwards lint covered with honey must be laid on, and over that a
linen cloth, and either spunge, or sordid wool. The following days the
eye must be opened daily, lest the eye-lids be agglutinated together by
a cicatrix (for that is also a third danger) and lint be put on in the
same way: lastly, it must be anointed with a collyrium, that cicatrizes
ulcers.
[GW] πτερύγιον.
[GX] ῥυὰς.
But this operation should be performed in the spring, or at least
before winter. Which circumstance, though it belongs to several places,
it will be sufficient to mention once for all. For there are two kinds
of cures; one, in which we are not at liberty to chuse a time, but that
must be laid hold of, that offers, as in wounds and fistulas; another,
in which we are not pressed for time; but it is quite safe and easy to
wait the most convenient season; as is the case in these disorders,
which both increase slowly, and are not extremely painful. In such, we
must defer it till spring; or if there is any urgent circumstance, the
autumn however, is better than the winter or summer; and of that the
middle, when the excessive heats are gone, and the colds not yet set
in. Now the more necessary the part is, whose cure shall be undertaken,
the greater will the danger be it is exposed to. And often by how much
larger the wound is to be made, so much the more must the season of the
year be regarded.
[Sidenote: _Of an encanthis._]
From the operation for the unguis, as I observed, disorders arise,
which may also sometimes proceed from other causes. For sometimes after
the imperfect excision of an unguis, or upon some other occasion, a
tubercle grows in the angle, which hinders the entire opening of the
eye-lids; the Greek name for it is encanthis[GY]. It ought to be laid
hold of with a hook, and cut round; and here also the operator must be
cautious not to cut away any thing from the angle itself. Then a small
piece of lint must be sprinkled either with cadmia, or copperas; and
the eye-lids being opened it must be introduced into that angle, and
bound over in the same manner as the former; and for some following
days must be dressed in like manner, first bathing it with water, just
warm, or even cold water.
[GY] ἐγκανθὶς.
[Sidenote: _Of the ancyloblepharon._]
Sometimes the eye-lids grow together, and the eye cannot be opened.
Which is often attended with this disorder besides, that the eye-lids
adhere to the white of the eye; that is when an ulcer in either of
them has been negligently cured. For as it heals, what might, and
ought to have been separated, will be agglutinated; both species of
the distemper is called by the Greeks ancyloblepharon[GZ]. When the
eye-lids only cohere, they are separated without difficulty; but
sometimes to no purpose: for they are agglutinated again. However trial
ought to be made; because the case often turns out well. Therefore
the broad end of the probe must be introduced betwixt them, and the
eye-lids separated by that; then small penecilla are to be put between
them, till the ulceration of the part be cured. But when the eye-lid
adheres to the white of the eye itself, Heraclides the Tarentine
advises to cut under it gently with a knife with great caution, lest
any thing be cut away either from the eye, or the eye-lid; and if
that cannot be entirely avoided, rather to take something from the
eye-lid. After these let the eye be anointed with such medicines as
cure an asperity; and the eye-lid be inverted every day, not only that
the medicine may be applied to the ulcer, but also to prevent its
adhesion: the patient himself must also be charged to raise it often
with two fingers. I do not remember an instance of one person cured
by this method. Meges too tells us he tried many ways, and never was
successful; for the eye-lid always adhered again to the eye.
[GZ] ἀγκυλοβλέθαρον.
[Sidenote: _Of the aegilops._]
Again in that angle, that is next the nose, from some disorder, a kind
of small fistula is opened, through which gum(9) perpetually distils;
the Greeks call it ægilops[HA]. And this gives constant uneasiness
to the eye; sometimes also eating through the bone, it penetrates to
the nostrils. This sometimes is of a cancerous nature; when the veins
are tense and crooked, the colour of it is pale, the skin hard, and
irritated by a slight touch, and it raises an inflammation in the
contiguous parts. It is dangerous to attempt the cure of those, that
are cancerous: for it even hastens death. And it is needless to meddle
with such as reach to the nostrils: for neither do they heal. But the
cure of these in the angle may be attempted; though it should be known
however that it is difficult; and the nearer to the angle the opening
is, so much the more difficult, because there is a very little room
for the management of the hand; yet it is easier to cure the disorder
when recent. The top of the opening must be taken hold of with a small
hook; and then all the cavity as I directed in fistulas, must be cut
out to the bone; and the eye and other contiguous parts being well
covered, the bone must be strongly cauterized with a hot iron. But if
it be already affected with a caries, that a thicker scale may cast
off, some apply caustic medicines; as copperas, or chalcitis, or rasile
verdigrease: which method is both slower, and not so effectual. When
the bone is cauterized, the remaining part of the cure is the same as
in other burns.
[HA] αἰγίλωψ.
[Sidenote: _Of hairs in the eye lashes irritating the eye._]
The hairs of the eye-lids sometimes irritate the eye; and that from
two causes. For sometimes the skin of the eye-lid is relaxed, and
falls down; whence it happens, that the lashes are turned in upon
the eye itself, because the cartilage is not also relaxed; at other
times, beside the natural row of hairs, another grows under it, which
point directly inward upon the eye. The methods of cure are these. If
preternatural hairs have grown, an iron needle thin and broad, like a
spatha(10), must be put into the fire, and when it is red-hot, the
eye-lid being lift up in such a manner, that the offending lashes are
in the view of the operator, it must be passed from the angle close to
the roots of the hair, till it move over the third part of the eye-lid;
then it must be applied a second and third time, as far as the other
angle. The consequence of which is, that all the roots of the hairs
being burnt, die away. Then a medicine to prevent an inflammation must
be applied: and when the eschars have cast off, it must be brought to
cicatrize. This kind heals very easily. Some alledge that it is proper
to pierce the external part of the eye-lid near the eye-lashes with a
needle, which must be passed through with a woman’s hair doubled for a
thread; and when the needle has gone through, that the offending hair
must be taken up into the loop of the woman’s hair, and by that drawn
upward to the superior part of the eye-lid, and there to be glued down
to the flesh, and a medicine applied to close up the orifice thus made:
for that this will cause the eye-lash to point afterwards externally.
This in the first place cannot be practised, but upon a pretty long
hair; whereas they generally grow short there. And then if there be
several hairs, the patient must suffer a long torture, and the needle
passing so often through will raise a great inflammation. Lastly, when
any humour is settled there, the eye being irritated both before by the
hairs, and afterwards by the perforations of the eye-lids, it is hardly
possible to prevent the glutinous matter, which fastens the hair, from
being dissolved: and thus of course the hair returns to the place, from
whence it was drawn away.
The method of cure for a relaxed eye-lid, which is universally
practised, never fails of success. For the eye being closed, one must
take hold of the middle part of the skin of the eye-lid, whether it be
the upper or the lower, with his fingers, and raise it; then consider
how much must be taken away, to reduce it to its natural condition.
For there are two dangers attending this case; lest if too much be cut
off, the eye cannot be covered; if too little, the end be not obtained,
and the patient have suffered to no purpose. The part, which it shall
be thought needful to cut, must be marked by two lines with ink in
such a manner, that betwixt the range of hairs and the line nearest
to it, some space may be left for the needle to lay hold of. These
things being determined, the knife is to be used: and if it be the
upper eye-lid, the incision next the eye-lashes must be made first;
if the inferior one, last: and it must begin in the left eye, at the
angle next the temple; in the right, at the angle next the nose; and
what lies between the two lines must be cut out. Then the lips of the
wound are to be joined together by a single stitch, and the eye must
be covered; and if the eye-lid does not descend far enough, it must
be relaxed; if too much, it must be either straiter drawn, or a small
habenula again cut off from that lip of the wound, which is farthest
from the eye-lashes. When it is cut off, other stitches must be added,
not above three. Moreover a scarification must be made in the upper
eye-lid, under the roots of the eye-lashes, that being raised from the
inferior part they may point upwards: and this alone will be sufficient
for the cure, if they are but little turned in. The lower eyelid does
not need this process. When these are done, a spunge squeezed out
of cold water must be bound on: the day following an agglutinating
plaister should be applied. On the fourth, the stitches must be
taken away, and the wound anointed with a collyrium, to prevent an
inflammation.
[Sidenote: _Of the lagophthalmus._]
Sometimes from this operation, when too much of the skin is cut away,
it happens, that the eye cannot be covered. And this sometimes proceeds
from another cause. The Greeks call the disorder lagophthalmos[HB].
When too much of the eye-lid is wanting, there is no remedy for it;
if but a small part, it may be cured. An arched incision must be made
in the skin a little below the eye-brow, with its horns pointing
downward. The wound ought to go as deep as the cartilage, but without
injuring it: for if that be cut, the eye-lid falls down, and cannot
afterwards be raised. Let the skin then be only divided, so as to
allow it to descend a little in the lower part of the eye; which will
be the consequence of the wound’s gaping above. Let lint be put into
it to prevent the union of the divided skin, and to generate a little
flesh in the middle: and when this has filled up the part, the eye is
afterwards properly covered _by the eye-lid_.
[HB] λαγώφθαλμος, or hare’s eye, outward.
[Sidenote: _Of an ectropium._]
As it is a disorder of the upper eye-lid not to descend far enough to
cover the eye, so there is a disease of the lower, in which it is not
raised high enough, but hangs down, and cannot be brought close to the
other. And this also sometimes proceeds from a similar fault in the
cure, sometimes even from old age. The Greeks call it ectropium[HC].
If it happens from a faulty cure, the treatment is the same as in the
foregoing case: only the horns of the wound are turned towards the
cheeks, and not to the eye. If it proceed from old age, the whole of it
must be cauterized externally with a thin plate of iron; then anointed
with honey; and from the fourth day fomented with hot water, and
anointed with medicines to bring on a cicatrix.
[HC] ἐκτρόπιον, from turning.
[Sidenote: _Of the staphyloma._]
These then are the general disorders, that commonly occur in the parts
about the eye, the angles, and eye-lids. In the eye itself the external
coat is sometimes raised, either from the rupture or relaxation of some
of the internal membranes; and it resembles a raisin stone in its form,
whence the Greeks call it a staphyloma[HD]. There are two methods of
cure for it. One is to pass through the middle, at the root of it, a
needle with a double thread; then to tie tight the ends of one of the
threads above, and of the other below; which by cutting it gradually
may bring it off. The other is, to cut out from its surface about the
bigness of a lentil; then to rub in spodium or cadmia. When either
of these is done, the white of an egg must be spread upon wool and
applied; and afterwards the eye must be fomented with the steam of hot
water, and anointed with mild medicines.
[HD] σταφύλωμα.
[Sidenote: _Of clavi._]
Callous tubercles in the white of the eye are called clavi; which name
is given them from their figure. The best method is to pierce them at
their very roots with a needle; and below that to cut them off, and
then to anoint with mild medicines.
[Sidenote: _Description of the eye._]
I have already elsewhere mentioned a cataract, because when recent,
it is often removed by medicines. But when it is of long standing, it
requires a manual operation, and one, which may be reckoned amongst the
nicest. Before I treat of this, I shall give a short account of the
nature of the eye; the knowledge of which, as it is of importance in
several other parts, so it is peculiarly necessary here. The eye then
has two external coats; the exterior of which by the Greeks is called
ceratoides[HE]; and this, where it is white, is pretty thick, but
before the pupil is thinner. The interior coat is joined to this, in
the middle where the pupil is, and is concave, with a small aperture;
round the pupil it is thin, but at a distance from it, something
thicker; and by the Greeks is called chorioides[HF]. As these two coats
surround the internal part of the eye, they again join behind it, and
becoming finer, and uniting together, pass through the opening, which
is between the bones, to the membrane of the brain, and are fixed to
it. Under these, in the part where the pupil is, there is a void space;
then again below, is an exceeding fine coat, which Herophilus called
arachnoides[HG], the middle part of which subsides, and in that cavity
is contained somewhat, which from its resemblance to glass the Greeks
call hyaloides[HH]. This is neither liquid, nor dry; but seems to be a
concreted humour; from the colour of which, that of the pupil is either
black, or grey, though the external coat be white. This is inclosed
by a small membrane, which proceeds from the internal part of the
eye. Under these is a drop of humour resembling the white of an egg,
from which proceeds the faculty of vision. By the Greeks it is called
chrystalloides.
[HE] κερατοειδὴς.
[HF] χοριοειδὴς.
[HG] ἀραχνοειδὴς.
[HH] ὑαλοειδὴς.
[Sidenote: _Of a cataract._]
Now a humour concretes under the twoὑαλοειδὴς. coats, where I mentioned
the void space to be, either from a disease, or a blow; and being
gradually indurated, it obstructs the interior faculty _of vision_.
There are several species of this malady, some of which are curable,
and others not. For if the cataract be small, immoveable, of the colour
of sea-water, or burnished iron, and leaves some sense of light on its
sides, there remains hope. If it is large, if the black part of the
eye, losing its natural appearance, is changed into some other, if the
cataract be of the colour of wax(11), or gold; if it slides and moves
to and fro, it is scarcely ever cured. And for the most part, the more
severe the disease, or the greater the pains of the head, or the more
violent the blow has been, which gave rise to it, so much the worse it
is. Neither is old age a proper time of life for a cure; which without
an additional disease causes a dimness of sight: nor even childhood;
but the middle age betwixt these. Neither is a very small eye, nor one,
that is hollow, fit for this operation. And there is also a certain
maturity of the cataract itself: wherefore we must wait till it seems
to be no longer fluid, but to have concreted with a certain degree of
hardness.
Before the operation, the patient must use a spare diet, drink water
for three days, the day immediately preceding take nothing at all.
After this preparation he must be set in a light place, in a seat
facing the light, and the physician must sit opposite to the patient
on a seat a little higher; an assistant behind taking hold of the
patient’s head, and keeping it immoveable; for the sight may be lost
for ever by a slight motion. Moreover the eye itself, that is to be
cured, must be rendered more fixed by laying wool upon the other, and
tying it on. The operation must be performed on the left eye by the
right hand, and on the right by the left hand. Then the needle sharp
pointed(12), but by no means too slender, is to be applied, and must
be thrust in, but in a straight direction, through the two coats, in
the middle part betwixt the black of the eye and the external angle
opposite to the middle of the cataract, care being taken to wound
no vein. And it must not be introduced with timidity(13) neither,
because it comes into a void space. A person of very moderate skill
cannot but know when it arrives there; for there is no resistance
to the needle: when we reach it, the needle must be turned upon the
cataract, and gently moved up and down there, and by degrees work the
cataract downward below the pupil; when it has past the pupil, it must
be prest down with a considerable force, that it may settle in the
inferior part. If it remain there, the operation is compleated. If it
rises again, it must be more cut with the same needle, and divided into
several pieces; which when separate, are both more easily lodged, and
give less obstruction. After this the needle must be brought out in a
straight direction, and the white of an egg spread upon wool must be
applied, and over that something to prevent an inflammation, and then
_the eye_ be bound up.
Afterwards there is a necessity for rest, abstinence, mild unctuous
medicines, and food (which it is soon enough to give on the day
following) at first liquid, that the jaws may not be too much employed,
then when the inflammation is gone, such as was directed in wounds. To
which we must add this rule, that the patient’s drink be water for a
pretty long time.
[Sidenote: _Of a flux of gum._]
I have already treated of a flux of thin gum, which infests the eyes,
so far as the cure depends upon medicines. I now come to these cases,
that require manual operation. Now we observe that some people’s eyes
never grow dry, but are always moistened with a thin humour; which
circumstance occasions a constant asperity, and from slight causes
excites inflammations, and lippitudes, and in fine renders a person
uneasy all his life. And this disorder in some no remedy can relieve;
in others it is curable. Which difference ought first of all to be
known, that we may relieve the one, and not meddle with the other.
And in the first place, it is in vain to attempt the operation in
those, who have this disorder from their infancy, because it will
certainly continue to their dying day. Secondly, it is needless, where
the discharge is not great, but acrid; because they are not assisted
by a manual operation, but are brought to a sound state by medicines,
and a proper diet for generating a thicker phlegm. Broad heads also are
hardly susceptible of the remedy. Then it makes a difference whether
the gum be discharged by the veins, that lye between the skull and the
skin, or by those between the membrane of the brain and the skull:
for the former moisten the eyes by the temples; the others by the way
of those membranes, that go from the eyes to the brain. Now a remedy
may be applied to those veins, that discharge above the bone, but not
to those below the bone(14). Neither can relief be given, where the
discharge comes from both places; because when one part is relieved,
nevertheless the other remains disordered.
The source of the disorder is discovered by this method. After shaving
the head, such medicines, as stop the gum in a lippitude, ought to
be laid on from the eye-brows as far as the top of the head: if the
eyes begin to be dry, it appears that they are moistened by those
veins, which are under the skin: if the moisture is not diminished,
it is manifest it descends from below the bone: if a humour still
flows(15), but in less quantity, the disorder is from both. In most
patients however the complaint is found to be derived from the superior
veins; and therefore the greater number may be relieved. And this is
very well known, not only in Greece, but amongst other nations too: so
that no part of medicine has been more clearly explained in any country.
Some _practitioners_ in Greece cut the skin of the head in nine lines;
two straight ones in the occiput, one transverse above these; then two
above the ears, one also transverse betwixt them; and lastly three
straight ones between the top of the head and the forehead. Others drew
these incisions in a straight direction from the top of the head to
the temples; and discovering from the motion of the jaws the origins
of the muscles, made gentle incisions in the skin above these, and
separating their lips by means of blunt hooks, they inserted lint in
such a manner, as to prevent the edges of the skin from uniting, and to
cause flesh to sprout up in the middle, which might bind those veins,
from whence the humour passes to the eyes. Others again have drawn a
line with ink from the middle of one ear to the middle of the other,
and another line from the nose to the crown of the head; and where
these lines met, made an incision with a knife; and after the effusion
of blood, cauterized the bone in that part. And notwithstanding this,
they also applied the actual cautery to the rising veins both in the
temples, and betwixt the forehead and crown of the head.
It is a common method of cure to cauterize the veins in the temples,
which indeed are generally turgid in this kind of disorder; but that
they may be more inflated and show themselves better, the neck must
first be tied pretty strait. And the veins must be cauterized with
small and blunt irons; till the flux of gum upon the eyes stop: for
that is a sign the passages are blocked up, by which the humour was
conveyed.
However it is a more effectual method, when the veins are small and
lie deep, and therefore cannot be separated(16), to make a ligature
about the neck in the same manner, and the patient keeping in his
breath, that the veins may rise the more, to mark with ink these in
the temples, and between the crown of the head and the forehead;
then loosing the neck, to cut the veins, where these marks are, and
discharge blood; when a sufficient quantity has flowed, to cauterize
them with small irons: in the temples indeed with caution; lest the
muscles lying below, which secure the jaws, be hurt; but betwixt the
forehead and the crown so strongly, that a scale may cast off from the
bone.
But the method of the Africans is still more efficacious, who cauterize
the crown of the head to the bone, so as to make it cast off a scale.
But nothing is better than what is done in Gallia Comata, where they
separate the veins in the temples, and the upper part of the head.
The manner of treating cauterized parts I have already explained. At
present I shall add this one direction; that when veins are cauterized,
we should not endeavour to hasten the separation of the eschars, nor
the filling up of the ulcers; lest either an hemorrhage ensue, or the
pus be quickly suppressed; since it is fit these parts be dried by the
latter, and it is not proper they should be exhausted by the former. If
however an hemorrhage should at any time happen, medicines for stopping
blood must be rubbed in, but not such as will prove caustic. Now the
method of separating veins, and what is to be done, when they are
separated, I shall explain, when I come to the varices of the legs.
CHAP. VIII.
OF THE OPERATIONS REQUISITE IN THE EARS.
But as the eyes require many operations, so in the ears there are very
few disorders, which come under this branch of medicine. However it
sometimes happens, either immediately from the birth, or some time
after, when there has been an ulceration, and the ear has been filled
by a cicatrix, that there is no opening in it, and there it is deprived
of the faculty of hearing. When this happens, trial must be made with
a probe whether it be filled up to any depth, or be only agglutinated
in the surface. For if it be deep, it does not yield to the pressure;
if superficial, it presently receives the probe. The first ought not to
be touched, lest a convulsion follow without any hopes of success, and
from that there may be a danger of death; the other is easily cured.
For where the foramen ought to be, either some caustic medicine must
be applied, or it must be opened by the actual cautery, or even cut
with a knife. And when that is opened, and the ulcer is clean, a quill
must be introduced there, armed with a cicatrizing medicine; and round
something must be applied, to promote the healing of the skin about the
quill; the effect of which is, that after it is removed, the patient
has the faculty of hearing.
But where the ears have been bored and give offence, it is sufficient
to pass a hot needle through the cavity very quick, that its lips may
be slightly ulcerated; or even to ulcerate it with a caustic medicine;
then afterwards to apply something to deterge it; next somewhat to
fill up the part, and bring on a cicatrix. But if this opening be
large, as it generally is in those who have worn heavy ear-rings, it is
proper to cut through what remains,(17) to its extremity; then above
that to scarify the edges _of the foramen_ with a knife, and afterwards
to stitch them, and apply an agglutinating medicine. The third case
consists in giving a supply to any part, that is deficient; which as it
may also be done in the lips and nose, and the method is the same, it
will be best to treat of it once for all.
CHAP. IX.
THE OPERATION NECESSARY IN A WANT OF SUBSTANCE IN THE EARS, LIPS, AND
NOSE.
Defects in these three parts, if they be small(18), may be cured: if
considerable, they either do not admit of a cure, or by the cure itself
are so deformed, that they were less offensive before. And in the ear
indeed, and the nose, deformity is the only thing to be feared: but in
the lips, if they are too much contracted, there is also a disadvantage
in respect of their use; because the food is taken, and the speech is
articulated with more difficulty. For flesh is not generated there; but
is brought from the adjacent part. Which though in a slight mutilation
it may both cause no defect, and escape observation, in a great one
cannot. Now an old person is not a proper subject for this operation,
nor one in a bad habit of body, nor one in whom ulcers heal with
difficulty; because there is no part, where a gangrene more quickly
seizes, or is harder to remove.
The method of cure is this; to reduce that, which is mutilated, into a
square; from its interior angles to cut in transverse lines, so as to
divide the part, that lies within these lines, from that beyond them;
then to draw together the parts we have thus opened: if they do not
fully meet, then beyond the lines we made before, to cut in two places
in a lunated form, with the horns turned towards the wound, so as only
to separate the surface of the skin: for by this means what we draw
together will be more at liberty to follow; which is not to be forced
by violence, but gently drawn, so as it may easily follow, and when let
go, not recede far.
Sometimes however, the skin not being altogether brought from one side,
renders the part, which it has left, deformed(19). In such a place an
incision must be made only on one side, and the other kept untouched.
Therefore we must not attempt to draw any thing either from the lower
part of the ears, or the middle of the nose, or the lower parts of the
nostrils, or from the angles of the lips. We may draw on both sides,
where there is any defect in the upper parts of the ear, or the lower
parts or the middle of the nostrils, or the middle of the lips: which
however are sometimes mutilated in two places; but the method of cure
is the same. If a cartilage projects in the part where the incision is
made, it must be cut off; for it neither unites again, nor is safely
pierced by the needle. Neither must much of it be cut away, lest
between the two extremities of the skin freed from it on both sides,
there should be a collection of pus. Then the lips of the wound being
brought into contact, must be stitched together, the skin being taken
up on both sides; and where the lines above mentioned are, there also
the suture must be used. In dry parts, as the nostrils, the application
of litharge does very well. Into the interior and lunated incisions
lint must be put; that granulations of flesh may fill up the wound. And
that the part thus sewed must be attended to with the greatest care,
may appear from what I said before of a gangrene. Therefore every third
day, it must be fomented with the steam of hot water, and the same
medicine applied again, which commonly on the seventh day unites it.
Then the stitches ought to be taken out, and the ulcer healed up.
CHAP. X.
OF THE EXTIRPATION OF A POLYPUS IN THE NOSE.
I have elsewhere said that the knife is the principal cure for a
polypus growing in the nostrils. Wherefore it is necessary to separate
this from the bone with a sharp iron instrument made in the form of
a spatha: care being taken not to hurt the cartilage below, which is
difficult to cure. When it is cut off, it must be extracted with an
iron hook. Then a piece of lint twisted, or some part of a penecillum
must be sprinkled with a styptick medicine, and the nostrils be gently
filled with it. The blood being stopped, the ulcer must be deterged
with lint. When it is clean, a quill armed with a cicatrizing medicine
must be introduced within, in the same manner as was directed in the
ear, till it be entirely sound.
CHAP. XI.
OF THE CHIRURGICAL CURE OF AN OZÆNA.
I do not find in the eminent surgeons any operation for the cure of
that disorder, which the Greeks call ozæna, when it does not yield to
medicines. I suppose because the operation seldom works a cure, and is
nevertheless attended with great pain. By some however it is directed
to introduce either a small cannula, or writing reed into the nostril,
till it reach up to the bone; then through this to pass a small hot
iron to the very bone; next to deterge the cauterized part with
verdigrease and honey; and when clean, to heal it up with lycium: Or
that an incision be made in the nostril from its extremity to the bone,
that the part may be seen, and the hot iron may be more easily applied;
then that the nostril be stitched; and the cauterized ulcer cured as in
the former method; and litharge or some other agglutinant laid upon the
suture.
CHAP. XII.
OF THE OPERATIONS REQUISITE IN THE MOUTH.
[Sidenote: _Of the teeth._]
In the mouth also some disorders are cured by manual operation. Here in
the first place the teeth are sometimes loosened, either by reason of
the weakness of their roots, or from the gums decaying. It is proper in
both cases to apply a hot iron to the gums, so as to touch them gently,
but not to make a deep impression. The gums when cauterized must be
rubbed with honey, and washed with mulse. When the ulcers begin to be
clean, some dry repellent medicines must be sprinkled upon them.
But if a tooth occasions pain, and it seems proper to extract it,
because medicines give no relief, it ought to be scraped all round,
that the gum may be loosened from it; then it is to be shook; which
must be continued till it move easily: for the extraction of a fast
tooth is attended with the greatest danger, and sometimes the jaw-bone
is dislocated. It is attended with more danger still in the upper
teeth; because it may give a shock to the temples or eyes. After these
precautions, the tooth is to be taken out, if possible, by the hand, if
not, by a forceps.
But if it be corrupted before, its cavity must be filled up either with
lint, or lead well adapted to it, lest it break under the forceps. The
forceps must be drawn out straight, lest the thin bone, to which the
tooth adheres, be fractured in some part by its bended roots. Neither
is this without danger; especially in the short teeth, which generally
have longer roots; for often, when the forceps cannot lay hold of the
tooth, or does it without success, it takes hold of the jaw-bone, and
breaks that.
One may immediately be sure, when there is a large effusion of blood,
that something is broken off from the bone. Therefore the scale,
that has come off, must be sought for by a probe, and taken out with
a vulsella. If it does not come away, the gum ought to be cut, till
the scale loosened from the bone can be taken out. And if it be not
entirely broken, but the external part of the jaw swells, so that the
mouth cannot open, on the outside must be applied a warm cataplasm of
meal and figs, till it bring on a suppuration there; then an incision
must be made in the gum. A copious discharge of pus is also a sign of a
fractured bone: so that even then it is proper to extract it. Sometimes
too, when it is injured, there is a fissure, which ought to be scraped.
A rough tooth ought to be scraped, where it is black, and rubbed with
the powder of rose leaves, with an addition of one-fourth part of
galls, and another of myrrh; and pure wine must be held in the mouth
frequently. And in this case the head must be covered, the patient must
walk much, make use of friction to his head, and a diet not acrid.
But if either, from a blow, or some other misfortune, some of the teeth
are loosened, they must be tied with gold to those that are firm;
and restringents must be held in the mouth, such as wine, in which
pomegranate bark has been boiled, or in which hot galls have been
infused. And if one tooth should happen to grow in children, before the
former has fallen out, that, which should have dropped, must be scraped
round and pulled out; that which is growing in the place of the former,
must be pushed into its proper place, with the finger, every day, till
it come to its just size. Whenever a tooth is extracted, and its root
has been left, that also must be immediately taken out by a forceps
made for that purpose, which the Greeks call rizagra.
[Sidenote: _Of indurated tonsils._]
Tonsils, that are indurated, after an inflammation, called antiades[HI]
by the Greeks, when they are covered by a slight coat, should be
disengaged all round by the finger, and pulled out. If they are not
separated by this method, it is necessary to take hold of them with a
small hook, and cut them out with a knife; then to wash the ulcer with
vinegar, and rub the wound with a styptic medicine.
[HI] ἀντιάδες.
[Sidenote: _Of the uvula._]
The uvula, if it is inflamed, and falls down, and is painful, and of a
ruddy colour, cannot be cut without danger; for there is commonly a
great effusion of blood: therefore it is better to make use of those
remedies I have mentioned elsewhere. But if there be no inflammation,
and nevertheless it is relaxed to a great length by a humour, and is
small, sharp, and white, a portion of it ought to be cut off: and
likewise, if the extremity of it be livid and thick, and the superior
part small. There is no better method than to take hold of it with a
vulsella (_a kind of forceps_), and under that, to cut off what we
think fit: for there is no danger, that either too much or too little
be cut off; as we have it in our power to leave no more below the
vulsella, than appears to be useless, and to cut off so much as shall
reduce the uvula to its natural magnitude. After the operation, the
same applications are proper, which were prescribed above for the
tonsils.
[Sidenote: _Of the tongue._]
The tongue, in some people, is joined with the part below it from their
birth; who are by that means deprived of speech. The end of their
tongue must be taken hold of with a vulsella, and the membrane below it
cut; great care being taken, that the contiguous veins be not wounded,
and the patient hurt by an effusion of blood. The remaining part of the
cure of the wound is already directed in the preceding cases. And most
people speak, as soon as it is healed. But I have known an instance,
where a person after the cutting of his tongue, though he could thrust
it far enough beyond his teeth, did not attain the faculty of speaking.
Thus it happens in the practice of physic, that what is always right to
do, is not always attended with success.
[Sidenote: _An abscess under the tongue._]
An abscess also sometimes gathers under the tongue; which is generally
included in a coat, and excites violent pains. If this be small, it is
sufficient to make one incision into it: if larger, the surface of the
skin must also be cut off to the coat, then the lips of it are to be
laid hold of on both sides with small hooks, and the membrane must be
freed from its connections all round; great care being taken in this
operation not to wound any large vein.
[Sidenote: _Of chopped lips._]
The lips are frequently chopped; which besides the pain, is attended
with this inconvenience, that it hinders our speaking, as that action
by opening the fissures causes them to bleed, and to give pain. If
these be only in the surface, it is better to treat them by those
medicines, which are composed for ulcers of the mouth: if they are
deeper, it is necessary to cauterize them with a thin iron; which being
made in the form of a spatha, ought to slide over them as it were, and
not press upon them. Afterwards, the same method must be followed, as
was laid down in cauterized ulcers of the nostrils.
CHAP. XIII.
OF THE BRONCHOCELE.
In the neck, between the skin and the wind-pipe, a tumour rises,
which the Greeks call bronchocele[HJ], in which there is contained
sometimes insensible flesh, at other times a humour like honey or
water; sometimes also hairs mixed with small bones. Whatever that be,
which is contained in the coat, it may be cured by caustic medicines,
which burn the surface of the skin, together with the coat below it.
When this is done, if it be a humour, it runs out; if it be any thing
substantial, it is taken out by the fingers; then the ulcer is healed
by lint. But the cure by the knife is more expeditious. An incision is
made in one line in the middle of the tumour down to the coat; after
which, the morbid body is separated by the finger from the sound parts,
and is taken out entire with its coat: then it is washed with vinegar,
to which either salt or nitre has been added; and the lips are joined
by one stitch. The other applications are the same as in other sutures;
afterwards it must be bound up gently, lest it press the fauces. If
it should happen that the coat cannot be taken out, we must sprinkle
escharotics into it, and dress it with lint and other digestives.
[HJ] βρογχοκήλη.
CHAP. XIV.
OF THE OPERATIONS PERFORMED AT THE NAVEL.
There are several disorders about the navel, concerning which, because
they are very uncommon, authors are not agreed. Now it is probable,
that each one omitted what he had not met with, and that none of them
feigned a disease he had not seen. An indecent prominence of the navel
is common to them all. The question is, what are its causes? Meges has
assigned three; that sometimes the intestine makes its way into that
part, sometimes the omentum, at other times a humour. Sostratus has
not mentioned the omentum. To the other two he has added, that flesh
sometimes grows there; which is sometimes sound, at other times of a
cancerous nature. Gorgias also has omitted the omentum, but allowing
the other three causes, says, that air too sometimes is forced into
this part. Heron has mentioned all these four, and the omentum too; and
that species also, in which there is both the omentum and the intestine.
The following symptoms discover what species it is. When the intestine
is protruded, the tumour is neither hard nor soft; is lessened by
cold, increases not only by heat, but even by keeping in the breath;
sometimes it sounds; and when a person lies on his back, the intestine
returns of itself, and the swelling subsides. When it is the omentum,
the other symptoms are similar, but the tumour is softer, and from its
base, tapers towards the top; and if one takes hold of it, it slips
away. Where both these are together, the symptoms are also complicated,
and the degree of softness is between both. But flesh is harder, and
there is a swelling always, though the patient lies on his back; it
does not yield to pressure, whereas the former easily does. If it be
corrupted, it has the same appearances which I described in a cancer.
A humour, if it be pressed, fluctuates. Air gives way to pressure, but
quickly returns; and when the body is in a supine posture, the tumour
retains the same figure.
Of these species, that which proceeds from air, does not admit of
a cure. It is dangerous also to meddle with flesh that resembles a
cancer; and therefore it must be let alone. Where it is sound, it ought
to be cut out, and the wound dressed with lint. Some discharge the
humour by making an incision in the top of the tumour, and cure that
also by lint. With regard to the others, the opinions are various.
However, the circumstances themselves make it plain, that the body
must be laid in a supine posture; that whether it be the intestine or
the omentum, it may fall back into the abdomen. Then the cavity of
the navel being empty, by some is laid hold of by two regulae(20),
and their ends being tied tight, the part mortifies: by others it is
pierced to the bottom with a needle, followed by two threads, and is
tied on the one side and the other by the two ends of each of these
threads (as is done in the staphyloma of the eye) for by this means
the part above the ligature mortifies. Others added this process to
the operation: before tying, they made a single incision on the top,
that, by introducing a finger, they might push back the protruded
part, and then made the ligature. But it is sufficient to order the
patient to hold in his breath, that the tumour may show itself in its
full magnitude; then to mark the base of it with ink; and laying the
person on his back, to press down the tumour, that if any part has
not returned, it may be forced in by the hand; this done, to draw up
the navel, and where the mark of the ink is, to tie it strongly with
a thread; then to cauterize the part above the ligature, either with
medicines, or the actual cautery, till it be mortified; and to dress
the ulcer like other burns. This method is very successful not only
when the intestine, or the omentum, or both are contained in it, but
even where it is a tumour.
But some circumstances are to be considered, before proceeding to the
operation, that no danger may arise from the ligature. For neither
an infant, nor an adult, nor an old man are proper subjects for this
method of cure; but generally such as are from seven to fourteen
years old. Next, that person is in a fit condition for it, whose body
is sound; but one, who is in a bad habit, and labours under papulæ,
impetigoes, and the like disorders, is not a proper subject. Slight
tumours also are easily removed; but there is danger in attempting
to cure those that are too large. The autumnal and winter season of
the year must be avoided. Spring is most suitable: and the beginning
of summer is not amiss. Besides these precautions, it is necessary to
fast the day before. Nor is that sufficient; for a clyster must also be
given, that all the protruded parts may the more easily subside within
the abdomen.
CHAP. XV.
THE METHOD OF DISCHARGING THE WATER IN HYDROPICK PEOPLE.
I have elsewhere observed, that it is necessary to discharge the water
in dropsical patients. I must now describe the manner of performing it.
Some do it below the navel, about four fingers breadth to the left:
some by perforating the navel itself. Others first cauterize the skin,
and then make an incision through the interior teguments, because what
is divided by the actual cautery unites less quickly. The instrument
is to be introduced with great care not to wound any vein. It ought to
be of such a form, that the breadth of its point should be about the
third part of a finger; and it must be introduced so as to pass through
the membrane also, which separates the flesh from the internal part;
then a leaden or copper pipe must be introduced into it, its lips being
either spread outward, or surrounded with some check to prevent its
slipping through. The part that goes within ought to be a little longer
than that without, that it may reach beyond the internal membrane. By
this the water must be evacuated, and when the greater part of it is
discharged, the pipe must be stopped with a bit of linen, and left in
the wound, if it was not cauterized. Then on the following days, about
a hemina must be let out every day, till no water appears to remain.
Some even take out the pipe, though the skin has not been cauterized,
and tie over the wound a spunge squeezed out of cold water, or vinegar,
and the day following introduce the pipe again (which the recent wound,
by being a little stretched open, will admit of) that so, if any
humour remains, it may be evacuated; and this they recommend to be done
only twice.
CHAP. XVI.
OF WOUNDS OF THE BELLY AND INTESTINES.
Sometimes the belly is perforated by a wound; upon which the intestines
roll out. When this happens, it must be first of all considered,
whether they be unhurt; and then whether they retain their natural
colour. If the smaller intestine be perforated, I have already
observed, that there is no cure for it. The large intestine may be
sewed; not that there is any reliance on the cure, but because a
doubtful hope is preferable to certain despair: for it sometimes
reunites. However, if either the intestine be livid, or pale, or black,
which symptoms also are necessarily attended with a want of sensation,
all remedies are vain. But if they yet retain their proper colour,
they must be treated with great expedition; for they are changed in
a moment, when exposed to the external air, to which they are not
accustomed. The patient must be laid on his back, with his hips raised
pretty high; and if the wound be so narrow, that the intestines cannot
be conveniently reduced, a sufficient opening must be made by incision.
And if the intestines are already become too dry, they must be washed
with water mixed with a little oil. Then the assistant ought gently to
separate the lips of the wound with his hands, or even with two hooks
passed through the peritonaeum, and the physician must insert those
intestines first that came out last, in such a manner as to preserve
the order of their several convolutions. When they are all replaced,
the patient must be shook gently, which causes all the intestines to
return to their proper places, and settle there. These being lodged,
the omentum must also be considered; and if any part of that be already
black or mortified, it must be cut off by the scissars; if any of it is
sound, it must be reduced upon the intestines. Now, neither a suture of
the skin alone, nor of the interior membrane is sufficient, but both of
them together. And that must be performed with two threads, and sewed
closer than in other places; because it may both be more easily broken
by the motion of the belly, and this part is not so liable to violent
inflammations. Therefore, threads are to be put into two needles, and
these held in both hands; the interior membrane must be sewed first,
beginning at the extremity of the wound, in such a manner, that the
needle may pass from the internal towards the external part, the left
hand carrying it through the right lip, and the right hand through the
left, by which means, the points of the needles are always farthest
from the intestines, and the blunt part next to them. When each side
is pierced once, the needles must be changed in the hands, that the
needle, which was in the left hand, may be in the right, and that come
into the left, which the right held before: and in the same manner they
must pass through the lips again; and also a third and fourth time,
and so on, the hands each time interchanging the needles, and thus the
wound must be closed. Then the same threads and needles must be brought
to the skin, and in like manner both sutures be performed on that part
too; the needles always passing from the internal part, and from the
one hand to the other. Afterwards agglutinants must be applied: to
which it is needless to repeat, from time to time, that it is necessary
to add either spunge or sordid wool squeezed out of vinegar. When these
are applied, a gentle bandage ought to be passed round the belly.
CHAP. XVII.
OF A RUPTURE OF THE PERITONAEUM.
Sometimes either from a blow, or keeping in the breath too long, or
by the pressure of a heavy load, the internal membrane of the abdomen
breaks, when the skin above is whole: which also frequently happens
to women from pregnancy; and it generally occurs about the ilia. The
consequence is, that the flesh above being soft, does not bind the
intestines strongly enough, and the skin distended by them forms an
indecent tumour. And this disease is cured in different ways. For some
passing a needle with two threads into the base _of the tumour_, tie
it on both sides in the same manner described in the cases of the
navel and the staphyloma, that whatever is above the ligature may
mortify. Others cut out the middle of it in the form of a myrtle leaf
(according to the rule before laid down for all cases of a like nature)
and then join the lips by a suture. However, the best method is to
lay the patient on his back, and try by the hand, in what part the
tumour yields most, because the membrane must necessarily be ruptured
there, and resist more, where it is sound: then, where it appears to be
ruptured, incisions are to be made in two lines(21) by a knife, that
the part betwixt them being cut out, the internal membrane may have a
recent wound on both sides; because what has been long disunited does
not unite by a suture. The place being laid open, if the membrane in
any part should appear not to be fresh wounded, a small slip must be
cut off, only to ulcerate its edges. What else relates to the suture,
and the remaining part of the cure, has been above directed.
[Sidenote: _Of varices in the belly._]
Besides these, some people have varices in their bellies; but as the
method of cure here does not differ from that which is practised in the
legs, and being about to describe it by and by, I shall refer it to
that place.
CHAP. XVIII.
A DESCRIPTION OF THE TESTICLES, AND THEIR DISEASES.
I now come to those diseases which arise in the private parts about the
testicles: which, that I may the more easily explain, I shall first
give a short account of the nature of the part. The testicles then have
something resembling small glands(22): for they do not discharge
blood, and are void of all sensation; the coats, however(23), which
contain them, are pained in wounds and inflammations. Now each of them
hangs from the groin by a nerve (_the vas deferens_) which the Greeks
call cremaster[HK]: and with each descends both a vein and an artery.
And these are covered with a membrane, thin, nervous, not sanguineous,
and white, which by the Greeks is called elytroides[HL]. Over that is a
firmer coat, which adheres strongly in the lowest part to the interior
one. The Greeks call it dartos[HM]. Besides, there are many small
membranes, which inclose the veins and arteries, and those nerves; and
betwixt the two coats in the superior part they are thin and open. Thus
far then the coats and vessels are peculiar to each testicle. But there
is a sinus common to both, and to all the internal part, which is also
exposed to our view. The Greeks call it oscheum[HN]; in our language it
is scrotum. And this in the lower part is slightly connected with the
middle coats, above only envelopes them.
[HK] κρεμαστὴρ.
[HL] λυτροειδὴς.
[HM] δαρτὸς.
[HN] ὀσχεὸν.
Under this then several disorders occur: which happen sometimes
when these coats, which I said had their origin from the groin, are
ruptured; at other times, when they are entire: for sometimes the coat,
which ought to separate the intestines from the inferior parts, is
either first inflamed from a distemper, and afterwards burst by the
weight, or ruptured at once by some wound. Then either the omentum
alone, or that and the intestine together, fall down into it by their
own weight. And finding a way there, they bear down gradually from the
groin upon the inferior parts, and by and by divide the nervous coats,
which, for the reason I gave before, are open. The Greeks call these
enterocele[HO] and epiplocele[HP]: with us an indecent, but common name
for them is hernia.
[HO] ἐντεροκήλη.
[HP] ἐπιπλοκήλη.
Now if the omentum descends, the tumour in the scrotum is never removed
either by fasting, turning the body one way or another, or placing it
in any particular posture; and if the breath be kept in, it is not much
increased, is unequal to the touch, and soft and slippery.
But if the intestine also descends, the tumour without any inflammation
sometimes lessens, at other times increases, and it is generally free
from pain, and when a person is at rest, or lies down, it sometimes
entirely subsides, at other times it is so diminished, that a very
small part of it remains in the scrotum; but upon vociferation, or
repletion, and a violent exertion of force in bearing a great weight,
it increases: by cold it is contracted, by heat dilated; and at that
time the scrotum is both round and smooth to the touch, and what lies
within is slippery; if it be pressed, it returns to the groin; and
being let go, it rolls down again with a murmuring kind of noise, and
this happens in the lesser degrees of this malady. But sometimes from
the reception of excrements, the swelling is vastly enlarged, and
cannot be reduced; and occasions pain at such times to the scrotum and
groin, and abdomen. Sometimes too the stomach is affected, and throws
up first reddish coloured bile, then green, and in some even black.
Sometimes the membranes being entire, a fluid distends this part: and
there are also two species of this. For it either collects between the
coats, or in the membranes, which surround the veins and arteries in
that part, when they are oppressed, and have grown callous. Neither
has that fluid betwixt the coats one certain seat: for sometimes
it lodges between the external and middle, sometimes betwixt the
middle and internal coat. The Greeks call this by the general name of
hydrocele[HQ], of whatever species it be. Our countrymen, not being
acquainted with any distinctions, include this also under the same name
as the former disorders.
[HQ] ὑδροκήλη.
Now in these there are some symptoms, that belong to all, and others,
that are peculiar to each particular species. The general are such as
indicate the collection of a fluid; the particular, its seat. We know a
fluid is contained within, if there be a tumour, that never disappears
entirely, but is sometimes lessened by fasting, or a slight fever, and
chiefly in children. And this is soft, if there is not a very great
quantity of fluid within; but if it has greatly increased, it resists
like a bottle filled, and tightly tied; the veins in the scrotum also
are inflated; if we press upon it with our finger, the fluid yields,
and fluctuating raises the part that is not pressed; and it appears
through the scrotum, as if it were in a glass or a horn; and in itself
is attended with no pain. The seat of it is thus known: If the water be
betwixt the external and middle coat, when we press with two fingers,
it gradually returns between them; the scrotum is somewhat lax and
whitish; if it is stroked, it stretches little or nothing; the testicle
can neither be seen nor felt in that part. But if it is within the
middle coat, the scrotum is more stretched and raised higher, so that
the penis above it is concealed under the swelling.
Besides these, when the coats are equally entire, a ramex grows there.
The Greeks call it cirsocele[HR], when the veins swell. These being
sometimes twisted, and rolled up toward the superior part, fill either
the scrotum, or the middle coat, or the innermost one; sometimes they
grow even within the innermost coat about the testicle itself and its
nerve. Those that are in the scrotum itself are exposed to view; and
those which lie upon the middle or innermost coat, as being deeper, are
not indeed equally discernible, but yet are visible; besides that there
is both some swelling, according to the size and capacity of the veins,
and it also resists pressure more, and is unequal by reason of the
varicous dilatations of the veins; and on that side where it is, the
testicle is more dependent than it should be. But when this malady has
grown upon the testicle itself and its nerve, the testicle hangs down
much lower, and becomes less than the other, as being deprived of its
nutriment.
[HR] κιρσοκήλη.
Sometimes, though seldom, flesh grows between the coats. The Greeks
call that sarcocele[HS].
[HS] σαρκοκήλη.
Sometimes too the testicle itself swells from an inflammation, and
also brings on fevers; and unless the inflammation has quickly ceased,
the pain reaches to the groin and ilia; and these parts swell, and the
nerve, by which the testicle hangs, is enlarged, and grows hard at the
same time.
Besides the foregoing, the groin is also sometimes filled with ramices;
which case they call bubonocele[HT].
[HT] βουβωνοκήλη.
CHAP. XIX.
GENERAL DIRECTIONS FOR OPERATIONS IN THE FOREGOING DISEASES ABOUT THE
TESTICLES.
These disorders being known, we must proceed to treat of their cure: in
which some things are common to them all, some proper to the particular
kinds. I shall first speak of the general: and now treat of those,
which require the knife. For those, that are either incurable, or ought
to be treated in a different manner, I shall take notice of, when I
come to the particular species. Now the incision is made sometimes in
the groin, sometimes in the scrotum. In either method it is necessary
for the patient to drink water for three days before; and the preceding
day even to fast: on the day of the operation, he must be laid on his
back; and if the incision is to be in the groin, and that is covered
with hair, it must first be shaved; then the scrotum being extended to
render the skin tense, the incision must be made at the bottom of the
belly, where the inferior coats are joined to the abdomen. It must be
opened boldly, till the external coat, which is the scrotum itself, be
cut, and the middle one come in view. When the wound is made, there
is an opening toward the inferior parts. Into that the fore finger of
the left hand must be introduced, that by separating the intervening
membranes it may enlarge the sinus. And an assistant taking hold of the
scrotum with his left hand, must extend it upward, drawing it away as
much as possible from the groin; at first with the testicle, while the
physician cuts away by the knife, if he cannot separate them by his
finger, all the small membranes, that are above the middle coat; after
this, letting go the testicle, that it may slip down, and come near to
the wound, and be brought out thence by the finger, and laid upon the
belly with its two coats. And if any part of it is corrupted, it must
be cut off. And as several veins are dispersed upon it, the small ones
may be cut at once, but the larger should be first tied with a pretty
long thread, to prevent a dangerous hemorrhage from them.
But if the middle coat be affected, or the disease lies below it, it
must be cut out in such manner, that in the higher part close to the
groin it should be clean cut off: but the whole must not be taken away
below; for what is strongly connected at the base of the testicle with
the innermost coat, cannot be cut off without the greatest danger, and
for that reason must be left there.
The same method is to be taken in the innermost coat too, if that be
injured. But it must be cut off, not at the top of the wound in the
groin, but a little below that; lest it bring on inflammations by
wounding the membrane of the abdomen. Neither on the contrary must
too much of it be left; lest afterwards it form a sinus, and afford a
receptacle to the same distemper.
The testicle being thus cleansed must be gently let down through the
wound, with the veins, and arteries and its nerve; and care must be
taken, that no blood fall into the scrotum, and that it does not remain
coagulated in any part: which will be prevented, if the physician has
been careful to tie the veins. The threads, by which their ends are
secured, must hang without the wound: and when a suppuration comes on,
they will fall off without any pain. Upon the wound itself must be put
two fibulæ; and over them an agglutinating medicine.
It is sometimes necessary to cut off something from one of the lips,
that the cicatrix may be larger and broader. When this is the case,
the lint must not be pressed down upon it, but only laid on lightly;
and over it some medicines to repel an inflammation, such as sordid
wool, or spunge squeezed out of vinegar; every thing else must be used
as when a suppuration ought to be excited. But when it is necessary
to make the incision beneath, the patient being laid on his back, the
left hand must be put below the scrotum; and a strong hold must be
taken of it, and the incision made; if the seat of the disorder be
small, the incision must be moderately sized, so as to leave a third
part _of the scrotum_ below entire, in order to support the testicle;
if it be larger, the wound may be greater, a little at the bottom
only being left entire, upon which the testicle may rest. But the
knife at first should be held in a straight direction, with a very
light hand, till it divide the scrotum itself; then the point of it
must be turned aside a little, to cut the transverse membranes, that
are between the external and middle coats. But the middle coat ought
not to be touched, if the disease lie above it; but if it lies below
the middle coat, that must be cut too; as likewise the third, if that
cover the malady. Wherever the disorder is found, the assistant should
squeeze the scrotum gently at the lower part; and the physician having
separated the inferior part by his finger, or the handle of the knife,
should bring the coat out of the wound, and make such an incision with
an instrument, which from its figure is called corvus, that he may
introduce his fore and middle fingers: when this is done, the remaining
part of the coat must be cut, and the knife must pass between the
two fingers, and whatever is noxious must either be taken out, or be
allowed to run out.
Whatever coat is injured in the operation must be cut off; and the
middle one, as I observed before, as high as possible at the groin; the
innermost one a little lower. But before they are cut off, the vessels
ought to be tied very carefully by a thread; and the ends of this
thread must be left without the wound, which must be done also in other
veins, where the ligature is requisite.
When that is done, the testicle must be returned into its place: and
the lips of the scrotum joined together by a suture: and the stitches
must not be too few, lest they be not agglutinated, and the cure prove
tedious; nor yet too many, lest they increase the inflammation. And in
this case too we must be cautious, that no blood remain in the scrotum:
afterwards agglutinants must be applied.
If however blood has made its way into the scrotum, or any coagulated
blood has fallen down into it, an incision should be made below it;
and after cleansing it, a spunge moistened with sharp vinegar must be
applied round it. A wound that has been made for these reasons, after
it is tied up, if there be no pain, must not be opened for the first
five days; but either the wool or spunge, that lies over it, must be
sprinkled twice a day with vinegar alone; if there be pain, it must
be opened on the third day; and where there are fibulæ, they must be
cut; and where lint, that must be changed; and what is put on, must be
wet with oil of roses and wine. If the inflammation increases, to the
foregoing applications must be added a cataplasm of lentils and honey,
of pomegranate bark boiled in a rough wine, or a mixture of these.
If the inflammation does not give way to them, after the fifth day,
the wound must be fomented with plenty of hot water, till the scrotum
itself be both extenuated, and become more wrinkled; then a cataplasm
must be applied of wheat meal, with an addition of pine resin; which,
if the patient be a robust man, must be boiled up with vinegar; if more
delicate, with honey. And whatever the disorder has been, if there be
a great inflammation, without doubt medicines to promote a suppuration
must be applied.
But if pus is generated within the scrotum, a small incision ought to
be made to give a vent; and so much lint is to be applied as to cover
the orifice. When the inflammation is removed, upon account of the
nerves, the last-mentioned cataplasm, and then cerate must be used.
This is the peculiar treatment of wounds of this kind. All other things
both in regard to the manner of dressing, and the diet, should be
conformable to the directions we have given about other wounds.
CHAP. XX.
OF THE CURE OF A RUPTURE OF THE INTESTINE INTO THE SCROTUM.
These things being premised, we must descend to the particular species.
And if the intestine comes down in a young child, a bandage must be
made trial of before the knife: for this purpose a roller is sewed, to
which in one part a bolster is used made of cloths, which is applied
under the intestine to repel it; and then the rest of the roller is
bound tight about him: by means of which, the intestine is often forced
in, and the coats are agglutinated together. Again if the patient be
advanced in years, and from the largeness of the tumour it appears,
that much of the intestine has fallen down, and the case is attended
with pains and vomiting (which generally proceeds from the excrements
getting down into that part by a crudity) it is plain that the knife
cannot be used without fatal consequences; the complaint is therefore
only to be alleviated; and the intestine evacuated by other methods.
The patient ought to be bled in the arm: and then if his strength will
admit, abstinence must be enjoined for three days; if he cannot bear
that, at least as long as his strength will allow. At the same time
must be kept upon it a cataplasm of lintseed boiled in mulse. After
these both barley meal with resin must be applied, and the patient put
into a bath of warm water mixed with oil; and some light and hot food
must be given. Some even administer clysters. These may carry something
into the scrotum, but cannot evacuate any thing from thence. The
disease being mitigated by the methods above prescribed, if the pain
returns at any time, the same course must be pursued.
If a great portion of the intestine has fallen down without pain, it is
also needless to make an incision; not but that it may be removed from
the scrotum (unless an inflammation prevent) but because when repelled
thence, it stops at the groin, and raises a tumour there; and thus
there is not a termination, but a change of the malady.
But where the use of the knife is proper, as soon as the wound made in
the groin shall reach to the second coat, that must be taken hold of
near the lips with two small hooks, while the physician disengages it
by taking out all the small membranes: for that, which is to be cut,
cannot be injured without danger, as the intestine must lie below it.
When it shall be separated, an incision must be made from the groin to
the testicle, care being taken not to wound the last; then it must be
cut out. For the most part however this operation is _only_ practicable
in children, and in a moderate degree of the malady.
But if it be a robust man, and the disorder be more considerable, the
testicle ought not to be taken out, but to remain in its place. The
operation is performed in this manner. The groin is opened in the
same way by a knife, as far as the middle coat; and this coat in like
manner is taken hold of with two hooks, and the testicle is held by an
assistant(24), so as to prevent its coming out at the wound; then an
incision must be made downward in this coat with a knife; and below
it the fore finger of the left hand is introduced to the bottom of the
testicle, which it forces up to the wound: then the thumb and fore
finger of the right hand separate the vein and artery, and their nerve,
and coat from the external coat. And if any small membranes obstruct
this, they are divided by the knife, till the coat be wholly exposed to
view. When all is cut out, that requires excision, and the testicle is
replaced, a pretty broad habenula is to be taken from the lip of the
wound in the groin, that the wound may be the larger, and generate the
more flesh.
CHAP. XXI.
OF THE CURE OF A RUPTURE OF THE OMENTUM INTO THE SCROTUM.
But if the omentum descends, the groin must be opened, and the coats
separated in the same manner as directed before. And it must be
considered whether it be a large or small part of it. For when it is
very small, it must be forced back over the groin into the abdomen by
a finger or the broad end of a probe: if it is large, whatever has
fallen out of the abdomen must be allowed to remain there; and it must
have escharotic medicines laid on it, till it mortify and fall off.
Some in this case pass through it a needle with two threads, and tie
the two ends of each contrary ways; by which it mortifies with equal
certainty, but not so soon. The effect is accomplished sooner, if the
part of the omentum above the ligature be rubbed with eating medicines,
but not corrosive; they are called septica by the Greeks. There have
been others, who have cut off the omentum with scissars: which is not
necessary, where the quantity is small; and if large, it may occasion
an hemorrhage; for the omentum is also connected by veins, and some of
them large. Neither can this practice be justified by an example drawn
from the cases of the belly opened by a wound, where the part of the
omentum, which falls out, is cut away by the scissars: since in this
case, it is both mortified, and cannot be taken off in any other way
more safely. If the omentum be reduced, the wound ought to be stitched;
or if it has been large and has mortified externally, the lips must be
cut off, as proposed before.
[Sidenote: _Of a hydrocele._]
If there be a fluid within _the membranes_, an incision must be made,
in boys upon the groin, unless too large a quantity of fluid forbid the
operation in that place; but in men, and where-ever there is a large
quantity, the scrotum must be opened. Then if the incision be made in
the groin, the coats must be drawn out at that part, and the humour
evacuated; if at the scrotum, and the disease be immediately below that
coat, there is no more required but to evacuate the humour, and cut
away any of the membranes, that happen to contain it; then it must be
washed with water, and an addition either of salt, or nitre: if the
disease lie within the middle or innermost coat, they must be taken
entirely out of the scrotum and cut off.
CHAP. XXII.
OF A RAMEX IN THE SCROTUM.
A ramex situated upon the scrotum must be cauterized with small and
sharp irons run into the veins themselves, provided they burn nothing
else: it is peculiarly necessary to apply the cautery where they are
twisted and rolled together; afterwards meal mixed up with cold water
must be laid on; and the bandage must be applied, which I recommended
for the anus; on the third day lentils with honey must be put to it:
after the separation of the eschars, the ulcers must be deterged with
honey, embrocated with rose oil, and brought to cicatrize by dry lint.
Where the veins above the middle coat swell, the groin must be cut, and
the coat brought without the orifice; after which the veins are to be
separated from it by the finger, or the handle of the knife, and where
they adhere, tied both above and below by a thread; then they must be
cut through close to the ligatures, and the testicle replaced. But if
the ramex be situated upon the innermost coat, it is necessary to cut
out the middle one. And then if two or three veins swell, so that some
part be affected, but the greater part be from the disease, the same
method must be pursued as directed above; that is, the veins being
tied both at the groin and testicle, may be cut off, and the testicle
reduced to its place. But if the ramex have seized upon the whole of
it, the fore finger must be introduced through the wound, and put under
the veins, so as to draw them out gradually and uniformly, till the one
testicle be equal to the other; then fibulæ are to be put in the lips
in such a manner, as to lay hold of these veins likewise. It is done
thus. A needle passes through the lip from the external part, and then
is directed not through the vein itself, but its membrane, and from
thence is forced into the other lip. The veins ought not to be wounded,
lest they discharge blood. There is always a membrane between these
veins, which occasions no danger, and holds them fast enough, when
taken up by the thread: and therefore two fibulæ are sufficient. After
this, whatever veins have been brought out, should be returned into the
groin with the broad end of the probe. The time for loosing the fibulæ
is, when the inflammation is gone, and the ulcer deterged; that the
cicatrix may at once bind up both the lips and the veins.
When the ramex has grown between the innermost coat, and the testicle
itself and its nerve, the only cure is to cut off the whole testicle:
for it does not in the least contribute to generation, and hangs down
in all indecently, in some even with pain. But in this case too, an
incision is to be made in the groin, and the middle coat must be drawn
out and cut away; the innermost one is to be treated in the same
manner; and the nerve, by which the testicle depends, to be cut off.
After this, the veins and arteries must be tied by a thread at the
groin, and cut off below the ligature.
CHAP. XXIII.
OF A SARCOCELE.
If flesh happen to grow between the coats, it must certainly be taken
out; and the most convenient way of doing it is by an incision in the
scrotum.
But if the nerve be indurated, the disorder cannot be cured either
by the hand or medicines. For the patients are oppressed with ardent
fevers, and either green, or black vomitings, besides these a violent
thirst, and roughness of the tongue; and generally about the third
day, frothy bile is discharged by stool, which excoriates the parts;
and food can neither be easily taken or retained; not long after,
the extremities grow cold, a tumour comes on, the hands are expanded
involuntarily; then comes on a cold sweat in the forehead, which is
followed by death.
CHAP. XXIV.
OF A RAMEX IN THE GROIN.
When there is a ramex in the groin, if the swelling be small, a single
incision ought to be made; if it be larger, it ought to be done in two
lines, that what lies between may be cut out; and then without taking
away the testicle, as I have above shewn to be sometimes practised in a
rupture of the intestines, the veins must be taken up, and tied, where
they adhere to the coats, and cut off below these knots. The cure of
this wound is no way different from others.
CHAP. XXV.
THE OPERATIONS REQUISITE IN THE DISORDERS OF THE PENIS.
From those we are to proceed to the operations upon the penis. If the
glans be bare, and a person chuses for the sake of decency to have
it covered, that may be done; but more easily in a boy than a man;
and more easily in one, to whom it is natural, than in another, who
according to the custom of some nations has been circumcised; better
where the glans is small, and the skin about it pretty large, and the
penis itself short, than where there is quite the reverse of these
circumstances. The cure of these, in whom it is natural, is performed
in this manner. The skin about the glans is laid hold of, and extended
till it cover it, and tied there; then near the pubes a circular
incision is made on the skin of the penis, till it be laid bare; and
great caution is used not to cut either the urinary pipe, or the
veins in that part. When this is done, the skin is drawn towards the
ligature, so that a part near the pubes is laid bare resembling a hoop;
then over it is applied lint, that the flesh may grow and fill it up,
and the breadth of the wound may afford a sufficient covering to the
glans. But the ligature must be continued till a cicatrix be formed,
leaving only in the middle a small passage for the urine. But in a
person, that has been circumcised, under the circle of the glans, the
skin ought to be separated by a knife from the inner part of the penis.
This is not very painful, because the extremity being loosened, it may
be drawn backwards by the hand, as far as the pubes; and no hemorrhage
follows upon it. The skin being disengaged, is extended again over the
glans; then it is bathed with plenty of cold water, and a plaister put
round it of efficacy in repelling an inflammation. For the following
days the patient is to fast, till he be almost overcome with hunger,
lest a full diet should perhaps cause an erection of that part. When
the inflammation is gone, it ought to be bound up from the pubercles to
the circle of the glans; and a plaister being first laid on the glans,
the skin ought to be brought over it; for thus it will happen, that the
inferior part may be united, and the superior heal so as not to adhere.
On the contrary, if the glans be covered, so that it cannot be denuded
(which malady the Greeks call phymosis) it must be opened: which is
done in this manner. An incision is made in the prepuce below its
extremity, in a right line to the frænum; and the upper part being
thus relaxed, may be drawn back. But if this be not effectual, either
upon account of the straitness or hardness of the prepuce, a piece of
skin must be immediately cut out in the lower part in the form of a
triangle, with its vertex at the frænum, and the base at the extremity
of the prepuce. Then lint is to be applied over it, and other medicines
to heal it. And it is necessary to continue at rest till it be
cicatrized; for walking, by the attrition it causes, renders the ulcer
foul.
[Sidenote: _Of infibulating boys._]
Some have made a practice of infibulating boys, sometimes upon account
of their health(25): the method of doing it is this. The skin that
covers the glans is extended, and marked on both sides with ink, where
it may be perforated, and then is let go. If these marks return upon
the glans, too much has been taken up, and it ought to be marked nearer
the extremity: if the glans is not reached by them, that part is proper
for the fibula. Then where the marks are, the skin is pierced by a
needle followed by a thread, and the two ends of this thread are tied
together, and moved every day, till small cicatrices be formed about
the orifice. When these are confirmed, the thread is taken out, and a
fibula put in, which, the lighter it is, is so much the better. But
this operation however is more frequently needless than necessary.
CHAP. XXVI.
OF THE OPERATION NECESSARY IN A SUPPRESSION OF URINE, AND LITHOTOMY.
Sometimes when no urine is made, an operation is necessary to discharge
it, either because the passage is collapsed from old age, or because a
stone, or some other concretion from blood has obstructed it within;
and a moderate inflammation also often prevents it from being evacuated
in a natural way. And this is requisite not only in men, but in women
too sometimes. For this purpose are made copper pipes; and that these
may serve for all bodies larger and smaller, a physician must have by
him three for men, and two for women. Of the male kind, the largest is
fifteen fingers breadth long, the middle size twelve, the least nine;
for the females, the greater is nine, and the lesser six. They ought
to be curved, but more especially the male kind, and very smooth; and
their diameter neither too large, nor too small.
The patient then is to be laid on his back, in the same manner as is
described in the operation for the stone, either on a couch or bed. The
physician standing on the right side, ought with his left hand to take
hold of the penis if it be a man, and with his right to introduce the
pipe into the urinary passage; and when it comes to the neck of the
bladder, by an inclination of the pipe and the penis at once, to force
it into the bladder, and when the urine is evacuated, to take it out
again. In a woman, the urethra is both shorter, and straighter, and
resembles a caruncle, being situated between the labia pudenda above
the vagina; and they as frequently require assistance, but it is not
attended with so much difficulty.
Sometimes a stone sliding into the urethra, sticks, where that grows
narrower(26), not far from the end; if possible it ought to be
drawn out either by a specillum oricularium, or the instrument, with
which the stone is extracted in cutting for that distemper. If that
has proved impracticable, the prepuce must be drawn out as much as
possible, and the glans being covered, must be tied by a thread; then
on one side a longitudinal incision must be made into the penis, and
the stone extracted; after this the prepuce is let go; for by this
means the sound part of the skin covers the incision in the penis, and
the urine will be discharged in the natural way.
Since I have made mention of the bladder and stone, the place itself
seems to require me to subjoin the _chirurgical_ cure for calculous
patients, when they can be relieved no other way. But since that is
a very dangerous method, it is by no means proper to undertake it
precipitately. Nor is it to be attempted in every season, nor at all
times of life, nor in every degree of the disease; but only in the
spring, and upon a patient, whose age exceeds nine years, and not
fourteen; also if the disease has arisen to such a height that it can
neither be overcome by medicines, nor protracted, but that in some time
it must kill. Not but that now and then even a rash attempt succeeds;
however it more frequently fails in this case, because there are more
kinds and seasons of danger, all which I shall mention together with
the operation itself.
Therefore when it is resolved to try the last remedy, for some
days before, the body must be prepared by diet, that is, by taking
moderately wholesome food, no way glutinous, and drinking water. In the
mean time the patient must exercise by walking, to cause the stone to
descend towards the neck of the bladder. Whether this has happened may
be known by introducing the fingers, as I shall shew in the operation.
When that is certain, the boy must first fast for a day; and then the
operation must be performed in a warm place; which is conducted in this
manner.
A strong and skilful man sits down upon a high seat, and laying the
boy, whose back is towards him, in a supine posture, setting his hips
upon his knees, takes hold of him, and drawing up his legs, orders the
boy to put down his hands to his hams, and pull them toward his body
with all his might, and at the same time he holds them in that posture.
But if the patient be pretty strong, two able men must sit behind him
on two contiguous seats, and both their seats, and their legs next each
other must be tied together, to prevent their giving way. Then he is
placed upon both their knees in the same manner, and the one according
as he sits, lays hold of his left leg, and the other of his right; and
at the same time he himself draws up his hams. Whether he be held by
one or two, they lie forward with their breasts upon his shoulders.
Whence it happens, that the sinus above the pubes, between the ilia, is
extended without any wrinkles, and the bladder being compressed into a
small compass, the stone may be the more easily laid hold of. Besides,
two strong men are placed one at each side, who stand by, and do not
suffer either the one or two, that hold the boy, to give way.
Then the physician, having carefully pared his nails, introduces his
fore and middle fingers of the left hand together, being first slightly
anointed with oil(27), into the anus of the patient, and lays the
fingers of his right hand lightly upon the lowest part of his abdomen;
lest if his fingers on both sides at once should press strongly upon
the calculus, it might hurt the bladder. And this must not be done
hastily, as in most cases; but so as may be safest: for hurting the
bladder brings on convulsions, with a danger of death. And first of all
the stone is sought for about the neck: where if it be found, it is
expelled with less trouble; and therefore I said the operation was not
to be attempted, unless this were known by its proper signs. If either
it was not there, or has gone backward, the fingers are applied to the
end of the bladder; and the right hand being removed also beyond it, it
is brought gradually down.
And when the stone is found (as it must necessarily fall between the
surgeon’s hands) it is drawn down with the greater caution by how much
it is smaller and smoother, lest it escape, that is, lest there be a
necessity to harass the bladder again and again. Therefore the right
hand is always kept before the stone; and the fingers of the left force
it downwards, till it come to the neck. Into which part, if it be
oblong, it must be forced so as to come out prone(28); if flat, so as
to be transverse; if square, that it may rest upon two angles; if it be
larger at one end, so that the smallest may pass first. In a round one,
from the figure itself it is plain, there is no difference, save that
if it be smoother in one part than another, that should come out first.
When it is brought to rest upon the neck of the bladder, a lunated
incision must be made in the skin, near the anus, as far as the neck of
the bladder, with the horns pointing a little towards the ischia; then
in that part where the bottom of the wound is straiter, again under the
skin(29), another transverse wound must be made, by which the neck
may be cut; till the urinary passage be open in such a manner, that the
wound is something larger than the stone. For those, who through fear
of a fistula (which in that part the Greeks call ouroruas[HU]) make but
a small opening, are reduced to the same inconvenience with greater
danger; because the stone, when it is brought away by force, makes a
passage, if it does not find one. And this is even more pernicious, if
the shape or asperity of the stone contribute any thing to it: whence
both an hemorrhage and convulsion may ensue. But though a person escape
these, the fistula will be much larger, when the neck is lacerated,
than it would have been if cut.
[HU] Οὐρορυὰς: this word, as far as I can find, occurs no where else.
It is variously written in the different editions. The sense seems to
determine it to what I have expressed in the translation, with which
the etymology of it agrees.
When the opening is made, the stone comes into view; the size of which
makes a material difference _with respect to its management_. Therefore
if it be small, it may be pushed forward on one side, and drawn out
on the other by the fingers. If larger, a crotchet(30) made for the
purpose must be put over the upper part of it. This at its extremity is
thin, beat out into the form of a semicircle, broad and blunt; on the
external part smooth(31), where it comes in contact with the wound;
on the inside rough, where it touches the stone. And it ought to be
pretty long; for one too short has not force enough to extract it. When
it is fixed, it ought to be inclined to each side, that the stone may
appear, and be held fast, because if it be laid hold of, it also gives
way to it. And the necessity for this is, lest when the crotchet begins
to be drawn, the stone may fly inward, and the crotchet fall upon the
edge of the wound, and lacerate it, the danger of which I have already
shewn.
When it appears that the stone is securely held, a triple motion
must be made, almost at the same instant, to both sides, and then
externally; but this must be done gently, and the stone must be first
drawn a little forward; after this, the end of the crotchet must be
raised upward, that it may be farther within the bladder, and bring it
out the more easily. But if the stone cannot be conveniently held at
the superior part, its side must be taken hold of. This is the most
simple method.
But a variety of circumstances requires some particular observations.
For there are some stones not only rough, but also full of sharp
points, which falling of themselves into the neck of the bladder, are
extracted without any danger. But if they are within the bladder, it
is neither safe to seek them, nor draw them forward; because when they
wound it, they bring on convulsions and death; and more especially if
any point is fixed in the bladder, and causes it to fall into folds,
as it is brought down _towards the neck_. Now a stone is discovered to
be in the neck, when the urine is made with greater difficulty than
ordinary; and to be pointed, when it comes away bloody; and this is
particularly to be tried by the fingers, and the operation is not to
be attempted unless we are sure it is there. And even then the fingers
must be introduced, and opposed to it behind tenderly, lest they
wound by pushing it with violence; then the incision must be made.
And in this case also many have made use of the knife. Meges (because
the knife being weak might fall on some prominence of the stone, and
after having cut the flesh above it, would not divide where there is
a hollow, but leave what will require a second incision) made an iron
straight instrument, with a broad back on its upper part, and its
lower part semicircular and sharp. This being taken between his fore
and middle fingers, and his thumb laid upon it, he prest it so, that
together with the flesh, he might cut any part of the stone that was
prominent: by which he gained this advantage, that he made a sufficient
opening at once. Now in whatever method the incision in the neck is
made, a rough stone ought to be extracted gently; no violence being
used for the sake of expedition.
But a sandy stone is easily discovered both before the operation,
from the discharge of sandy urine, and in the operation; because it
makes but a faint resistance to the fingers, and that not equally,
and besides is apt to slide away. Also urine, that brings off with
it something like scales, discovers the stones to be soft, and that
they are composed of several small ones not firmly united together.
All these it is proper to bring away gently, changing alternately the
fingers in such a manner, that they may not hurt the bladder, and
no broken relics stay behind, which may afterwards render the cure
difficult. Any of these, that come into view, must be extracted either
by the fingers or crotchet.
But if there are several stones, they must every one be taken out;
but if any very small one remain, it may rather be left: for it is
difficult to find it in the bladder; and when found, it quickly
escapes. Thus by long search the bladder is hurt, and mortal
inflammations are brought on; in so much that some, though they were
not cut, when the bladder has been long, and to no purpose, roughly
handled, by the fingers, have died. Besides all which, a small stone
being brought to the wound afterwards by the urine, drops out.
In case the stone appears so large, that it cannot be extracted without
lacerating the neck, it must be split. The author of this contrivance
was Ammonius, who upon that account was called Lithotomus[HV] (_the
stone-cutter_.) It is done in this manner. A crotchet is fixed upon the
stone with so sure a hold as to prevent it from recoiling inward: then
an iron instrument of moderate thickness, with a thin edge, but not
sharp, is made use of. This is applied to the stone, and being struck
on the other side, cleaves it; great care being taken, that neither the
instrument come to the bladder, nor any thing fall in by the breaking
of the stone.
[HV] λιθοτόμος.
These operations are performed upon females much in the same manner,
concerning whom a very few peculiarities must be mentioned. For in
them, where the stone is very small, cutting is unnecessary; because it
is forced by the urine into the neck, which is both shorter, and laxer
than in men: therefore it often drops out of itself, and if it sticks
in the urinary passage, which is narrower, it is however extracted
without any harm by the abovementioned crotchet. But in larger stones
the same method is necessary. However, in a virgin, the fingers should
be introduced _into the rectum_ as in a man, in a married woman by
the vagina. Again, in a virgin, the incision must be made below the
left lip of the pudendum; but in a married woman, between the urinary
passage, and the bone of the pubes; the wound also must be transverse
in both places, and we need not be alarmed if the hæmorrhage be
considerable from a female body.
When a stone is extracted, if the patient be strong, and not greatly
spent, we may let the blood flow to lessen the inflammation. And it is
not amiss for the patient to walk a little, that if any grumous blood
remain within, it may drop out. But if it does not cease of itself, it
must be stopped, lest the strength be entirely exhausted; and this is
to be done immediately after the operation in weak patients. For as a
person is in danger of a convulsion, whilst the bladder is fatigued, so
there is another fear, when the applications are removed, lest there be
such an hæmorrhage as to prove mortal: to prevent which, the patient
ought to sit down in sharp vinegar with the addition of a little salt;
by which means both the blood commonly stops, and the bladder is
contracted, and therefore is less inflamed. But if that does little
service, a cupping vessel must be applied, both in the knees(32) and
hips, and above the pubes too.
When either a sufficient quantity of blood has been evacuated, or the
hæmorrhage stopped, the patient must be laid upon his back, with his
head low, and his hips a little raised; and over the wound must be
applied a double or triple linen cloth wet with vinegar. Then after an
interval of two hours, he must be let down in a supine posture into
a bath of hot water, so that he may be under water from the knees
to the navel, the other parts being covered with clothes, only with
his hands and feet bare, that he may be both less exhausted, and be
able to continue there the longer. This commonly produces a plentiful
sweat; which in the face is to be now and then wiped off by a spunge.
And the rule for the continuance of this bathing is, till it hurts by
weakening. After that the patient must be anointed plentifully with
oil, and a handful of soft wool saturated with warm oil, must be laid
on, so as to cover the pubes and hips, and groin, and the wound itself,
which must still remain covered with the linen beforementioned; and
this is to be moistened now and then with warm oil; that it may both
prevent the admission of cold to the bladder, and gently mollify the
nerves. Some make use of healing cataplasms. These do more hurt by
their weight, which by pressing upon the bladder(33) irritates the
wound, than service by their heat: and for that reason, not so much as
any kind of bandage is necessary.
On the day following, if there be a difficulty in breathing, if the
urine is not evacuated, or if the part above the pubes has immediately
swelled, we may be assured, that grumous blood has staid within the
bladder. Therefore the fingers being introduced in the same manner as
above, the bladder must be handled gently, and whatever has happened
to be coagulated there dispersed; by which means it is afterwards
discharged from the bladder through the wound. Neither is it improper
to inject through the wound into the bladder by a syringe, a mixture
of vinegar and nitre; for if there be any bloody concretions, they are
discussed in that way. And these may be done even the first day, if
we are afraid of any thing being within; especially when weakness has
prevented the evacuation of it by walking. The other methods laid down
for the preceding day, the putting him into the bath, applying the
cloth, and wool in the manner above described, are to be continued.
But a boy is neither to be put so often into the warm water, nor kept
there so long _at a time_, as a youth; the weak, as the strong; one
affected with a slight inflammation, as another, in whom it is more
violent; one whose body is disposed to evacuations, as he that is
bound. But in the mean time, if the patient sleep, and his breathing
be equal, his tongue moist, his thirst tolerable, his lower belly not
at all swelled, and the pain and fever moderate, we may take it for
granted that the cure goes on well.
But in such patients the inflammation ceases commonly about the fifth
or seventh day: when that is abated, the bath is needless. Only the
wound, as the patient lies in a supine posture, must be fomented with
hot water, that if the urine corrodes, it may be washed away. Digestive
medicines must be laid on; and if the ulcer appears to want deterging,
honey may be applied. If that corrodes, it must be tempered with rose
oil. The enneapharmacum plaister seems fittest for this intention, for
it both contains suet to promote digestion, and honey to deterge the
ulcer, marrow also, and especially that of veal, which is particularly
efficacious in preventing a fistula from remaining. And at that time
lint is not necessary over the ulcer; but is properly laid above the
medicine to keep that on. But when the ulcer is cleansed, it must be
brought to cicatrize by lint alone.
At this time, however, if the cure has not proceeded happily, various
dangers arise: which one may quickly prognosticate, if there be a
continual watching, or a difficulty of breathing, if the tongue be
dry, if there be a violent thirst, if the bottom of the belly swells,
if the wound gapes, if the urine that makes its way through it, does
not corrode it; in like manner, if before the third day some livid
stuff drops out; if the patient makes no answers to questions, or very
slowly; if there are vehement pains; if after the fifth day violent
fevers come on, and a nausea continues; if lying upon the belly is the
most agreeable posture. However nothing is worse than a convulsion,
and a bilious vomiting before the ninth day. But there being reason to
fear an inflammation, it must be obviated by abstinence, and moderate
food seasonably administered; and by applying, at the same time,
fomentations, and the other means above prescribed.
CHAP. XXVII.
OF A GANGRENE AFTER CUTTING FOR THE STONE.
The next danger is that of a gangrene. This is known by a discharge of
fetid sanies both by the wound and the penis, and together with that,
something not very different from grumous blood, and little films like
small locks of wool; it is also known by the lips of the wound being
dry, by a pain in the groin, by the continuance of the fever, and its
increase at night, and by the accession of irregular shudderings. Now
it must be considered to what part the gangrene spreads. If to the
penis, that part grows hard and red, and is painful to the touch, and
the testicles swell, if to the bladder, a pain of the anus follows,
the hips swell, the legs cannot be easily extended; but if to one side,
it is apparent to the sight, and has these same symptoms on either
side, but not so violent.
The first circumstance of importance is, that the body lie in a proper
posture, that the part into which the disease is propagated be always
laid highest. Thus if it tends to the penis, the patient should lie
supine; if to the bladder, upon his belly; if to one side, upon the
other, which is sound. Then as to the means of cure, the patient must
be put into a bath made of a decoction of horehound, or cypress, or
myrtle, and the same liquor must be injected into the wound by a
syringe; then a mixture of lentils and pomegranate bark both boiled in
wine must be laid on; or bramble, or olive leaves boiled in the same
manner, or other medicines, which we have prescribed for restraining
and cleansing gangrenes. And if any of these shall be in a dry form,
they must be blown in through a writing reed.
When the gangrene begins to stop, the ulcer should be washed with
mulse. And at this time cerate must be avoided, which softens the
flesh, and prepares it for receiving the infection. Rather let washed
lead with wine be laid on; over which shall be applied the same spread
upon a linen cloth: by which a cure may be accomplished. Nevertheless
we should not be ignorant, that when a gangrene has begun, the stomach,
which has a certain sympathy with the bladder, is often affected;
whence it happens, that the food can neither be retained, nor if any is
retained, can it be concocted, nor the body nourished; and therefore
the wound can neither be deterged nor incarned: which must of necessity
soon bring on death.
But as it is not possible, by any means, to save patients under these
circumstances, from the first day however, the method of cure must be
_regularly_ observed. In _the conduct of_ which some caution is also
necessary with regard to the food and drink: for at the beginning,
none but moist food ought to be given; when the ulcer is deterged, of
the middle kind; greens and salt fish are always hurtful. A moderate
quantity of drink is required: for if too little is drunk, the wound
is inflamed, the patient labours under a want of sleep, and the
strength of the body is diminished: if too much be taken, the bladder
is frequently filled, and by that means irritated. It is too plain to
require a frequent repetition, that the drink must be nothing but water.
It generally happens from a diet of this kind, that the belly is bound.
A clyster must be given of a decoction of fenugreek or mallows in
water. The same liquor mixed with rose oil, must be injected into the
wound by a syringe, when the urine corrodes it, and prevents it from
being cleansed. For the most part, at first, the urine is discharged
by the wound; whilst it is healing, it is divided, and part begins to
be discharged by the penis, till the wound be entirely closed: which
happens sometimes in the third month, sometimes not before the sixth,
at other times after a whole year.
And we should not despair of a solid agglutination of the wound, unless
where the neck has been greatly lacerated, or many and large caruncles,
and at the same time some nervous substances have come away by a
gangrene. But the greatest precaution must be used, that no fistula, or
at least a very small one, be left there. Therefore, where the wound
tends to cicatrize, the patient should lie with his thighs and legs
extended: unless the stones have been soft or sandy; for in that case
the bladder is not so soon cleansed: and, therefore, it is necessary
for the wound to be longer open; and never to be brought to cicatrize
till nothing more of that nature be discharged.
But if the lips have united before the bladder was cleansed, and the
pain and inflammation have returned, the wound must be separated by the
fingers, or the broad end of a probe, to allow a passage to what causes
the pain: which being evacuated, and the urine having come away pure
for a pretty while, cicatrizing medicines must at length be laid on,
and the feet extended, as I directed before, as close to one another as
possible.
But if from those causes, which I mentioned, there appears to be danger
of a fistula, to close it the more easily, or at least to contract it,
a leaden pipe must be introduced into the anus(34); and the legs
being extended, the thighs and ancles must be tied together, till there
be a cicatrix as good as we can obtain.
CHAP. XXVIII.
OF THE OPERATIONS REQUIRED WHEN A MEMBRANE, OR FLESH OBSTRUCTS THE
VAGINA IN WOMEN.
The foregoing diseases may happen both to men and women. But some are
peculiar to women; as in the first place, where the vagina, by its lips
being joined, does not admit of coition. And this happens sometimes in
the womb of the mother; at other times, from an ulcer in those parts,
and the lips, in healing, having by bad management been united. If it
be from the birth, a membrane obstructs the vagina: if from an ulcer,
it is filled up with flesh.
In the membrane an incision must be made in two lines crossing each
other, in the form of the letter X, great care being taken not to
wound the urinary passage; and then the membrane is to be cut out. But
if flesh has grown there, it is necessary to open it in a straight
line; then taking hold of it with a vulsella or hook, to cut off a
small habenula, as it were, from the orifice of the vagina, after
which must be introduced a piece of lint rolled in a long form (by the
Greeks called lemniscus) dipped in vinegar; and over this sordid wool
moistened with vinegar is to be bound on; the third day, these are to
be removed, and the part dressed like other wounds. And when it begins
to heal, it is proper to introduce into the part a leaden pipe armed
with a cicatrizing medicine; and over that to apply the same medicine,
till the wound be cicatrized.
CHAP. XXIX.
THE METHOD OF EXTRACTING A DEAD FOETUS OUT OF THE WOMB.
When a woman conceives, if the foetus dies in the womb, near the time
of delivery, and cannot come away of itself, an operation is necessary.
This may be reckoned amongst the most difficult: for it both requires
the highest prudence and tenderness, and is attended with the greatest
danger. But above all, the wonderful nature of the womb, as in other
cases, so in this also, is easily discovered.
In the first place, it is proper to lay the woman on her back, across a
bed, in such a posture, that her ilia may be compressed by her thighs:
whence it happens, that both the bottom of her belly is presented to
the view of the physician, and the child is forced to the mouth of the
womb; which is close shut, when the foetus is dead, but at intervals
opens a little. The physician, making use of this opportunity, having
his hand anointed, ought to introduce, at first, the fore-finger,
and keep it there till the mouth be opened again, and then he must
introduce another finger, and the rest upon the like opportunities
offering, till his whole hand be within it. Both the capacity of the
womb, and the strength of its nerves, and the habit of the whole body,
and even the fortitude of the mind conduce much to the facility of
doing this: especially, as in some cases, it is necessary to have both
hands within the womb.
It is of importance, that both the bottom of the belly, and the
extremities of the body be as warm as possible; and that an
inflammation be not begun, but that help be administered instantly,
while the case is recent. For if the body be already swelled, the hand
can neither be introduced, nor the fœtus brought away without the
greatest difficulty; and together with a vomiting and tremor, there
generally follow mortal convulsions. When the hand is introduced upon
the dead fœtus, it immediately discovers its posture: for it is either
turned upon the head, or the feet, or lies transverse but commonly in
such a manner; that either its hand or foot is near.
The intention of the physician is, by his hand, to turn the child,
either upon its head, or even upon its feet, if it happened to be in
a different posture. And if there is no other hinderance, taking hold
of the hand or foot puts the body in a better posture: for the hand
_being laid hold of_, will turn it upon the head, and the foot upon its
feet. Then if the head is nearest, a crotchet should be introduced,
in every part smooth, with a short point, which is properly fixed,
either in the eye, or the ear, or the mouth, sometimes even in the
forehead; and then being drawn outwards, brings away the child. Yet it
is not to be extracted at any moment of time indifferently: for should
it be attempted, when the mouth of the womb is shut, there being no
exit for the child, it breaks to pieces, and the point of the crotchet
slips upon the mouth of the womb itself, and there ensue convulsions,
and extreme danger of death. Therefore, it is necessary to forbear,
when the womb is shut; and when it opens, to draw gently; and every
such opportunity to extract it gradually. The right hand must draw the
crotchet, the left being kept within, must pull the child, and at the
same time direct it.
It sometimes happens, that the child is distended with water, and there
is a fœtid sanies discharged from it. If this be the case, the body
must be perforated with the fore-finger, that its bulk may be lessened
by the discharge of the humour: then it must be taken out gently by the
hands only: for the crotchet being fixed in a putrid body, easily loses
its hold. The danger attending which, I have already pointed out.
But a child being turned upon its feet, is not difficult to extract:
for these being taken hold of, it is easily brought away by the hands
alone.
If it be transverse, and cannot be got into a proper direction, a
crotchet must be fixed in the armpit, and gradually pulled: in this
case, the neck is generally doubled, and the head turns back upon the
body. The remedy is, to cut through the neck, that the two parts may be
brought away separately. This is done by a crotchet, which resembles
the former, save that it is sharp all along the internal part. Then
we must endeavour to bring away the head first, after that, the rest
of the body: because generally, when the largest part is extracted,
the head slips back into the womb, and cannot be extracted without the
greatest danger.
However, if this has happened, a double cloth must be laid upon the
belly of the woman, and a strong and skilful man ought to stand at her
left side, and put both his hands upon the lower part of her belly, and
press with one upon another: by which means the head is forced into the
mouth of the womb, and may then be extracted by the crotchet, in the
manner above described.
But if one foot be found at the mouth of the womb, and the other is
behind, with the body, whatever is protruded, must be gradually cut
away. And if the buttocks begin to press upon the mouth of the womb,
they must be thrust back again, and the other foot sought for and
brought forward. There are also some other difficulties, which make it
necessary to cut the child into pieces, when it cannot be brought away
entire.
Whenever a fœtus is brought away, it must be delivered to an assistant;
who must take it in his hands, and then the physician ought to draw the
umbilical cord gently with his left hand, but not to break it, and with
the right to follow it, as far as what they call the secundines, which
were the covering of the fœtus within the womb; and taking hold of the
extremities of these, to separate all the small veins and membranes in
the same manner, by his hand, from the womb, and to extract the whole
of it, and any concreted blood that remains within. Then the woman’s
thighs must be laid close together, and she placed in a room moderately
warm, without any thorough air. To the bottom of her belly must be
applied sordid wool dipped in vinegar and rose-oil. The remaining part
of the cure ought to be the same, as is used in inflammations, and such
wounds as are in nervous parts.
CHAP. XXX.
THE OPERATIONS REQUIRED IN DISEASES OF THE ANUS.
Diseases of the anus also, when they are not removed by medicines,
require the assistance of the hand. Therefore, if any fissures, in
that part, by long continuance, have become indurated, and are already
callous, it is most proper to give a clyster; then to apply a hot
spunge, in order to relax them, and bring them to the external part,
when they are in view, to cut off each of them with a knife, and renew
the ulcers; then to lay on soft lint, and over it honey spread upon a
linen cloth; and to fill up the part with soft wool, and thus bind it
up; on the next and following days, to dress with mild medicines, which
I have elsewhere prescribed for the same disorders when recent; and in
the first days to diet the patient with gruels, after that gradually
to add to the food, but something of that kind, which I have directed
in the same place. If at any time, from an inflammation, pus arises
in them, as soon as that appears, an incision must be made to prevent
the anus itself from suppurating. But we must not be in a hurry to
do it before; for if it be cut while crude, the inflammation is much
increased, and a greater quantity of pus is generated. In these wounds
too, there is a necessity for mild food, and the same kind of medicines.
But the tubercles called condylomata, when they have grown hard, are
cured in this manner. First of all, a clyster must be given. Then the
tubercle being laid hold of by a vulsella, must be cut out near its
roots. When this is done, the same course must be followed, that I
prescribed after the preceding operation; only if there is any fungus,
it must be kept under by copper scales.
The mouths of the hæmorrhoidal veins, discharging blood, are taken
off thus. When there is a discharge of sanies besides blood, an acrid
clyster must be administered, that the mouths of the veins may be
pushed the farther outward; which causes all the vessels to appear like
small heads. Then if a head be very little, and have a small base, it
must be tied with a thread a little above the point, where it joins
the anus; and a spunge squeezed out of hot water must be laid over it,
till it grow livid; then above the knot it must be scarified either by
the nail or the knife. If this is not done, violent pains ensue, and a
difficulty in making water. If it be pretty big, and the base broad, it
must be taken hold of with a small hook or two, and an incision made
round the tumour, a little above the base; and neither any part of the
head must be left, nor any thing taken off the anus: which a person
may accomplish, if he neither draws the hooks too much nor too little.
Where the incision has been made, a needle should be put in, and below
that the head tied with a thread. If there be two or three of them, the
inmost must be cured first; if more than that number, not all at once,
lest there be(35) sore places all round the part at the same time. If
there is a discharge of blood, it must be received in a spunge; then
lint must be applied; the thighs, groin, and what lies contiguous to
the ulcer, be anointed, and cerate laid over it, and the part filled
with warm barley meal, and thus bound up. The day following, the
patient ought to sit down in warm water, and be dressed with the same
cataplasm. And twice in the day, both before and after the dressing,
the ischia and thighs must be anointed with liquid cerate, and the
patient kept in a warm place. After an interval of five or six days,
the lint is to be taken out with a specillum oricularium; and if these
heads have not dropped off at the same time, they must be pushed off
by the finger. Afterwards, the ulcer must be brought to heal by mild
medicines, such as I have prescribed before. The proper treatment, when
the disease is cured, I have already mentioned elsewhere.
CHAP. XXXI.
OF VARICES IN THE LEGS.
From these disorders we go on to the legs. Varices in these are not
difficult to remove. To this place I have deferred the cure of those
small veins, which hurt in the head, as also the varices in the
belly, because it is the same in them all. Therefore any vein that
is troublesome, either is cauterized, and so decays, or is cut out.
If it be straight, or though transverse, yet simple, it is better to
cauterize it. If it be crooked, and as it were twisted into orbs, or
several of them are involved within each other, it is more convenient
to cut them out.
The method of cauterizing is this. An incision is made in the skin over
it; then the vein being laid bare, is moderately pressed by a small and
blunt iron instrument red hot: and we must avoid burning the lips of
the wound itself, which it is easy to draw back with small hooks. This
is repeated over the whole varix, at the distance of about four fingers
breadth; and after that a medicine for healing burns is laid on.
But it is cut out in this manner. An incision being made in the same
way in the skin over the vein, the lips are taken up with a small hook;
and the vein is separated all round from the flesh by a knife, but in
this great care is taken not to wound the vein itself; and a blunt hook
is put under it; and generally, at the same distance mentioned before,
in the same vein, the same operation is repeated. The course of it is
easily discovered by extending it with the hook.
When this has been done, as far as the varices go, the vein, being
brought forward in one part by the hook, is cut through, then where
the next hook is, it is drawn up and pulled away, and is cut off
there again. And in this manner the leg being entirely freed from the
varices, the lips of the wounds are then brought together, and an
agglutinating plaister is laid over them.
CHAP. XXXII.
OPERATIONS REQUIRED IN COHERING AND CROOKED FINGERS.
If the fingers, either from the birth, or by an ulceration in their
opposite sides, have afterwards adhered together, they are separated by
the knife; round each of them a plaister, not greasy, is put on, and
thus they heal separately.
But if there has been an ulcer in a finger, and afterwards a cicatrix
injudiciously brought on, has rendered it crooked; in the first place
a malagma must be tried. If that does no good (which generally happens
both in an old cicatrix, and where the tendons are hurt) then we
ought to see whether the fault be in the tendon or the skin. If in
the tendon, it ought not to be touched, for it is not curable: if in
the skin, the whole cicatrix must be cut off, which being generally
callous, prevents the fingers from being extended. Then being kept
extended, it must be brought to cicatrize afresh.
CHAP. XXXIII.
OF THE OPERATION REQUIRED IN A GANGRENE.
I have elsewhere observed, that a gangrene comes about the nails,
armpits or groin; and that if it does not yield to medicines, the
member ought to be cut off.
But even this is attended with very great danger: for the patients
often die in the operation, either by a hæmorrhage, or faintings. But
in this, as well as other cases, it is not to be considered, whether
the remedy is very safe, which is the only one we have. Between the
sound and corrupted part then, an incision must be made with a knife in
the flesh, as far as the bone. But this must not be done over a joint;
and some of the sound part must rather be cut off, than any of the
corrupt left. When we come to the bone, the sound flesh must be drawn
back from it, and cut below round the bone, that some part of the bone
may also be laid bare under it; then the bone must be cut off with a
saw, as close as we can to the sound flesh, that still adheres to it;
and then the fore part of the bone, that has been roughened with the
saw, must be smoothed, and the skin brought over it; which in a cure
of this kind ought to be lax, that it may cover the bone as much as
possible all round. The part, which the skin does not reach, must be
covered with lint, and above that a spunge squeezed out of vinegar must
be tied on the place. The remaining part of the cure must be the same,
as I have directed in wounds which are brought to digestion(36).
A. CORNELIUS CELSUS
OF
MEDICINE.
_BOOK VIII._
CHAP. I.
OF THE SITUATION AND FIGURE OF THE BONES OF THE HUMAN BODY.
It now remains, that I speak of what relates to the bones: for the
easier understanding of which, I shall first describe their situations
and forms. The first then is the skull, which is concave on the
internal side, externally gibbous, and on each side smooth, both where
it covers the membrane of the brain, and where itself is covered by
the skin, from which the hair grows. In the occiput and temples it
is simple; but double from the forehead to the vertex. And the bones
of it in their external part are hard; on the inside, where they are
connected with each other, softer. And veins are distributed between
them, which probably supply them with nourishment.
Now the skull is rarely entire without sutures; but in hot countries it
is more frequently found so. And such a head is strongest, and the most
safe from pain; of others, the fewer sutures there are, so much the
freer is the head from complaints; for their number is not certain, nor
indeed their situation. However, for the most part two above the ears
divide the temples from the upper part of the head; the third running
to each side through the vertex, separates the occiput from the top
of the head; the fourth goes from the vertex along the middle of the
head to the forehead; and this ends in some at the point, to which the
hair extends, in others between the eye-brows, dividing the forehead
itself(1). The other sutures are exactly fitted to each other upon
the same level. But the transverse ones above the ears, grow gradually
thinner to their edges; and thus the inferior bones slightly overtop
the superior ones. The bone behind the ear is the thickest in the
head; for which reason, probably hair does not grow there. Over these
muscles too(2), that cover the temples, a bone is situated in the
middle, which is inclined to the external part. But the face has the
largest suture; which beginning from the one temple runs transversely
through the middle of the eyes, and the nose, to the other temple; from
which two short ones point downward under the internal angles. The
cheek-bones also have each of them a transverse suture in the upper
part. And from the middle of the nose, or the sockets of the upper
teeth, proceeds one through the middle of the palate; and another also
divides the palate transversely. These then are the sutures found in
most people.
The largest foramina of the head are those of the eyes; next the
foramina of the nose; then those we have at the ears. The foramina of
the eyes run straight and undivided to the brain. Two foramina are
observed in the nose, divided by a bone in the middle: for these about
the eye-brows and angles of the eyes begin osseous, and so proceed
near the third part of the way; then turning cartilaginous, the nearer
they approach to the mouth, so much the softer and more fleshy they
become. But these foramina, which from the beginning of the nostrils
to the internal part are simple, are there again divided each into two
courses; the branches opening into the fauces both emit and receive
the breath; the others go to the brain; in the end they are branched
into many small openings, which afford the sense of smelling. In the
ear too the passage at first is straight, and simple, but farther in,
it becomes winding; the part next the brain is separated into many and
small openings, from which we have the faculty of hearing. Near these
there are as it were two small sinuses; and above them, that bone
terminates, which going in a transverse direction from the cheeks is
sustained by the inferior bones. It may be called jugale from the same
resemblance, which gave it the Greek name of Zygodes[HW]. The maxilla
is a soft bone(3), and only one in number: the middle and lowest
part of which compose the chin; from whence it proceeds on both sides
to the temples; and this only moves: for the malæ with the whole bone,
that contains the upper teeth, are immoveable: but the extremities of
the maxilla shoot as it were into two horns. One of these processes is
broader below(4), and is narrowed at the vertex, and being extended
forward enters below the os jugale, and over that is tied down by the
muscles of the temples. The other is shorter and rounder, and is lodged
like a hinge in that cavity, which is near the foramina of the ear;
and there turning itself different ways, gives the maxilla a power of
moving.
[HW] ζυγὼδες.
The teeth are harder than bone; part of them are fixed in the lower
jaw-bone, and part in the upper. The four first from their cutting
are by the Greeks called tomici[HX]. On each side of these _above and
below_ stand the four canine teeth; beyond which there are commonly
five maxillary teeth, except in those, in whom the genuine (_dentes
sapientiae_) which generally grow late, have not come out. The fore
teeth adhere each by one root, the maxillary by two at least, some by
three or four. And a longer root commonly emits a shorter tooth; and
the root of a straight tooth is straight, that of a crooked one bent.
From this root in children, a new tooth springs, which most frequently
forces out the former; sometimes however it appears above or below it.
[HX] τομικοὶ.
Next to the head is the spine, which consists of twenty-four Vertebræ.
There are seven in the neck, twelve by the ribs, and the other five are
below the ribs. These are round and short, and send out two processes
on each side; in the middle they are perforated, where the spinal
marrow, connected with the brain, descends. The sides also between
the two processes are perforated by small holes, through which, from
the membrane of the brain similar small membranes proceed. And all
the Vertebræ(5) (except the three uppermost) at the superior part
in the processes themselves have small depressions; at the lower, on
the contrary, they send out processes pointing downwards. The first
then immediately sustains the head, by receiving small processes of it
into two depressions; which is the reason that the surface of the head
below is rendered unequal by two prominences. The second is inserted
into the under part of the first, and the superior part of the second
is round and narrow (_processus dentatus_) in order to admit of a
circular motion, so that the first surrounding the second allows the
head to move towards each side. The third receives the second in the
same manner; whence the neck has great facility of motion. And indeed
it would not be able to sustain the head, if straight and strong nerves
on each side did not secure the neck; these the Greeks call Carotæ.
For one of them in every flexure, being always stretched, prevents the
upper parts from slipping further. The third Vertebra has prominences,
which are inserted into that below it. All the rest are inserted
each into its inferior one by processes pointing downwards; and by
depressions, which they have on each side, they receive the superior,
and are secured by many ligaments, and a great quantity of cartilage.
And thus one moderate flexure forward being allowed, a man both stands
erect for some kinds of employment, and at other times bends himself as
the actions he is engaged in require.
Below the neck, the first rib is situated opposite to the shoulders.
After that the six inferior ones(6) reach the bottom of the breast:
and these at their origin being round, and furnished with something
like small heads, are fixed to the transverse processes of the
vertebræ, which are in that part a little depressed; then they grow
broader, and bending outward, degenerate gradually into cartilage;
and in that part being again turned gently inward, are joined to the
pectoral bone: which begins strong and hard at the fauces, being
excavated on each side, and terminates at the præcordia, where it is
softened into a cartilage. And under the superior ribs there are five,
which the Greeks call Nothæ (_spurious_) shorter, and thinner, which
also gradually turn to cartilage, and adhere to the external parts of
the abdomen; the lowest of these in the greatest part of it is nothing
else but a cartilage.
From the neck two broad bones, one on either side, go to the shoulders,
by us called scutula operta, by the Greeks Omoplatæ. These have
cavities at their vertices; from the vertices they become triangular,
and growing gradually broader tend to the spine; and the broader they
are in any part, so much the duller is their sensation. These too at
their extremity are cartilaginous, and in their back part lie as it
were loose, because, unless at the top, they are fixed to no bone, but
are there tied down by strong muscles and nerves.
But at the first rib(7) a little within the middle of it, a bone
grows out, in that part indeed slender; but going forward, the nearer
it comes to the broad bone of the scapula, it becomes thicker, and
broader, bending a little inwards, which being a little enlarged at its
other vertex, sustains the clavicle. This bone is crooked, and is to be
reckoned amongst the hardest bones; the one end of it is joined to the
bone I just mentioned before, and by the other it is fixed in a small
depression of the pectoral bone, and is moved a little in the motion of
the arm; and its lower head is connected by ligaments and a cartilage
with the broad bone of the shoulders.
Here the humerus begins, which at both its ends is enlarged, soft,
without marrow, and cartilaginous; in the middle round and hard, and
containing marrow; is a little concave(8) in its fore and internal
part; and convex in its posterior and external part. Now the fore part
is next the breast; the posterior is toward the scapulæ; the internal
next the side; and the external at the greatest distance from the side:
which distinctions will afterwards appear applicable to all joints in
the extremities. The upper end of the humerus is rounder than the other
bones, which I have yet mentioned, and _a small part of it_ is inserted
into the vertex of the broad bone of the shoulder; the greatest part,
standing out of it, is secured by ligaments. But the inferior head
has two processes; the intermediate space between which, is even more
depressed than its extremities.
This affords a reception to the fore-arm; which consists of two bones.
The Radius, which the Greeks call cercis[HY], is the superior one and
shorter, and at first being more slender, with its ends round, and
a little concave, receives the small tubercle of the humerus, which
is secured there by ligaments and a cartilage. The cubitus is the
inferior and longer; it is at first larger in its upper end, and by
two vertices, as it were, standing out, fixes itself into the sinus
of the humerus, which I mentioned, betwixt its two processes. The two
bones of the fore arm at first(9) are close together, then separate
by degrees, and meet again at the hand, their former proportions being
reversed: for there the radius is pretty large, and the cubitus very
small. After that the radius rising to a cartilaginous head is inserted
into its neck. The cubitus is round at its extremity, and projects a
little on one part. And to save frequent repetition, this ought to be
known, that most bones end in a cartilage, and that every articulation
is thus terminated: for it could neither be moved, unless it pressed
upon something smooth, nor be joined with flesh and ligaments, unless
these were connected by some matter of a middle nature.
[HY] κερκὶς.
In the hand, the first part of the palm consists of many and small
bones, the number of which is uncertain. But all of them are oblong and
triangular, and connected together by a peculiar kind of structure,
the plain of each one being higher than another alternately; whence it
happens, that the whole makes up the appearance of one bone a little
concave on the internal part. But from the hand two small processes
are lodged in the cavity of the radius. Then at the other end five
straight bones going to the fingers, compleat the palm; from which
the fingers themselves have their origin. These consist each of three
bones. The conformation of them all is the same. The more internal
bone has a depression in its vertex, and receives the small tubercle
of the external, and these are secured by ligaments. From them arise
the nails, which grow hard: and thus they adhere by their roots, not
to bone, but rather to flesh. This then is the construction of the
superior parts.
But the lower part of the spine ends in the hip-bone, which is
transverse, and far the strongest, and defends the womb, bladder, and
intestine Rectum. And this in the external part is convex; at the spine
inclined backward; on the sides, that is, at the hips themselves,
it has round cavities; from whence arises the bone, which is called
pecten; and that being situated transversely over the intestines under
the pubes, strengthens the belly; it is straighter in men, but in women
more bent externally, that it may not prevent the birth.
From these proceed the thigh bones; the heads of which are still
rounder than those of the humeri; though the latter have more
rotundity, than is found in any of the rest. A little lower they have
two processes on the fore and posterior part. From that they descend
hard and full of marrow, externally convex, and are again enlarged at
the inferior heads. The superior ones are inserted into the cavities of
the hip-bone, as the humeri into the bones of the scapulæ; then, lower
down, they slope gently inward, that they may more equally sustain the
superior parts. And their inferior heads have also depressions between
them, that they may be the more easily received by the bones of the
leg: which articulation is covered by a small, soft, and cartilaginous
bone, which is called Patella. This floating above, and not being fixed
to any bone, but bound down by flesh and tendons, and a little more
inclined to the thigh bone, defends the joint in all flexures of the
legs.
The leg consists of two bones; for in every thing the thigh resembles
the arm, and the leg the fore-arm; so that the shape and elegance of
the one may be known from the other; which beginning with the bones,
answers also in the flesh. One of these bones is situated on the
external part of the calf of the leg, and from that properly enough
takes the name of Sura(10). This is shorter and more slender above,
but is enlarged at the ancles. The other, which is placed in the fore
part, and has the name of Tibia, is longer and larger in the upper
part, and is alone connected with the lower end of the thigh-bone, as
the cubitus is with the humerus: and these bones too, being joined both
below and above, separate in the middle, as those of the fore arm.
The leg bones are received below by a transverse bone in the ancle;
and that is situated above the heel bone; which in one part has a
depression and in another prominences, and it both receives the
processes from the ancle-bone, and is inserted into its cavity. And
this is hard, without marrow, and projecting more to the posterior part
makes a round figure there. The other bones of the foot are constructed
in a similar manner to those of the hand. The soles answer to the
palms, the toes to the fingers, and the nails to the nails.
CHAP. II.
GENERAL DIVISION OF DISORDERS IN THE BONES. OF A BLACKNESS AND CARIES,
AND THEIR TREATMENT.
Whenever a bone is injured, it is either corrupted, or fissured, or
fractured, or perforated, or contused, or dislocated. A corrupted bone
generally turns first oily, and afterwards either black or carious.
These cases happen from large ulcers, or fistulas over them, when they
have either grown antient, or have been seized with a gangrene. First
of all it is necessary to lay bare the bone, cutting out the ulcer, and
if the disorder extends farther than the ulcer was, to pare away the
flesh below, till the sound part of the bone be exposed all round; then
it is sufficient to cauterize the part that is oily, once or twice,
by the application of an iron instrument, that so a scale may cast
off; or to scrape it, till some blood appear, which is the mark of a
sound bone: for whatever is vitiated must necessarily be dry. The same
method must also be pursued in a cartilage that is injured; for that
too must be scraped by a knife, till what remains be sound. And then
what is thus scraped, whether bone or cartilage, must be sprinkled with
nitre well powdered. And nothing else is to be done, where a caries or
blackness is in the surface of the bone: for in that case, the cautery
or the scraping must only be continued a little longer. A person,
that scrapes these, ought to press the instrument boldly, that he may
both do it effectually, and have the sooner done. The operation is
finished, when we come to the white or firm bone. It is evident, that
when the defect is a blackness, it ends in the white, and that where
there is a certain degree of solidity, there the caries terminates. We
have already observed, that there is also some blood in a sound bone:
But when either of these happen to go in pretty deep, it is uncertain
where they end.
It is easy to form a judgment in a caries, if a small probe is
introduced into the foramina, which by penetrating more or less, shews
that the caries is either in the surface, or of greater depth. The
same may be collected(11) even from the pain and fever; for when
these are moderate, it cannot have penetrated deep. A greater certainty
is obtained however by the application of the perforator: for the
disease ends, where the dust of the bone ceases to be black. Therefore
if the caries has gone deep, several holes must be made in it by the
perforator, as deep as the disease goes; then into these holes must be
put hot irons, till the bone become entirely dry. For the consequences
of this operation will be, that whatever is spoilt will be separated
from the bone below; and the cavity will be filled up with flesh;
and afterwards either no humour at all, or a small quantity will be
discharged.
But if the blackness goes through(12) to the other side of the
bone, it ought to be cut out. The same may be done also in a caries,
that penetrates to the other side of the bone. But where the whole is
spoilt, the whole must be taken away. If the inferior part is sound,
so far as is corrupted, ought to be cut out. Likewise if the skull or
pectoral bone, or a rib be carious, the actual cautery is needless, but
there is a necessity for excision. Neither does the opinion of these
people deserve our attention, who defer the excision to the third day
after the bone is laid bare, before they cut it out; for in all cases
it is safer to perform an operation, before an inflammation come on.
Therefore both the skin is to be cut, and the bone laid bare, and freed
from every fault, as far as possible, in the same moment. Now a disease
in the pectoral bone is far the most pernicious of any; because though
the operation have succeeded well, it hardly ever restores a perfect
soundness.
CHAP. III.
OF THE USE OF THE MODIOLUS AND PERFORATOR, AND OTHER INSTRUMENTS,
ESPECIALLY FOR THE BONES OF THE HEAD.
There are two ways of cutting out a bone; if the part injured be very
small, by a modiolus, which the Greeks call chœnicion[HZ], if larger
by terebræ. I shall explain the method of each. The modiolus is a
concave and round iron instrument with serrated edges in its lowest
extremity; through the middle of which is put a pin, surrounded also
by an interior circle. Of perforators there are two kinds: one of them
resembling that, which carpenters use; the other with a longer head,
which begins from a sharp point, and then turns quickly broader; and
again from another beginning goes upward with thickness pretty near
equal.
[HZ] χοινίκιον. This was the name of a measure among the Greeks, and
from its resemblance in shape, they have probably used the same word
for this chirurgical instrument; for the same reason, I suppose the
Romans have named it _modiolus_. Though I have chosen to retain our
author’s term, yet the reader will see the difference is not material
betwixt that, and the trepan of our surgeons; the terebra comes so
near to the perforator, that I have used the modern term for it.
If the disease be confined to a small space, so that the modiolus can
cover it, that must be used preferably. But if a caries appear below,
the pin in the middle is put into the opening. If there be a blackness,
a small hole is made by the angle of a chisel(13) to receive the
pin, that the modiolus resting upon that, by being turned round may
not slip, and then it is turned like the perforator by a strap. And
there is a certain degree of pressure required, that both a perforation
may be made, and it may go round; because if it be lightly impressed,
it does not produce the effect; if too much, it has no motion. And it
is not improper to drop in a little rose oil or milk, the smoothness
of which may make it turn with the greater ease; yet too much of the
liquid blunts the edge of the instrument. But when the modiolus has
marked out a way for itself, the middle pin is taken out, and it is
worked about by itself. And then, when the soundness of the inferior
part is discovered by the dust, the modiolus is taken away.
But if the disease is more extended than to be covered by that, we must
make use of the perforator. By this a hole is made in the limit, that
divides the injured from the sound part of the bone; and not far from
that a second, and a third, till the part, that is to be cut out, be
surrounded with these holes. And in this case too the dust indicates
how deep the perforator is to go. Then a chisel being drove by a mallet
from one hole to another, cuts out the intermediate space between them;
and thus a circumference is formed like to that, which is imprinted in
a smaller circle by the modiolus. In whichever way the circle has been
made, let the same chisel, laid flat on the corrupted bone, smooth each
superior lamina, till the bone be left entirely sound.
A blackness hardly ever goes quite through a bone, but a caries does,
especially where the skull is faulty. There also the disorder is
discovered by the probe, which being introduced into the hole, that
terminates at the sound part of the bone, both finds some resistance,
and comes out moist. If it prove pervious, the probe going in deeper
between the bone and the membrane, meets with no resistance, and comes
out dry: not because there is no corrupt sanies within, but because it
is there diffused, as being in a larger cavity.
Now whether a blackness, which the perforator has discovered, or a
caries, which the probe has shewn, pass through the bone, the use of
the modiolus is generally fruitless: because, where the disease has
penetrated so deep, it must also necessarily be largely extended in
breadth. Here then we must use the second kind of perforator above
described; and to prevent its growing too hot, it must be dipped now
and then in cold water. But then we must proceed with greater caution,
when we have perforated either half through in a simple bone, or the
superior lamina in a double one. The space itself guides us in the
first case; and in the other, the blood. Therefore at that time the
strap must be drawn slower, the left hand should press more gently, and
be taken off pretty frequently: also the depth of the perforation is
to be considered, that we may be sensible whenever the bone is broke
through, and run no risque of wounding the membrane of the brain by its
point, from which proceed violent inflammations, with danger of death.
When the holes are made, the intermediate spaces must be cut out in
the same manner, but with much more circumspection; lest the angle of
the chisel chance to wound the same membrane; till a passage be made,
through which the instrument to protect the membrane may be introduced.
The Greeks call it meningo-phylax[IA]. It is a copper plate, firm,
bent a little upward towards the end, and externally smooth: which
being introduced in such a manner, that its external surface be next
the brain, is put under that part, which is to be separated by the
chisel; and if it receives its angles, it stops its progress; and upon
this account the physician repeats his strokes upon the chisel both
more boldly, and more safely, till the bone being cut out all round is
raised by this plate, and may be taken away without any hurt to the
brain. When the whole bone is taken out, the edges must be scraped
round and smoothed, and if any dust has fallen upon the membrane, it
must be gathered up. When the superior part is taken away, and the
inferior left, not only the edges, but the whole bone must be smoothed,
that the skin may afterwards generate upon it without being hurt, which
growing upon a rough bone, does not immediately become sound, but
produces new pains.
[IA] Μηνιγγοφύλαξ: the etymology of this word answers exactly to its
use: it is delineated by Scultet. tab. 2. fig. 9.
The steps to be taken after the brain is uncovered, I shall mention,
when I come to fractured bones. If any base is preserved, medicines
not greasy, that are calculated for recent wounds, must be applied,
and over them must be laid sordid wool moistened with oil and vinegar.
In process of time flesh grows from the bone itself, which fills up
the cavity made by the operation. And when any bone is cauterized,
it separates from the sound part, and granulations sprout up between
the sound and mortified part, which expel what has separated. And
this, because it is a thin and small lamina, by the Greeks is called
lepis[IB], that is, a scale.
[IB] λεπὶς.
It may happen too, that from a blow, a bone may be neither fissured,
nor broke through, but the surface of it only contused, and rendered
rough. When this occurs, it is sufficient to scrape and smooth it.
Though these methods are most commonly practised in the head, yet they
are common to the other bones too; so that wherever the like case
shall occur, the same remedy must be used. But as they are fractured,
fissured, perforated, and contused, they require some particular
methods of cure in each kind, and in most of them, some general ones
also. Of these I shall proceed to treat, beginning with the head.
CHAP. IV.
OF FRACTURES OF THE SKULL.
When a blow has been received upon the skull, we must immediately
enquire, whether the person has vomited bile; whether he have lost
his sight, or his speech; whether blood has issued by his nostrils,
or ears; whether he has immediately fallen down; whether he has lain
insensible, as if asleep: for these do not happen without a fracture of
the bone. And when they occur, we may be assured, that an operation is
necessary, but of uncertain success. If besides, a torpor has come on;
if he is delirious, if either a palsy, or a convulsion has followed, it
is probable that the membrane of the brane too is wounded; and of such
patients there is still less hope. But if none of these have ensued,
and it may be doubted, whether the bone be fractured, it is first to be
considered, whether the blow was given by a stone or a stick, or iron,
or any other weapon, and whether _the instrument_ was smooth, or rough,
small or large, whether struck with force, or more lightly; because
the more gentle the stroke was, so much the more easily we may suppose
the bone to have resisted it. But it is best to examine that by a more
certain mark. Therefore a probe ought to be introduced where the wound
is, neither too small nor sharp, lest if it should light upon any of
the natural sinuses, it mislead us into an opinion of a fracture,
where there is none; and not too thick, lest small fissures escape it.
When the probe comes to the bone, if nothing but what is smooth and
slippery occur, one may judge it to be sound; if there is an asperity,
especially where there are no sutures, that is an evidence the bone is
fractured.
Hippocrates has recorded, that he was himself deceived by the sutures.
This is the custom of great men, who have a just consciousness of their
own superior abilities: for little minds, because they are deficient
in every thing, never allow themselves to be deficient in any. An
ingenuous confession of an error is worthy of a great genius, who will
have enough besides to entitle him to esteem; and it is especially
_laudable_ in a practical art, which is handed down to posterity for
their benefit; that they may not be deceived in the same way another
was deceived before them. A regard to the memory of a professor, in
other respects so great a man, led us into this digression.
Now a suture may deceive for this reason, because it is equal in
asperity to the other; so that though there be a fissure, one may
readily take it for a suture, in a place, where it is likely one lies
below. Therefore it is not fit to be thus deceived; but the safest
method is to lay bare the bone: for, as I observed before, the place
of the sutures is not certain; and the same part may both have this
natural junction, and be fissured by a blow, or may have some fissure
near it. Nay sometimes, when the blow has been violent, though nothing
be found by the probe, yet it is better to open it. And if even then
the fissure is not manifest, writing ink must be drawn over the bone,
and then scraped off with a chisel, for if there be any fissure it
retains the blackness.
Sometimes it even happens, that the blow has been given on one side,
and the bone fissured on the other. For that reason, if upon receiving
a violent blow, bad symptoms have followed, and no fissure be found in
that part, where the skin is lacerated; it is not improper to consider,
whether any part on the opposite side be softer, and swelled; and to
open that; for there a fissure in the bone will be found. Nor is
it very troublesome to heal the skin again, though nothing has been
discovered by the incision. A fractured bone, unless help be seasonably
administered, brings on violent inflammations, and is treated with more
difficulty afterwards.
Rarely, but sometimes it happens, that the whole bone remains sound;
but from the blow some internal vein in the membrane of the brain is
broke, and discharges blood, which being coagulated there, raises
violent pains, and deprives some people of their sight. But there is
generally a pain in the part that covers it, and an incision being made
in the skin there, the bone is found pale; and therefore this must also
be cut out. Upon whatever account this operation is necessary, if the
opening of the skin is too small, it must be enlarged, till all the
injured part be in view. In this great care must be taken to leave upon
the bone no part of that fine membrane that covers the skull below the
skin; because when this is lacerated by the chisel, or perforators, it
excites violent fevers with inflammations. Therefore it is better to
separate it entirely from the bone. If the external wound be made by
the blow, we cannot alter the form of it. If we are to make one, the
best is that made by two transverse lines in the shape of the letter
X, that afterwards the skin may be cut below, beginning at each of the
prominent angles.
If blood is discharged in the time of doing this, it must be frequently
restrained by a spunge dipped in vinegar, and taken up by lint applied
upon it, and the head raised high. This accident is attended with no
danger except among the muscles, which secure the temples; but even in
that place there is no safer method.
In almost every fissure, or fracture of the bone, the ancient
physicians had immediate recourse to instruments to cut it. But it
is far the best method, first to try plaisters that are composed for
the skull. Some one of these, it is proper to soften with vinegar,
and apply alone upon the fissured or fractured bone; then over that,
somewhat broader than the wound, a piece of linen spread with the same
medicine, and besides that, sordid wool dipped in vinegar; then to bind
up the wound, and open it again every day; and dress it in this manner
for five days; from the sixth, to foment it also with the vapour of
hot water by a spunge, continuing all the former treatment. And if
granulations begin to grow, if the febricula is either gone, or abated,
if the appetite has returned, and the patient gets sufficient sleep, we
must continue the same dressings. Some time after, the plaister must be
softened, with the addition of a cerate made of rose oil, to promote
the growth of flesh: for, by itself, it has a repellent quality. By
this method often the fissures are filled with a kind of callus, which
is as it were a cicatrix in a bone. And in large fractures, if the
bones do not cohere together in any part, they are united by the same
callus; and this is a far better covering to the brain, than the flesh
that grows, when the bone is cut out. If, under the first treatment,
the fever increases, the sleeps are short and disturbed by dreams, the
ulcer is moist and does not fill, small glandular swellings rise in the
neck; the pains are violent; and with all these the loathing of food
increases; then, and only in that case, recourse must be had to the
hand and the chisel.
There are two dangers attending a blow upon the skull; that it be
either split, or depressed in the middle. If it is fissured, the lips
of it may be compressed; either because one of them rises above the
other, or even because they have run together again with force: whence
it happens, that a humour descends upon the membrane, and has no vent,
and thus irritates it, and brings on violent inflammations.
When the bone is depressed in the middle, it presses upon that same
membrane of the brain; and sometimes also some sharp points from the
fracture, prick it. In the cure of these cases as little as possible
must be taken off the bone. Therefore, if one edge rests upon the
other, it is sufficient to cut off the prominence with a plain chisel.
After that is removed, if the fissure gapes a little, it is enough for
the cure. But if the edges are compressed together, an opening must be
made with the perforator, at a finger’s breadth distance on one side,
and from that the chisel must be carried in two lines, to the fissure,
in the form of the letter Λ: so that the vertex of it may be at the
opening, and the base at the fissure.
But if the fissure extends to a great length, it will be proper to
repeat the operation from another foramen; and thus nothing that is
broke off can be concealed under the bone, and a large opening is
procured for whatever is hurtful within. Nor is it necessary to cut
out the whole of a fractured bone, though it be depressed; but if it
be either entirely broke through, and has separated wholly from the
cranium, or if it adhere to _the surrounding skull_ in a small part,
it must be divided from the sound bone by the chisel. Then in the
depressed bone, near the fissure we have made, holes must be bored;
if the injured part be small, two; if larger, three; and the spaces
betwixt these must be cut out; and then the chisel must be drove on
both sides to the fissure, in such a manner as to make a semicircular
cavity, and let the middle part be toward the fracture, and the horns
point to the sound bone. Then if any pieces be loose, and can be
easily taken away, they must be removed by the forceps, which is made
for that purpose, especially those sharp pieces, which irritate the
membrane. If this cannot be easily done, the plate, which I called
meningo-phylax, must be put below it; and above that whatever is
prickly, and stands inward, must be cut off; and whatever is depressed
inward must be raised by the same plate. The effect of such treatment
is, that the fractured bones, if they adhere together in any part, may
be consolidated; and wherever they are broke away, in time they may be
separated by medicines without any pain; and at the same time a space
may be left sufficiently large between them, to evacuate the sanies;
and the brain may have a better protection from the bone than it would
have had, if that were cut out.
After these things are done, the membrane must be sprinkled with
sharp vinegar; that, if there be a discharge of blood from it, it may
be restrained, or if any blood remain coagulated within, it may be
discussed; then the same medicine must be applied, softened in the
manner above prescribed, to the membrane itself; the other directions,
which relate to the linen spread, and the sordid wool, must be observed
in the same manner, and the patient must be kept in a warm place, and
the wound dressed every day; and in summer even twice.
But if, by reason of an inflammation, the membrane has swelled, warm
rose oil must be infused upon it. If it shall swell to such a height
as to rise above the bones, it will be restrained by lentils well
powdered, or vine leaves powdered, and mixed with either fresh butter,
or recent goose fat; and the neck will require to be mollified by
liquid cerate made of iris ointment. But if the membrane shall appear
not to be clean, equal quantities of the plaister and honey must be
mixed; which must be infused upon it; and to keep that on, a piece of
lint or two must be clapped on, and that again covered with a linen
cloth spread with a plaister. When the membrane is sufficiently clean,
cerate must be added in the same manner to the plaister to promote the
growth of flesh.
As to abstinence, and the food, and drink, in the first and more
advanced stages of the cure, the same rules must be observed which I
prescribed in wounds, and with the greater exactness, by how much a
hurt in this part is more dangerous. Nay even when it shall be fit to
allow such a quantity of food as not barely to sustain the patient, but
to nourish him, yet every thing that requires chewing must be avoided;
also smoke, and whatever excites sneezing. The membrane being moveable,
and of its natural colour, granulations of ruddy flesh, and an easy
motion of the lower jaw and neck, afford certain hopes of recovery. The
bad signs are, the membrane immoveable, black, livid, or of any other
vitiated colour; a delirium, acrid vomiting, a palsy, or convulsion,
livid flesh, or rigor of the jaws and neck. The other symptoms that
relate to sleep, appetite, fever, and the colour of the pus, are either
salutary or mortal, as in other wounds.
When the case succeeds well, the growth of flesh begins from the
membrane itself; or if the bone in that part be double, it sprouts from
thence too, and fills up the void space between the bones; sometimes
it even rises higher than the surface of the skull. If that happens,
copper scales must be sprinkled on to keep it down; and medicines
applied to bring a cicatrix over it, which is easily obtained in every
place, except the part of the forehead, which is a little above the
space that lies between the eyebrows (_sinus frontalis_): for there, an
ulceration for the whole life after, can hardly be prevented; this must
be covered with a linen cloth spread with a medicine. And the following
directions must be always observed in a fractured skull, that till the
cicatrix be strong, the sun, wind, frequent bathing, and excess in wine
be avoided.
CHAP. V.
OF FRACTURES OF THE NOSE.
In the nose, both the bone and the cartilage are liable to be
fractured; and that sometimes happens in the fore part, sometimes on
one side. If either both, or one of them be fractured in the fore part,
the nostrils fall in, and the breath is drawn with difficulty. If the
bone is fractured on one side, that part is hollow; if the cartilage,
the nostrils are turned to the opposite side.
Any part of the cartilage, that has given way, must be gently raised,
either by a probe put under it, or two fingers compressing it on both
sides; then lint platted of a due length, sewed up in soft leather,
must be put within; or some part of a dry penecillum composed in the
same manner; or a large quill dipped in gum or joiner’s glue, and
covered with soft leather, which prevent the cartilage from sinking
in. But if the fracture be in the fore part, both nostrils are to be
equally filled. If on one side, what is put in ought to be thicker
in that part where the nose falls in, and smaller on the other; and
externally, a soft strap must be carried round, the middle of which is
spread with fine flour and soot of frankincense mixed together; and
this must be drawn beyond the ears, and the two ends being crossed
there and returned, are to be glued to the forehead: for it sticks to
the skin like glue, and when it has grown hard, it keeps the nostrils
firm. But if what is put within gives pain, which happens chiefly where
the interior part of the cartilage is broke through, the nostrils being
raised in the same(14) manner, must be only held firm by the strap
abovementioned; then, after fourteen days, that must be removed; it is
to be separated by hot water, with which also the swelled part(15)
must be fomented every day.
But if the bone be fractured, that must also be reduced into its
place by the fingers; and when the fracture is in the fore part, both
nostrils must be filled; when on the side, that to which the bone has
been forced; cerate also must be applied, and it is to be bound down a
little more tightly; because in that part, there not only grows callus
enough to make it sound, but even to form an eminence. From the third
day, it must be fomented with hot water, and the more so, the nearer
it may be expected to approach a sound state. And if there be several
small pieces in the fracture, nevertheless each of them _that are beat
in_, must be forced into its place by the fingers: also the strap must
be applied externally, as before directed; and over that a cerate,
without any other bandage.
But if any fragment be separated all round, and will not be united with
the rest, as may be known from the humour, which will be discharged in
great quantity from the wound, it must be extracted by a vulsella; and
when the inflammation is gone, some one of those medicines that are
gently repellent, must be applied. The case is worse, when besides a
fracture of the bone, or cartilage, there is also a wound in the skin.
This very seldom occurs. When it does happen, they must nevertheless
be raised to their place in the same manner; and upon the skin must be
laid some one of these plaisters, that are adapted to recent wounds:
but no bandage must be applied over it.
CHAP. VI.
OF FRACTURES OF THE EARS.
Sometimes the cartilage of the ear is broke. When this happens, an
agglutinating medicine must be applied, before a suppuration begins;
for that often prevents it, and heals the ear. Both here and in the
nose, it should be understood, that the cartilage itself is not
re-united, but that the flesh growing round it consolidates the part;
and therefore, if, together with the skin the cartilage is broke,
the skin is sewed on both sides; but I now speak of the cartilage
fractured, when the skin is entire. If pus then is already formed, the
skin must be opened on one side, and over against the incision, the
cartilage itself must be cut in a lunated form; then a gentle styptic
must be used; such as lycium diluted with water, till the bleeding be
stopped; after that a plaister that is not greasy, spread upon linen,
must be laid on, and soft wool put behind the ear, to fill up the
space between that and the head; then it must be fastened by a gentle
bandage; and from the third day fomented with warm water, as I directed
for the nostrils; and in these kinds of accidents, at first abstinence
is necessary, till the inflammation be gone.
CHAP. VII.
OF A FRACTURED MAXILLA, TOGETHER WITH SOME GENERAL OBSERVATIONS
RELATING TO FRACTURES.
As I am to proceed from these parts to the lower jaw, I think it proper
to insert some observations relating to all the bones in general, to
prevent a frequent repetition of them. Every bone then is sometimes
split longitudinally, like wood, sometimes is fractured transversely,
sometimes obliquely; and in this last species the ends are sometimes
blunt, sometimes acute, which last is of the worst kind; because they
are not easily united, where they do not rest upon something obtuse,
then they also wound the flesh, and sometimes a nerve or a muscle:
moreover, one fragment sometimes happens to be divided into several. In
fractures of the other bones, one end often recedes entirely from the
other; but the broken ends of a jaw-bone remain always in contact in
some one part.
Therefore, first the bones are to be forced into their place, by two
fingers pressing on each side, both within the mouth and upon the
chin; then if the fracture of the jaw-bone be transverse, (in which
case one tooth generally stands out beyond that next to it) when it is
reduced, the two contiguous teeth, or if they are loose, those next to
them, must be tied together by a horse-hair. In a different kind of
fracture this is needless. All the other steps are the same _as in the
above-described fractures_; for a double linen cloth dipped in wine and
oil must be laid upon it, and with that fine flour, and the soot of
frankincense; then a roller or soft strap, with a longitudinal opening
in the middle, that it may take in the chin both above and below; and
lastly, the ends of it must be brought over the head and tied there.
With regard to the bones in general, it may further be remarked once
for all, that fasting at first is necessary; then from the third day
moist food; when the inflammation is removed a little fuller diet and
such as promotes the growth of flesh; wine is hurtful through the whole
time. On the third day, they ought to be opened, and fomented with the
vapour of hot water by a spunge, and the same dressings, as at first,
are to be put on; this to be repeated on the fifth day, and so on,
till the inflammation is gone, which ceases, either on the ninth day,
or generally on the seventh: when that is removed, the bones must be
examined again, that if any fragment is not in its place, it may be
reduced, and the bandage must not be taken away, till two thirds of the
time have elapsed, in which the several bones unite.
Now, generally between the fourteenth and twenty-first day, the
following bones heal: the lower jaw, cheek-bone, clavicle, breast-bone,
scapula, ribs, the spine at the hips, the ancle-bone, heel, hand, and
foot; between the twentieth and thirtieth, the bones of the leg and
fore arm; between the twenty-seventh and fortieth, the arm and thigh
bones.
But concerning the lower jaw-bone I must add, that the case requires
the long use of a liquid diet. Also far a considerable time pancakes
and such like must be continued, and nothing be chewed, till the callus
has perfectly restored the strength of the bone: and for some days, at
first, the patient must not speak at all.
CHAP. VIII.
OF A FRACTURED CLAVICLE.
The clavicle, if it be fractured transversely, sometimes unites very
well of itself, and if it be not moved, may do well without a bandage;
but sometimes, and especially when it is moved, it slides away; and
generally the part next the breast lies over, and behind that next the
humerus. The reason of which is, that it does not move by itself;
but complies with the motion of the humerus: therefore, this standing
still, the humerus is moved upon it. That part of the clavicle, next
the breast, very seldom lies on the forepart; insomuch that men of
great character in the profession have told us they never met with it;
but the authority of Hippocrates is sufficient to put the fact beyond
dispute.
However, as these cases are dissimilar, so each requires a treatment
somewhat different from the other. When the clavicle flies back
towards the scapulæ, the humerus must be pushed backward by the palm
of the right hand, and at the same time the clavicle itself be brought
forward. When turned to the breast, this must be forced backward, and
the humerus brought forward; and if the humerus fall below the other,
that part of the bone next the breast must not be depressed, because it
is immoveable; but the humerus itself must be raised; but if it rise
higher, the part next the breast must be filled with wool, and the arm
bound down to the breast. If there be sharp pieces in the fracture, an
incision must be made in the skin over it; and any parts of the bone,
that wound the flesh, must be cut off; then the blunted bones must be
brought together; and if there be a prominence any where, it must be
kept down by a linen cloth, three times folded, dipped in wine and oil:
if there be several fragments, they are to be covered with a splint,
the inside of which is to be smeared with wax, lest the roller should
slip on one side. The roller must be bound over the clavicle, when
reduced, rather often than tight: and this rule holds in all fractures.
In a fracture of the right clavicle, the bandage ought to pass from
it to the left arm-pit; if, of the left _clavicle_, to the right;
and again under the arm-pit of the affected bone: this done, if the
clavicle be inclined toward the scapula, the fore-arm must be tied to
the side; if forward, to the neck; and the patient laid on his back.
All the other directions given before must be observed.
Now there are several bones that have very little motion, and are
either hard, or cartilaginous, which are liable to be fractured, or
pierced, or bruised, or fissured, as the malae, the breast-bone,
scapula, ribs, spine of the hips, ancle-bone, heel, hand, and foot.
The method of cure is the same in all these. If there is an external
wound, that must be dressed with the medicines proper for it. While
the wound is healing, a callus also fills up the fissures of the bone,
or any vacuity that may be in it. If the skin is entire, and from the
pain we infer that the bone is injured, there is nothing else to do but
rest; and cerate must be applied, and tied on gently, till the pain is
removed by the bone becoming sound.
CHAP. IX.
OF FRACTURES OF THE RIBS AND SPINE.
But there are some peculiarities to be observed relating to the ribs;
because they are near the viscera, and that part is exposed to great
dangers. A rib then is sometimes fissured in such a manner, that not
the exterior surface of the bone, but the interior part of it, which is
thin, is hurt; sometimes it is broke entirely through. If the whole is
not fractured, there rarely follows either a spitting of blood, or a
febricula, or any suppuration; and the pain is not great; however the
place is slightly pained upon being touched. But this case requires no
more than to do what is above directed; and in binding it up to begin
at the middle of the roller (_a double-headed roller_) lest it draw the
skin to either side. After the twenty-first day, when the bone ought to
be united, we must endeavour, by a more plentiful diet, to render the
body as plump as possible, that it may cover the bone the better; which
being yet tender is in that part exposed to injuries under a thin skin.
And through the whole time of the cure, vociferation must be avoided,
and even speaking, hurrying, anger, all violence of motion, smoke,
dust, and whatever excites either coughing or sneezing; and it is not
even proper to hold in the breath much.
But if a rib be entirely broke through, the case is more troublesome:
for both violent inflammations, and a fever and suppuration, and often
a danger of death ensue; and a spitting of blood. Therefore, if the
strength admits, blood must be taken from the arm of the same side
with the rib; if it does not allow this, a clyster must be given,
but without any thing acrid; and the patient must fast a considerable
time. He must not eat bread before the seventh day, but live upon
gruel alone; and upon the part must be applied cerate made of lycium,
with an addition of boiled resin; or the malagma of Polyarchus; or
cloths squeezed out of wine, rose oil, and common oil; and over these
soft sordid wool, and two double-headed rollers, but not tight. What
I mentioned before as hurtful, are in this case to be avoided with
greater caution; so that even the breath must not be too often fetched.
But if a cough be troublesome, a potion must be taken for it, either
of germander, or rue, or the herb staechas, or of cummin and pepper.
When there are severe pains, it is proper to lay on a cataplasm either
of darnel or barley, with an addition of a third part of mellow figs.
And this must lie on in the day time; but in the night, either cerate,
or a malagma, or cloths; because the cataplasm may drop off. Therefore
it must be opened every day, till such time as we may be content with
the cerate or malagma. And for ten days the body must be reduced by
fasting; from the eleventh we must begin to nourish it; and therefore
the bandage about it must be more lax than at first; and generally this
method is continued to the fortieth day.
In the course of which, if there be any fear of a suppuration,
the malagma will be more effectual to discuss it than cerate. If,
notwithstanding, the suppuration take place, and cannot be discussed
by the medicines prescribed before, no time must be lost, lest the
bone below be affected; but in the part where it shall swell most,
a hot iron must be introduced, till it reach the pus, which must be
evacuated. If a tumour does not appear any where, we may discover where
the pus is principally lodged in this manner. We must rub all the part
with Cimolian chalk, and suffer it to dry; and wherever the moisture
shall penetrate deepest, there the pus is nearest to the skin; and here
the actual cautery is to be used. If there shall be a pretty large
abscess, it will require two or three perforations; and lint to be put
into them, or some part of a penecillum; which may be tied by a thread
at the top, that it may be easily drawn out. What remains to be done is
the same as in other burns. When the ulcer shall be clean, the body
must be nourished, lest a consumption follow, which would be fatal.
Sometimes too, when the bone is more slightly affected, and neglected
at first, not pus, but a certain humour like mucus is collected within,
and the skin over it grows soft; in which case, we must use the cautery
in the same manner.
[Sidenote: _Fracture of the spine._]
There is also something peculiar to be noted in the spine: for if any
part has separated from a vertebra, or is any way broken(16), the
part becomes hollow; prickings are felt there, because these fragments
must necessarily be jagged: whence it happens, that the patient now and
then leans forward. These are indications of the case; and the same
medicines are necessary, which have been mentioned in the first part of
this chapter.
CHAP. X.
OF FRACTURES OF THE HUMERUS, FORE-ARM, THIGH, LEG, FINGERS, AND TOES.
The cases which occur in the arms and thighs, and their methods of
cure, are in a great measure similar. There are also some general
things that belong equally to the arms, fore-arms, thighs, legs,
fingers, and toes; for a fracture in the middle of these is least
dangerous; but the nearer the fracture is, either to the superior or
inferior head, so much the worse: for it both creates greater pain,
and is more difficult to cure. Of fractures, the most innocent is a
simple transverse one; worse, where it is oblique, and where there are
fragments; worst of all, when these are sharp. Sometimes the bones
in these parts being fractured, continue in their places: but they
much more frequently give way, and one part lies over the other. This
circumstance ought to be first of all considered; and there are certain
marks for knowing it. If they are displaced, they are bent, and cause
the sensation of pricking, and are unequal to the touch. But if they
meet one another, not directly, but obliquely (which happens, when they
are not in their place) that limb is shorter than the other, and the
muscles of it swell.
Therefore, if this is found to be the case, it is proper to extend the
limb immediately: for the tendons and muscles being _in a natural state
kept_ stretched by the bones, are _in this case_ contracted; neither do
they return to their place, unless they be extended by force. Again,
if that is neglected for some days at first, an inflammation comes on,
during which, it is both difficult and dangerous to use violence to the
tendons; for there follows a convulsion or gangrene; or at least, which
is the mildest of the bad consequences, a suppuration; therefore, if
the bones have not been replaced before _the inflammation_, they must
not be reduced till after it is gone. Now one person alone may extend a
finger, also any other member, if it be of a child, by taking hold of
one part with his right hand, and the other with his left. A stronger
limb requires two to pull different ways. If the tendons are very firm,
as is the case in robust men, and chiefly in their thighs and legs, the
ends of the joints on both sides must be tied with straps, or linen
rollers, and pulled contrary ways by several persons; and when this
force has stretched the limb a little beyond its natural length, then
the bones must be pressed by the hands into their place; and the sign
of a bone’s being reduced, is the removal of the pain. The limb being
made equal with the other, must be wrapt up in cloths two or three
times doubled, dipped in wine and oil; for which purpose linen is best.
Six bandages are generally required. The first to be applied is the
shortest; which should be rolled about the fracture(17), and ascend
spirally like a screw; and it is sufficient for it to go round in this
manner thrice. The second is one half longer than this; which, if
the bone project in any part, must begin there; if it be every where
equal, it may begin any where upon the fracture, and go in an opposite
direction to the former, tending downwards, and returning again to
the fracture, end in the upper part beyond the former bandage. Over
these must be laid cerate, upon a broad piece of linen, to keep them
on. And if the bone is prominent in any part, a cloth, three times
doubled, moistened in the wine and oil before mentioned, must be laid
upon it. These are to be secured by a third and a fourth bandage, in
such a manner, that the following move always in a contrary direction
to the former, the third alone must end in the lower part, and the
other three in the superior; because it is better to make several
convolutions, than to bind it tight; for a strict bandage disorders
a part, and makes it liable to a gangrene. We ought to bind an
articulation as little as possible; but if the fracture of the bone is
near the joint, there is a necessity for it.
When the limb is bound up, it must be kept so to the third day, and
the bandage should be such, as on the first day not to hurt _by its
stricture_, and yet not to seem lax; on the second it should be a
little laxer; the third almost loosened. Therefore, the limb must then
be bound up again, and a fifth roller must be added to the former;
after which it must be again opened on the fifth day, and then secured
by six rollers, in such a manner, that the third and fifth may end
below, and the rest above. As often as the limb is opened, it must be
fomented with hot water. But if the fracture be near a joint, wine,
with the addition of a small proportion of oil, must be dropped upon
it for a long time, and all the other directions observed, till the
inflammation leave it, or the limb become smaller than ordinary: which,
if it does not happen on the seventh day, will certainly be effected by
the ninth. Then the bones are handled with great ease.
Therefore, if they are not well joined to each other, they must be set
again; and if any fragments rise above the rest, they must be reduced
into their places, and then the limb must be rolled up in the same
manner, and splints be fitted round it, to keep the bones in their
places. And on that side, to which the fracture inclines, a broader
and stronger splint must be applied. About a joint all these should
turn outward, that they may not hurt it, and be bound no tighter than
is necessary to secure the bone: as they grow laxer in time, they must
be a little tightened every third day by their straps; and if there
be no itching nor pain, continue so, till two-thirds of the time be
compleated, in which each of these bones unites; afterwards, it is to
be bathed more gently with hot water; for at first it is necessary to
dissipate the humours, and afterwards to make them transpire. Therefore
it must also be anointed lightly with liquid cerate, and the surface of
the skin rubbed; and the fracture be bound up more loosely. It must be
opened every third day, and all the applications be repeated, except
the hot water; only one of the rollers, as often as it is loosed, must
be withdrawn.
[Sidenote: _Of a fractured humerus._]
The foregoing rules are general; the following peculiar to each
bone. If the humerus be fractured, the extension must not be made as
in another limb; but the patient is placed in a high seat, and the
physician in a lower one opposite to him. Then the patient’s fore-arm
is to be supported by a bandage passed round it, and fastened behind
the neck. _This done_, a second bandage, _with two heads_, is to be
rolled round the upper part of the humerus, and have its two ends
tied into a knot above the head. Lastly, a third bandage of the like
kind is to be fastened to the lower part of the humerus, and carried
downwards, its two ends being also tied together. Then, from behind
the patient’s head, an assistant stretching his own arm _through the
loop of_ the second mentioned roller, his right, if the right humerus
is to be extended, his left, if the left _humerus_, takes hold of a
stick placed between the patient’s thighs; the physician also sets his
right foot, if he be to operate upon the left humerus, his left, if
upon the right, on the third of these rollers; and at the same time the
assistant raises the one roller, and the physician depresses the other;
by which means, the humerus is gently extended. If the fracture be in
the middle or lower part of the bone, shorter rollers are required; if
in the superior, longer; so that they may be extended from thence over
the breast, under the other arm-pit to the shoulders. In binding it
up, the fore-arm must be so inclined, and the affected part put into
such a position by the bandages, that the suspending of the forearm
afterwards, do not turn the humerus any other way, than when it was
bound up. And the fore-arm being hung, the humerus is to be also gently
tied down to the side; by which means it will be prevented from moving,
and therefore the bones continue as they have been set. When we come to
the application of splints, these ought to be longest on the external
side, shorter on the fore-part, but shortest of all under the arm-pit.
And when the humerus is fractured near the cubitus, they must be pretty
often removed, lest the tendons there grow rigid, and the fore-arm be
rendered useless. Whenever they are removed, the fracture must be held
in the hand; and the cubitus fomented with hot water, and rubbed over
with soft cerate; and splints must either not be put upon the processes
of the cubitus at all, or they must be somewhat shorter _than the
others_.
[Sidenote: _Of a fracture of the fore-arm._]
But if there is a fracture in the fore-arm, it must be first of all
considered, whether one bone or both be broken: not that there is any
different method of cure to be used; but first that the extension may
be the stronger, if both bones be fractured, because the tendons must
necessarily be less contracted, when one of the bones is entire, and
keeps them upon the stretch; in the next place, that every thing which
relates to securing the bones, may be done with the greater accuracy,
if one of them does not help the other: for where one is unhurt, it
helps more than rollers and splints. The fore-arm ought to be tied
up with the thumb turned a little toward the breast; for that is the
most natural posture of the fore-arm: and after the bandages are put
on, it is best held in a scarf, the full breadth of which is under the
fore-arm, with its ends, which are very narrow, fixed over the neck;
thus the arm is conveniently suspended from the neck, and ought to hang
a little higher than the other elbow.
But if any part of the top of the cubitus be fractured, it is improper
to secure it by bandages, because the fore-arm becomes immoveable. And
if means only are found(18) to remove the pain, it remains as useful
as before.
[Sidenote: _Fractures of the thighs and legs._]
It is of equal importance in the leg for one of the bones to continue
entire. Both in this and the thigh it is fit after binding it up to
put it in a box. This box ought to have holes below, through which any
humour that is discharged, may descend; and at the foot a prop, which
may both sustain, and not suffer it to slip; and holes in the sides,
through which straps being past, some bars[IC] may keep the leg and
thigh in their position. If it be a fracture of the leg, this ought to
reach from the foot to the ham; if of the thigh, as far as the hip;
if near the head of the thigh-bone, so as that the hip likewise may
be within it. We ought not to be ignorant, however, that a fractured
thigh becomes shorter, because it never entirely returns to its former
state; and that the person ever after supports himself upon his toes in
that foot, which occasions great weakness; however it is much worse,
where the misfortune has been encreased by neglect.
[IC] morae.
[Sidenote: _Fractures of the fingers._]
It is sufficient to bind a finger to one small twig, after the
inflammation is gone.
[Sidenote: _General rules._]
The foregoing directions are confined to the cases relating to
particular limbs; the following are general: fasting for some days
at first; then when the callus is growing, a pretty full diet; long
abstinence from wine; plentiful fomentations of hot water, while
the inflammation continues; when that has ceased, they must be more
sparing; lastly, a pretty long but gentle rubbing of liquid cerate
into the more remote parts. Nor must the limb be immediately put upon
exercise, but by degrees returned to its former motions.
The case is a good deal worse, when, besides the fracture of the bone,
there is also a wound in the flesh; and particularly if that happen in
the muscles of the thigh or arm: for the inflammations there are much
greater, and they are more liable to gangrenes. And generally, where
the bones of the thigh have slipped past each other, it is necessary
to cut it off. The arm is also endangered in the same circumstances,
but is more easily preserved. And these dangers are still more to be
apprehended, if the fracture be near the joints: therefore, such a case
must be treated with more care, and the muscle must be cut through
transversely over the middle of the wound; and if the hæmorrhage has
been but small, the patient must be bled, and extenuated by fasting
for ten days. And though the other limbs may be extended slowly, and
the bones reduced gently to their place; yet in these it is not quite
expedient either to extend the tendons, or handle the bones. And the
patient must be allowed to keep them in the position that is easiest
to him. To all such wounds must be applied, at first, lint dipped in
wine, with an addition of a very little rose oil: the other management
is the same as above recommended. They are to be bound up with rollers
broader(19) than the wound; which must be applied looser, than if
there was not a wound there; and as the wound is more liable to
corruption and a gangrene, we are by a number of rollers to manage it
so, that though they are slack, they may keep the bones firm.
This method may be followed in the thigh or arm, provided the bones
have chanced to return to their proper place; but if they be in any
different situation, they must only have such a bandage, as will keep
on the medicine that is applied. The other directions I gave before
must be observed: except that neither splints nor boxes be used, with
which the wound cannot heal; but only more and broader rollers are
necessary; and both hot oil and wine must be poured upon them now and
then; more frequently the latter. At the beginning the patient must
fast; the wound must be bathed with hot water; he must avoid the cold;
and recourse must be had to medicines for promoting digestion of the
wound, and more care must be taken of the wound than the bone: for that
reason it must be opened every day and dressed.
In the mean time, should any small fragment of the bone project, if
it be blunt, it must be reduced into its place; if sharp, its point,
when long, must first be cut off, when short, filed, and in either case
smoothed with a chisel; and then it must be returned in again. And if
that cannot be done by the hand, a vulsella, such as workmen make use
of, must be applied with that part(20) which turns inward to the
sharp point of the bone, that by its convex part the prominent bone
may be thrust into its place. If it be too large, and covered by small
membranes, we should allow these to be dissolved by medicines, and when
the bone is laid bare, cut it off; which is to be done pretty early,
and afterwards, in this method we may let the bone unite and the wound
heal; the first in its proper time, and the other as the circumstances
admit.
Sometimes too it happens in a large wound, that some fragments as it
were mortify, and do not unite with the rest. This may be discovered
from the quantity of discharge; which makes it necessary to open the
ulcer oftener than it is dressed; and the consequence generally is,
that this bone, after some days, of itself falls off; otherwise, though
the condition of the wound is miserable enough before, that often
encreases it, and makes it more tedious of cure. The bone too is often
broken away, when the skin is entire, and immediately an itching and
pain come on. Wherefore, if that happens it is proper to open it the
sooner, and bathe it in the summer time with cold water; and in the
winter with water just warm; and then apply myrtle cerate.
Sometimes, the fracture, by some points like prickles, irritates
the flesh: which being discovered by the itching and prickings, the
physician must open it, and cut off these points. The other part of the
cure is the same in both these cases as in a recent wound. When the
ulcer is clean, nourishing food must be taken. If the limb is still too
short, and the bones are not in their places, a wedge of the smallest
and smoothest kind must be put in between them with its head standing
out a little, and the thick part of it must be driven farther in every
day, till that limb be equal to the other. Then the wedge must be taken
out, and the wound healed up. When a cicatrix is brought on, it must be
bathed with a decoction of myrtle, ivy, and other like vervains, cold,
and a drying medicine applied upon it; and in this case, there is a
greater necessity for rest, till the limb recover its strength.
When the bones happen not to unite, because they have been often
opened, and often moved, the method of cure is obvious; for they may
unite. If the fracture be of long standing, the limb must be extended,
to create a fresh injury; the bones must be separated from one another
by the hand, that their surfaces may be roughened by rubbing against
each other, and if there be any fat substance, it may be abraded, and
the whole of it become as it were recent: great care, however, must
be taken not to wound tendons or muscles. Then it must be bathed with
a decoction of pomegranate bark in wine; and the same mixed with the
white of eggs, must be applied to it; on the third day it must be
opened, and bathed with a decoction of the vervains abovementioned:
which must be repeated on the fifth day, and splints put round it;
the other steps, both before and after, which I directed already,
must be taken in the same manner. However, sometimes the bones unite
obliquely(21); and thus the limb becomes both shorter and deformed,
and if the ends are pretty sharp, continual prickings are felt: for
this reason the bones ought to be fractured again, and put in a proper
direction. It is done in this manner. The limb is fomented with plenty
of hot water, and rubbed over with liquid cerate and extended; in the
mean time, the physician handling the bones, the callus being yet
tended, separates them by his hands, and forces the part that projects,
into its place: and if that is not effectual, on that side, to which
the bone inclines, he puts a regula wrapped up in wool; and by thus
binding it up brings it to a habit of lodging in its former place.
Sometimes also, though the bones have united as they should do, too
large a callus grows upon them; and therefore the part is swelled. When
this happens, the limb must be rubbed gently for a long time, with oil,
salt and nitre, and bathed with plenty of salt water; a discutient
malagma must be applied; and a tight bandage put on; and the patient
must eat herbage, and take vomits; by which course, the callus is
reduced together with the flesh. Some good is done by an application
of mustard and a fig upon another limb, till it corrode a little, and
derive the matter to that part. When the tumour is lessened by these
means, the person may return to his ordinary course of life.
CHAP. XI.
OF LUXATIONS.
Thus far then we have treated of fractures. Now the bones are
dislocated in two ways. For sometimes those that are joined together,
separate from each other, as when the broad bone of the scapula
recedes from the humerus(22), and in the fore-arm the radius from
the cubitus, and in the leg, the tibia from the fibula, and sometimes
in leaping the heel-bone from the ancle; which last, however, seldom
happens. Sometimes the articulations are displaced. I shall speak first
of the former.
When such an accident happens, the part is immediately hollow, and
by pressing upon it with the finger one feels a cavity. After that,
a violent inflammation comes on; and particularly in the ancle; for
generally it occasions fevers and gangrenes, and either convulsions, or
contractions, which draw the head down upon the shoulders. To avoid
which, the same method must be followed here, as in injuries of the
moveable bones. And whenever it happens, the medicines prescribed
before must be laid on these parts to remove the pain and tumour: for
bones once separated in this manner never come together again; and
though some degree of comeliness be attainable in the part, yet it is
of no use(23).
But the lower jaw and the vertebræ, and all the joints, though they be
secured by strong ligaments, are luxated by the force of a blow, or
when the ligaments are either ruptured, or some way weakened; and more
easily in children or lads, than in those that are more robust. And
they slip out forward and backward, and inward and outward; some of
them in all these ways, others in particular ways. And there are some
general signs belonging to all, others peculiar to each one: for there
is always a tumour in that part, to which the bone is propelled, and a
cavity in that from whence it recedes. Now these marks are common to
them all; the others peculiar to the several bones will be mentioned,
when I speak of each case distinctly.
But though all the articulations may be dislocated, they cannot be
all replaced; for the head is never reduced, nor a vertebra in the
spine, nor a jaw-bone, which being out on both sides, has raised an
inflammation before it could be returned. Again, those that slip out
from the fault of the ligaments, when they are forced into their
places, give way again. And those that have been dislocated in
childhood, and have not been reduced, grow less than the rest: and the
flesh of all these that are not in their place, is decayed, and more so
in the member nearest to it, than in one beyond it. For instance, if
the humerus is not in its place, the arm wastes more than the fore-arm,
and that more than the hand. Then according to the situations, and the
nature of the accidents, there is left either more or less use of the
limb; and the more use remains of it, the less it is wasted.
Now whatever is dislocated should be reduced before an inflammation
begin. If that has already seized it, till it cease, it must not be
meddled with; after its removal, trial must be made in such limbs
as are reducible. A great deal depends upon the habit both of the
body and the ligaments: for if the body be slender, or humid, or if
the ligaments be weak, the bone is more quickly reduced; but it is
both more liable to dislocation, and is less firmly held after it
is reduced(24). Bodies of the contrary qualities hold it faster
in its place; but when once forced out, admit of its return with
difficulty. It is proper to alleviate the inflammation by applying
sordid wool squeezed out of vinegar; and if the misfortune be in a
strong articulation, to abstain from food for three, and sometimes even
five days; to drink warm water till the thirst be gone; to observe
these rules more strictly in luxations of those bones, that are held
by strong large muscles; and much more so if a fever has ensued; on
the fifth day to foment with hot water; and taking away the wool, to
apply cerate made of Cyprine oil, with the addition of nitre, till the
inflammation be entirely removed. Then it is proper to use friction
to the limb; to take food of good juices, wine in moderate quantity;
and by this time, to make some use of the limb: because motion, as it
is extremely hurtful in pain, so it is very salutary when the pain
is removed. These observations are general; I shall now treat of the
particular cases.
CHAP. XII.
OF A LUXATED MAXILLA.
In a dislocation of the lower jaw it is pushed forward, but sometimes
on one side, sometimes on both. If on one side, it inclines together
with the chin to the contrary side, the teeth do not answer to each
other, but the canine teeth below are opposite to the incisores: if
on both sides, the chin leaves its place, and is protruded to the
external part; and the lower teeth come farther out than the upper;
and the muscles of the temples appear tense. The patient, as soon as
possible, must be placed in a seat in such a manner, that an assistant
may secure his head behind; or he may be seated near a wall, putting a
hard leather cushion between the wall and his head, and let his head
be pressed upon the cushion by an assistant, that it may be kept the
steadier; then the thumbs of the physician being wrapped up with linen
cloths, or rollers, that they may not slip, must be introduced into
his mouth; and the fingers must be applied externally. When the maxilla
is firmly grasped, if the luxation be on one side, the chin must be
shaken, and brought towards the throat; then at the same time his head
must be held, and the chin being raised, the maxilla forced into its
place, and the mouth shut; and all this must be done almost in the same
instant. But if the luxation be on both sides, the same method must
be taken; but the jaw-bone must be forced back equally on both sides.
When the bone is replaced, if the case was attended with a pain of the
eyes and neck, blood must be taken from the arm. And as liquid food at
first is proper for all persons, whose bones have been dislocated, so
particularly in this circumstance; where even frequent speaking, by the
motion of the mouth, hurts the nerves of the temples(25).
CHAP. XIII.
OF A LUXATION OF THE HEAD.
In the first part of this book, I have already observed, that the head
is secured upon the neck by two processes received into two depressions
of the upper vertebra. These processes are sometimes dislocated toward
the posterior part; the consequence of which is, that the nerves below
the occiput are extended, the chin is fixed upon the breast, and the
patient can neither drink, nor speak, and sometimes discharges his
semen involuntarily. Such patients die very quickly. I judged it
necessary to mention this case, not because there is any cure for
it; but that it might be known by its symptoms, and if any should
lose a friend in this way, they might not think it was for want of a
physician.
CHAP. XIV.
OF A LUXATION IN THE SPINE.
The same misfortune attends those, whose vertebræ of the spine are
luxated. For this cannot happen, unless both the medulla, which passes
through the middle, and the two membranes, that go through the two
processes on the sides, as also the ligaments, that secure them, be
ruptured. They are dislocated both backward, and forward; both above
and below the transverse septum. As they slip the one way or the
other, there will be either a swelling or a cavity behind. If this
happens above the septum, the hands become paralytick, a vomiting
or convulsions follow, the breath is oppressed, and a violent pain
and deafness ensue. If below the septum, the thighs are paralytick,
the urine is suppressed, and sometimes it even flows involuntarily.
Though a person does not in such cases die so quickly as where the
head is luxated, yet it commonly happens within three days; for what
Hippocrates has directed in a vertebra luxated externally, that the
patient must be laid prone, and extended, and then a person ought
to stand upon him with his heel and force it in, must be understood
of those, that are but partially displaced, not of these, that are
entirely luxated; for sometimes a weakness of the ligaments causes a
vertebra to protuberate forwards, though it be not dislocated: this is
not mortal. But it is not possible to force it back from the internal
part. If any vertebra be reduced from the external side, it generally
returns again, unless, which is very rare, the tone of the nerves be
restored(26).
CHAP. XV.
OF A LUXATION OF THE HUMERUS.
The humerus slips sometimes into the axilla, sometimes forward. If it
has fallen into the arm-pit, the cubitus recedes from the body, and
cannot be brought upward with the humerus to the ear of the same side;
also that arm is longer than the other: if forward, the upper part of
the fore-arm is extended, but not to its full length; and the cubitus
is moved with more difficulty forward than backward.
Therefore if the humerus has fallen into the arm-pit, and the patient
be young, or of a lax habit, so that the ligaments are weak, it is
sufficient to place him in a seat; and to order one assistant to draw
back gently the head of the broad bone of the scapula, and another to
extend the fore-arm; while the physician himself sitting behind, with
his knee under the patient’s arm-pit, forces the humerus upwards, and
at the same time presses the scapula with one hand, while he pushes the
cubit to the side with the other.
But if the patient be of a large stature, or the ligaments more robust,
a wooden spatha is necessary of the thickness of two fingers, and so
long as to reach from the arm-pit to the fingers. In the top of it, is
a small round head a little hollowed; that it may receive some part of
the head of the humerus; and in three places at due distances there
are two holes made for the admission of soft straps. This spatha being
wrapt up in a roller, that it may hurt the less, is applied from the
fore-arm to the arm pit, in such a manner, that the head of it is put
under the axilla; then it is tied to the arm by its straps, in one
place a little below the head of the humerus, another a little above
the elbow, and the third above the hand; to which purpose the distances
of the holes are then also to be adapted. The arm being thus tied up
is put over a step of a ladder, so high, that the patient cannot stand
upon the ground; and at the same time his body is suffered to sink on
one side, and his arm kept extended on the other; the effect is, that
the head of the humerus, being impelled by the head of the spatha, is
forced into its place, sometimes with a crack, sometimes without it. It
appears from Hippocrates alone, that there are many other methods; but
none of them has been more approved by experience than this.
But if the humerus is luxated forward, the patient must be laid on his
back, and a roller, or strap put round the middle of the arm-pit, and
the ends of it delivered to one assistant behind the patient’s head,
and his fore-arm to another; then the first must be ordered to extend
the strap, and the other the fore-arm; and the physician must thrust
back the patient’s head with his left hand, and with his right raise
the cubitus together with the humerus, and force the bone into its
place; which in this case is more easily reduced than in the former.
When the humerus is replaced, wool must be put under the arm-pit; that
if the bone was in the interior part, it may prevent its returning; if
forward, that it may however be more conveniently rolled up. Then the
roller being first carried under the arm-pit, ought to surround the
head of the bone, and passing over the breast to the other arm-pit, and
from that to the scapulæ, and back again to the head of the _luxated_
humerus, it must be carried round in this manner several times, till
the head of the humerus be well secured. The humerus being thus bound
up is better fixed, if it be drawn close to the side, and tied down to
it with a roller.
CHAP. XVI.
OF A LUXATION OF THE CUBITUS.
From what has been said in the first part of this book, it may be
understood, that three bones meet together at the elbow, the humerus,
radius, and cubitus. If the cubitus, which is fixed to the humerus,
separates from it, the radius, which is contiguous to it, is sometimes
dislocated, and sometimes remains firm. Now the cubitus may be luxated
in all the four different ways. If it be displaced forward, the
fore-arm is extended, and cannot be bent; if backward, the fore-arm is
bent, cannot be extended, and is shorter than the other; sometimes it
brings on a fever and bilious vomiting; if externally, or internally,
the fore-arm is stretched, but is a little bent to that part, from
whence the bone has receded.
Whatever species it be, the method of reduction is the same (and not
only in the cubitus, but in all the larger limbs, which are joined in
the articulation by a long process) to extend both limbs different
ways, till there be a void space between the bones; and then to thrust
the luxated bone from that side, into which it has prolapsed, to the
contrary. However the methods of extension are various according to the
strength of the ligaments, and the position of the luxated bones. And
sometimes the hands alone are used, sometimes other means.
Therefore if the cubitus is displaced forward, it is sufficient for
it to be extended by two hands, sometimes assisted by two straps;
then some round body must be put into the bend of the elbow, and upon
that, the cubitus is to be suddenly forced towards the humerus. But in
the other cases the best method is so extend the fore-arm in the same
manner, as was directed in a fractured humerus, and then to reduce the
bones.
The remaining part of the cure is the same as in the other luxations;
only this must be sooner, and more frequently opened, also more
plentifully fomented with hot water, and rubbed longer with oil, and
nitre, and salt. For the cubitus, whether it remain displaced, or be
reduced, is more quickly surrounded by a callus than another joint, and
if this grows, while the arm is at rest, it afterwards prevents its
flexure.
CHAP. XVII.
OF A LUXATED HAND.
The hand too may be displaced in all the four directions. If it slips
backward, the fingers cannot be extended; if forward, they cannot be
bent; if on either side, the hand is turned to the opposite, that is,
either toward the thumb, or the little finger, and may be replaced
without much difficulty. The hand and fore-arm should be extended on
something, that is hard and will not give way, the hand being prone,
if the luxation was to the posterior part; and supine, if forward; if
internally, or externally, it should be laid on one side. When the
ligaments are sufficiently stretched, if the luxation was lateral, it
must be repelled to the contrary side by the hands: but where it was
forward, or backward, some hard body is to be put upon it, and pressed
upon the prominent bone by the hand, which additional force pushes it
more easily into its place.
CHAP. XVIII.
OF LUXATIONS IN THE PALM.
The bones also in the palm are sometimes dislocated, and that either
forward, or backward. For they cannot be luxated laterally by reason
of the resistance from the parallel bones on each side. There is only
one indication of it, which is common to them all: a tumour in that
part, to which the bone comes, and a cavity in the other, from which it
recedes. But the bone being well pressed by a finger, returns without
extension to its place.
CHAP. XIX.
OF LUXATED FINGERS.
In the fingers there are as many different cases, and the same signs,
as in the hands. But an equal degree of force is not necessary in their
extension; because the _several_ bones are shorter, and the ligaments
less strong. They ought only to be extended upon a table, when the
luxation is forward or backward; and then compressed with the palm of
the hand that thus the finger may be(27) restored to the place from
whence it slipped.
CHAP. XX.
OF A LUXATION OF THE FEMUR.
Having treated of the humerus(28), what I said there may seem to
suffice for the lower extremities; for there is some similitude in this
case between the femur, and humerus, the tibia, and cubitus, the foot
and hand. However something must be said in particular about these.
The femur is protruded in all the four ways; most frequently to the
internal part, next externally, very rarely forward, or backward. If it
be luxated internally, the leg is longer and turned round externally
more than the other; for the toes point outward. If to the external
part, it is shorter and bowed inward, and the foot turns the same way;
the heel in walking does not touch the ground, but the person rests
upon the extremity of the sole of the foot; and in this case, the leg
sustains the superior part of the body better than in the former, and
less needs the help of a staff. If forward, the leg cannot be bent, and
being extended is as long at the heel as the other: but the toes are
turned less inward; also the pain is most violent in this case; and the
urine very liable to be suppressed: when the inflammation together with
the pain have ceased, such patients walk pretty well, and their foot is
straight. If the luxation be backward, the leg cannot be extended; and
is shorter; also in standing, the heel does not reach the ground.
But there is a great danger attending the femur, that it be either
difficult to reduce, or slip out again after it is replaced: some
affirm it always comes out again; but Hippocrates, and Diocles,
and Philotimus, and Nileus, and Heraclides the Tarentine, very
celebrated authors, have affirmed, that they have made a perfect cure.
Neither would Hippocrates, Andreas, Nileus, Nymphodorus, Protarchus,
Heraclides, and a certain artificer too, have contrived so great a
variety of machines for extending the femur in this case, if it were to
no purpose. But as this is a false opinion, so on the other hand it is
true, that the ligaments and muscles there being very strong, if they
retain their natural firmness, they will hardly admit of a reduction;
if they do not, they do not hold it fast, when reduced.
Therefore trial must be made, and if the limb be but tender, it is
sufficient to make an extension by one strap at the groin, and another
at the knee; if it be muscular, the extension will be better made by
tying these straps to strong sticks; and then putting the lower ends
of the sticks against a fulcrum, and pulling the upper ends with both
hands. The extension of the limb is still more strong upon a bench,
that has axes at both ends, to which these straps are tied; which being
turned as in a wine-press, by persevering, they will not only extend,
but even break the ligaments and muscles. Now the patient must be laid
upon this bench, either prone or supine, or on one side, so that the
part, into which the bone has slipped, be always uppermost, and that,
from which it has receded, lowermost. When the ligaments are extended,
if the bone is luxated forward, some round body must be put upon the
groin; and the knee must suddenly be drawn towards the body, in the
same manner, and for the same reason, as is done in the arm; and if the
femur gives way to the flexion, it is reduced.
But in the other cases, where the bones have receded a little from
each other, the physician ought to force back the prominent part; and
an assistant to push the hip in a contrary direction. When the bone is
reduced, there is nothing different required in the treatment, except
confining the patient longer to his bed; lest if the femur be moved,
while the ligaments are too lax, it may slip out again. However it may
be secured by keeping the middle or upper part of the joint in some
canaliculus(29).
CHAP. XXI.
OF A LUXATION OF THE KNEE.
It is very well known, that the knee slips inward, outward, and
backward. Most authors have written, that it is not displaced forward.
And that may appear very probable; as in that place the patella is
opposed to it, and likewise keeps in the head of the tibia. But Meges
has given an instance of a person cured by him, where the luxation was
forward.
In these cases the ligaments may be extended by the same means, which
I recited in the femur. And where the bone is luxated backward, it is
reduced in the same manner, by some round body applied to the ham, and
drawing up the leg. In the other cases the hands are only to be used,
and then the bones are at the same time forced different ways.
CHAP. XXII.
OF A LUXATED ANCLE.
The ancle is luxated in all directions. When it is inward, the sole of
the foot is turned outward. When the contrary case to this happens,
there is also the contrary symptom. But if it be luxated forward, the
broad tendon behind is hard, and tense; and the foot turns downward. If
backward, the heel is almost hid, and the sole of the foot is enlarged.
This luxation is reduced by the hands; the foot and leg being first
extended different ways. And in this case also the patient must be kept
longer in bed; lest the ancle, which sustains the whole body, yield
beneath its load, and be forced out again before the ligaments have
recovered their strength. And at first low shoes must be used, lest the
binding hurt the ancle.
CHAP. XXIII.
OF LUXATIONS IN THE SOLES OF THE FEET.
The bones in the soles of the feet are luxated in the same manner as
those in the hands; and are reduced by the same methods; only it is
necessary to put a roller round the heel; lest as the middle part and
extremity of the sole require to be bound, the ancle being left free,
may receive the redundant matter, and thus come to suppuration.
CHAP. XXIV.
OF LUXATED TOES.
In the toes there is nothing else required, than what has been directed
before in the fingers.
CHAP. XXV.
OF LUXATIONS ATTENDED WITH A WOUND.
These are the methods to be taken, when the bones have been displaced
without a wound; but they are often dislocated, and the part wounded at
the same time; and here the danger is great, and so much the greater,
as the limb is larger, and the ligaments, or muscles that hold it,
stronger; and therefore, from the arm and thigh bones there is danger
of death: and if the bones are reduced, there is no hope; and yet when
they are not replaced, there is also some danger. In both, the event
is the more to be feared, the nearer the wound is to the articulation.
For Hippocrates has asserted, that no bone could in this case be
safely reduced, except the fingers and toes, and the bones of the feet
and hands; and that even here great caution must be used, lest it
suddenly destroy the patient. Some have reduced both arms and legs;
and to prevent gangrenes and convulsions (which in such cases often
terminate in speedy death) they let blood from the arm. But not even a
finger (where, as the malady, so also the danger is least) ought to be
reduced, either while there is an inflammation, or afterwards, when the
bones have continued long luxated. And farther, if after the reduction
of the bone, convulsions come on, it must be immediately put out again.
Now every member that is at once wounded and dislocated, and continues
unreduced, ought to lie in the posture easiest to the patient; provided
it neither be moved nor hang down. In every case of this kind the cure
is much promoted by long fasting; and then the use of those methods
prescribed before. In fractured bones, where there is a wound, if the
naked bone project, it will always prevent its healing; therefore, the
prominent part must be cut away, and dry lint applied, and medicines
not greasy; till the greatest degree of soundness attainable in such a
case be restored; for it both leaves a weakness behind it, and the part
is covered with a thin cicatrix, which must of necessity be ever after
greatly exposed to injuries.
NOTES
TO
BOOK I.
1. _Their gods._ Though Æsculapius lived so near to the time of the
Trojan war, yet the Greeks knew very little about him. The superstition
of those times gave him a place among the gods: and as he was adored
under the character of the genius of physick, it came at last to be
doubted whether he was ever a mortal. This blind devotion, however,
produced one happy consequence: his priests were obliged, for their
own interest, to make themselves masters of all the physic that was
known in that country, that they might be qualified to give advice to
the people, who applied to them. Their prescriptions passed for the
suggestions of the god; their cures for miraculous. But both diseases
and remedies were carefully recorded.----Strabo tells us, that from
these registers in the temple of Æsculapius at Cos, Hippocrates formed
his plan for a proper diet.----_Strabon. Geograph. lib. 14. p. 657.
Edit. Casaub._
2. _Immortal gods._) That this was really the opinion of the
ancients, may be seen by many passages in Homer’s poems, where he
mentions Jupiter punishing wicked nations by diseases, as well as
famine, wars, and other calamities.
3. _Principles._) Some of the ancient philosophers maintained, that
the human body, as well as the whole material system, was composed of
four principles or elements, viz. fire, air, earth, and water.
4. _Vessels_, in the original, _vena_; which is used by our author
as a general term for arteries and veins. In this place it is evident
he means arteries; for mentioning the same opinion again, page 16, he
says, _At si sanguis in arterias transfusus_; and he often speaks of
the motion of the veins, where, it is plain, he intends the pulsation
of the arteries. _Arteria_ he uses to signify the wind-pipe, and
likewise the sanguiferous arteries, as in chap. 1. of book 4. _Circa
guttur venae grandes, quae sphagitides nominantur; item arteriæ, quas
carotidas vocant._
5. _Distribution of the same._) The word in the original is _digero_,
which, by the modern physicians, is generally applied to the digestion
of the aliment in the stomach. But that is what our author never
intends by it. _Digero_ he uses in three different senses; 1st, for the
distribution of the aliment from the stomach (after its concoction)
to all the other parts of the body, which appears to be his meaning
here: 2dly, for any evacuation made by the pores of the skin, as
_sudore digerit_ in the end of the ninth chapter of this book: 3dly,
for discussing any collection of humour, so as to prevent its coming to
suppuration; _vel avertenda concurrens eo materia_, _vel digerenda_,
_vel ad maturitatem perducenda est: si priora contigerunt_, _nihil
praeterea necessarium est_. Lib. vii. c. 2. ad fin. p. 408. Unless we
restrain the meaning of this last passage to discussing by the skin,
which would bring it under the second sense.
6. _Asperity._) Ten of the most ancient editions mentioned by
Morgagni[ID] read _contactum_; but as that seems to convey no
convenient sense, others prefer _contractum_, which is found in one
of the manuscripts, and suppose it to mean asperity, a sense which
it is not found to bear elsewhere; and therefore, Constantine boldly
enough substitutes _confractum_, which he thinks agreeable to this
interpretation. The same reason may, perhaps, have led him to that
alteration, as induced the others to explain _contractum_ by asperity,
that it might stand in opposition to smoothness. For my own part,
though _confractus_ is not found in any other classic, yet I have given
this translation, because I can find no other sense of the place, as it
now stands. If I durst offer my own conjecture, ἀπόζυμος γαστὴρI would
rather chuse to read _anfractum_, which, I think, is applicable to the
windings of some of the internal parts.
[ID] Ep. iii. p. 53.
7. _Lippitudo_ is used by Celsus, and the more ancient Latins in the
same sense as the Greek term _Ophthalmia_.
8. _Abdomen._) The word in the original is _uterus_, which our author
generally uses for the cavity of the abdomen.
9. _Indeed may be opened._) The text in Almeloveen and Linden runs
thus, _Nam ne uterum quidem ut nihilominus aerem contineat_, &c. The
particle _ne_ is not in the older copies or the MS. of Morgagni[IE],
and as it spoils the sense, I have omitted it. The same older copies
read _qui minus ad rem pertineat_, instead of _ut nihilominus aerem
contineat_; but as the first can bear no sense at all in this place,
and the other has not the elegance of Celsus, I have taken no notice
of either; and as the connection is perfect without any addition, I
suspect both to have crept in from the margin.
[IE] Ep. vii. p. 187.
10. _Praecordia._) This word frequently occurs in Celsus; and he
seems to use it in two senses: 1st, For the cavity of the thorax,
as lib. 4. c. 1. _At sub corde atque pulmone transversum ex valida
membrana est septum, quod è praecordiis uterum diducit._ 2dly, For
the hypochondria; for which see several passages in the first eight
chapters of the second book, where he considers the symptoms of
distempers from the external appearance of the præcordia; by which
word, in those passages, he translates the Greek term ὑποχονδρίον in
Hippocrates; the derivation of which demonstrates it to be below the
Cartilago Xiphoides.
11. _Quantity of flesh._) I shall not trouble the reader with several
various and opposite opinions of this case, by different commentators;
it will be sufficient to recite the opinion of Morgagni[IF] (which
appears the only probable one) and the reasons with which he supports
it. In his anatomical lectures he explained it as an inverted uterus,
which he says resembles nothing more than flesh, and is quickly seized
with a gangrene, for the reasons given by Ruysch. Observ. Anat. Chir.
10. and thus[IG] Celsus, in the description of a gangrene, mentions
_siccam et aridam carnem_; and Boerhaave says, an inverted uterus is
seized with a gangrene in three hours after its inversion, which agrees
with _intra paueas horas_ in this place.----The ingenious author,
first mentioned, confirms this explanation by a case that occurred to
a surgeon, who, struck with the novelty of it, came immediately to ask
his opinion: upon his shewing the surgeon Ruysch’s delineation of an
inverted uterus, he confessed it to be perfectly similar.----Morgagni
advised him to run back and replace it immediately, which he did in an
hour after its inversion, and the lady was cured.
[IF] Ep. iv. p. 89.
[IG] Lib. 5. c. 26. p. 301.
12. _Nervus._) Though it might be doubted, whether the ancients
comprehended under this word, what is now properly called a nerve,
yet, it is certain they used it for a tendon, or ligament; which so
evidently appears in many passages of Celsus, particularly the eighth
book, that it is quite superfluous to instance any single example.
And this is agreeable to the signification of the Greek word νευ̃ρον,
a chord or string; and thus Hippocrates says, “The nerves are dry
and void of any cavity, and grow to the bone, and have most of their
nourishment from thence; they are nourished also from the flesh, and
their colour and strength is in a middle degree between bone and
flesh.” Hippocrat. Opera, sect. 4: lib. de loc. in homin. p. 409.
ad finem. That I might not seem to determine, what may be thought
doubtful, I have generally retained the author’s term _nerve_, and
left the application to the reader’s judgment; but in some places,
particularly in the eighth book, where the meaning was very evident,
and the word νευ̃ρον_nerve_ would have been harsh to an English reader,
I have rendered it tendon, or ligament, as the connection appeared to
require.
13. _Another loose._) The word in the original is _fluens_, that is a
disorder attended with some discharge.
14. Our author means here the ἀχμὴ of a disease, after which it
increases no more.
15. _A dinner also._) Mercurialis conjectures that the custom among
the Romans of making but one set meal in the day, arose from their
spending so much time in cleaning their bodies, and going through the
several processes at the baths, that they had hardly time left even for
one meal; considering that besides all these operations, they had each
his own private business to transact, and their bathing was too sacred
to be omitted. Hieron. Mercurial. de Art. Gymnast. lib. i. cap. 11.
16. _Iatroalipta._) This is a Greek word, and signifies _a physician
that anoints_. There was always one or more of these attending a
gymnasium, to whose province belonged every thing that related to
unction. To their care was committed the strength and complexion of
the body; thus Cicero in an epistle to Lentulus, says, _Sed vellem non
solum salutis meae, quemadmodum medici, sed etiam ut aliptae, virium
et coloris rationem babere voluissent_. It is probable, that at their
first institution, they were acquainted with the nature and effects of
their operations on human bodies; and according to Plato, de Legibus,
lib. xi. they were either physicians, or in many things equal to them.
But Galen complains, that in his time they were ignorant. For a more
particular account, see Mercurial. de Art. Gymnast. lib. i. cap. 12.
17. _Sometimes the warm bath_, &c.) No practice was ever more
universally followed, than that of bathing among the ancients. The
first design of it was certainly the preservation of health; but, as
riches and luxury increased among both Greeks and Romans, the edifices
for this purpose grew proportionably more elegant and sumptuous. The
construction of baths and their several appurtenances must have been
so well known, when in use, that it is not to be wondered we have so
imperfect accounts of them transmitted to us. Without entering into
any of the disputes about the form or use of several of their parts,
I shall subjoin what seems to be generally agreed to by all, and may
serve to explain any passages in our author which have relation to them.
In the baths there were five apartments--One, called _Tepidarium_,
was a room close all round, and rendered tepid by dry vapours from a
fire. Persons staid here so long as to rarify their humours, that they
might not go unprepared into the hotter rooms. The _Calidarium_, or
_Laconicum_, was in all things similar to the foregoing, only the heat
was greater. Some affirm, that in both these apartments there were
vessels of water, of the same temperature with their air. Next followed
the _Solium_, where was the hot bath. People sat here, sometimes,
without going into the bath, and had water poured over them, as Celsus
in several places prescribes. The _Baptisterium_, or _Piscina_, was
the receptacle for cold water, for bathing and swimming in. There was
also an apartment called _Frigidarium_, concerning which there is a
dispute, whether it contained water or not; Mercurialis says, ‘Some
have imagined there was water here for those who were fond of swimming;
but there is no mention of water in authors.’--He adds, ‘that it was
contrived for those that came immediately from the _Tepidarium_ and
_Calidarium_, and wanted to enjoy a cool air.’ Pliny[IH] the younger
mentions a _Frigidarium_ in a bath at his villa, where there was water
for swimming in; but this may have been a new mode, and not known in
Celsus’s time. Whether this apartment contained water or not, I shall
not determine; but it would appear from authors, that either the air or
water here was of a mild temperature, not quite cold, nor yet so warm
as the _Tepidarium_. To[II] these several parts were subservient; the
_Aquarium_, in which a large reservoir was built for holding water
brought from the aqueducts and elsewhere.--The _Vasarium_, where the
necessary vessels were placed, and where the water was heated; this
stood above the _Hypocaustum_, or stove.
[IH] Plin. epist. 6. lib. v.
[II] Vitruv. lib. v. c. 10.
Seneca[IJ] has shown us of how great importance the Romans esteemed the
baths in the time of the republic, when he observes, ‘What pleasure
there would be in going into the baths, which a person knew to be
tempered by the hand of Cato in his edileship, or Fabius Maximus, or
one of the Cornelii--for, says he, this function the most noble ediles
performed, of inspecting those places frequented by the people, and
requiring cleanliness and a convenient and salutary temperature; not
such as has been lately brought into use, in which the heat is so
violent, that one would imagine a slave convicted of some crime were
condemned to that punishment.’
[IJ] Senec. epist. lxxxvi.
These several parts of the baths were variously used, according to
the case of the person, and the intention pursued. Where no epithet
is added to the bath in the text, it will appear from the connection,
generally, that the hot bath is to be understood. For any further
particulars relating to the baths, see Mercurial. de Art. Gymnast. lib.
i. c. 10.
18. _Gravedoes._) I have here retained the original word, because
we have no one English term which will answer to it. See its symptoms
enumerated, lib. iv. c. 4.
19. _In one that has laboured little._) According to the reading
of Almeloveen and Linden, which is, _In eo, qui minus laboravit, et
bene concoxit, remissior: in eo, qui assuetus est, et minus concoxit,
amplior_, Celsus gives a precept contrary to what he had directed
before, p. 22. l. 2. _Qui parum concoxit, quiescere debet._ In justice,
therefore, to our author, I restore with Morgagni[IK] the old reading,
_In eo, qui minus laboravit, et bene concoxit, amplior: in eo, qui
fatigatus est, et minus concoxit, remissior_.
[IK] Ep. 6. p. 148.
20. _Salt fish, salsamentum._) By this is generally understood fish
salted and dried (resembling our dried ling), for in several ancient
authors it is ordered to be macerated before boiling; and it is often
mentioned as made of fish: but it would appear from Strabo[IL], that
the same name was also given to flesh cured in like manner; for he
mentions a ταρχεία, or _salsamentum_, made of pork, amongst the
Sequani, which was brought to the Roman market.
[IL] Strabon. lib. iv. p. 192. See Athenæus--A. Terent. in Adelph.
21. _Sexes._) Our author here proposes the difference arising from
the sexes, as one of the subjects to be treated of, but no notice is
taken of it in the subsequent part of the chapter: so that this word
must either have been interpolated, or, as Constantine observes, Celsus
must have forgot it, (which is not probable,) or his observations upon
that article may be lost, by the carelessness of transcribers.
22. _Frequent yawning._) As this whole paragraph relates to
people that are fatigued, it renders the old reading more probable,
_fatigatio_, instead of _oscitatio_, especially as it follows, that a
change of labour relieves from fatigue; unless we reckon yawning as
one of the symptoms of lassitude; Morgagni[IM] prefers _fatigatio_:
but as the difference is of small importance, I have not departed from
Almeloveen.
[IM] Ep. 6. p. 133.
23. _Warm water._) It appears a little doubtful, why our author
should mention this, as he adds _the bath_ immediately after: unless
by _balneum_ he means all the processes at the bath; and by the other,
bathing in warm water alone.
24. _Mulse_ was made of two parts of wine, and one of honey. Dios.
lib. v. cap. 790. But from Celsus, it would appear that the
proportions were arbitrary: for he says, Mulse is more nourishing the
more honey it contains. Lib. ii. cap. 18.
25. _Hyssop._) Hippocrates thus prescribes it for a vomit to
corpulent men; let about a gill of powdered hyssop be given to drink
in a gallon of water, adding a little vinegar and salt, to make it as
pleasant as possible; and let this be drunk at first gradually, and
afterwards more quickly. Lib. de Salub. Vict. Rat. p. 338. Edit. Gen.
1657.
26. _Lotus._) There are several species of this mentioned by ancient
authors; but the particular kind intended here seems to be the lotus
Ægyptius, growing in the water, with a stalk resembling the _cyamus_.
It has a root like a quince, and is eaten both raw and boiled, and in
the last way, in quality, it is like the white of an egg. The Egyptians
make bread of its head, which resembles poppy.--See Dioscorid. lib. iv.
cap. 696. and Plin. Hist. Nat. lib. xiii. cap. 17 and 18.
27. _The body is rendered humid._) Lommius asserts the copies to be
every one corrupted in this place. From the moisteners he strikes out
the following,--_continuing awake_, _long and brisk walking_, _morning
exercise without eating after it_,--as unworthy of our author. And
for the same reason, in the list of dryers, inserts _watching and
unction, without bathing in cold water_. This I thought proper to
mention in a note, but did not chuse to take so great liberties with
the text against the authority of all the other copies, but leave it
to the judgment of the learned reader, though I rather incline to the
alteration proposed. Vide Lomm. Comment. de Sanitat. tuend. p. 218 and
219.
28. _Apples_, _Poma_.) Under this Celsus includes all the apple-kind;
and he elsewhere comprehends in this genus, cherries, mulberries, &c.
so that he seems to take in all the pulpy fruits, whether they have
stones or not. Wherever he intends what we particularly call apples, he
makes a distinction, as _Quæque propriè poma nominantur_, lib. ii. cap.
18.
29. _Salt wine._) “Wines are prepared with sea water in different
ways; for some, immediately after gleaning the grapes, mix sea-water
with them; others expose them to the sun, and thus tread them, adding
sea-water. Others again, make the grapes into raisins, and macerate
them in vessels with sea-water, and thus tread and press them. Wine
made in this way is sweet: but there are others prepared of a more
austere taste[IN].”
[IN] Dioscorid. lib. v. c. 801.
Pliny tells us, That the properties of this wine were first
accidentally discovered by a servant stealing some wine, and filling up
the vessel with sea-water[IO].
[IO] Nat. Hist. lib. xiv. c. 8.
30. _Defrutum_ is sweet must, boiled to one half its quantity, done
to imitate honey. Plin. lib. xiv. cap. 9. Columella says to one-third,
which Pliny calls sapa. Ibid.
NOTES
TO