Translated by Francis Adams
PART 1
Those who composed what are called "The Cnidian Sentences" have described
accurately what symptoms the sick experience in every disease, and how
certain of them terminate; and in so far a man, even who is not a physician,
might describe them correctly, provided he put the proper inquiries to
the sick themselves what their complaints are. But those symptoms which
the physician ought to know beforehand without being informed of them by
the patient, are, for the most part, omitted, some in one case and some
in others, and certain symptoms of vital importance for a conjectural judgment.
But when, in addition to the diagnosis, they describe how each complaint
should be treated, in these cases I entertain a still greater difference
of opinion with them respecting the rules they have laid down; and not
only do I not agree with them on this account, but also because the remedies
they use are few in number; for, with the exception of acute diseases,
the only medicines which they give are drastic purgatives, with whey, and
milk at certain times. If, indeed, these remedies had been good and suitable
to the complaints in which they are recommended, they would have been still
more deserving of recommendation, if, while few in number, they were sufficient;
but this is by no means the case. Those, indeed, who have remodeled these
"Sentences" have treated of the remedies applicable in each complaint more
in a medical fashion. But neither have the ancients written anything worth
regimen, although this be a great omission. Some of them, indeed, were
not ignorant of the many varieties of each complaint, and their manifold
divisions, but when they wish to tell clearly the numbers (species?) of
each disease they do not write for their species would be almost innumerable
if every symptom experienced by the patients were held to constitute a
disease, and receive a different name.
PART 2
For my part, I approve of paying attention to everything relating to
the art, and that those things which can be done well or properly should
all be done properly; such as can be quickly done should be done quickly;
such as can be neatly done should be done neatly; such operations as can
be performed without pain should be done with the least possible pain;
and that all other things of the like kind should be done better than they
could be managed by the attendants. But I would more especially commend
the physician who, in acute diseases, by which the bulk of mankind are
cut off, conducts the treatment better than others. Acute diseases are
those which the ancients named pleurisy, pneumonia, phrenitis, lethargy,
causus, and the other diseases allied to these, including the continual
fevers. For, unless when some general form of pestilential disease is epidemic,
and diseases are sporadic and [not] of a similar character, there are more
deaths from these diseases than from all the others taken together. The
vulgar, indeed, do not recognize the difference between such physicians
and their common attendants, and are rather disposed to commend and censure
extraordinary remedies. This, then, is a great proof that the common people
are most incompetent, of themselves, to form a judgment how such diseases
should be treated: since persons who are not physicians pass for physicians
owing most especially to these diseases, for it is an easy matter to learn
the names of those things which are applicable to persons laboring under
such complaints. For, if one names the juice of ptisan, and such and such
a wine, and hydromel, the vulgar fancy that he prescribes exactly the same
things as the physicians do, both the good and the bad, but in these matters
there is a great difference between them.
PART 3
But it appears to me that those things are more especially deserving
of being consigned to writing which are undetermined by physicians, notwithstanding
that they are of vital importance, and either do much good or much harm.
By undetermined I mean such as these, wherefore certain physicians, during
their whole lives, are constantly administering unstrained ptisans, and
fancy they thus accomplish the cure properly, whereas others take great
pains that the patient should not swallow a particle of the barley (thinking
it would do much harm), but strain the juice through a cloth before giving
it; others, again, will neither give thick ptisan nor the juice, some until
the seventh day of the disease, and some until after the crisis. Physicians
are not in the practice of mooting such questions; nor, perhaps, if mooted,
would a solution of them be found; although the whole art is thereby exposed
to much censure from the vulgar, who fancy that there really is no such
science as medicine, since, in acute diseases, practitioners differ so
much among themselves, that those things which one administers as thinking
it the best that can be given, another holds to be bad; and, in this respect,
they might say that the art of medicine resembles augury, since augurs
hold that the same bird (omen) if seen on the left hand is good, but if
on the right bad: and in divination by the inspection of entrails you will
find similar differences; but certain diviners hold the very opposite of
these opinions. I say, then, that this question is a most excellent one,
and allied to very many others, some of the most vital importance in the
Art, for that it can contribute much to the recovery of the sick, and to
the preservation of health in the case of those who are well; and that
it promotes the strength of those who use gymnastic exercises, and is useful
to whatever one may wish to apply it.
PART 4
Ptisan, then, appears to me to be justly preferred before all the other
preparations from grain in these diseases, and I commend those who made
this choice, for the mucilage of it is smooth, consistent, pleasant, lubricant,
moderately diluent, quenches thirst if this be required, and has no astringency;
gives no trouble nor swells up in the bowels, for in the boiling it swells
up as much as it naturally can. Those, then, who make use of ptisan in
such diseases, should never for a day allow their vessels to be empty of
it, if I may say so, but should use it and not intermit, unless it be necessary
to stop for a time, in order to administer medicine or a clyster. And to
those who are accustomed to take two meals in the day it is to be given
twice, and to those accustomed to live upon a single meal it is to be given
once at first, and then, if the case permit, it is to be increased and
given twice to them, if they appear to stand in need of it. At first it
will be proper not to give a large quantity nor very thick, but in proportion
to the quantity of food which one has been accustomed to take, and so as
that the veins may not be much emptied. And, with regard to the augmentation
of the dose, if the disease be of a drier nature than one had supposed,
one must not give more of it, but should give before the draught of ptisan,
either hydromel or wine, in as great quantity as may be proper; and what
is proper in each case will be afterward stated by us. But if the mouth
and the passages from the lungs be in a proper state as to moisture, the
quantity of the draught is to be increased, as a general rule, for an early
and abundant state of moisture indicates an early crisis, but a late and
deficient moisture indicates a slower crisis. And these things are as I
have stated for the most part; but many other things are omitted which
are important to the prognosis, as will be explained afterwards. And the
more that the patient is troubled with purging, in so much greater quantity
is it to be given until the crisis, and moreover until two days beyond
the crisis, in such cases as it appears to take place on the fifth, seventh,
or ninth day, so as to have respect both for the odd and even day: after
this the draught is to be given early in the day, and the other food in
place is to be given in the evening. These things are proper, for the most
part, to be given to those who, from the first, have used ptisan containing
its whole substance; for the pains in pleuritic affections immediately
cease of their own accord whenever the patients begin to expectorate anything
worth mentioning, and the purgings become much better, and empyema much
more seldom takes place, than if the patients used a different regimen,
and the crises are more simple, occur earlier, and the cases are less subject
to relapses.
PART 5
Ptisans are to be made of the very best barley, and are to be well boiled,
more especially if you do not intend to use them strained. For, besides
the other virtues of ptisan, its lubricant quality prevents the barley
that is swallowed from proving injurious, for it does not stick nor remain
in the region of the breast; for that which is well boiled is very lubricant,
excellent for quenching thirst, of very easy digestion, and very weak,
all which qualities are wanted. If, then, one do not pay proper attention
to the mode of administering the ptisan, much harm may be done; for when
the food is shut up in the bowels, unless one procure some evacuation speedily,
before administering the draught, the pain, if present, will be exasperated;
and, if not present, it will be immediately created, and the respiration
will become more frequent, which does mischief, for it dries the lungs,
fatigues the hypochondria, the hypogastrium, and diaphragm. And moreover
if, while the pain of the side persists, and does not yield to warm fomentations,
and the sputa are not brought up, but are viscid and unconcocted, unless
one get the pain resolved, either by loosening the bowels, or opening a
vein, whichever of these may be proper;- if to persons so circumstanced
ptisan be administered, their speedy death will be the result. For these
reasons, and for others of a similar kind still more, those who use unstrained
ptisan die on the seventh day, or still earlier, some being seized with
delirium, and others dying suffocated with orthopnoee and riles. Such persons
the ancients thought struck, for this reason more especially, that when
dead the affected side was livid, like that of a person who had been struck.
The cause of this is that they die before the pain is resolved, being seized
with difficulty of respiration, and by large and rapid breathing, as has
been already explained, the spittle becoming thick, acid, and unconcocted,
cannot be brought up, but, being retained in the bronchi of the lungs,
produces riles; and, when it has come to this, death, for the most part,
is inevitable; for the sputa being retained prevent the breath from being
drawn in, and force it speedily out, and thus the two conspire together
to aggravate the sputa being retained renders the respiration frequent,
while the respiration being frequent thickens the sputa, and prevents them
from being evacuated. These symptoms supervene, not only if ptisan be administered
unseasonably, but still more if any other food or drink worse than ptisan
be given.
PART 6
For the most part, then, the results are the same, whether the patient
have used the unstrained ptisan or have used the juice alone; or even only
drink; and sometimes it is necessary to proceed quite differently. In general,
one should do thus: if fever commences shortly after taking food, and before
the bowels have been evacuated, whether with or without pain, the physician
ought to withhold the draught until he thinks that the food has descended
to the lower part of the belly; and if any pain be present, the patient
should use oxymel, hot if it is winter, and cold if it is summer; and,
if there be much thirst, he should take hydromel and water. Then, if any
pain be present, or any dangerous symptoms make their appearance, it will
be proper to give the draught neither in large quantity nor thick, but
after the seventh day, if the patient be strong. But if the earlier-taken
food has not descended, in the case of a person who has recently swallowed
food, and if he be strong and in the vigor of life, a clyster should be
given, or if he be weaker, a suppository is to be administered, unless
the bowels open properly of themselves. The time for administering the
draught is to be particularly observed at the commencement and during the
whole illness; when, then, the feet are cold, one should refrain from giving
the ptisan, and more especially abstain from drink; but when the heat has
descended to the feet, one may then give it; and one should look upon this
season as of great consequence in all diseases, and not least in acute
diseases, especially those of a febrile character, and those of a very
dangerous nature. One may first use the juice, and then the ptisan, attending
accurately to the rules formerly laid down.
PART 7
When pain seizes the side, either at the commencement or at a later
stage, it will not be improper to try to dissolve the pain by hot applications.
Of hot applications the most powerful is hot water in a bottle, or bladder,
or in a brazen vessel, or in an earthen one; but one must first apply something
soft to the side, to prevent pain. A soft large sponge, squeezed out of
hot water and applied, forms a good application; but it should be covered
up above, for thus the heat will remain the longer, and at the same time
the vapor will be prevented from being carried up to the patient's breath,
unless when this is thought of use, for sometimes it is the case. And further,
barley or tares may be infused and boiled in diluted vinegar, stronger
than that it could be drunk, and may then be sewed into bladders and applied;
and one may bran in like manner. Salts or toasted millet in woolen bags
are excellent for forming a dry fomentation, for the millet is light and
soothing. A soft fomentation like this soothes pains, even such as shoot
to the clavicle. Venesection, however, does not alleviate the pain unless
when it extends to the clavicle. But if the pain be not dissolved by the
fomentations, one ought not to foment for a length of time, for this dries
the lungs and promotes suppuration; but if the pain point to the clavicle,
or if there be a heaviness in the arm, or about the breast, or above the
diaphragm, one should open the inner vein at the elbow, and not hesitate
to abstract a large quantity, until it become much redder, or instead of
being pure red, it turns livid, for both these states occur. But if the
pain be below the diaphragm, and do not point to the clavicle, we must
open the belly either with black hellebore or peplium, mixing the black
hellebore with carrot or seseli, or cumin, or anise, or any other of the
fragrant herbs; and with the peplium the juice of sulphium (asafoetida),
for these substances, when mixed up together, are of a similar nature.
The black hellebore acts more pleasantly and effectually than the peplium,
while, on the other hand, the peplium expels wind much more effectually
than the black hellebore, and both these stop the pain, and many other
of the laxatives also stop it, but these two are the most efficacious that
I am acquainted with. And the laxatives given in draughts are beneficial,
when not very unpalatable owing to bitterness, or any other disagreeable
taste, or from quantity, color, or any apprehension. When the patient has
drunk the medicine, one ought to give him to swallow but little less of
the ptisan than what he had been accustomed to; but it is according to
rule not to according to rule not to give any draughts while the medicine
is under operation; but when the purging is stopped then he should take
a smaller draught than what he had been accustomed to, and afterwards go
on increasing it progressively, until the pain cease, provided nothing
else contra-indicate. This is my rule, also, if one would use the juice
of ptisan (for I hold that it is better, on the whole, to begin with taking
the decoction at once, rather than by first emptying the veins before doing
so, or on the third, fourth, fifth, sixth, or seventh day, provided the
disease has not previously come to a crisis in the course of this time),
and similar preparations to those formerly described are to be made in
those cases.
PART 8
Such are the opinions which I entertain respecting the administering
of the ptisan; and, as regards drinks, whichsoever of those about to be
described may be administered, the same directions are generally applicable.
And here I know that physicians are in the practice of doing the very reverse
of what is proper, for they all wish, at the commencement of diseases,
to starve their patients for two, three, or more days, and then to administer
the ptisans and drinks; and perhaps it appears to them reasonable that,
as a great change has taken place in the body, it should be counteracted
by another great change. Now, indeed, to produce a change is no small matter,
but the change must be effected well and cautiously, and after the change
the administration of food must be conducted still more so. Those persons,
then, would be most injured if the change is not properly managed, who
used unstrained ptisans; they also would suffer who made use of the juice
alone; and so also they would suffer who took merely drink, but these least
of all.
PART 9
One may derive information from the regimen of persons in good health
what things are proper; for if it appear that there is a great difference
whether the diet be so and so, in other respects, but more especially in
the changes, how can it be otherwise in diseases, and more especially in
the most acute? But it is well ascertained that even a faulty diet of food
and drink steadily persevered in, is safer in the main as regards health
than if one suddenly change it to another. Wherefore, in the case of persons
who take two meals in the day, or of those who take a single meal, sudden
changes induce suffering and weakness; and thus persons who have not been
accustomed to dine, if they shall take dinner, immediately become weak,
have heaviness over their whole body, and become feeble and languid, and
if, in addition, they take supper, they will have acid eructations, and
some will have diarrhoea whose bowels were previously dry, and not having
been accustomed to be twice swelled out with food and to digest it twice
a day, have been loaded beyond their wont. It is beneficial, in such cases,
to counterbalance this change, for one should sleep after dinner, as if
passing the night, and guard against cold in winter and heat in summer;
or, if the person cannot sleep, he may stroll about slowly, but without
making stops, for a good while, take no supper, or, at all events, eat
little, and only things that are not unwholesome, and still more avoid
drink, and especially water. Such a person will suffer still more if he
take three full meals in the day, and more still if he take more meals;
and yet there are many persons who readily bear to take three full meals
in the day, provided they are so accustomed. And, moreover, those who have
been in the habit of eating twice a day, if they omit dinner, become feeble
and powerless, averse to all work, and have heartburn; their bowels seem,
as it were, to hang loose, their urine is hot and green, and the excrement
is parched; in some the mouth is bitter, the eyes are hollow, the temples
throb, and the extremities are cold, and the most of those who have thus
missed their dinner cannot eat supper; or, if they do sup, they load their
stomach, and pass a much worse night than if they had previously taken
dinner. Since, then, an unwonted change of diet for half a day produces
such effects upon persons in health, it appears not to be a good thing
either to add or take from. If, then, he who was restricted to a single
meal, contrary to usage, having his veins thus left empty during a whole
day, when he supped according to custom felt heavy, it is probable that
if, because he was uneasy and weak from the want of dinner, he took a larger
supper than wont, he would be still more oppressed; or if, wanting food
for a still greater interval, he suddenly took a meal after supper, he
will feel still greater oppression. He, then, who, contrary to usage, has
had his veins kept empty by want of food, will find it beneficial to counteract
the bad effects during that day as follows: let him avoid cold, heat, and
exertion, for he could bear all these ill; let him make his supper considerably
less than usual, and not of dry food, but rather liquid; and let him take
some drink, not of a watery character, nor in smaller quantity than is
proportionate to the food, and on the next day he should take a small dinner,
so that, by degrees, he may return to his former practice. Persons who
are bilious in the stomach bear these changes worst, while those who are
pituitous, upon the whole, bear the want of food best, so that they suffer
the least from being restricted to one meal in the day, contrary to usage.
This, then, is a sufficient proof that the greatest changes as to those
things which regard our constitutions and habits are most especially concerned
in the production of diseases, for it is impossible to produce unseasonably
a great emptying of the vessels by abstinence, or to administer food while
diseases are at their acme, or when inflammation prevails; nor, on the
on the whole, to make a great change either one way or another with impunity.
PART 10
One might mention many things akin to these respecting the stomach and
bowels, to show how people readily bear such food as they are accustomed
to, even if it is not naturally good, and drink in like manner, and how
they bear unpleasantly such food as they are not accustomed to, even although
not bad, and so in like manner with drink; and as to the effects of eating
much flesh, contrary to usage, or garlic, or asafoetida, or the stem of
the plant which produces it, or things of a similar kind possessed of strong
properties, one would be less surprised if such things produce pains in
the bowels, but rather when one learned what trouble, swelling, flatulence,
and tormina the cake (maza) will raise in the belly when eaten by a person
not accustomed to it; and how much weight and distention of the bowels
bread will create to a person accustomed to live upon the maza; and what
thirst and sudden fullness will be occasioned by eating hot bread, owing
to its desiccant and indigestible properties; and what different effects
are produced by fine and coarse bread when eaten contrary to usage, or
by the cake when usually dry, moist, or viscid; and what different effects
polenta produces upon those who are accustomed and those who are unaccustomed
to the use of it; or drinking of wine or drinking of water, when either
custom is suddenly exchanged for the other; or when, contrary to usage,
diluted wine or undiluted has been suddenly drunk, for the one will create
water-brash in the upper part of the intestinal canal and flatulence in
the lower, while the other will give rise to throbbing of the arteries,
heaviness of the head, and thirst; and white and dark-colored wine, although
both strong wines, if exchanged contrary to usage, will produce very different
effects upon the body, so that one need the less wonder that a sweet and
strong wine, if suddenly exchanged, should have by no means the same effect.
PART 11
Let us here briefly advert to what may be said on the opposite side;
namely, that a change of diet has occurred in these cases, without any
change in their body, either as to strength, so as to require an increase
of food, or as to weakness, so as to require a diminution. But the strength
of the patient is to be taken into consideration, and the manner of the
disease, and of the constitution of the man, and the habitual regimen of
the patient, not only as regards food but also drink. Yet one must much
less resort to augmentation, since it is often beneficial to have recourse
to abstraction, when the patient can bear it, until the disease having
reached its acme and has become concocted. But in what cases this must
be done will be afterwards described. One might write many other things
akin to those which have been now said, but there is a better proof, for
it is not akin to the matter on which my discourse has principally turned,
but the subject-matter itself is a most seasonable proof. For some at the
commencement of acute diseases have taken food on the same day, some on
the next day; some have swallowed whatever has come in their way, and some
have taken cyceon. Now all these things are worse than if one had observed
a different regimen; and yet these mistakes, committed at that time, do
much less injury than if one were to abstain entirely from food for the
first two or three days, and on the fourth or fifth day were to take such
food; and it would be still worse, if one were to observe total abstinence
for all these days, and on the following days were to take such a diet,
before the disease is concocted; for in this way death would be the consequence
to most people, unless the disease were of a very mild nature. But the
mistakes committed at first were not so irremediable as these, but could
be much more easily repaired. This, therefore, I think a strong proof that
such or such a draught need not be prescribed on the first days to those
who will use the same draughts afterwards. At the bottom, therefore, they
do not know, neither those using unstrained ptisans, that they are hurt
by them, when they begin to swallow them, if they abstain entirely from
food for two, three, or more days; nor do those using the juice know that
they are injured in swallowing them, when they do not commence with the
draught seasonably. But this they guard against, and know that it does
much mischief, if, before the disease be concocted, the patient swallow
unstrained ptisan, when accustomed to use strained. All these things are
strong proofs that physicians do not conduct the regimen of patients properly,
but that in those diseases in which total abstinence from food should not
be enforced on patients that will be put on the use of ptisans, they do
enforce total abstinence; that in those cases in which there should be
no change made from total abstinence to ptisans, they do make the change;
and that, for the most part, they change from abstinence to ptisans, exactly
at the time when it is often beneficial to proceed from ptisans almost
to total abstinence, if the disease happen to be in the state of exacerbation.
And sometimes crude matters are attracted from the head, and bilious from
the region near the chest, and the patients are attacked with insomnolency,
so that the disease is not concocted; they become sorrowful, peevish, and
delirious; there are flashes of light in their eyes, and noises in their
ears; their extremities are cold, their urine unconcocted; the sputa thin,
saltish, tinged with an intense color and smell; sweats about the neck,
and anxiety; respiration, interrupted in the expulsion of the air, frequent
and very large; expression of the eyelids dreadful; dangerous deliquia;
tossing of the bed-clothes from the breast; the hands trembling, and sometimes
the lower lip agitated. These symptoms, appearing at the commencement,
are indicative of strong delirium, and patients so affected generally die,
or if they escape, it is with a deposit, hemorrhage from the nose, or the
expectoration of thick matter, and not otherwise. Neither do I perceive
that physicians are skilled in such things as these; how they ought to
know such diseases as are connected with debility, and which are further
weakened by abstinence from food, and those aggravated by some other irritation;
those by pain, and from the acute nature of the disease, and what affections
and various forms thereof our constitution and habit engender, although
the knowledge or ignorance of such things brings safety or death to the
patient. For it is a great mischief if to a patient debilitated by pain,
and the acute nature of the disease, one administer drink, or more ptisan,
or food, supposing that the debility proceeds from inanition. It is also
disgraceful not to recognize a patient whose debility is connected with
inanition, and to pinch him in his diet; this mistake, indeed, is attended
with some danger, but much less than the other, and yet it is likely to
expose one to much greater derision, for if another physician, or a private
person, coming in and knowing what has happened, should give to eat or
drink those things which the other had forbidden, the benefit thus done
to the patient would be manifest. Such mistakes of practitioners are particularly
ridiculed by mankind, for the physician or nonprofessional man thus coming
in, seems as it were to resuscitate the dead. On this subject I will describe
elsewhere the symptoms by which each of them may be recognized.
PART 12
And the following observations are similar to those now made respecting
the bowels. If the whole body rest long, contrary to usage, it does not
immediately recover its strength; but if, after a protracted repose, it
proceed to labor, it will clearly expose its weakness. So it is with every
one part of the body, for the feet will make a similar display, and any
other of the joints, if, being unaccustomed to labor, they be suddenly
brought into action, after a time. The teeth and the eyes will suffer in
like manner, and also every other part whatever. A couch, also, that is
either softer or harder than one has been accustomed to will create uneasiness,
and sleeping in the open air, contrary to usage, hardens the body. But
it is sufficient merely to state examples of all these cases. If a person
having received a wound in the leg, neither very serious nor very trifling,
and he being neither in a condition very favorable to its healing nor the
contrary, at first betakes himself to bed, in order to promote the cure,
and never raises his leg, it will thus be much less disposed to inflammation,
and be much sooner well, than it would have been if he had strolled about
during the process of healing; but if upon the fifth or sixth day, or even
earlier, he should get up and attempt to walk, he will suffer much more
then than if he had walked about from the commencement of the cure, and
if he should suddenly make many laborious exertions, he will suffer much
more than if, when the treatment was conducted otherwise, he had made the
same exertions on the same days. In fine, all these things concur in proving
that all great changes, either one way or another, are hurtful. Wherefore
much mischief takes place in the bowels, if from a state of great inanition
more food than is moderate be administered (and also in the rest of the
body, if from a state of great rest it be hastily brought to greater exertion,
it will be much more injured), or if from the use of much food it be changed
to complete abstinence, and therefore the body in such cases requires protracted
repose, and if, from a state of laborious exertion, the body suddenly falls
into a state of ease and indolence, in these cases also the bowels would
require continued repose from abundance of food, for otherwise it will
induce pain and heaviness in the whole body.
PART 13
The greater part of my discourse has related to changes, this way or
that. For all purposes it is profitable to know these things, and more
especially respecting the subject under consideration,- that in acute diseases,
in which a change is made to ptisans from a state of inanition, it should
be made as I direct; and then that ptisans should not be used until the
disease be concocted, or some other symptom, whether of evacuation or of
irritation, appear in the intestines, or in the hypochondria, such as will
be described. Obstinate insomnolency impairs the digestion of the food
and drink, and in other respects changes and relaxes the body, and occasions
a heated state, and heaviness of the head.
PART 14
One must determine by such marks as these, when sweet, strong, and dark
wine, hydromel, water and oxymel, should be given in acute diseases. Wherefore
the sweet affects the head less than the strong, attacks the brain less,
evacuates the bowels more than the other, but induces swelling of the spleen
and liver; it does not agree with bilious persons, for it causes them to
thirst; it creates flatulence in the upper part of the intestinal canal,
but does not disagree with the lower part, as far as regards flatulence;
and yet flatulence engendered by sweet wine is not of a transient nature,
but rests for a long time in the hypochondria. And therefore it in general
is less diuretic than wine which is strong and thin; but sweet wine is
more expectorant than the other. But when it creates thirst, it is less
expectorant in such cases than the other wine, but if it do not create
thirst, it promotes expectoration better than the other. The good and bad
effects of a white, strong wine, have been already frequently and fully
stated in the disquisition on sweet wine; it is determined to the bladder
more than the other, is diuretic and laxative, and should be very useful
in such complaints; for if in other respects it be less suitable than the
other, the clearing out of the bladder effected by it is beneficial to
the patient, if properly administered. There are excellent examples of
the beneficial and injurious effects of wine, all which were left undetermined
by my predecessors. In these diseases you may use a yellow wine, and a
dark austere wine for the following purposes: if there be no heaviness
of the head, nor delirium, nor stoppage of the expectoration, nor retention
of the urine, and if the alvine discharges be more loose and like scrapings
than usual, in such cases a change from a white wine to such as I have
mentioned, might be very proper. It deserves further to be known, that
it will prove less injurious to all the parts above, and to the bladder,
if it be of a more watery nature, but that the stronger it is, it will
be the more beneficial to the bowels.
PART 15
Hydromel, when drunk in any stage of acute disease, is less suitable
to persons of a bilious temperament, and to those who have enlarged viscera,
than to those of a different character; it increases thirst less than sweet
wine; character;the lungs, is moderately expectorant, and alleviates a
cough; for it has some detergent quality in it, whence it lubricates the
sputum. Hydromel is also moderately diuretic, unless prevented by the state
of any of the viscera. And it also occasions bilious discharges downwards,
sometimes of a proper character, and sometimes more intense and frothy
than is suitable; but such rather occurs in persons who are bilious, and
have enlarged viscera. Hydromel rather produces expectoration, and softening
of the lungs, when given diluted with water. But unmixed hydromel, rather
than the diluted, produces frothy evacuations, such as are unseasonably
and intensely bilious, and too hot; but such an evacuation occasions other
great mischiefs, for it neither extinguishes the heat in the hypochondria,
but rouses it, induces inquietude, and jactitation of the limbs, and ulcerates
the intestines and anus. The remedies for all these will be described afterwards.
By using hydromel without ptisans, instead of any other drink, you will
generally succeed in the treatment of such diseases, and fall in few cases;
but in what instances it is to be given, and in what it is not to be given,
and wherefore it is not to be given,- all this has been explained already,
for the most part. Hydromel is generally condemned, as if it weakened the
powers of those who drink it, and on that account it is supposed to accelerate
death; and this opinion arose from persons who starve themselves to death,
some of whom use hydromel alone for drink, as fancying that it really has
this effect. But this is by no means always the case. For hydromel, if
drunk alone, is much stronger than water, if it do not disorder the bowels;
but in some respects it is stronger, and in some weaker, than wine that
is thin, weak, and devoid of bouquet. There is a great difference between
unmixed wine and unmixed honey, as to their nutritive powers, for if a
man will drink double the quantity of pure wine, to a certain quantity
of honey which is swallowed, he will find himself much stronger from the
honey, provided it do not disagree with his bowels, and that his alvine
evacuations from it will be much more copious. But if he shall use ptisan
for a draught, and drink afterward hydromel, he will feel full, flatulent,
and uncomfortable in the viscera of the hypochondrium; but if the hydromel
be taken before the draught, it will not have the same injurious effects
as if taken after it, but will be rather beneficial. And boiled hydromel
has a much more elegant appearance than the unboiled, being clear, thin,
white, and transparent, but I am unable to mention any good quality which
it possesses that the other wants. For it is not sweeter than the unboiled,
provided the honey be fine, and it is weaker, and occasions less copious
evacuations of the bowels, neither of which effects is required from the
hydromel. But one should by all means use it boiled, provided the honey
be bad, impure, black, and not fragrant, for the boiling will remove the
most of its bad qualities and appearances.
PART 16
You will find the drink, called oxymel, often very useful in these complaints,
for it promotes expectoration and freedom of breathing. the following are
the proper occasions for administering it. When strongly acid it has no
mean operation in rendering the expectoration more easy, for by bringing
up the sputa, which occasion troublesome hawking, and rendering them more
slippery, and, as it were, clearing the windpipe with a feather, it relieves
the lungs and proves emollient to them; and when it succeeds in producing
these effects it must do much good. But there are cases in which hydromel,
strongly acid, does not promote expectoration, but renders it more viscid
and thus does harm, and it is most apt to produce these bad effects in
cases which are otherwise of a fatal character, when the patient is unable
to cough or bring up the sputa. On this account, then, one ought to consider
beforehand the strength of the patient, and if there be any hope, then
one may give it, but if given at all in such cases it should be quite tepid,
and in by no means large doses. But if slightly acrid it moistens the mouth
and throat, promotes expectoration, and quenches thirst; agrees with the
viscera seated in the hypochondrium, and obviates the bad effects of the
honey; for the bilious quality of the honey is thereby corrected. It also
promotes flatulent discharges from the bowels, and is diuretic, but it
occasions watery discharges and those resembling scrapings, from the lower
part of the intestine, which is sometimes a bad thing in acute diseases,
more especially when the flatulence cannot be passed, but rolls backwards;
and otherwise it diminishes the strength and makes the extremities cold,
this is the only bad effect worth mentioning which I have known to arise
from the oxymel. It may suit well to drink a little of this at night before
the draught of ptisan, and when a considerable interval of time has passed
after the draught there will be nothing to prevent its being taken. But
to those who are restricted entirely to drinks without draughts of ptisan,
it will therefore not be proper at all times to give it, more especially
from the fretting and irritation of the intestine which it occasions, (and
these bad effects it will be the more apt to produce provided there be
no faeces in the intestines and the patient is laboring under inanition,)
and then it will weaken the powers of the hydromel. But if it appears advantageous
to use a great deal of this drink during the whole course of the disease,
one should add to it merely as much vinegar as can just be perceived by
the taste, for thus what is prejudicial in it will do the least possible
harm, and what is beneficial will do the more good. In a word, the acidity
of vinegar agrees rather with those who are troubled with bitter bile,
than with those patients whose bile is black; for the bitter principle
is dissolved in it and turned to phlegm, by being suspended in it; whereas
black bile is fermented, swells up, and is multiplied thereby: for vinegar
is a melanogogue. Vinegar is more prejudicial to women than to men, for
it creates pains in the uterus.
PART 17
I have nothing further to add as to the effects of water when used as
a drink in acute diseases; for it neither soothes the cough in pneumonia,
nor promotes expectoration, but does less than the others in this respect,
if used alone through the whole complaint. But if taken intermediate between
oxymel and hydromel, in small quantity, it promotes expectoration from
the change which it occasions in the qualities of these drinks, for it
produces, as it were, a certain overflow. Otherwise it does not quench
the thirst, for it creates bile in a bilious temperament, and is injurious
to the hypochondrium; and it does the most harm, engenders most bile, and
does the least good when the bowels are empty; and it increases the swelling
of the spleen and liver when they are in an inflamed state; it produces
a gurgling noise in the intestines and swims on the stomach; for it passes
slowly downwards, as being of a coldish and indigestible nature, and neither
proves laxative nor diuretic; and in this respect, too, it proves prejudicial,
that it does not naturally form does in the intestines: and, if it be drunk
while the feet are cold, its injurious effects will be greatly aggravated,
in all those parts to which it may be determined. When you suspect in these
diseases either strong heaviness of the head, or mental alienation, you
must abstain entirely from wine, and in this case use water, or give weak,
straw-colored wine, entirely devoid of bouquet, after which a little water
is to be given in addition; for thus the strength of the will less affect
the head and the understanding: but in which cases water is mostly to be
given for drink, when in large quantity, when in moderate, when cold, and
when hot; all these things have either been discussed already or will be
treated of at the proper time. In like manner, with respect to all the
others, such as barley-water, the drinks made from green shoots, those
from raisins, and the skins of grapes and wheat, and bastard saffron, and
myrtles, pomegranates, and the others, when the proper time for using them
is come, they will be treated of along with the disease in question, in
like manner as the other compound medicines.
PART 18
The bath is useful in many diseases, in some of them when used steadily,
and in others when not so. Sometimes it must be less used than it would
be otherwise, from the want of accommodation; for in few families are all
the conveniences prepared, and persons who can manage them as they ought
to be. And if the patient be not bathed properly, he maybe thereby hurt
in no inconsiderable degree, for there is required a place to cover him
that is free of smoke, abundance of water, materials for frequent baths,
but not very large, unless this should be required. It is better that no
friction should be applied, but if so, a hot soap (smegma) must be used
in greater abundance than is common, and an affusion of a considerable
quantity of water is to be made at the same time and afterwards repeated.
There must also be a short passage to the basin, and it should be of easy
ingress and egress. But the person who takes the bath should be orderly
and reserved in his manner, should do nothing for himself, but others should
pour the water upon him and rub him, and plenty of waters, of various temperatures,
should be in readiness for the douche, and the affusions quickly made;
and sponges should be used instead of the comb (strigil), and the body
should be anointed when not quite dry. But the head should be rubbed by
the sponge until it is quite dry; the extremities should be protected from
cold, as also the head and the rest of the body; and a man should not be
washed immediately after he has taken a draught of ptisan or a drink; neither
should he take ptisan as a drink immediately after the bath. Much will
depend upon whether the patient, when in good health, was very fond of
the bath, and in the custom of taking it: for such persons, especially,
feel the want of it, and are benefited if they are bathed, and injured
if they are not. In general it suits better with cases of pneumonia than
in ardent fevers; for the bath soothes the pain in the side, chest, and
back; concocts the sputa, promotes expectoration, improves the respiration,
and allays lassitude; for it soothes the joints and outer skin, and is
diuretic, removes heaviness of the head, and moistens the nose. Such are
the benefits to be derived from the bath, if all the proper requisites
be present; but if one or more of these be wanting, the bath, instead of
doing good, may rather prove injurious; for every one of them may do harm
if not prepared not prepared by the attendants in the proper manner. It
is by no means a suitable thing in these diseases to persons whose bowels
are too loose, or when they are unusually confined, and there has been
no previous evacuation; neither must we bathe those who are debilitated,
nor such as have nausea or vomiting, or bilious eructations; nor such as
have hemorrhage from the nose, unless it be less than required at that
stage of the disease (with those stages you are acquainted), but if the
discharge be less than proper, one should use the bath, whether in order
to benefit the whole body or the head alone. If then the proper requisites
be at hand, and the patient be well disposed to the bath, it may be administered
once every day, or if the patient be fond of the bath there will be no
harm, though he should take it twice in the day. The use of the bath is
much more appropriate to those who take unstrained ptisan, than to those
who take only the juice of it, although even in their case it may be proper;
but least of all does it suit with those who use only plain drink, although,
in their case too it may be suitable; but one must form a judgment from
the rules laid down before, in which of these modes of regimen the bath
will be beneficial, and in which not. Such as want some of the requisites
for a proper bath, but have those symptoms which would be benefited by
it, should be bathed; whereas those who want none of the proper requisites,
but have certain symptoms which contraindicate the bath, are not to be
bathed.
APPENDIX PART 1
Ardent fever (causus) takes place when the veins, being dried up in
the summer season, attract acrid and bilious humors to themselves; and
strong fever seizes the whole body, which experiences aches of the bones,
and is in a state of lassitude and pain. It takes place most commonly from
a long walk and protracted thirst, when the veins being dried up attract
acrid and hot defluxions to themselves. The tongue becomes rough, dry,
and very black; there are gnawing pains about the bowels; the alvine discharges
are watery and yellow; there is intense thirst, insomnolency, and sometimes
wandering of the mind. To a person in such a state give to drink water
and as much boiled hydromel of a watery consistence as he will take; and
if the mouth be bitter, it may be advantageous to administer an emetic
and clyster; and if these things do not loosen the bowels, purge with the
boiled milk of asses. Give nothing saltish nor acrid, for they will not
be borne; and give no draughts of ptisan until the crisis be past. And
the affection is resolved if there be an epistaxis, or if true critical
sweats supervene with urine having white, thick, and smooth sediments,
or if a deposit take place anywhere; but if it be resolved without these,
there will be a relapse of the complaint, or pain in the hips and legs
will ensue, with thick sputa, provided the patient be convalescent. Another
species of ardent fever: belly loose, much thirst, tongue rough, dry, and
saltish, retention of urine, insomnolency, extremities cold. In such a
case, unless there be a flow of blood from the nose, or an abscess form
about the neck, or pain in the limbs, or the patient expectorate thick
sputa (these occur when the belly is constipated), or pain of the hips,
or lividity of the genital organs, there is no crisis; tension of the testicle
is also a critical symptom. Give attractive draughts.
APPENDIX PART 2
Bleed in the acute affections, if the disease appear strong, and the
patients be in the vigor of life, and if they have strength. If it be quinsy
or any other of the pleuritic affections, purge with electuaries; but if
the patient be weaker, or if you abstract more blood, you may administer
a clyster every third day, until he be out of danger, and enjoin total
abstinence if necessary.
APPENDIX PART 3
Hypochondria inflamed not from retention of flatus, tension of the diaphragm,
checked respiration, with dry orthopnoea, when no pus is formed, but when
these complaints are connected with obstructed respiration; but more especially
strong pains of the liver, heaviness of the spleen, and other phlegmasiae
and intense pains above the diaphragm, diseases connected with collections
of humors,- all these diseases do not admit of resolution, if treated at
first by medicine, but venesection holds the first place in conducting
the treatment; then we may have recourse to a clyster, unless the disease
be great and strong; but if so, purging also may be necessary; but bleeding
and purging together require caution and moderation. Those who attempt
to resolve inflammatory diseases at the commencement by the administration
of purgative medicines, remove none of the morbific humors which produce
the inflammation and tension; for the diseases while unconcocted could
not yield, but they melt down those parts which are healthy and resist
the disease; so when the body is debilitated the malady obtains the mastery;
and when the disease has the upper hand of the body, it does not admit
of a cure.
APPENDIX PART 4
When a person suddenly loses his speech, in connection with obstruction
of the veins,- if this happen without warning or any other strong cause,
one ought to open the internal vein of the right arm, and abstract blood
more or less according to the habit and age of the patient. Such cases
are mostly attended with the following symptoms: redness of the face, eyes
fixed, hands distended, grinding of the teeth, palpitations, jaws fixed,
coldness of the extremities, retention of airs in the veins.
APPENDIX PART 5
When pains precede, and there are influxes of black bile and of acrid
humors, and when by their pungency the internal parts are pained, and the
veins being pinched and dried become distended, and getting inflamed attract
the humors running into the parts, whence the blood being vitiated, and
the airs collected there not being able to find their natural passages,
coldness comes on in consequence of this stasis, with vertigo, loss of
speech, heaviness of the head, and convulsion, if the disease fix on the
liver, the heart, or the great vein (vena cava?); whence they are seized
with epilepsy or apoplexy, if the defluxions fall upon the containing parts,
and if they are dried up by airs which cannot make their escape; such persons
having been first tormented are to be immediately bled at the commencement,
while all the peccant vapors and humors are buoyant, for then the cases
more easily admit of a cure; and then supporting the strength and attending
to the crisis, we may give emetics, unless the disease be alleviated; or
if the bowels be not moved, we may administer a clyster and give the boiled
milk of asses, to the amount of not less than twelve heminae, or if the
strength permit, to more than sixteen.
APPENDIX PART 6
Quinsy takes place when a copious and viscid defluxion from the head,
in the season of winter or spring, flows into the jugular veins, and when
from their large size they attract a greater defluxion; and when owing
to the defluxion being of a cold and viscid nature it becomes enfarcted,
obstructing the passages of the respiration and of the blood, coagulates
the surrounding blood, and renders it motionless and stationary, it being
naturally cold and disposed to obstructions. Hence they are seized with
convulsive suffocation, the tongue turning livid, assuming a rounded shape,
and being vent owing to the veins which are seated below the tongue (for
when an enlarged uvula, which is called uva, is cut, a large vein may be
observed on each side). These veins, then, becoming filled, and their roots
extending into the tongue, which is of a loose and spongy texture, it,
owing to its dryness receiving forcibly the juice from the veins, changes
from broad and becomes round, its natural color turns to livid, from a
soft consistence it grows hard, instead of being flexible it becomes inflexible,
so that the patient would soon be suffocated unless speedily relieved.
Bleeding, then, in the arm, and opening the sublingual veins, and purging
with the electuaries, and giving warm gargles, and shaving the head, we
must apply to it and the neck a cerate, and wrap them round with wool,
and foment with soft sponges squeezed out of hot water; give to drink water
and hydromel, not cold; and administer the juice of ptisan when, having
passed the crisis, the patient is out of danger. When, in the season of
summer or autumn, there is a hot and nitrous defluxion from the head (it
is rendered hot and acrid by the season), being of such a nature it corrodes
and ulcerates, and fills with air, and orthopnoea attended with great dryness
supervenes; the fauces, when examined, do not seem swollen; the tendons
on the back part of the neck are contracted, and have the appearance as
if it were tetanus; the voice is lost, the breathing is small, and inspiration
becomes frequent and laborious. In such persons the trachea becomes ulcerated,
and the lungs engorged, from the patient's not being able to draw in the
external air. In such cases, unless there be a spontaneous determination
to the external parts of the neck, the symptoms become still more dreadful,
and the danger more imminent, partly owing to the season, and the hot and
acrid humors which cause the disease.
APPENDIX PART 7
When fever seizes a person who has lately taken food, and whose bowels
are loaded with faces which have been long retained, whether it be attended
with pain of the side or not, he ought to lie quiet until the food descend
to the lower region of the bowels, and use oxymel for drink; but when the
load descends to the loins, a clyster should be administered, or he should
be purged by medicine; and when purged, he should take ptisan for food
and hydromel for drink; then he may take the cerealia, and boiled fishes,
and a watery wine in small quantity, at night, but during the day, a watery
hydromel. When the flatus is offensive, either a suppository or clyster
is to be administered; but otherwise the oxymel is to be discontinued,
until the matters descend to the lower part of the bowels, and then they
are to be evacuated by a clyster. But if the ardent fever (causus) supervene
when the bowels are empty, should you still judge it proper to administer
purgative medicine, it ought not be done during the first three days, nor
earlier than the fourth. When you give the medicine, use the ptisan, observing
the paroxysms of the fevers, so as not to give it when the fever is setting
in, but when it is ceasing, or on the decline, and as far as possible from
the commencement. When the feet are cold, give neither drink nor ptisan,
nor anything else of the kind, but reckon it an important rule to refrain
until they become warm, and then you may administer them with advantage.
For the most part, coldness of the feet is a symptom of a paroxysm of the
fever coming on; and if at such a season you apply those things, you will
commit the greatest possible mistake, for you will augment the disease
in no small degree. But when the fever ceases, the feet, on the contrary,
become hotter than the rest of the body; for when the heat leaves the feet,
it is kindled up in the breast, and sends its flame up to the head. And
when all the heat rushes upwards, and is exhaled at the head, it is not
to be wondered at that the feet become cold, being devoid of flesh, and
tendinous; and besides, they contract cold, owing to their distance from
the hotter parts of the body, an accumulation of heat having taken place
in the chest: and again, in like manner, when the fever is resolved and
dissipated, the heat descends to the feet, and, at the same time, the head
and chest become cold. Wherefore one should attend to this; that when the
feet are cold, the bowels are necessarily hot, and filled with nauseous
matters; the hypochondrium distended: there is jactitation of the body,
owing to the internal disturbance; and aberration of the intellect, and
pains; the patient is agitated, and wishes to vomit, and if he vomits bad
matters he is pained; but when the heat descends to the feet, and the urine
passes freely, he is every way lightened, even although he does not sweat;
at this season, then, the ptisan ought to be given; it would be death to
give it before.
APPENDIX PART 8
When the bowels are loose during the whole course of fevers, in this
case we are most especially to warm the feet, and see that they are properly
treated with cerates, and wrapped in shawls, so that they may not become
colder than the rest of the body; but when they are hot, no fomentation
must be made to them, but care is to be taken that they do not become cold;
and very little drink is to be used, either cold water or hydromel. In
those cases of fever where the bowels are loose, and the mind is disordered,
the greater number of patients pick the wool from their blankets, scratch
their noses, answer briefly when questions are put to them, but, when left
to themselves, utter nothing that is rational. Such attacks appear to me
to be connected with black bile. When in these cases there is a colliquative
diarrhoea, I am of opinion that we ought to give the colder and thicker
ptisans, and that the drinks ought to be binding, of a vinous nature, and
rather astringent. In cases of fever attended from the first with vertigo,
throbbing of the head, and thin urine, you may expect the fever to be exacerbated
at the crisis; neither need it excite wonder, although there be delirium.
When, at the commencement, the urine is cloudy or thick, it is proper to
purge gently, provided this be otherwise proper; but when the urine at
first is thin, do not purge such patients, but, if thought necessary, give
a clyster; such patients should be thus treated; they should be kept in
a quiet state, have unguents applied to them, and be covered up properly
with clothes, and they should use for drink a watery hydromel, and the
juice of ptisan as a draught in the evening; clear out the bowels at first
with a clyster, but give no purgative medicines to them, for, if you move
the bowels strongly, the urine is not concocted, but the fever remains
long, without sweats and without a crisis. Do not give draughts when the
time of the crisis is at hand, if there be agitation, but only when the
fever abates and is alleviated. It is proper to be guarded at the crises
of other fevers, and to withhold the draughts at that season. Fevers of
this description are apt to be protracted, and to have determinations,
if the inferior extremities be cold, about the ears and neck, or, if these
parts are not cold, to have other changes; they have epistaxis, and disorder
of the bowels. But in cases of fever attended with nausea, or distention
of the hypochondria, when the patients cannot lie reclined in the same
position, and the extremities are cold, the greatest care and precaution
are necessary; nothing should be given to them, except oxymel diluted with
water; no draught should be administered, until the fever abate and the
urine be concocted; the patient should be laid in a dark apartment, and
recline upon the softest couch, and he should be kept as long as possible
in the same position, so as not to toss about, for this is particularly
beneficial to him. Apply to the hypochondrium linseed by inunctions, taking
care that he do not catch cold when the application is made; let it be
in a tepid state, and boiled in water and oil. One may judge from the urine
what is to take place, for if the urine be thicker, and more yellowish,
so much the better; but if it be thinner, and blacker, so much the worse;
but if it undergo changes, it indicates a prolongation of the disease,
and the patient, in like manner, must experience a change to the worse
and the better. Irregular fevers should be let alone until they become
settled, and, when they do settle, they are to be treated by a suitable
diet and medicine, attending to the constitution of the patient.
APPENDIX PART 9
The aspects of the sick are various; wherefore the physician should
pay attention, that he may not miss observing the exciting causes, as far
as they can be ascertained by reasoning, nor such symptoms as should appear
on an even or odd day, but he ought to, be particularly guarded in observing
the odd days, as it is in them, more especially, that changes take place
in patients. He should mark, particularly, the first day on which the patient
became ill, considering when and whence the disease commenced, for this
is of primary importance to know. When you examine the patient, inquire
into all particulars; first how the head is, and if there be no headache,
nor heaviness in it; then examine if the and sides be free of pain; for
if the hypochondrium be painful, swelled, and unequal, with a sense of
satiety, or if there be pain in the side, and, along with the pain, either
cough, tormina, or belly-ache, if any of these symptoms be present in the
hypochondrium, the bowels should be opened with clysters, and the patient
should drink boiled hydromel in a hot state. The physician should ascertain
whether the patient be apt to faint when he is raised up, and whether his
breathing be free; and examine the discharges from the bowels, whether
they be very black, or of a proper color, like those of persons in good
health, and ascertain whether the fever has a paroxysm every third day,
and look well to such persons on those days. And should the fourth day
prove like the third, the patient is in a dangerous state. With regard
to the symptoms, black stools prognosticate death; but if they resemble
the discharges of a healthy person, and if such is their appearance every
day, it is a favorable symptom; but when the bowels do not yield to a suppository,
and when, though the respiration be natural, the patient when raised to
the night table, or even in bed, be seized with deliquium, you may expect
that the patient, man or woman, who experiences these symptoms, is about
to fall to fall into a state of delirium. Attention also should be paid
to the hands, for if they tremble, you may expect epistaxis; and observe
the nostrils, whether the breath be drawn in equally by both; and if expiration
by the nostrils be large, a convulsion is apt to take place; and should
a convulsion occur to such a person, death may be anticipated, and it is
well to announce it beforehand.
APPENDIX PART 10
If, in a winter fever, the tongue be rough, and if there be swoonings,
it is likely to be the remission of the fever. Nevertheless such a person
is to be kept upon a restricted diet, with water for drink, and hydromel,
and the strained juices, not trusting to the remission of the fevers, as
persons having these symptoms are in danger of dying; when, therefore,
you perceive these symptoms, announce this prognostic, if you shall judge
proper, after making the suitable observations. When, in fevers, any dangerous
symptom appears on the fifth day, when watery discharges suddenly take
place from the bowels, when deliquium animi occurs, or the patient is attacked
with loss of speech, convulsions, or hiccup, under such circumstances he
is likely to be affected with nausea, and sweats break out under the nose
and forehead, or on the back part of the neck and head, and patients with
such symptoms shortly die, from stoppage of the respiration. When, in fevers,
abscesses form about the legs, and, getting into a chronic state, are not
concocted while the fever persists, and if one is seized with a sense of
suffocation in the throat, while the fauces are not swelled, and if it
do not come to maturation, but is repressed, in such a case there is apt
to be a flow of blood from the nose; if this, then, be copious, it indicates
a resolution of the disease, but if not, a prolongation of the complaint;
and the less the discharge, so much worse the symptoms, and the more protracted
the disease; but if the other symptoms are very favorable, expect in such
a case that pains will fall upon the feet; if then they attack the feet,
and if these continue long in a very painful, and inflamed state, and if
there be no resolution, the pains will extend by degrees to the neck, to
the clavicle, shoulder, breast, or to some articulation, in which an inflammatory
tumor will necessarily form. When these are reduced, if the hands are contracted,
and become trembling, convulsion and delirium seize such a person; but
blisters break out on the eyebrow, erythema takes place, the one eyelid
being tumefied overtops the other, a hard inflammation sets in, the eye
become strongly swelled, and the delirium increases much, but makes its
attacks rather at night than by day. These symptoms more frequently occur
on odd than on even days, but, whether on the one or the other, they are
of a fatal character. Should you determine to give purgative medicines
in such cases, at the commencement, you should do so before the fifth day,
if there be borborygmi in the bowels, or, if not, you should omit the medicines
altogether. If there be borborygmi, with bilious stools, purge moderately
with scammony; but with regard to the treatment otherwise, administer as
few drinks and draughts as until there be some amendment, and the disease
is past the fourteenth day. When loss of speech seizes a person, on the
fourteenth day of a fever, there is not usually a speedy resolution, nor
any removal of the disease, for this symptom indicates a protracted disease;
and when it appears on that day, it will be still more prolonged. When,
on the fourth day of a fever, the tongue articulates confusedly, and when
there are watery and bilious discharges from the bowels, such a patient
is apt to fall into a state of delirium; the physician ought, therefore,
to watch him, and attend to whatever symptoms may turn up. In the season
of summer and autumn an epistaxis, suddenly occurring in acute diseases,
indicates vehemence of the attack, and inflammation in the course of the
veins, and on the day following, the discharge of thin urine; and if the
patient be in the prime of life, and if his body be strong from exercise,
and brawny, or of a melancholic temperament, or if from drinking has trembling
hands, it may be well to announce beforehand either delirium or convulsion;
and if these symptoms occur on even days, so much the better; but on critical
days, they are of a deadly character. If, then, a copious discharge of
blood procure an issue to the fullness thereof about the nose, or what
is collected about the anus, there will be an abscess, or pains in the
hypochondrium, or testicles, or in the limbs; and when these are resolved,
there will be a discharge of thick sputa, and of smooth, thin urine. In
fever attended with singultus, give asafoetida, oxymel, and carrot, triturated
together, in a draught; or galbanum in honey, and cumin in a linctus, or
the juice of ptisan. Such a person cannot escape, unless critical sweats
and gentle sleep supervene, and thick and acrid urine be passed, or the
disease terminate in an abscess: give pine-fruit and myrrh in a linctus,
and further give a very little oxymel to drink; but if they are very thirsty,
some barley-water.
APPENDIX PART 11
Peripneumonia, and pleuritic affections, are to be thus observed: If
the fever be acute, and if there be pains on either side, or in both, and
if expiration be if cough be present, and the sputa expectorated be of
a blond or livid color, or likewise thin, frothy, and florid, or having
any other character different from the common, in such a case, the physician
should proceed thus: if the pain pass upward to the clavicle, or the breast,
or the arm, the inner vein in the arm should be opened on the side affected,
and blood abstracted according to the habit, age, and color of the patient,
and the season of the year, and that largely and boldly, if the pain be
acute, so as to bring on deliquium animi, and afterwards a clyster is to
be given. But if the pain be below the chest, and if very intense, purge
the bowels gently in such an attack of pleurisy, and during the act of
purging give nothing; but after the purging give oxymel. The medicine is
to be administered on the fourth day; on the first three days after the
commencement, a clyster should be given, and if it does not relieve the
patient, he should then be gently purged, but he is to be watched until
the fever goes off, and till the seventh day; then if he appear to be free
from danger, give him some unstrained ptisan, in small quantity, and thin
at first, mixing it with honey. If the expectoration be easy, and the breathing
free, if his sides be free of pain, and if the fever be gone, he may take
the ptisan thicker, and in larger quantity, twice a day. But if he do not
progress favorably, he must get less of the drink, and of the draught,
which should be thin, and only given once a day, at whatever is judged
to be the most favorable hour; this you will ascertain from the urine.
The draught is not to be given to persons after fever, until you see that
the urine and sputa are concocted (if, indeed, after the administration
of the medicine he be purged frequently, it may be necessary to give it,
but it should be given in smaller quantities and thinner than usual, for
from inanition he will be unable to sleep, or digest properly, or wait
the crisis); but when the melting down of crude matters has taken place,
and his system has cast off what is offensive, there will then be no objection.
The sputa are concocted when they resemble pus, and the urine when it has
reddish sediments like tares. But there is nothing to prevent fomentations
and cerates being applied for the other pains of the sides; and the legs
and loins may be rubbed with hot oil, or anointed with fat; linseed, too,
in the form of a cataplasm, may be applied to the hypochondrium and as
far up as the breasts. When pneumonia is at its height, the case is beyond
remedy if he is not purged, and it is bad if he has dyspnoea, and urine
that is thin and acrid, and if sweats come out about the neck and head,
for such sweats are bad, as proceeding from the suffocation, rales, and
the violence of the disease which is obtaining the upper hand, unless there
be a copious evacuation of thick urine, and the sputa be concocted; when
either of these come on spontaneously, that will carry off the disease.
A linctus for pneumonia: Galbanum and pine-fruit in Attic honey; and southernwood
in oxymel; make a decoction of pepper and black hellebore, and give it
in cases of pleurisy attended with violent pain at the commencement. It
is also a good thing to boil opoponax in oxymel, and, having strained it,
to give it to drink; it answers well, also, in diseases of the liver, and
in severe pains proceeding from the diaphragm, and in all cases in which
it is beneficial to determine to the bowels or urinary organs, when given
in wine and honey; when given to act upon the bowels, it should be drunk
in larger quantity, along with a watery hydromel.
APPENDIX PART 12
A dysentery, when stopped, will give rise to an aposteme, or tumor,
if it do not terminate in fevers with sweats, or with thick and white urine,
or in a tertian fever, or the pain fix upon a varix, or the testicles,
or on the hip-joints.
APPENDIX PART 13
In a bilious fever, jaundice coming on with rigor before the seventh
day carries off the fever, but if it occur without the fever, and not at
the proper time, it is a fatal symptom.
APPENDIX PART 14
When the loins are in a tetanic state, and the spirits in the veins
are obstructed by melancholic humors, venesection will afford relief. But
when, on the other hand, the anterior tendons are strongly contracted,
and if there be sweats about the neck and face, extorted by the violent
pain of the parched and dried tendons of the sacral extremity (these are
very thick, sustaining the spine, and giving rise to very great ligaments,
which terminate in the feet,) in such a case, unless fever and sleep come
on, followed by concocted urine and critical sweats, give to drink a strong
Cretan wine, and boiled barley-meal for food; anoint and rub with ointments
containing wax; bathe the legs and feet in hot water, and then cover them
up; and so in like manner the arms, as far as the hands, and the spine,
from the neck to the sacrum, are to be wrapped in a skin smeared with wax;
this must extend to the parts beyond, and intervals are to be left for
applying fomentations, by means of leather bottles filled with hot water,
then, wrapping him up in a linen cloth, lay him down in bed. Do not open
the bowels, unless by means of a suppository, when they have been long
of being moved. If there be any remission of the disease, so far well,
but otherwise, pound of the root of bryonia in fragrant wine, and that
of the carrot, and give to the patient fasting early in the morning, before
using the affusion, and immediately afterwards let him eat boiled barley-meal
in a tepid state, and as much as he can take, and in addition let him drink,
if he will, wine well diluted. If the disease yield to these means, so
much the better, but, if otherwise, you must prognosticate accordingly.
APPENDIX PART 15
All diseases are resolved either by the mouth, the bowels, the bladder,
or some other such organ. Sweat is a common form of resolution in all these
cases.
APPENDIX PART 16
You should put persons on a course of hellebore who are troubled with
a defluxion from the head. But do not administer hellebore to such persons
as are laboring under empyema connected with abscesses, haemoptysis, and
intemperament, or any other strong cause, for it will do no good; and if
any thing unpleasant occur the hellebore will get the blame of it. But
if the body have suddenly lost its powers, or if there be pain in the head,
or obstruction of the ears and nose, or ptyalism, or heaviness of the limbs,
or an extraordinary swelling of the body, you may administer the hellebore,
provided these symptoms be not connected with drinking, nor with immoderate
venery; nor with sorrow, vexation, nor insomnolency, for, if any of these
causes exist, the treatment must have respect to it.
APPENDIX PART 17
From walking arise pains of the sides, of the back, of the loins, and
of the hip-joint, and disorder of the respiration has often been from the
same cause, for, after excesses of wine and flatulent food, pains shoot
to the loins and hips, accompanied with dysuria. Walking is the cause of
such complaints, and also of coryza and hoarseness.
APPENDIX PART 18
Disorders connected with regimen, for the most part, make their attack accordingly as any one has changed his habitual mode of diet. For persons who dine contrary to custom experience much swelling of the stomach, drowsiness, and fullness; and if they take supper over and above, their belly is disordered; such persons will be benefited by sleeping after taking the bath, and by walking slowly for a considerable time after sleep; if, then, the bowels be moved, he may dine and drink a small quantity of wine not much diluted; but if the bowels are not opened, he should get his body rubbed with hot oil, and, if thirsty, drink of some weak and white wine, or a sweet wine, and take repose; if he does not sleep he should repose the longer. In other respects he should observe the regimen laid down for those who have taken a debauch. With regard to the bad effects of drinks, such as are of a watery nature pass more slowly through the body, they regurgitate, as it were, and float about the hypochondria, and do not flow readily by urine; when filled up with such a drink, he should not attempt any violent exertion, requiring either strength or swiftness, but should rest as much as possible until the drink has been digested along with the food; but such drinks as are stronger or more austere, occasion palpitation in the body and throbbing in the head, and in this case the person affected will do well to sleep, and take some hot draught for which he feels disposed; for abstinence is bad in headache and the effects of a surfeit. Those who, contrary to usage, restrict themselves to one meal, feel empty and feeble, and pass hot urine in consequence of the emptiness of their vessels; they have a salt and bitter taste in the mouth; they tremble at any work they attempt; their temples throb; and they cannot digest their supper so well as if they had previously taken their dinner. Such persons should take less supper than they are wont, and a pudding of barley-meal more moist than usual instead of bread, and of potherbs the dock, or mallow, and ptisan, or beets, and along with the food they should take wine in moderation, and diluted with water; after supper they should take a short walk, until the urine descend and be passed; and they may use boiled fish.
Articles of food have generally such effects as the following: Garlic
occasions flatulence and heat about the chest, heaviness of the head, and
nausea, and any other habitual pain is apt to be exasperated by it; it
is diuretic, which, in so far, is a good property which it possesses; but
to eat it when one means to drink to excess, or when intoxicated. Cheese
produces flatulence and constipation, and heats the other articles of food;
and it gives rise to crudities and indigestion, but it is worst of all
to eat it along with drink after a full meal. Pulse of all kinds are flatulent,
whether raw, boiled, or fried; least so when macerated in water, or in
a green state; they should not be used except along with food prepared
from the cerealia. Each of these articles, articles, however, has bad effects
peculiar to itself. The vetch, whether raw or boiled, creates flatulence
and pain. The lentil is astringent, and disorders the stomach if taken
with its hull. The lupine has the fewest bad effects of all these things.
The stalk and the juice of silphium (asafoetida), pass through some people's
bowels very readily, but in others, not accustomed to them, they engender
what is called dry cholera; this complaint is more especially produced
by it if mixed with much cheese, or eaten along with beef. Melancholic
diseases are most particularly exacerbated by beef, for it is of an unmanageable
nature, and requires no ordinary powers of stomach to digest it; it will
agree best with those who use it well boiled and pretty long kept. Goat's
flesh has all the bad properties of beef; it is an indigestible, more flatulent
and engenders acid eructations and cholera; such as has a fragrant smell,
is firm, and sweet to the taste, is the best, when well baked and cooled;
but those kinds which are disagreeable to the taste, have a bad smell,
and are hard, such are particularly bad, and especially if very fresh;
it is best in summer and worst in autumn. The flesh of young pigs is bad,
either when it is too raw or when it is over-roasted, for it engenders
bile and disorders the bowels. Of all kinds of flesh, pork is the best;
it is best when neither very fat, nor, on the other hand, very lean, and
the animal had not attained the age of what is reckoned an old victim;
it should be eaten without the skin, and in a coldish state.
APPENDIX PART 19
In dry cholera the belly is distended with wind, there is rumbling in
the bowels, pain in the sides and loins, no dejections, but, on the contrary,
the bowels are constipated. In such a case you should guard against vomiting,
but endeavor to get the bowels opened. As quickly as possible give a clyster
of hot water with plenty of oil in it, and having rubbed the patient freely
with unguents; put him into hot water, laying him down in the basin, and
pouring the hot water upon him by degrees; and if, when heated in the bath,
the bowels be moved, he will be freed from the complaint. To a person in
such a complaint it will do good if he sleep, and drink a thin, old, and
strong wine; and you should give him oil, so that he may settle, and have
his bowels moved, when he will be relieved. He must abstain from all other
kinds of food; but when the pain remits, give him asses milk to drink until
he is purged. But if the bowels are loose, with bilious discharges, tormina,
vomitings, a feeling of suffocation, and gnawing pains, it is best to enjoin
repose, and to drink hydromel, and avoid vomiting.
APPENDIX PART 20
There are two kinds of dropsy, the one anasarca, which, when formed,
is incurable; the other is accompanied with emphysema (tympanites?) and
requires much good fortune to enable one to triumph over it. Laborious
exertion, fomentation, and abstinence (are to be enjoined). The patient
should eat dry and acrid things, for thus will he pass the more water,
and his strength be kept up. If he labors under difficulty of breathing,
if it is the summer season, and if he is in the prime of life, and is strong,
blood should be abstracted from the arm, and then he should eat hot pieces
of bread, dipped in dark wine and oil, drink very little, and labor much,
and live on well-fed pork, boiled with vinegar, so that he may be able
to endure hard exercises.
APPENDIX PART 21
Those who have the inferior intestines hot, and who pass acrid and irregular
stools of a colliquative nature, if they can bear it, should procure revulsion
by vomiting with hellebore; but if not, should get a thick decoction of
summer wheat in a cold state, lentil soup, bread cooked with cinders, and
fish, which should be taken boiled if they have fever, but roasted if not
feverish; and also dark-colored wine if free of fever; but otherwise they
should take the water from medlars, myrtles, apples, services, dates, or
wild vine. If there be no fever, and if there be tormina, the patient should
drink hot asses' milk in small quantity at first, and gradually increase
it, and linseed, and wheaten flour, and having removed the bitter part
of Egyptian beans, and ground them, sprinkle on the milk and drink; and
let him eat eggs half-roasted, and fine flour, and millet, and perl-spelt
(chondrus) boiled in milk;- all these things should be eaten cold, and
similar articles of food and drink should be administered.
APPENDIX PART 22
The most important point of regimen to observe and be guarded about
in protracted diseases, is to pay attention to the exacerbations and remissions
of fevers, so as to avoid the times when food should not be given, and
to know when it may be administered without danger; this last season is
at the greatest possible distance from the exacerbation.
APPENDIX PART 23
One should be able to recognize those who have headache from gymnastic
exercises, or running, or walking or hunting, or any other unseasonable
labor, or from immoderate venery; also those who are of a pale color, or
troubled with hoarseness; those who have enlarged spleen, those who are
in a state of anaemia, those who are suffering from tympanites, those having
dry cough and thirst, those who are flatulent, and have the course of the
blood in their veins intercepted; those persons whose hypochondria, sides,
and back are distended: those having torpor; those laboring under amaurosis,
or having noises in their ears; those suffering from incontinence of urine
or jaundice, or whose food is passed undigested; those who have discharges
of blood from the nose or anus, or who have flatulence and intense pain,
and who cannot retain the wind. In these cases you may do mischief, but
cannot possibly do any good by purging, but may interrupt the spontaneous
remissions and crises of the complaints.
APPENDIX PART 24
If you think it expedient to let blood, see that the bowels be previously
settled, and then bleed; enjoin abstinence, and forbid the use of wine;
and complete the cure by means of a suitable regimen, and wet fomentations.
But if the bowels appear to be constipated, administer a soothing clyster.
APPENDIX PART 25
If you think it necessary to give medicines, you may safely purge upwards
by hellebore, but none of those should be purged downwards. The most effectual
mode of treatment is by the urine, sweats, and exercise; and use gentle
friction so as not to harden the constitution; and if he be confined to
bed let others rub him. When the pain is seated above the diaphragm, place
him erect for the most part, and let him be as little reclined as possible;
and when he is raised up let him be rubbed for a considerable time with
plenty of hot oil. But if the pains be in the lower belly below the diaphragm,
it will be useful to lie reclined and make no motion, and to such a person
nothing should be administered except the friction. Those pains which are
dissolved by discharges from the bowels, by urine, or moderate sweats,
cease spontaneously, if they are slight, but if strong they prove troublesome;
for persons so affected either die, or at least do not recover without
further mischief, for they terminate in abscesses.
APPENDIX PART 26
A draught for a dropsical person. Take three cantharides, and removing
their head, feet, and wings, triturate their bodies in three cupfuls (cyathi)
of water, and when the person who has drunk the draught complains of pain,
let him have hot fomentations applied. The patient should be first anointed
with oil, should take the draught fasting, and eat hot bread with oil.
APPENDIX PART 27
A styptic. Apply the juice of the fig inwardly to the vein; or having
moulded biestings into a tent, introduce up the nostril, or push up some
chalcitis with the finger, and press the cartilages of the nostrils together;
and open the bowels with the boiled milk of asses: or having shaved the
head apply cold things to it if in the summer season.
APPENDIX PART 28
The sesamoides purges upwards when pounded in oxymel to the amount of
a drachm and a half, and drunk; it is combined with the hellebores, to
the amount of the third part, and thus it is less apt to produce suffocation.
APPENDIX PART 29
Trichiasis. Having introduced a thread into the eye of a needle push
it through the upper part of the distended eyelid, and do the same at the
base of it; having stretched the threads tie a knot on them, and bind up
until they drop out: and, if this be sufficient, so far well; but if otherwise,
you must do the same thing again. And hemorrhoids, in like manner, you
may treat by transfixing them with a needle and tying them with a very
thick and large woolen thread; for thus the cure will be more certain.
When you have secured them, use a septic application, and do not foment
until they drop off, and always leave one behind; and when the patient
recovers, let him be put upon a course of hellebore. Then let him be exercised
and sweated; the friction of the gymnasium and wrestling in the morning
will be proper; but he must abstain from running, drinking, and all acrid
substances, except marjoram; let him take an emetic every seven days, or
three times in a month; for thus will he enjoy the best bodily health.
Let him take straw-colored, austere, and watery wine, and use little drink.
APPENDIX PART 30
For persons affected with empyema. Having cut some bulbs or squill,
boil in water, and when well boiled, throw this away, and having poured
in more water, boil until it appear to the touch soft and well-boiled;
then triturate finely and mix roasted cumin, and white sesames, and young
almonds pounded in honey, form into an electuary and give; and afterwards
sweet wine. In draughts, having pounded about a small acetabulum of the
white poppy, moisten it with water in which summer wheat has been washed,
add honey, and boil. Let him take this frequently during the day. And then
taking into account what is to happen, give him supper.
APPENDIX PART 31
For dysentery. A fourth part of a pound of cleaned beans, and twelve
shoots of madder having been triturated, are to be mixed together and boiled,
and given as a linctus with some fatty substance.
APPENDIX PART 32
For diseases of the eyes. Washed spodium (tutty?) mixed with grease,
and not of a thinner consistence than dough, is to be carefully triturated,
and moistened with the juice of unripe raisins; and having dried in the
sun, moisten until it is of the consistence of an ointment. When it becomes
again dry, let it be finely levigated, anoint the eyes with it, and dust
it upon the angles of the eyes.
APPENDIX PART 33
For watery eyes. Take one drachm of ebeny and nine oboli of burnt copper,
rub them upon a whetstone, add three oboli of saffron; triturate all these
things reduced to a fine powder, pour in an Attic hemina of sweet wine,
and then place in the sun and cover up; when sufficiently digested, use
it.
APPENDIX PART 34
For violent pains of the eyes. Take of chalcitis, and of raisin, of
each 1 dr., when digested for two days, strain; and pounding myrrh and
saffron, and having mixed must, with these things, digest in the sun; and
with this anoint the eyes when in a state of severe pain. Let it be kept
in a copper vessel.
APPENDIX PART 35
Mode of distinguishing persons in an hysterical fit. Pinch them with
your fingers, and if they feel, it is hysterical; but if not, it is a convulsion.
APPENDIX PART 36
To persons in coma, (dropsy?) give to drink meconium (euphorbia peplus?)
to the amount of a round Attic leciskion (small acetabulum).
APPENDIX PART 37
Of squama aeris, as much as three specilla can contain, with the gluten
of summer wheat: levigate, pound, form into pills, and give; it purges
water downwards.
APPENDIX PART 38
A medicine for opening the bowels. Pour upon figs the juice of spurge,
in the proportion of seven to one: then put into a new vessel and lay past
when properly mixed. Give before food.
APPENDIX PART 39
Pounding meconium, pouring on it water, and straining, and mixing flour, and baking into a cake, with the addition of boiled honey, give in affections of the anus and in dropsy; and after eating of it, let the patient drink of a sweet watery wine, and diluted hydromel prepared from wax: or collecting meconium, lay it up for medicinal purposes.
End of Etext On Regimen in Acute Diseases by Hippocrates
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