THE remedies of acute diseases are connected with the form of the symptoms, certain of which have been described by me in the preceding works. Whatever, therefore, relates to the cure of fevers, according to their differences, the form of the diseases, and the varieties in them, the greater part of these will be treated of in my discourses on fevers. But acute affections which are accompanied with fevers, such as Phrenitis, or those without fevers, as Apoplexy, of these alone will I now write; and that I may not commit blunders, or become diffuse by treating of the same matters in different places, the beginning and end correspond to the same in the work on the affections.

THE patient ought to be laid in a house of moderate size, and mild temperature—in a warm situation, if winter, and in one that is cool and humid, if summer; in spring and autumn, to be regulated according to the season. Then the patient himself, and all those in the house, are to be ordered to preserve quiet; for persons in phrensy are sharp of hearing, are sensitive to noise, and easily become delirious. The walls should be smooth, level, without projections, not adorned with frieze ¹ or paintings; for painting on a wall is an excitant. And, moreover, they catch at certain false appearances before their eyes, and grope about things which are not projecting, as if they were so; and any unreal occasion may be a cause sufficient to make them raise their hands. Length and breadth of the couch moderate, so that the patient may neither toss about in a broad one, nor fall out of a narrow bed. In plain bed clothes, so that there may be no inducement to pick at their nap. But on a soft bed, for a hard one is offensive to the nerves; as in phrenitics, above all others, the nerves especially suffer, for they are subject to convulsions. Access of their dearest friends is to be permitted; stories and conversation not of an exciting character; for they ought to be gratified in everything, especially in cases where the delirium tends to anger. Whether they are to be laid in darkness or in light must be determined by the nature of the attack; for if they are exasperated by the light, and see things which exist not, and represent to themselves things not present, or confound one thing with another, or if strange images obtrude themselves upon them; and, in a word, if they are frightened at the light, and the things in the light, darkness must be chosen; but if not, the opposite state. It is a good symptom, too, when they become of a sound mind, and their delirium abates, on exposure to the light. Abstinence from food should not be prolonged; food should be rather liquid, scanty, and frequently administered, for food soothes the soul: the proper time for giving it is during the remissions, both of the fever and of the delirium. But if they have become delirious from want of food, and if the fever do not remit, we are to give food that does not do much harm in fever. It is a favourable circumstance, when the fever and the delirium agree both as to the paroxysms and intermissions.

If, therefore, the time for the administering of food be come, in the first place, it must be enquired whether it be necessary to abstract blood. If, then, the delirium have come on with fever at the commencement, in the first or second day, it will be proper to open a vein at the elbow, especially the middle. But if the delirium supervene on the third or fourth day, we are to open a vein up to the first period of critical days. But if it was past the proper time for bleeding, on the sixth or seventh day, it will be proper to evacuate considerably before the crises in acute diseases, either by giving purgative medicines, or by using other stimulants. But when opening a vein you must not abstract much, even if you open the vein at the commencement; for phrenitis is an ailment easily convertible into syncope. But if the patient be plethoric and youthful, and if the ailment be connected with fulness in eating and drinking, those indications have nothing to do with the phrenitis; for even without the delirium, it would be proper to abstract much blood in such circumstances; but much less is to be abstracted, if such persons labour under phrenitis. But we may open a vein the more boldly in these cases, if the disease proceed from the præcordia, and not from the head; for there (in the præcordia) is the origin of life. But the head is the seat of sensation, and of the origin of the nerves; and it attracts more blood from the heart than it imparts to the others. If it therefore suffer, it is not proper to open the vein at the elbow; for these affections are such that it is no small injury to evacuate in them. And if the strength be sufficient to withstand the evacuation, we must abstract only once, lest during the interval between the acts of evacuation, the proper season for food be lost. The fevers, in cases of phrenitis, are of a continual type, neither have they long intermissions, but experience short and ill-marked remissions. But if the patient give way before a sufficient quantity has been abstracted, it must be put off until another remission, unless it occur at a distant period; but, if not, having resuscitated the patient by odours, stroking the face, and pricking the feet, we are immediately to abstract blood. The measure of sufficiency is the strength.

Liquid food is proper in all febrile diseases, but especially in phrenitic cases, for these are more arid than mere fevers. The mulse is to be given, unless they are bilious, for it is indigestible in patients who are subject to bitter bile. Alica ² washed with water, or mulse, is a good thing; also it is good to give pottages of a plain kind, such as decoctions of savory, of parsley, or of dill, for these are beneficial to the respiration, and are diuretic, and a free discharge of urine is beneficial in phrenetics. All kinds of pot-herbs, especially melons, for their gluten is good for lubricating the tongue, the trachea, and for the alvine evacuations; but the best of all are beet, blite, cress, gourd in season, and whatever else is best in its own season. The juice of ptisan in a very liquid state, and containing little nourishment, is most proper at first, being made always thicker as the disease progresses. But the quantity of nourishment is to be diminished at the crises, and a little before them. And, if the disease be protracted, the customary food must not be abstracted, but we must give nourishing articles from the cereals, in order to support the patient; and when there is need, of the flesh of the extremities of beasts and fowls, mostly dissolved in the soups: these ought to be completely dissolved during the process of boiling. The rock fishes are preferable to all others; ³ but on the whole we must choose the best in the country, for countries are believed to differ as to the kinds of fish which are best in them. Fruit containing wine must be given restrictedly, for it is apt to affect the head and præcordia; but if required by the state of the strength and of the stomach, we must give such articles as apples boiled in mulse or roasted in suet. Of other things, each is to be diluted with hot water, if you give it solely for the refreshment of the stomach; but if it is wanted also for strength, you must not dilute the vinous part much. In a word, the food must be such as I have described.

For the sake of refrigeration, the head is to be damped with the oil of the unripe olive pounded; for in phrenitics the head is not fond of being kept warm. But if restlessness and false visions be present, we must mix equal parts of rose-oil at first; and the rose-oil is to be increased for the astringing and cooling of the head. But if they become disordered in understanding, and their voice change, the hair ( capillary leaves?) of the wild thyme must be boiled in oils, or the juice of ivy or of knot-grass is also to be infused. But if the delirium get more violent, hog’s-fennel and cow-parsnip are to be boiled in the oils, and some vinegar poured in; for these things dissipate the vapours and heat, and are solvents of the thick humours which contribute to the delirium. But care must be taken that the moist application do not extend to the neck and the tendons, for it is prejudicial to tendons and nerves. Every season is suitable for the damp application, except the commencement of a paroxysm; it should be used more rarely during the increase, but most frequently at the acme; and whenever they are delirious, then, in particular, it will be proper to use a cold application, made still more cold in the season of summer, but in winter tepid. To soothe the delirium it is well to foment the forehead with oxycrate, or the decoction of fleabane, by means of a sponge, and then to anoint with the oil of wild vine or of saffron, and also to anoint the nose and ears with them.

These things, moreover, also induce sleep. For if they lay awake all night, nor sleep during the day, and the eyes stand quite fixed like horns, and the patients toss about and start up, we must contrive to procure sleep and rest for them; first, by fomentations to the head, with unmixed rose-oil, or oil of marjoram with the juice of ivy, or the decoction of wild thyme or of melilot. But poppy boiled in oil is particularly soporific when applied to the fontenelle of the head, or with a sponge to the forehead. But the poppies, if recently plucked and green, may be applied whole under the pillows; for they thicken and humectate the spirit ( pneuma), which is dry and attenuated, and diffuse over the senses fumes which prove the commencement of sleep. But if greater applications are needed, we may rub in the meconium ( expressed juice of poppy) itself on the forehead with water, and also anoint the nostrils with the same, and pour it into the ears. Gentle rubbing of the feet with oil, patting of the head, and particularly stroking of the temples and ears is an effectual means; for by the stroking of their ears and temples wild beasts are overcome, so as to cease from their anger and fury. ⁴ But whatever is familiar to any one is to him a provocative of sleep. Thus, to the sailor, repose in a boat, and being carried about on the sea, the sound of the beach, the murmur of the waves, the boom of the winds, and the scent of the sea and of the ship. But to the musician the accustomed notes of his flute in stillness; or playing on the harp or lyre, or the exercise of musical children with song. To a teacher, intercourse with the tattle of children. Different persons are soothed to sleep by different means.

To the hypochondria and region of the stomach, if distended by inflammation, hardness, and flatulence, embrocations and cataplasms are to be applied, with the addition of the oil of the over-ripe olive, for it is thick, viscid, and calefacient; it therefore is required in inflammation: let dill or flea-bane be boiled in it, and it is a good thing to mix all together; but if flatulence be present also, the fruits of cumin and parsley, and whatever other things are diuretic and carminative, along with sifted natron, are to be sprinkled on the application. But if the liver experience suffering and pain, apply unwashed wool just taken from the ewe, oil from the unripe olive, or rose-oil; but we must mix also Hellenic or Cretan rob, and boil in it melilot, and mixing all these things into one juice, foment the liver therewith. To the spleen the oil must be mixed with vinegar; or if it should appear to be enlarged in bulk, oxycrate, and instead of the wool a soft sponge; for the spleen delights in and is relieved by such things. But if the hypochondria be collapsed and retracted upwards, and the skin be stretched, it will be best instead of the oil, or along with it, to use thick butter in equal quantity, and let fleabane and rosemary be boiled in the decoction, and dill is not unsuitable.

But if it be the proper time for cataplasms, we may use the same oils to the same places, the ingredients of the cataplasms being linseed, fenugreek, or fine barley-meal; beans and vetches, also, are proper if the abdomen be swelled. Roasted millet, also, in bags, makes a light and soft fomentation; when ground it makes, along with honey, oil, and linseed, an excellent cataplasm for the hypochondria. Also let the same flowers, herbs, and seeds which I have described among the embrocations be used for the cataplasms. Honey, also, is useful along with these things, to give consistency to the dry things, and for the mixing of the toasted things, and for the preservation of the heat; it is a good thing, likewise, by itself; also a cataplasm half-boiled, and an embrocation dissolved in some of the liquids, is effectual as an emollient, calefacient, carminative, and diuretic, and to moderate the inflammations. These effects are produced also by mulse when drunk, and even more and greater effects when conveyed internally to the trachea, the lungs, the thorax, and the stomach.

The bowels, also, are to be frequently stimulated by suppositories or liniments (for they are generally constipated), in order to act as derivatives from the head, and also for the evaporation of the vapours in the chest, and for the evacuation of the matters in the belly; but, if the belly be confined for several days, it must be opened by a clyster of mulse, oil, and natron.

But if the distension of the inflammation do not properly subside, we must apply a cupping-instrument with scarificators where the inflammation points and is greatest, on the first or second day, according as the inflamed parts may indicate, and the strength direct; and from those the amount of the evacuation of the blood must be determined, for excess occasions syncope. During the first and second day the fomentation should be the same; but, on the third, cerate with some of the oils used in the embrocations is to be applied: then, if they be still in a state of inflammation, epithemes, consisting of hyssop, fenugreek boiled in mulse, the resin of the turpentine plant, and wax; the oils the same for these places. If by these means the delirium do not at all abate, it will be necessary to have recourse to cropping of the head, provided the hairs be very long, to the extent of one half; but, if shorter, down to the skin: then, in the meantime having recruited the strength, to apply a cupping-instrument to the vertex, and abstract blood. But dry-cupping is first to be applied to the back.

But since in all the acute diseases the chest must be remedied, this part generally suffering with the heart and lungs, more especially from the difficulty of the respiration, which is sometimes hot, at other times cold; and, moreover, from ardent fever, cough, badness of the humours, and sympathy of the nerves, and complaint of the stomach, and illness of the pleura and of the diaphragm (for the heart, if it suffer from any dreadful illness, never recovers),—in cases of phrenitis these parts in particular must be soothed. For, indeed, the delirium in certain cases arises from some of the parts in the chest; respiration hot and dry; thirst acrid; febrile heat not easily endured, as being determined from all parts to the chest; and illness from the perversion of its native heat, but greater and more intolerable the communication of the same from the other parts to the chest: for the extremities are cold—the head, the feet, and the hands; but, above these last, the chest. It is to be remedied, then, by humectation and refrigeration. For bathing, oil boiled with camomile or nard; in summer, also, Hellenic rob. But if it be necessary also to apply epithemes, dates moistened with austere wine, then levigated and pounded into a mass with nard, barley meal, and flower of the wild vine, form a soothing cataplasm for the chest: a cooling one is formed of apples bruised with mastich and melilot; all these things, however, are to be mixed up with wax and nard. But if the stomach be affected with torpor and loathing of food, the juice or hair of worm-wood are mixed up with them; and the hypochondriac region is to be fomented with this boiled up in oil. The infusion or the juice of it may be drunk before food to the amount of two cupfuls of the infusion, or one cupful of the bitter juice with two cupfuls of water. But if the stomach be affected with heartburn, not from the constitution of the disease, but of itself from acrid and saltish humours, or from being pinched with bile, or from being parched with thirst, we must give in the food milk mixed with water to the amount of half a hemina of milk in one cupful of water; the patient should swallow the most of it, but he may take a small portion of it with bread.

But if the patient be also affected with Causus, and there be thirst, restlessness, mania, and a desire of cold water, we must give less of it than in a case of Causus without phrenitis, for we must take care lest we injure the nerves; we are to give them as much as will prove a remedy for the stomach, and a little is sufficient, for phrenitics are spare drinkers.

But if converted into syncope, and this also happens (the powers of life being loosened, the patient being melted in sweat, and all the humours being determined outwardly, the strength and spirit ( pneuma) being also dissolved), we must disregard the delirium, and be upon our guard lest the patient be resolved into vapours and humidity. Then the only support is wine, to nourish quickly by its substance, and to penetrate everywhere, even to the extremities; to add tone to tone, to rouse the torpid spirit ( pneuma), warm that which is cold, brace what is relaxed, restrain those portions which are flowing and running outwards, wine being sweet to the senses of smell so as to impart pleasure; powerful to confirm the strength for life; and most excellent to soothe the mind in delirium. Wine, when drunk, accomplishes all these good purposes; for they become composed by the soothing of their minds, are spontaneously nourished to strength, and are inspired with pleasure.

But when the fever has become protracted and feeble, and the delirium is converted into fatuity, but the hypochondrium is not much injured by swelling, flatulence, or hardness, and the head is the part principally affected, we must boldly wash the head, and practise copious affusions on it; for thus will the habit of body be moistened, the respiration of the head and exhalation over the whole body will be restored; and thus will that which is dry become diluted, and the sense purified of its mist, while the understanding remains sound and firm. These, indeed, are the indications of the removal of the disease.

LETHARGICS are to be laid in the light, and exposed to the rays of the sun (for the disease is gloom); and in a rather warm place, for the cause is a congelation of the innate heat. A soft couch, paintings on the wall, bed-clothes of various colours, and all things which will provoke the sense of sight; conversation, friction along with squeezing of the feet, pulling, tickling. If deep sleep prevail, shouting aloud, angry reproach, threats regarding those matters which he is accustomed to dread, announcement of those things which he desires and expects. Everything to prevent sleep—the reverse of that which is proper for phrenitics.

With regard to the depletion of lethargics this should be known:—If the obliviousness be the sequela of another disease, such as phrenitis, we must not open a vein, nor make a great evacuation of blood in any way, but inject the belly, not solely for the evacuation of its contents, but in order to produce revulsion from above, and to determine from the head: there should be a good deal of salts and natron in it, and it answers very well if you add a sprinkling of castor to the clyster; for in lethargics the lower intestine is cold, and dead, as it were, to evacuation. But, if the lethargy is not the consequence of another disease, but is the original affection, and if the patient appear to be plethoric, provided it be with blood, we must open a vein at the elbow; but, if with a watery phlegm, or other humours, we must purge by means of cneoros ⁵ with the ptisan, or by black hellebore with honeyed-water, in the beginning, if you wish to do so moderately; but if to a greater extent, you must give to the patient when fasting of the medicine called Hiera, to the extent of two drams with three cupfuls of honeyed-water; and, having waited until it purges, then give food, if it be the proper season; but otherwise nourishment is to be given the next day. It will be seasonable then to give in the evening a dram of the hiera, dissolved either in two cupfuls of water or of honeyed-water.

Total abstinence from food is bad, as is also much food. It is proper, then, to administer a little food every day, but not to withdraw food altogether; for the stomach to be reminded of its duties and fomented, as it were, during the whole day. Also the food must be attenuant and laxative, rather in the form of soups than roasted, such as hens or shell-fish; and the herb mercury is to be boiled with it, and some vinegar added. And we may add to the juices, if it be proper to use the juice of ptisan, something to promote exhalation and the discharge of urine, such as fennel, parsley—the pot-herbs themselves, or their fruits. Horehound, also, by its acrid qualities, does good; and likewise colewort with oil, and the brine of fish ( garum). The sweet cumin is a most excellent medicine for the flatulence and urine; for the stomach and bladder are to be stimulated during the whole time of the disease.

The moist applications to the head the same as in the case of phrenitics; for in both the senses are filled with vapours, which must either be expelled by refrigerants and astringents, such as the oil of roses or the juice of ivy, or dissipated into exhalation by attenuants, such as wild thyme in vinegar, with the rose-oil. But if there be pain of the nerves, and coldness of the whole body, but more especially of the extremities, we must besmear and bathe the head and neck with castor and oil of dill, and anoint the spine with the same along with Sicyonian oil, the oil of must, or old oil; at the same time, we must rub both the arms from the shoulders and both the legs from the groins. With these, moreover, the bladder is to be soothed, which suffers, as being of a nervous nature, and is stressed as being the passage for the urine; and also is irritated by the acrimony of the humours, for the urine is bilious. But if the trembling increase, and there be danger of a convulsion, we must necessarily use Sicyonian oil to the head, but use it in small quantity. But if there be inflammation of the hypochondria, and fulness thereof, flatulence, and tension of the skin, or if there be a hollow there from retraction inwards of the hypochondria, we must apply the embrocations and cataplasms, described by us under Phrenitics.

The cupping-instrument is by no means to be used if the disease be the consequence of phrenitis, but this may be done more boldly if it be the original disease. If the tongue be black, and a swelling point in the hypochondria, the cupping-instrument must necessarily be used. When in the course of time the senses have been evacuated, and the patient is otherwise more tolerant of the disease, we may apply the cupping-instrument to the top of the head, since we can evacuate from it without injury to the strength.

Flatulence is to be expelled both upwards and downwards; for lethargy produces collections of flatus both in the cavities and in the whole frame, from inactivity, torpor, and want of spirit, which motion and watchfulness dissipate; wherefore, having rubbed up green rue with honey and natron, we anoint therewith; it will expel the wind more effectually if one part of the resin of turpentine be added to these things. A fomentation also will expel flatus, either with hot unwashed wool, or with rough old rags, or a sponge with water in which hyssop, marjoram, penny-royal, or rue, have been boiled. The potions ⁶ also which are taken before food expel flatus, and these also bring away phlegm and bile in the stomach and bowels; such are hyssop, boiled mulse, Cretan dictamny, or marjoram: maiden-hair and agrostis ⁷ are acrid, but possessed of expulsive qualities, for indeed they evacuate flatus and urine.

If there be trembling of the hands and head, he may take a draught, consisting of castor with three cupfuls of honeyed-water, for some days; or if he will not drink this, we may melt down the castor in a sufficient quantity of oil, wherein rue has been boiled, to the amount of three cupfuls; and a double amount of this is to be injected into the lower bowel, and is to be repeated for several days; and after the benefit derived from it (for it brings off flatus upwards and downwards, and, in certain cases, urine and fæces), if it should be diffused over the whole system in any way, the nerves recover from their tremblings and become strong, and it changes the habit of body to the hot and dry, and alters the constitutions of diseases. It is also a very excellent thing to blow it into the nostrils, for in this way it expels flatulence by sneezing; for as the bladder secretes urine, so does the nose mucus. It effects these things by its gentle heat, in which respect it is superior to the other sternutatories, pepper, hellebore, soap-wort, and euphorbium; for these things, both at their first and last impression are harsh, and disorder the head and the sense, whereas castor gradually creates a gentle heat. To the head it is also otherwise suitable, because the nerves everywhere derive their origin from it; and castor is a remedy for the diseases of the nerves; but to mix it with some one or more of the medicines described will not be disagreeable, for if it be mixed, it will not immediately disorder the head, even in a moderate degree, but after a time it will stir up the heat.

The nose is to be moistened by tickling; by odours acrid indeed to the sense, but possessed of heating powers, such as the castor itself, or savory, or penny-royal, or thyme, either in a green state, or in a dried, moistened well with vinegar.

Anointing with acrid medicines is proper to the feet and knees. The materiel thereof should be heating and pungent by degrees; for there is need of both in cases of lethargy to induce warmth and watchfulness. In the first place, it is proper to whip the limbs with the nettles, for the down thereof sticking to the skin does not endure long, but imparts no disagreeable tingling and pain; it also moderately stimulates, induces swelling, and provokes heat. But if you desire to have these effects produced more powerfully, rub in equal parts of lemnestis ⁸ and euphorbium, with oil of must. It is also a very good thing to rub with raw squill pulverised; but it is necessary to rub off the oily matter of the limb (for everything acrid loses its stimulant properties with oil) — unless it be medicinal — either the oil of privet, or that of must, or the Sicyonian. But if after these things a deep coma prevail, it will be proper, having pounded the wild cucumber with vinegar, and mixed it with an equal quantity of a cake of mustard, to apply this as an acrid cataplasm, and one which will speedily occasion redness, and will also quickly produce swelling. But if there be danger of blistering and of wounds, it will be proper to raise the cataplasm frequently, and see that none of these effects be produced. These things, therefore, are to be done to relieve the torpor and insensibility of the parts at all seasons, except at the commencement of the paroxysms.

But if the patient have already recovered his sensibility, but there is still some heaviness of the head, noise, or ringing thereof, it will be proper to evacuate phlegm by the mouth, first by giving mastich to chew, so that he may constantly spit, then again stavesacre, the granum cnidium, ⁹ but more especially mustard, because it is a common article, and also because it is more of a phlegmagogue than the others. And if the patient drink it willingly, it will be sufficient to dissolve the matters in the stomach, it will also be able to moisten the stomach and expel flatulence; for this once fortunately happened to myself in the case of a man who drank it by my directions; for experience is a good teacher, one ought, then, to try experiments, for too much caution is ignorance.

The head, then, after the hair has been clipped to the skin, if much good is not thereby accomplished, is to be shaven to procure insensible perspiration, and also to allow the anointing with acrid medicines, such as that from lemnestis (or adarce), or thapsia, ¹⁰ or mustard moistened with water; these things, with double the quantity of bread, are to be rubbed on an old piece of skin, and applied to the head, taking good care at the expiry of an hour to foment the parts with hot sponges.

It will also not be devoid of utility, when all, or most at least, of the fatal symptoms of the disease are gone, but the languor remains, to bathe; and then also gestation, friction, and all gentle motion will be beneficial.

IN these cases, indeed, if Marasmus prevail, we must remedy it by quickly having recourse to the bath and to exercises. And truly milk is a remedy of marasmus by nourishing, warming, moistening the stomach, and soothing the bladder. Moreover, the same means are beneficial in cases of catochus, for the form of these diseases is alike and the same. Castor, then, is more particularly proper in these cases, and most particularly soothing, whether to drink, to anoint with, or to inject into the bowel. The affections similar to these which happen to women from the uterus, will be treated of among female diseases.

. . . . . should indeed the apoplexy be severe, for by all means the patients are, as it were, dead men whenever one is old, to whom this affection is congenial, and they cannot survive the greatness of the illness, combined with the misery of advanced life. It has been formerly stated by me, how the magnitude of the disease is to be estimated. If the patient be young, and the attack of apoplexy weak, it is still no easy matter to effect a cure; it must, however, be attempted. The equivalent remedy, then, as being the great assistance in a a great disease, is venesection, provided there be no mistake as to quantity; but the amount is difficult to determine, since if you take a little too much, you despatch the patient at once; for to them a little blood is most potent, as being that which imparts the vital heat to the frame itself, and to the food. But, if the quantity be inferior to the cause, you do little good with this the great remedy, for the cause still remains. But it is better to err on the side of smallness; for, if it should seem to have been deficient, and the appearance of the eyes, as seen from below, be favourable, we can open a vein again. We must open the vein at the hollow of the elbow, for the blood flows readily from it in the left arm. But in smaller attacks of apoplexy, it is necessary to consider whether the paralytic seizure be on the left side or the right. In a word, the abstraction is to be made from the healthy parts, for there the blood flows more freely, and thither the revulsion is made from the parts affected. When, therefore, the patient is seized with apoplexy without any obvious cause, we should decide thus concerning the abstraction of the blood. But if the attack happen from a blow, a fall from a high place, or compression, there must be no procrastination, for in certain cases this alone is sufficient for the cure and to save life.

But if it is not thought expedient to open a vein, owing to the patient’s having been seized with much coldness, torpor, and insensibility, an injection must be given for the evacuation of the engorgement in the bowels (for very generally persons are seized with apoplexy from the immoderate use of food and wine), and for the revulsion of the humours seated in the head. The clyster should be acrid; and an evacuant of phlegm and bile, consisting not only of natron, but also of euphorbium, to the amount of three oboli, added to the usual amount of a clyster, also the medullary part of the wild cucumber, or the decoction of the hair ( leaves) of centaury in oil or water. The following is a very excellent clyster: To the usual amount of honey add rue boiled with oil and the resin of the turpentine tree, and some salts, instead of natron, and the decoction of hyssop.

And if by these means the patient be somewhat aroused, either from being moved by the supervention of fevers, or having recovered from his insensibility, or the pulse has become good, or if the general appearance of the face has become favourable, one may entertain good hopes, and apply the remedies more boldly. Wherefore, when the strength is confirmed, the purgative hiera may be given to the patient fasting, and particularly a full dose. But, if the strength be an objection, it is to be given, to the amount of one-half, with honeyed-water. And we are to move him about, after having laid him stretched on a couch; and those who carry him must do so gently, he being allowed to rest frequently, to avoid inducing lassitude. And if there be a copious evacuation from the bowels, we are to permit it; but if not, give water, or honeyed-water, to the amount of two cupfuls, for drink. And if nausea supervene upon the purging, we are not to interfere with it; for the exertions of the body have some tendency to resuscitate the patient, and the vomiting of the bile carries off the cause of the disease. The medicine hiera is a purger of the senses, of the head, and of the nerves. Enough, indeed, has been said respecting evacuation of every kind at the commencement.

But having wrapped the whole of his person in wool, we are to soak it with some oil — the Sicyonian, oil of musk ( gleucinum), or old oil, either each of these separately, or all mixed together; but it is best to melt into it a little wax, so as to bring it to the thickness of ointments; and it is to be rendered more powerful by adding some natron and pepper: these are to be reduced to a powder, and strained in a sieve. But castor has great efficacy in cases of palsy, both in the form of a liniment with some of the fore-mentioned oils, and it is still more potent when taken in a draught with honeyed-water, the quantity being to the amount we have stated under lethargics; but, at the same time, we must consider the age and disposition of the patient, whether he be ready to take the drink for several days. Inunctions are more powerful than fomentations, as being more easily borne, and also more efficacious; for the ointment does not run down so as to stain the bed-clothes (for this is disagreeable to the patient), and adheres to the body until, being melted by the heat thereof, it is drunk up. Moreover, the persistence of their effects is beneficial, whereas liquid applications run off. The ingredients of the ointments are such as have been stated by me; but along with them castor, the resin of the turpentine-tree, equal parts of euphorbium, of lemnestis, and of pellitory; of pepper, and of galbanum one-half, with triple the amount of Egyptian natron; and of wax, so as to bring it to a liquid consistence. But a much more complex mode of preparing these medicines has been described by me on various occasions, and under a particular head. Cataplasms are to be applied to the hardened and distended parts; their ingredients are linseed, fenugreek, barley-meal, oil in which rue or dill has been boiled, the root of mallows pounded and boiled in honeyed-water, so as to become of the consistence of wax. They should be of a soft and agreeable consistence. These things are to be done if the patient still remains free of fever, or if the fever be slight, in which case no regard need be had to the heat.

But if the fevers be of an acute nature, and the remaining disease appear to be of minor consequence, and if these induce urgent danger, the diet and the rest of the treatment must be accommodated to them. Wherefore, the patients must use food altogether light and of easy digestion; and now, most especially, attention ought to be paid to the proper season for eating, and, during the paroxysms, the whole of the remedial means must be reduced; and, altogether, we must attend to the fevers.

But if the disease be protracted, and if the head be at fault, we must apply the cupping-instrument to the back of the head, and abstract blood unsparingly; for it is more efficacious than phlebotomy, and does not reduce the strength. But, dry-cupping is to be first applied between the shoulders, in order to produce revulsion of the matters in the occiput.

Sometimes, also, the parts concerned in deglutition are paralysed, which is the sole help and safety of persons in apoplexy, both for the swallowing of food and for the transmission of medicines. For not only is there danger of want of nourishment and hunger, but also of cough, difficulty of breathing, and suffocation; for if one pour any liquid food into the mouth it passes into the trachea, neither the tonsils coming together for the protrusion of the food, nor the epiglottis occupying its proper seat where it is placed by nature, as the cover of the windpipe; we must, therefore, pour honeyed-water or the strained ptisan into a piece of bread resembling a long spoon, and passing it over the trachea, pour its contents into the stomach; for in this way deglutition is still accomplished. But if the patient be in the extremity of danger, and the neck with the respiration is compressed, we must rub the neck and chin with heating things and foment. They effect nothing, and are unskilful in the art, who apply the cupping-instrument to the throat, in order to dilate the gullet; for distension, in order to procure the admission of food, is not what is wanted, but contraction of the parts for the purposes of deglutition. But the cupping-instrument distends further; and, if the patient wish to swallow, it prevents him by its expansion and revulsion, whereas it is necessary to pass into a state of collapse, in order to accomplish the contraction of deglutition; and in addition to these, it stuffs the trachea so as to endanger suffocation. And neither, if you place it on either side of the windpipe, does it any good; for muscles and nerves, and tendons and veins, are in front of it.

The bladder and the loose portion of the rectum are sometimes paralysed, in regard to their expulsive powers, when the bowels are constantly filled with the excrements, and the bladder is swelled to a great size. But sometimes they are affected as to their retentive powers, for the discharges run away as if from dead parts. In this case one must not boldly use the instrument, the catheter, for there is danger of inducing violent pain of the bladder, and of occasioning a convulsion in the patient. It is better to inject with no great amount of strained ptisan; and if the bowel be evacuated of the fæces, it will be proper to inject castor with oil. But the sole hope, both of general and partial attacks of paralysis, consists in the sitz bath of oil. The manner of it will be described under the chronic diseases.

EVEN the first fall in epilepsy is dangerous, if the disease attack in an acute form; for it has sometimes proved fatal in one day. The periodical paroxysms are also dangerous; and, therefore, on these accounts, epilepsy has been described among the acute diseases. But if the patient has become habituated to the illness, and the disease has taken a firm hold of him, it has become not only chronic, but, in certain cases, perpetual; for if it pass the prime of life, it clings to him in old age and in death.

Such remedies, then, as are applicable in the chronic state will be described among the chronic diseases; but such things as must be done for a sudden attack of the disease, of these the greater number have been described under apoplectics, namely, venesection, clysters, anointings, the cupping instrument; these means being the most powerful for the purpose of arousing. But I will now describe the peculiar remedies for an attack of the falling sickness. In children, then, to whom, owing to dyspepsia, or from excessive cold, the disease is familiar, vomiting, either of food, or of phlegm, or of any other humour, is beneficial. Feathers, then, dipped in the ointment of iris, excite vomiting; and the unguentum irinum is not inapplicable for smearing the tonsils with. But having first laid the child on his belly (this is the easiest position for vomiting), we must press gently on his lower belly. But if the lower jaw be convulsed or distorted, or if the hands and legs be tossed about, and if the whole face be fixed, the limbs are to be soothed by gentle rubbing with oil, and the distortions of the countenance rectified; the straight parts are to be gently bound, so that they may not become distorted. The cold parts are to be fomented with unscoured wool, or with old rags. The anus is to be rubbed with honey along with the oil of rue, or with natron and liquid resin along with these things; and they are to be gently pushed within the anus, for they expel flatus, and children pass flatus in this disease. But if they can swallow, we may give them of this medicine: Of cardamom, one part; of copper, one siliqua. These things are to be drunk with honeyed-water; for either it is vomited up along with the matter annoying the stomach, or the bowels are opened. This is a very excellent linctus: Of cardamom, of mustard, and of the hair of hyssop equal parts; of the root of iris, one part, with a double quantity of natron; of pepper, to the amount of one-third. Having mixed up all these things together, and having separated the jaw, pour into the mouth, and even beyond the tonsils, so that the things may be swallowed. These things are proper for infants, and for young persons the same are applicable. But the more powerful emetics are to be taken: the bulbous root of narcissus; of mustard and of hyssop, equal parts; of copper and pepper, one-half the proportion of the former things. They are to be mixed with honey and given. These things are proper, in order to rouse from the paroxysm; but those calculated to produce the resolution of the disease will be described under the chronic diseases.

NOW, indeed, a soft, comfortable, smooth, commodious, and warm bed is required; for the nerves become unyielding, hard, and distended by the disease; and also the skin, being dry and rough, is stretched; and the eye-lids, formerly so mobile, can scarcely wink; the eyes are fixed and turned inwards; and likewise the joints are contracted, not yielding to extension. Let the house also be in a tepid condition; but, if in the summer season, not to the extent of inducing sweats or faintness; for the disease has a tendency to syncope. We must also not hesitate in having recourse to the other great remedies; for it is not a time for procrastination. Whether, then, the tetanus has come on from refrigeration, without any manifest cause, or whether from a wound, or from abortion in a woman, we must open the vein at the elbow, taking especial care with respect to the binding of the arm, that it be rather loose; and as to the incision, that it be performed in a gentle and expeditious manner, as these things provoke spasms; and take away a moderate quantity at first, yet not so as to induce fainting and coldness. And the patient must not be kept in a state of total abstinence from food, for famine is frigid and arid. Wherefore we must administer thick honeyed-water without dilution, and strained ptisan with honey. For these things do not press upon the tonsils, so as to occasion pain; and, moreover, they are soft to the gullet, and are easily swallowed, are laxative of the belly, and very much calculated to support the strength. But the whole body is to be wrapped in wool soaked in oil of must or of saffron, in which either rosemary, fleabane, or wormwood has been boiled. All the articles are to be possessed of heating properties, and hot to the touch. We must rub with a liniment composed of lemnestis, euphorbium, natron, and pellitory, and to these a good deal of castor is to be added. The tendons also are to be well wrapped in wool, and the parts about the ears and chin rubbed with liniments; for these parts, in particular, suffer dreadfully, and are affected with tension. Warm fomentations, also, are to be used for the tendons and bladder, these being applied in bags containing toasted millet, or in the bladders of cattle half filled with warm oil, so that they may lay broad on the fomented parts. Necessity sometimes compels us to foment the head, a practice not agreeable to the senses, but good for the nerves; for, by raising vapours, it fills the senses with fume, but relaxes the nervous parts. It is proper, then, to use a mode of fomentation the safest possible, and materials not of a very heavy smell; and the materials should consist of oil devoid of smell, boiled in a double vessel, ¹² and applied in bladders; or of fine salts in a bag: for millet and linseed are pleasant indeed to the touch, but gaseous, and of an offensive smell. The patient having been laid on his back, the fomentations are to be spread below the tendons, as far as the vertex; but we must not advance further to the bregma, for it is the common seat of all sensation, and of all remedial and noxious means it is the starting-point. But if it be necessary to apply cataplasms to the tendons, it must be done below the occiput; for if placed higher, they will fill the head with the steam of the linseed and fenugreek. After the cataplasms, it is a good thing to apply the cupping-instrument to the occiput on both sides of the spine; but one must be sparing in the use of heat, for the pressure of the lips of the instrument is thus painful, and excites contractions. It is better, then, to suck slowly and softly, rather than suddenly in a short time; for thus the part in which you wish to make the incision will be swelled up without pain. Your rule in regard to the proper amount of blood must be the strength. These are the remedies of tetanus without wounds.

But if the spasm be connected with a wound, it is dangerous, and little is to be hoped. We must try to remedy it, however, for some persons have been saved even in such cases. In addition to the other remedies, we must also treat the wounds with the calefacient things formerly described by me, by fomentations, cataplasms, and such other medicines as excite gentle heat, and will create much pus: for in tetanus the sores are dry. Let the application consist of the manna of frankincense, and of the hair of poley, and of the resins of turpentine and pine-trees, and of the root of marsh-mallow and of rue, and of the herb fleabane. These things are to be mixed up with the cataplasms, melting some of them, sprinkling the others upon them, and levigating others beforehand with oil; but the mallow, having been pounded, is to be boiled beforehand in honeyed-water. We are to sprinkle, also, some castor on the ulcer, for no little warmth is thereby communicated to the whole body, because the rigors proceeding from the sores are of a bad kind. Rub the nostrils with castor along with oil of saffron; but also give it frequently, in the form of a draught, to the amount of three oboli. But if the stomach reject this, give intermediately of the root of silphium an equal dose to the castor, or of myrrh the half of the silphium: all these things are to be drunk with honeyed-water. But if there be a good supply of the juice of the silphium from Cyrene, ¹³ wrap it, to the amount of a tare, in boiled honey, and give to swallow. It is best given in this way, as it slips unperceived through the palate; for it is acrid, and occasions disagreeable eructations, being a substance which has a bad smell. But if it cannot be swallowed thus, it must be given dissolved in honeyed-water; for it is the most powerful of all the medicines given to be swallowed, which are naturally warming, diluent, and can relax distensions and soothe the nerves. But if they can swallow nothing, we must inject it into the anus with the oil of castor; and thus the anus is to be anointed with oil or honey. With this, also, we must anoint the fundament, along with oil or honey. But if they will drink nothing, we must make an injection of some castor with the oil. With this, also, we are to anoint the fundament, along with fat or honey; and also foment the bladder; and use it as an ointment, having melted it with a sufficiency of wax to bring it to the proper consistence. But if it be the time for evacuating flatulence and fæces, we are to inject two drams of the purgative hiera along with honeyed-water and oil, since, along with the expulsion of these, it warms the lower belly; for hiera is both a compound and heating medicine.

THERE are two forms of quinsey. The one is attended with heat, and great inflammation of the tonsils, and swelling outwardly; moreover, the tongue, uvula, and all the parts there, are raised up into a swelling. The other is a collapse of these parts, and compression inwardly, with greater sense of suffocation, so that the inflammation appears to be determined to the heart. In it, then, particularly, we must make haste to apply our remedies, for it quickly proves fatal.

If, then, it proceed from taking too much food and wine, we must inject the bowels on the day of the attack, and that with two clysters: the one a common clyster, so as to bring off the feculent matters; and the other for the purpose of producing revulsion of the humours from the tonsils and chest. It will therefore be, but not undiluted . . . . . . . and the decoctions of centaury and hyssop; for these medicines also bring off phlegm. And if the patient has been on a restricted diet, we open the vein at the elbow, and make a larger incision than usual, that the blood may flow with impetuosity and in large quantity; for such a flow is sufficient to mitigate the heat most speedily, is able to relieve the strangulation, and reduce all the bad symptoms. It is no bad practice, likewise, to bring the patient almost to fainting, and yet not so as that he should faint altogether, for some from the shock have died of the fainting . . . . . . . . or binding them with ligatures above the ankles and knees. It is a very good thing, likewise, to apply ligatures to the forearms above the wrists, and above the forearms to the arms. And if deglutition be easy, we are to give elaterium with honeyed-water, and the whey of milk, as much as will be sufficient to purge the patient. In these cases, elaterium is preferable to all other cathartics; but cneoros and mustard are also suitable, for both these purge the bowels. If the inflammations do not yield to these means, having bent the tongue back to the roof of the mouth, we open the veins in it; and if the blood flow freely and copiously, it proves more effectual than all other means. Liquid applications to the inflamed parts, at first of an astringent nature, so as to dispel the morbid matters: unwashed wool, then, with hyssop, moistened in wine, and the ointment from the unripe olive. But the cataplasms are similar to the liquid applications,—dates soaked in wine, and levigated with rose-leaves. But in order that the cataplasm may be rendered glutinous and soft, let flour or linseed, and honey and oil be added, to produce the admixture of all the ingredients. But if it turn to a suppuration, we are to use hot things, such as those used in the other form of synanche. Let fenugreek be the powder, and manna and resin the substances which are melted; and let the hair of poley be sprinkled on it, and a hot fomentation be made with sponges of the decoction of the fruit of the bay and of hyssop. And the powdered dung of pigeons or of dogs, sifted in a sieve, is most efficacious in producing suppuration, when sprinkled on the cataplasm. As gargles, honeyed-water, with the decoction of dried lentil, or of hyssop, or of roses, or of dates, or of all together. We are also to smear the whole mouth, as far as the internal fauces, either with Simples, such as the juice of mulberries, or the water of pounded pomegranates, or the decoction of dates; or with Compound preparations, such as that from mulberries, or that from besasa, ¹⁴ or that from the juice of pomegranates, and that from swallows. But if the ulcers proceed from eschars, these gargles, and washes for the mouth, the decoction of hyssop in honeyed-water, or of fat figs in water, and along with them starch dissolved in honeyed-water, or the juice of ptisan, or of tragus ( spelt?).

But in the species of synanche attended with collapse, we are to make a general determination from within outwardly, of the fluids, of the warmth, and of all the flesh, so that the whole may swell out. Let the liquid applications then be of a hot nature, with rue and dill, natron being sprinkled upon them; and along with them the cataplasms formerly mentioned. It is a good thing also to apply a cerate with natron and mustard for inducing heat; for heat determined outwardly is the cure of such complaints; and thus swelling takes place in the neck, and an external swelling rescues from peripneumonia; but in cases of synanche, the evil when inwardly is of a fatal nature. But those who, in order to guard against suffocation in quinsey, make an incision in the trachea for the breathing, do not appear to me to have proved the practicability of the thing by actual experiment; for the heat of the inflammation is increased by the wound, and thus contributes to the suffocation and cough. And, moreover, if by any means they should escape the danger, the lips of the wound do not coalesce; for they are both cartilaginous, and not of a nature to unite. ¹⁵ * * * * * * * * * * * * * * * * * * * * * * * * * *

OF the affections which form about the columella, some require to be treated by excision; but the surgical treatment of such cases does not come within the design of this work. Some are to be treated as acute affections; for some of them readily prove fatal by suffocation and dyspnœa. These are the diseases which we call uva and columella; for both are attended with inflammation and increase in thickness and length, so that the parts hang down, and come into the arteria aspera. The columna is of equal thickness from the base to the extremity in the palate: the uva is of unequal thickness; for its base at the palate is slender, whereas at its extremity it is rounded and thick, with redness and lividity, whence it gets the appellation of uva. These, then, must be speedily relieved; for the death from suffocation is very speedy.

If, then, the patients be young, we must open the vein at the elbow, and evacuate copiously by a larger incision than usual; for such an abstraction frees one from suffocation, as it were, from strangulation. It is necessary, also, to inject with a mild clyster, but afterwards with an acrid one, again and again, until one has drawn from the parts above by revulsion; and let ligatures be applied to the extremities above the ankles and knees, and above the wrists and forearms to the arms. But if the suffocation be urgent, we must apply a cupping-instrument to the occiput and to the thorax, with some scarifications, and also do everything described by me under synanche; for the mode of death is the same in both. We must also use the same medicines to the mouth, both astringents and emollients, with fomentation of the external parts, cataplasms, and liniments to the mouth. For the forms named columella and uva, as an astringent medicine take the juice of pomegranate, acacia dissolved in honey or water, hypocistis, Samian, Lemnian, or Sinopic earth, and the inspissated juice of sour grapes. But if the diseased part be ulcerated, gum and starch moistened in the decoction of roses or of dates, and the juice of ptisan or of spelt ( tragus). But in columella let there be more of the stronger medicines, from myrrh, costus, ¹⁶ and cyperus; ¹⁷ for the columella endures these acrid substances. But should the part suppurate, in certain cases even the bones of the palate have become diseased, and the patients have died, wasted by a protracted consumption. The remedies of these will be described elsewhere.

IN some respects, the treatment of these is the same as that of the other affections in the tonsils, and in some peculiar. In inflammation and suffocation, the remedies are clysters, venesection, liquid applications, cataplasms, fomentation, ligatures, cupping; and all these are applicable here. But anointing with more potent medicines is proper; for the ulcers do not stop, nor do eschars form on the surface. But if a sanies from them run inwardly, the parts, even if before in a healthy state, very soon become ulcerated, and very soon the ulcers spread inwardly, and prove fatal. It might be beneficial to burn the affection with fire, but it is unsuitable owing to the isthmus. But we must use medicines resembling fire to stop the spreading and also for the falling off of the eschars: these are alum, gall, the flowers of the wild pomegranate, either in a dried state or with honeyed-water. And the same medicines may be blown in by means of a reed, or quill, or a thick and long tube, so that the medicines may touch the sores. The best of these medicines is calcined chalcitis, ¹⁸ with cadmia ¹⁹ triturated in vinegar. Let there be a double proportion of the cadmia, and of the root of rhubarb, with some fluid. It is necessary, however, to guard against their pressure, for the ulcers thus get moist and spread farther. We must, therefore, sprinkle them in a dry state with a quill. But the liquid medicines, having been much diluted, are to be injected upon the columella. But if the eschars be already loosened, and the ulcers become red, there is then most danger of convulsion; for generally the ulcers are dried up, and thereby tonic contractions of the nerves are induced. It is necessary then to soften and moisten by means of milk, with starch, and the juice of ptisan, or of tragus, or linseed, or the seed of fenugreek. In certain cases also the uvula has been eaten down to the bone of the palate and the tonsils to their base and epiglottis; and in consequence of the sore, the patient could neither swallow anything solid nor liquid; but the drink regurgitating has cut him off by starvation.

IN cases of Pleurisy there is no time for procrastination, nor for putting off the great remedy. For the fever, being very acute, hastens to a fatal termination; the pain also of the succingens hurries on to the worse; and moreover coughs which agitate the chest and head exhaust the powers. Wherefore then, on the selfsame day we must by all means open a vein. But if it be in connection with repletion of food and drink, having kept the patient fasting for one day, we are to abstract blood from the vein in the hollow of the elbow, in a line with the opposite side, (for it is better to take it from a very great distance); but not to the extent of deliquium animi, for there is danger of Peripneumonia supervening if the body, being congealed, should leave the soul; for the fluids rush inward when deprived of their external heat and tension. For the Lungs are of loose texture, hot, and possessed of strong powers of attraction; the lungs also are the neighbours of the ribs, and their associates in suffering; and this succession of disease is not readily recovered from; whereas in Pleuritis from Peripneumonia, recovery readily takes place, this combination being milder. It is necessary, therefore, after a moderate flow of blood, to recruit the patient for a time, and afterwards abstract again; if matters go on well, the same day, provided the remission be long; but if not, on the day following. But if there is no remission of the fever (for generally the fever prevails and increases for one day), we are to abstract blood the third day during the second remission, when also food is to be given—after having anointed the patient freely, having also applied to the side soft oil with the heating ointment of rue, or the decoction of dill. A very soothing fomentation is also to be applied to the side. In certain cases, the pain and inflammation are determined outwardly, so as to make it appear an affection of the parts there; but it is merely an exacerbation of the internal symptoms.

Let us now treat of regimen, in order that, respecting all the system of treatment, there may be no mistake. For in food will consist the medicines, but also the medicines in food. In kind, then, it is to be hot and humid, smooth and consistent, detergent, solvent, having the power of dissolving and attenuating phlegm. Of all kinds of food, therefore, ptisan is to be preferred; at the commencement, then, strained to its juice, so that the solid part of it may be separated; and made with honey only; and let the usual articles added to it for seasoning and variety be absent (for now the juice alone is sufficient). It will be calculated to moisten and warm, and able to dissolve and clear away phlegm, to evacuate upwards without pain such matters as should be brought up, and also readily evacuate the bowels downwards. For its lubricity is agreeable and adapted to deglutition. Moreover, its glutinous quality soothes heat, purges the membranes, concocts coughs, and softens all the parts. These are the virtues of barley. The next place to it is held by chondrus, ²⁰ being possessed of some of the good qualities of ptisan. For in regard to its glutinous quality, its lubricity, and its appropriateness for deglutition, it is equal to the other, but in other respects inferior. They are to be made plain, with honey alone. The tragus also is excellent. ²¹ But rice is worse than these, inasmuch as it has the property of drying, roughening, and of stopping the purgation of the sides, rather than of making it more fluid. A very excellent thing is dry bread, broken into pieces, passed through a sieve, gently warmed, well concocted, which with honeyed-water is sufficient nourishment. But if the disease have already progressed, and the patient have given up his food, the ptisan of barley is to be administered in a soft state, and well boiled. Dill and salts are to be the condiments of the ptisan, and oil which is thin, without quality, without viscidity, without asperity; it is better, however, not to boil much of the oil with the ptisan; for thus the draught becomes fatty, and the oil loses its badness, and with much boiling is no longer perceptible, being drunk up by the juice. And let leek with its capillary leaves, and bitter almonds, be boiled with the juice of ptisan; for the draught thus promotes perspiration, and becomes medicinal, and the leeks eaten out of the juice are beneficial and very delicious. Now also is the season for using wholesome eggs; but if the expectoration be fluid and copious, sprinkle on them some native sulphur and natron. But the best thing of all is to give new-laid eggs which have never been subjected to the fire; for the heat of the hen is more humid than fire, and more congenial to the patient, as proceeding from one animal to another. But if the phlegm be glutinous and viscid, pour oil into the eggs, and sprinkle some of the dried resin of pine—so that the sulphur may be more powerful; melting also with them some of the resin of turpentine; pepper also and all cognate substances are beneficial in eggs, and in all kinds of food; the extremities of animals melted down in soups, pigeons, boiled hens; the brains of swine roasted with the cawl, but without it they are not savoury. If the patient has no râle, we must give him fish from the depth of the sea, or rock fish, the best which the country produces. And that the patient may not transgress in regimen, owing to his appetite, nor become wasted by a spare diet, he is to be gratified with some fruit; such as apples boiled in water, or honeyed-water, or stewed in suet (but we must take off the skin and rough parts within along with the seeds,); and in season we may give some figs. We must give likewise of any other kind of autumn fruit which is not only not hurtful but also beneficial. So much with regard to diet.

Wool fumigated with sulphur and moistened with oil in which dill and rue have been boiled, is to be laid on the side. Foment the side constantly with these, and, before the administration of food, apply cataplasms, in addition to the usual ingredients containing melilot boiled with honeyed-water, and mixing therewith some of the fleshy part of the poppy in a boiled state, and sprinkling on it the meal of the manna thuris. ²² But if the expectoration be more fluid and copious, we are to mix the flour of darnel, or of hedge mustard, and sprinkle natron on it. But if the disease be prolonged, the pain having become fixed, and the purging liquid, it is to be apprehended that pus is about to form; wherefore mix with the cataplasms mustard and cachrys; ²³ and if the patients have a feeling as if the internal parts were cold, some vinegar may be poured into it. The heat of the cataplasms should be of a strong kind, that it may last the longer; for this is better than having the heat kept up by renewal of the cataplasms. Let the fomentations consist of salts and millet in bags, or of warm oil in bladders. Every apparatus used for fomentation should be light, so that the weight may not add to the pain. These things moreover are to be used also after the food, if the pain be urgent.

And, in addition to these means, now also should be the time of cupping; but it is best after the seventh day: before this you should not be urgent with it, for the diseases are not of a favourable character which require cupping before the seventh day. Let the instrument be large, broad every way, and sufficient to comprehend the place which is pained; for the pain does not penetrate inwardly, but spreads in width. There should be plenty of heat below the cupping-instrument, so as not only to attract, but also to warm before the extinction of the fire. And after the extinction, having scarified, we are to abstract as much blood as the strength will permit; much more than if you had to take away blood from the hypochondria for any other cause. For the benefit from cupping is most marked in cases of Pleurisy. But salts or natron are to be sprinkled on the scarifications, a pungent and painful practice indeed, but yet a healthful one. But we must estimate the powers and habits of the patient. For if strong in mind and robust in body, we must sprinkle some of the salts, not indeed so as to come into immediate contact with the wounds themselves, but they are to be sprinkled on a piece of linen-cloth damped with oil, and it is to be spread over the place; for the brine which runs from the melting of the salts is less stimulant than the salts themselves. We must also pour in much of the oil, that by its soothing properties it may obtund the pain occasioned by the acrimony of the other. On the second day it will be a very good rule to apply the cupping-instrument again, so as that a thin sanies may be abstracted from the wounds. This, indeed, is much more effectual than the previous cupping, and much less calculated to impair the strength; for it is not blood, the nutriment of the body, but sanies that runs off. This then you are to do after having made a previous estimate of the strength. On the third day we are to apply cerate with the ointments of privet and of rue. But if the sputa still require purging, we are to melt into the cerates some resin, or mix some native sulphur therewith, and again the part is to have a fomentation. With regard to the form of the cupping-instrument, it should either be an earthen vessel, light, and adapted to the side, and capacious; or, of bronze, flat at the lips, so as to comprehend the parts affected with pain; and we are to place below it much fire along with oil, so that it may keep alive for a considerable time. But we must not apply the lips close to the skin, but allow access to the air, so that the heat may not be extinguished. And we must allow it to burn a long while, for the heat within it, indeed, is a very good fomentation, and a good provocative of perspirations.

And we must not overlook purging downwards, in men injecting oil of rue into the gut, and, in women, also into the womb. And let something be constantly drunk and swallowed; for this purpose, honeyed-water, with rue and juice of ptisan, if there is a constant cough, as being a medicine in the food. But if it is not the season of administering food, let it be one of the compound preparations, such as butter boiled with honey to a proper consistence. Of this, round balls the size of a bean are to be given to hold under the tongue, moving them about hither and thither, so that they may not be swallowed entire, but melted there. The medicine also from poppies with honey and melilot is agreeable, being possessed of soothing and hypnotic properties. This is to be given before the administration of food, after it, and after sleep. To the patient when fasting, the following medicinal substances are to be given: of nettle, of linseed, of starch, and of pine fruit in powder, of each, a cupful ( cyathus), and of bitter almonds twenty-five in number, and as many seeds of pepper. These things being toasted and triturated with honey, are to be mixed up into a linctus; of these the dose is one spoonful ( cochleare). But if he expectorate thin and unconcocted matters, two drams of myrrh, one of saffron, and fifteen grains of pepper to be mixed with one pound of honey. This medicine should be given also before the administration of food to the amount of half a spoonful. It is good also in chronic cases, when oxymel likewise is to be given if the dyspnœa be urgent.

Such physicians as have given cold water to pleuritics, I cannot comprehend upon what principle they did so, nor can I approve the practice from experience; for if certain patients have escaped the danger from having taken cold water, these would appear to me not to have been pleuritic cases at all. But by the older physicians, a sort of congestion was called pleuritis, being a secretion of bile with pain of the side, attended with either slight fever or no fever at all. This affection, indeed, got the name of pleurisy, but it is not so in reality. But sometimes a spirit (or wind, pneuma) collecting in the side, creates thirst and a bad sort of pain, and gentle heat; and this ignorant persons have called pleurisy. In them, then, cold water might prove a remedy through the good luck of the person using it; for the thirst may have been extinguished, and the bile and wind expelled downwards, while the pain and heat have been dissipated. But in inflammation of the side and swelling of the succingeus, not only cold water but also cold respiration is bad.

If, then, owing to the treatment formerly described persons affected with pleurisy survive the attack, but have still a short cough, and now and then are seized with heat, we must hasten to dissipate these symptoms; for the residue of the disease either produces a relapse, or it is converted into a suppuration.