INFLAMMATION and swelling of the lungs, and along with them a sense of suffocation, which does not long endure, constitute a very acute and fatal ailment. The remedies opposed to it, therefore, ought to be of equal power and speedily applied. We are to open instantly the veins at the elbow, and both together, on the right and on the left side, rather than abstract blood from one larger orifice, so that revulsion of the humours may take place from either side of the lungs: but we must not carry it to the extent of deliquium animi for the deliquium cooperates with the suffocation. But when even a small respite has been obtained, we must suppress the flow and abstraet more afterwards; for, if the exciting causes be from blood, the venesection carries them away; and if phlegm, or froth, or any other of the humours be the agent, the evacuations of the veins widen the compass of the lungs for the passage of the breath.

We must expel the fluids and flatus downwards, by anointing the anus after the venesection with natron, honey, rue, and the liquid resin from turpentine. Instead of the venesection,—provided there be a greater impediment,—we must give a clyster of acrid juice, namely, of salts, in addition to the natron, and turpentine resin with the honey; and rue boiled in the oil, and hyssop boiled in the water; and the fleshy parts of the wild cucumber, boiled with water, are very excellent.

Dry-cupping applied to the back, the shoulder, and the hypochondria, is altogether beneficial. And if the chest be fleshy, so that the cupping-instrument may not by its pressure bruise the skin about the bones, it is to be also applied there; for if the humours be attracted from all parts of the body, and the spirit ( pneuma) be determined outwardly, in those cases in which the lungs are, as it were, choked, there will be respite from the mischief; for peripneumonia is to be attacked in every possible way.

But, likewise, neither are we to neglect any of the medicines which prove useful when swallowed by the mouth, for the lungs attract fluids whether they be in health or diseased. We must, therefore, give such medicines as attenuate the fluids so as to promote their perspiration, and such as will lubricate and render them adapted for expectoration. For speedy relief, then, natron is to be drunk with the decoction of hyssop, or brine with vinegar and honey; or mustard moistened with honeyed-water; and we may confidently sprinkle on each some of the root of iris and pepper. But also these things, having been sifted, are to be given in a powder along with honey. But if the patients get no sleep during the day, and remain sleepless also during all the night, it is to be feared lest they become delirious, and there will be need of various soporific medicines unless the disease give way, so that the seasonable administration of these medicines may lull the suffering, for these things are usually soporific. But if you give a medicine at the acme of the suffocation, or when death is at hand, you may be blamed for the patient’s death by the vulgar.

The food also must be suitable, acrid, light, solvent of thick matters, detergent: of pot-herbs, the leek, or the cress, or the nettle, or the cabbage boiled in vinegar; of austere things ( frumentacea?) the juice of ptisan, taking also of marjoram, or of hyssop, and of pepper, and more natron instead of the salts. Also spelt in grains well boiled with honeyed-water: in the course of the boiling, they should all be deprived of their flatulence, for flatulent things are hurtful to persons in peripneumonia. If they are free from fever, wine is to be given for drink, but not such as is possessed of much astringency, for astringency condenses bodies; but in these the parts are rather to be relaxed. We must also promote the expulsion of the sputa. On the whole the drink should be scanty, for drenching is prejudicial to the lungs, because the lungs attract from the stomach and belly.

Let the chest be covered up in wool, with oil, natron, and salts. The best ointment is that prepared of the lemnestis, and dried mustard with liquid cerate; and, on the whole, we are to determine outwardly the fluids, the heat, and the spirit ( pneuma). And smelling to acrid things is beneficial, also anointings, and ligatures of the extremities. When these things are done, if the disease do not yield, the patient is in a hopeless condition.

ALL the forms of the bringing up of blood are of an unmild character, not only as to mode, whether the flow proceed from rupture, erosion, or even rarefaction; and whether it come from the chest, the lungs, the stomach, or the liver, which are the most dangerous cases; but also from the head, although it occasions less mischief. For the flow is of blood; and blood is the food of all parts, the heat of all parts, and the colour of all parts. It is dreadful to see it flowing from the mouth in any way; but bad indeed if it proceed from an important viscus, and still worse if it proceed from rupture and erosion.

It is necessary, therefore, that the physician should make the more haste in bringing assistance to this affection; and, in the first place, the patient must get coldish air to breathe, a chamber on the ground, and a couch firmly fixed, so that he may not be shaken (for all shaking is stimulant); the bed should be solid, not very yielding, nor deep, nor heated; his position erect; rest from speaking and hearing; tranquillity of mind, cheerfulness, since depression of spirits especially accompanies these cases; for who is there that does not dread death when vomiting blood?

If, therefore, the patient be full of blood, and have large veins, in every form of rejection we must open a vein; whether it proceed from rupture, or erosion, venesection is very suitable; and even, if from rarefaction, there is danger, lest the fulness of blood burst forth. ¹ And we are to open the hollow vein at the elbow (for the blood flows readily from it, and it is easily opened, and the orifice can be safely kept open for several days). In a word, then, in all the diseases of all the vital organs, this is the outlet of the blood. For the one higher up and this are both branches of the humeral, so that the one above can have no more remedial power than the mesal. They are ignorant of these divisions who have connected the upper vein with the stomach and liver. But if the flow proceed from the spleen, they direct us to open the vein of the left hand, which runs between the little finger and the one next the middle; for certain physicians held it to terminate in the spleen; but it is a branch of the vein below those at the elbow. Why, then, should we rather open the vein at the fingers than the one at the elbow? for there it is larger, and the blood flows readily from it. Altogether, then, we are to stop before coming to deliquium animi. Yet neither, also, is much blood to be abstracted; for the hemorrhage itself is calculated to enfeeble the patient; but, after abstracting a small quantity, repeat the bleeding the same day, the next, and the day following. But if the patient be thin, and scantily supplied with blood, we must not open a vein. So much respecting the abstraction of blood.

We are also to assist by means of ligatures to the extremities. Above the feet to the ankles and knees, and above the hands to the wrists and arms, a broad band is to be used, so that the constriction may be strong, and yet not produce pain. To the regions, also, from which the blood flows, we are to apply unwashed wool from the sheep; but moisten it with a liquid, such as austere wine, and the oils of roses and of myrtles. But if the hemorrhage be of an urgent nature, instead of the wool we are to use sponges, and vinegar instead of the wine, and let the part be anointed with myrtle oil; and we are to dust upon the sponges some of the dry inspissated juices, such as that of acacia, or of hypocistis, or else of aloes. The juice of the unripe grape, dissolved in vinegar, is also a very excellent thing. But if the liquid application be troublesome or disagreeable, we are to use plasters; for these stretch the skin around, and press it, as it were, with the hand, and they are possessed of very strong powers as astringents and desiccants. In addition to these, there are very many others of tried efficacy; but the best are those which contain vinegar, and the expressed juice of ivy leaves, and asphaltos, and verdigris, alum, frankincense, myrrh, calcined copper, the squama æris, and such of the plasters as resemble these; or unscoured wool, or sponges damped in a small quantity of vinegar. But if the patients cannot bear the distension of the plasters, we are to make these things into an epitheme: fat dates, damped in dark austere wine, are pounded into a cake; then we are to sprinkle on it acacia in a soft state, and the rinds of pomegranate; these things having been all rubbed upon a rag, are applied to the chest. Barley-meal, moistened in wine or vinegar, or the fine flour of the dried lentil, sifted in a sieve, and made up with cerate or rose ointment, is to be applied; we are also to mix some of the root of the comfrey sifted. Another: Boil the roots of the wild prunes in vinegar, and having pounded into a cake, mix a little of sumach, and of gum, and of myrtle. These are to be mixed with one another differently, according as the strength of the medicines, mildness, or smell thereof is wanted. For we must also gratify the sick. These are the external remedies.

But a more important part of the treatment lies in things drunk and swallowed, since these remedies come nearest the injured parts. Of these there are three distinct kinds: either they are calculated by the contraction or compression of the vessels to bind the passages of the flux; or to incrassate and coagulate the fluid, so that it may not flow, even if the passages were in a state to convey it; or to dry up the outlets, by retaining the blood in its pristine state, so that the parts may not thus remain emptied by the flux, but may regurgitate where the effusion is. For rarefaction of the veins, astringency is sufficient, for it runs through the pores like a fluid when poured into a water-cask newly wetted. And also in the division of vessels stypticity is the remedy, by producing contraction of the lips; but for this purpose we must use the greater and more powerful medicines. But if the form of hemorrhage be that from erosion, and if the lips of the ulcer do not coalesce by the action of the astringents, but the wound gapes, and cannot be brought together by compression, we must produce congelation of the blood, and also of the heat; for the flow is stopped by the immobility and coagulation of these. To the rare parts, then, oxycrate is sufficient for producing astriction; for the fluid is not pure blood, but the sanies thereof from small orifices; and even of this medicine, there is no necessity of much being given, or frequently; and in certain cases, the external treatment is sufficient. So, likewise, the decoction of dates and of edible carobs, when drunk, has by itself proved sufficient. Let the vinegar be from wines of an astringent nature, and if not by pharmaceutical preparation, at all events let it be such as by time has become acrid and astringent. But in dilatations of the wounds, in addition to the oxycrate, let there be given the simple medicines at first, such as the juice of plantain, of knot-grass, or of endive; of each an equal part with the oxycrate. But if the flow increase, sprinkle on it one dram of the dried hypocistis, or of acacia, on three cupfuls of the oxycrate. The juice, also, of the wild grape is very excellent. But if the ailment prevail over this, sprinkle on it triturated gall, and the dried root of the bramble, and the sea stone, the coral, triturated and dried. But the root of rhubarb is more powerful than these to cool, to dry, to astringe; in short, for every purpose. But it is used with the oxycrate alone; or, if more powerful things are required, as a remedy. To the juices of endive with plantain we add some of the root, namely, three oboli of it to three or four cyathi of the fluid. But in crosions, we must produce astringency even in it, so as to induce coagulation of the blood that flows, and also for the sake of the containing vessels, so that the veins which have sustained a large wound may shut their mouths. But the medicines which are drunk should be strong, and capable of inducing coagulation. Wherefore, give the juice of coriander with vinegar, and the rennet of a hare, or of a hind, or of a kid, but not in great quantity (for certain of these have proved fatal in a large dose); but of the juice of the coriander give not less than half a cyathus to three of the oxycrate, and of the rennet three oboli, or at most four. For such modes of the flow, the Samian earth is very excellent, and the very white Aster, and the Eretrian, and the Sinopic, and the Lemnian seal: of these, at least, one dram weight, and at most three, with some of the decoctions, as of dates, or of edible carobs, or of the roots of brambles. But if there be roughness of the windpipe, and cough along with it, we must sprinkle these things on Cretic rob. Starch, dissolved in these, is a most excellent thing for lubricating the windpipe; for along with its power of lubricating, it also possesses that of agglutinating. If, therefore, the flow of blood be not urgent, it must be given once a day, before the administration of food; but if it be urgent, also a second and third time in the evening. And from the medicines are to be made draughts of the dried substances with honey, boiled to the proper consistence; galls pulverised: and a very good thing is sumach for the condiments, also grape-stones, and the fruit of the sharp dock, either each by itself, or all together. These things, moreover, are good to be kept below the tongue during the whole time of melting; but likewise common gum with the plant, (?) and the gum tragacanth. The compound medicines of tried efficacy are infinite; and various are the usages of trochisks—of that from Egyptian thorn, of another from amber, and another named from saffron, of which the composition has been described separately.

In the absence of fevers, everything is to be attempted in regard to medicines, giving them copiously and frequently. But if fever come on—and most frequently fever takes place, along with inflammations of the wounds—we must not stop the flow suddenly, nor give medicines during the paroxysms, for many die sooner of the fevers than of the flow of blood.

The articles of food are various in kind like the medicines, but also the medicines are in the food; for neither would it be easy to find all the good properties of food in any one article, nor even if a solitary thing were sufficient for the cure, should one only be used, as one would thus readily produce satiety; but we must grant variety if the disease should prove prolonged. Let the food, then, be astringent and refrigerant in properties, as also to the touch, for heat encourages bleeding. Washed alica; rice added to oxycrate; but if the vinegar excite coughing, the decoction of dates; baked bread which has been dried and pounded down to meal, and sifted. Of all these things a draught is to be made with oil; savory seasoned with salts, and sumach to be sprinkled upon it. And if you wish to gratify the patient’s palate, let coriander be added, for this purpose, whenever it is agreeable, or any of the diuretic and diffusible seeds. Lentil, then, with the juice of plantain, if the hemorrhage be urgent, but if not, we should spare the juice, for neither is it of easy digestion, nor pleasant to the taste; for in these cases we must not give indigestible things. But if you apprehend death from the hemorrhage, you must also give what is unpalatable and indigestible; nay, let even harsh things be given if they will preserve life; wherefore, let galls, dried and pulverised, be sprinkled when dry, and cold lentil: eggs thick from boiling, with the seeds of pomegranate or galls, for the food necessarily consists in the medicines. The drink altogether should be scanty, since liquids are incompatible with a dry diet. These are the proper things, provided you wish to astringe and cool. But if you wish also to thicken the blood and spirit ( pneuma), milk along with starch and granulated spelt ( chondrus), the milk being sometimes given with the starch, and sometimes with the chondrus; they should be boiled to such a consistence as that the draught may not be liquid. But if you wish to incrassate and astringe still more, let the chondrus be boiled with dates, and for the sake of giving consistence, let there be starch and milk; and the Tuscan far is a very excellent thing, being thick, viscid, and glutinous when given along with the milk; the rennet of the kid is to be added to the liquid decoctions for the sake of coagulation, so that with the milk, it attains the consistency of new cheese: still thicker than these is millet boiled with milk like the far, having gall and pomegranate rind sprinkled on it as a powder. But we must look to the proportions of the desiccants and incrassants, for all these things provoke coughing, and in certain cases, from excess of desiccant powers, they have burst the veins. But if things turn out well, and the blood is stopped, we must gradually change to the opposite plan of treatment, and nothing in excess, for these cases are apt to relapse, and are of a bad character. We must also strive to put flesh and fat on the patient by means of gestation, gentle frictions, exercise on foot, recreation, varied and suitable food.

These are the means to be used if, after the flow of blood, the wound adhere and the part heal properly. But if the ulcer remain and become purulent, another plan of treatment is needed, for a discharge of different matters succeeds. This, however, will be treated of among the chronic diseases.

IN Syncope, it is necessary that the physician should exercise fore-knowledge; for, if you foresee its approach, and if things present co-operate strongly with you, ² you may avert it before its arrival. When it is come on, patients do not readily escape from it, for I have said that syncope is the dissolution of nature; and nature when dissolved cannot be restored. We must try to prevent it then, when still impending, or if not, at the commencement. We must form our prognosis from the circumstances stated by us among the acute diseases, where we have described the cause and also the symptoms. The fever Causus, then, is the commencement of the attack, and with Causus the worst of symptoms, dryness, insomnolency, heat of the viscera, as if from fire, but the external parts cold; the extremities, that is to say, the hands and feet, very cold; breathing slowly drawn; for the patients desiderate cold air, because they expire fire: pulse small, very dense, and trembling. Judging from these and the other things stated by me among the symptoms, you will immediately give assistance at the commencement.

Unless, then, when everything is against it, the habit, the age, the season, the timidity of the patient, we must open a vein, and even if many symptoms contra-indicate it, but an especial one require it, such as the tongue rough, dry, and black (for it is indicative of all the internal parts). And in all cases we must form an estimate of the strength, whether or not it has failed owing to the pains of the disease and the regimen; for the loss of strength takes place, not only from deficiency, but also from smothering; and if the syncope arise from redundancy, and if inflammation of the hypochondria, or of the liver strongly indicate, there is no necessity for deferring the bleeding. We are to open the hollow vein at the elbow, and abstract the blood by a small orifice, that it may not have a marked effect on the strength; for sudden depletion tries the natural strength: and we must take away much less than if from any other cause; for in syncope, even a slight mistake readily sends a man to the regions below. We must, therefore, immediately give food for the restoration of the strength; for Nature delights in the removal of the old, and in the supply of new things.

But if the strength reject venesection, and inflammations be present, we must apply the cupping-instrument to the seat thereof a considerable time previous to the crisis of the disease; for the crisis takes place at the critical periods; since at the same periods Nature brings on a favourable crisis, and diseases prove fatal. And if the patient should come to such a state as to require wine, it is not very safe to take wine in inflammations; for, wine to persons labouring under inflammation is an increase of the pains, but to those free from inflammation it is an increase of the natural strength. A day or two before the cupping there is need of cataplasms, both in order to produce relaxation of the parts and to procure a flow of blood; and in certain cases, after the cupping, we are to apply a cataplasm on the next day. In this, too, let there be moderation; for there is the same danger from the abstraction of too much blood by cupping. Use clysters only for removing scybala which have long lodged in the bowels; but spare the strength.

Cold lotions to the head, such as have been directed by me under Phrenitis, but somewhat more liberally. Pure air, rather cooler than otherwise, for respiration. The delight of the sight is to be studied as to plants, painting, waters, so that everything may be regarded with pleasure. The conversation of attendants cheerful; silence and cheerfulness on the part of the patient. Smells fragrant, not calculated to prove heavy to the senses in the head. And let the articles of food also possess a fragrant smell, such as flour moistened with water or vinegar; bread hot, and newly baked. The mouth not to be very often rinsed with wine, nor is it to be altogether rejected.

Drink to be given more frequently and more copiously than in other complaints. Food every day, light, digestible, mostly from grain, and that which is pleasant, even if somewhat less suitable. For, in these cases, rather than in any other, the palate is to be gratified, since not unusually the disease is generated in the stomach, so as to occasion resolution thereof. Abstinence or famine by no means; for the disease is sufficient to devour up all. But if the period be already come to a crisis, if there be a dew on the clavicle and forehead, the extremities cold; the pulse very small and very frequent, as if creeping, and feeble in tone, the patient must take a little food, and partake of wine effectually. The head, too, is to be strengthened by lotions, as also the bladder. These remedies have been described by me under Phrenitis. We are to give wine, not copiously nor to satiety, for certain patients by unseasonable repletion have died of anorexia, and inability to eat and drink; and to many patients having a good appetite, when the natural powers were dissolved, the abundant supply of food was of no avail; the food descending, indeed, into the stomach, but not ascending from the belly to recruit the strength. Let the food, therefore, be diversified, for the most part from grain, so as that it may be supped rather than masticated; or if solid, let it be made easy to swallow. Eggs, not quite consistent nor roasted whole, but deprived of their solid portion; two or three pieces of bread soaked in wine, at first hot; but, after these, everything cold, unless there be latent inflammations. The wine is to be fragrant, and not very astringent; but by no means thick. Of the Greek wines, the Chian or Lesbian, and such other of the insular wines as are thin; of the Italian, the Surrentine, or Fundan, or Falernian, or Signine, unless it be very astringent; but of these we must reject such as are very old or very young. It is to be given at first hot, to the amount of not less than four cyathi, before the crisis, nor more than a hemina even if the patient be accustomed to drink. But after these things, having given food, if the symptoms of inflammation be past, we are again to give it cold as if for a remedy of the thirst; but this from necessity, and not by itself, but along with the food. We must also take care that the wine do not affect the brain; and after this, abstain. And if after an interval, he wish to sleep, quiet is to be enforced. But if much sweat flow, the pulse come to a stop, the voice become sharp, and the breast lose its heat, we are to give as much wine as the patient can drink. For those who are cold, wine is the only hope of life. Wine, therefore, if the patient be accustomed to it, is sometimes to be taken in drink, and sometimes food is to be eaten with the wine, after an interval, as a respite from the fatigue induced by the disease and the food, for when the strength is small, they are much fatigued, even by the act of taking food. Wherefore the patient must be stout-hearted and courageous, and the physician must encourage him with words to be of good cheer, and assist with diversified food and drink.

The other treatment is also to be applied energetically for restraining the sweats, and for resuscitating the spark of life. Let, therefore, an epitheme be applied to the chest on the left mamma,—dates triturated in wine along with aloes and mastich,—and let these things be mixed up with a cerate composed of nard. ³ And if this become disagreeable, we may apply another epitheme, made by taking the seed, and whatever is hard out of the apples, and having bruised them down, mix up with some fragrant meal; then we are to mix together some of the hair of wormwood, and of myrtle, and of acacia, and of the manna of frankincense, all sifted; which being all rubbed up together, are to be added to the cerate of wild vine. But if the sweat be not thereby restrained, the juice of the wild grape is to be added to the mixture, and acacia, and gum, and the edible part of sumach, and alum, and dates, and the scented juice of roses. All these things along with nard and oil of wild vine are to be applied to the chest; for this at the same time cools and is astringent. Let him lie in cool air, and in a house having a northern exposure; and if the cool breeze of Boreas breathe upon him, it will refresh his soul sadly gasping for breath. The prospect should be to-wards meadows, fountains, and babbling streams, for the sweet exhalations from them, and the delightful view, warm the soul and refresh nature. And, moreover, it is also an incentive to eat and to drink. But if from want one is not fortunate enough to possess these things, we must make an imitation of the cool breeze, by fanning with the branches of fragrant boughs, and, if the season of spring, by strewing the ground with such leaves and flowers as are at hand. The coverlet should be light and old, so as to admit the air, and permit the exhalation of the heat of the chest; the best kind is an old linen sheet. We are to sprinkle the neck, the region of the clavicle and chest with flour, so that it may nourish by its fragrance, and restrain by its dryness; and the spongy parts of the body are to be dusted with meal, but the face with the Samian earth, which is to be passed through a sieve; and having been bound into a spongy cloth, it is to be dusted on the part, so that the finer particles may pass through the pores to the forehead and cheeks. And slaked lime and roasted gypsum, sifted in a small sieve, are to be applied to the moist parts. A sponge out of cold water applied to the face has sometimes stopped the sweats, by occasioning congelation of the running fluids, and by condensation of the pores. The anus is to be anointed, so that the flatus arising from the cold and food may be discharged. And we are to recall the heat of the extremities by gleucinum, ⁴ or Sicyonian oil, along with pepper, castor, natron, and cachry, ⁵ melting into them a little wax, so that the liniment may stick. And we are to resuscitate the heat by means of the ointment of lemnestis, and of euphorbium, and of the fruit of the bay. The small red onions raw, along with pepper, and the powdered lees of vinegar, make an excellent cataplasm to the feet; but it is to be constantly raised from the place every hour, for there is danger of ulceration and blisters. From these things there is hope that the patient may thus escape.

And if the physician should do everything properly, and if everything turn out well, along with the syncope the inflammations that supervene are resolved; and sweat, indeed, is nowhere, but a restoration of the heat everywhere, even at the extremities of the feet and the nose; but the face is of a good colour; pulse enlarged in magnitude, not tremulous, strong; voice the same as customary, loud, and in every respect lively. Lassitude not out of place, but the patient is also seen sleeping: and, if sleep seize him, he digests his food, recovers his senses, and sprouts out into a new nature; and if roused from sleep, the breathing is free, he is light and vigorous; and here calls to his memory the circumstances of the disease like a dream.

But in other cases obscure fevers are left behind, and sometimes slight inflammations, and a dry tongue: they are parched, have rigors, are enfeebled, and relaxed, in which cases there is a conversion to marasmus; when we must not waste time with rest and a slender diet, but have recourse to motions, by gestation, and to friction and baths, so that the embers of life may be roused and mended. We are to give milk, especially that of a woman who has just borne a child, and that a male child; for such persons require nursing like new-born children. Or if it cannot be obtained, we must give the milk of an ass which has had a foal not long before, for such milk is particularly thin; ⁶ and by these means the patient is to be brought back to convalescence and his accustomed habits.

IN Cholera, the suppression of the discharges is a bad thing, for they are undigested matters. We must, therefore, readily permit them to go on, if spontaneous, or if not, promote them by giving some tepid water to swallow, frequently indeed, but in small quantity, so that there may be no spasmodic retchings excited in the stomach. But if there also be tormina and coldness of the feet, we are to rub the abdomen with hot oil, boiled with rue and cumin, to dispel the flatulence; and we are to apply wool. And, having anointed the feet, they are to be gently rubbed, stroking them rather than pinching them. And these things are to be done up to the knees for the restoration of the heat; and the same is to be practised until the fæces pass downwards, and the bilious matters ascend upwards.

But if all the remains of the food have been discharged downwards, and if bile be evacuated, and if there still be bilious vomiting, retchings, and nausea, uneasiness and loss of strength, we must give two or three cupfuls ( cyathi) of cold water, as an astringent of the belly, to stop the reflux, and in order to cool the burning stomach; and this is to be repeatedly done when what even has been drunk is vomited. The cold water, indeed, readily gets warm in the stomach, and then the stomach rejects it, annoyed as it is both by hot and cold: but it constantly desiderates cold drink.

But, if the pulse also fall to a low state, and become exceedingly rapid and hurried, if there be sweat about the forehead and region of the clavicles, if it run in large drops from all parts of the body, and the discharge from the bowels is not restrained, and the stomach still vomits, with retchings and deliquium animi, we must add to the cold water a small quantity of wine, which is fragrant and astringent, that it may refresh the senses by its bouquet, contribute to the strength of the stomach by its spirit, and to the restoration of the body by its nutritious powers. For wine is swiftly distributed upwards over the system, so as to restrain the reflux; and is subtil, so that when poured into the frame it strengthens the habit, and it is strong so as to restrain the dissolving powers. We are also to sprinkle on the body some fresh and fragrant meal. But if the bad symptoms become urgent, with sweating, and strainings, not only of the stomach, but also of the nerves, and if there be hiccups; and if the feet are contracted, if there be copious discharges from the bowels, and if the patient become dark-eoloured, and the pulse is coming to a stop, we must try to anticipate this condition beforehand; but if it be come on, we must give much cold water and wine, not indeed wine slightly diluted, for fear of intoxication, and of hurting the nerves, and along with food, namely, pieces of bread soaked in it. We are likewise to give of other kinds of food, such as have been described by me under syncope, autumnal fruit of an astringent nature, services, medlars, quinces, or the grape.

But if everything be vomited, and the stomach can contain nothing, we must return again to hot drink and food, for in certain cases the change stops the complaint; the hot things, moreover, must be intensely so. But if none of these things avail, we are to apply the cupping-instrument between the shoulder-blades, and turn it below the umbilicus; but we are to shift the cupping-instrument constantly, for it is painful when it remains on a place, and exposes to the risk of blistering. The motion of gestation is beneficial by its ventilation, so as to recreate the spirit ( pneuma), stay the food in the bowels, and make the patient’s respiration and pulse natural.

But if these symptoms increase, we must apply epithemes over the stomach and chest; and these are to be similar to those for syncope—dates soaked in wine, acacia, hypocistis, mixed up with rose cerate, and spread upon a linen cloth, are to be applied over the stomach; and to the chest we are to apply mastich, aloe, the pulverised hair of wormwood, with the cerate of nard, or of wild vine, as a cataplasm to the whole chest; but if the feet and muscles be spasmodically distended, rub into them Sicyonian oil, that of must, or old oil with a little wax; and also add in powder some castor. And if the feet also be cold, we are to rub them with the ointment containing lemnestis and euphorbium, wrap them in wool, and rectify by rubbing with the hands. The spine also, the tendons, and muscles of the jaws are to be anointed with the same.

If, therefore, by these means the sweat and discharges from the bowels are stopped, and the stomach receives the food without vomiting it again, the pulse becomes large and strong, and the straining ceases; if the heat prevails everywhere, and reaches the extremities, and sleep concocts all matters, on the second or third day the patient is to be bathed, and remitted to his usual course of living. But if he vomit up everything, if the sweat flow incessant, if the patient become cold and livid, if his pulse be almost stopped and his strength exhausted, it will be well in these circumstances to try to make one’s escape with credit.

IN Ileus it is pain that kills, along with inflammation of the bowels, or straining and swelling. A most acute and most disgusting form of death! For others, when in a hopeless state of illness, fear nothing except their impending death; but those in ileus, from excess of pain earnestly desire death. The physician, therefore, must neither be inferior to the affection, nor more dilatory; but, if he find inflammation to be the cause, open a vein at the elbow by a large orifice, so that blood, which is the pabulum of the inflammation, may flow copiously; and it may be carried the length of deliquium animi, for this is either the commencement of an escape from pain, or of a torpor ending in insensibility. For in ileus a breathing-time for a short space, even from loss of sensibility, will prove an interval from pain; since, also, to persons enduring these pains, to die is happiness, but to impart it is not permitted to the respectable physician; but at times it is permitted, when he foresees that present symptoms cannot be escaped from, to lull the patient asleep with narcotics and anæsthetics.

But if the ileus arise without inflammation, from corruption of the food or intense cold, we are to abstain from bleeding, but at the same time to do all the other things, and procure vomiting frequently by water, and drinking plenty of oil; then, again, we are to procure vomiting, and produce the expulsion of the flatus downwards, by stimulant medicines. Such a stimulant is the juice of sow-bread, and natron, or salts. Cumin and rue are carminatives. Wherefore we must rub in together all these things with turpentine resin, and foment with sponges; or we must inject with these things and oil, honey, hyssop, and the decoction of the fleshy parts of the wild cucumber. And if feculent matter be evacuated, we are again to inject hot oil with rue; for, if this remain inwardly, it proves a grateful fomentation to the bowels: and apply to the suffering parts lotions composed of oil which has been strongly boiled with rue and dill. And the fomentation is also to be applied, either by means of earthen or brazen vessels, or with millet and roasted salts. In addition to the ordinary cataplasms, one may be made of the flour of darnel and cumin, and the hair of hyssop and of marjoram. Cupping, without the abstraction of blood, indeed, but frequently applied, sometimes to one place, and sometimes to another—to the epigastric region, and to the loins as far as the groins, and behind to the ischiatic region as far as the kidneys and spine; for it is expedient to produce revulsion of the pain by all means. They should also get whetters ( propomata ⁷ ) of the decoction of cumin, or of rue, and of sison; ⁸ or along with these some of the anodyne medicines. Of these there are very many of tried efficacy. The medicine from vipers is also a good one, when drunk to a larger amount than usual. But if neither the pain remit, nor the flatulence nor fæces pass, we must necessarily give of the purgative hiera; for either the medicine is rejected with phlegm and bile, or it passes downwards, bringing off flatus, scybala, phlegm, and bile, which occasion the intensity of the evil. Laxative food: soups of hens, of shell-fish; the juice of ptisan boiled with much oil poured in at first before the boiling; boil along with it cumin, natron, leek with its hair. Or the cure is to be made with some laxative soup: snails much boiled, and their gravy, or that of limpet. Water is to be taken for drink, if there be fever, boiled with asarabacca, or nard, or cachry. For these things dispel flatus, are diuretic, and promote free breathing. But if he be free from pain, wine also is beneficial for the heat of the intestines, and for the restoration of the strength; and likewise the decoction of fennel-root, in a draught, and maiden-hair and cinnamon.

But if the inflammation turn to an abscess, it is better to contribute thereto by using the medicine for abscesses. These have been described under chronic diseases, where the treatment of cholics is described.

THE formation of the blood is in the liver, and hence the distribution of it over the whole system. And the entire liver is, as it were, a concretion of blood. Wherefore the inflammations there are most acute; for nutrition is seated in this place. If, therefore, inflammation form anywhere else, it is not remarkably acute; for it is an influx of blood that is inflamed; but in the liver there is no necessity for its coming from another quarter. For if any obstruction shut the outlets, the liver becomes inflamed by being deprived of its efflux, since the entrance of the food to the liver still continues patent; for there is no other passage of the food but this from the stomach and intestines to the whole body.

It is necessary, therefore, to make a copious evacuation, by opening the veins at the elbow, and taking away blood frequently, but not in large quantity at a time. Total abstinence from food at first, but restricted diet afterwards, so that the liver may be devoid of its customary ingesta. It is necessary, also, by external applications to dispel the matters impacted in the liver. Lotions, therefore, with aloe or natron are proper, and unwashed wool is to be applied. There is need, then, of cooling means, because the liver is inflamed by the blood; for the blood is hot. The cataplasms, also, should be of such a nature, consisting of the meal of darnel, or of hedge-mustard, or of barley, or of linseed; and of liquid substances, such as acid wine, the juice of apples, of the tendrils of the vine, or of the leaves of the vine in season, or of the oil prepared with it. Fomentations are to be applied on sponges, of the decoction of the fruit of bays, of the lentisk, of penny-royal, and of iris.

When you have soothed by these means, you must apply a cupping-instrument, unusually large, so as to comprehend the whole hypochondriac region, and make deeper incisions than usual, that you may attract much blood. And, in certain cases, leeches are better than scarifications; for the bite of the animal sinks deeper, and it makes larger holes, and hence the flow of blood from these animals is difficult to stop. And when the animals fall off quite full, we may apply the cupping-instrument, which then attracts the matters within. And if there be sufficient evacuation, we are to apply styptics to the wounds; but these not of a stimulant nature, such as spiders’ webs, the manna of frankincense, and aloe, which are to be sprinkled in powder on the part; or bread boiled with rue or melilot, and the roots of marsh-mallow; but on the third day a cerate, made with nut-ben, or the hairy leaves of wormwood and iris. The malagmata should be such as are calculated to attenuate, rarify, or prove diuretic. Of these the best is that from seeds ( diaspermatôn) well known to all physicians from experience. That also is a good one of which marjoram and melilot are ingredients.

The food should be light, digestible, possessed of diuretic qualities, and which will quickly pass through the bowels; such as granulated seeds of spelt ( alica ⁹ ) with honeyed-water, and a draught of these articles with salts and dill. The juice of ptisan, also, is detergent; and if you will add some of the seeds of carrot, you will make it more diuretic: for it evacuates by the passages which lead from the liver to the kidneys; and this is the most suitable outlet for matters passing out from the liver, owing to the wideness of the vessels and the straightness of the passage. We must also attract thither by cupping, applying the instrument to the region of the kidneys in the loins. To these parts, lotions are also to be applied, prepared with rue, the juncus, or calamus aromaticus. By these means, it is to be hoped that the patient may escape death.

But when it is turning to a suppuration, we must use the suppurative medicines which will be described by me under the head of colics. But if pus is formed, how the collection is to be opened, and how treated, will be explained by me in another place. The same observations apply to the spleen, in the event of an inflammation seizing this part also.

THE inflammation of the vena cava and large artery, which extend along the spine, was called a species of Causus by those of former times. For in these cases the affections are similar: febrile heat acute and acrid, loathing of food, thirst, restlessness; a palpitating pulsation in the hypochondriac region and in the back, and the other symptoms described by me under this head. Moreover, the febrile heat tends to syncope, as in cases of causus. For, indeed, the liver is formed by the roots of the veins, and the heart is the original of the artery. You may suppose, then, that the upper portions of these viscera are subject to fatal ailments; for it is the heart which imparts heat to the artery, and the liver which conveys blood to the vein; and being both mighty parts, the inflammations, likewise, which spring from them are great.

Wherefore we are to open the veins at the elbow, and abstract a considerable amount of blood; not all at once, however, but at two or three times, and on a different day, so that the strength may recruit during the interval. Then we are to apply a cupping-instrument and cataplasms to the hypochondrium, where is the pulsation of the artery; and also between the scapulæ, for there, too, there are pulsations. We are to scarify unsparingly, and abstract much blood; for from this sort of evacuation the patients are not much prone to deliquium. The bowels, also, are apt to be unusually confined, and emollient clysters are to be used to lubricate them, but not on any account acrid ones; for they suffer an increase of fever from brine and the melting of the natron. The juice, therefore, of linseed and of fenugreek, and the decoction of the roots of mallows, are sufficient to rouse and stimulate the bowels. The extremities, namely, the feet and hands, are to be warmed with gleucinum, ¹⁰ or Sicyonian oil, or with the liniment from lemnestis; for these parts of them become very cold. And before the administration of food, we must give draughts to promote the urinary discharge, containing spignel, asarabacca, and wormwood, to which some natron in powder is to be added. But of all such medicines the strongest are cassia and cinnamon, provided one has plenty of it. In such cases, milk is both food and medicine; for they stand in need of refrigeration, a sort of fire being wrapped up within; and also of sweet food, and of that a copious supply in small bulk. Such virtues milk possesses as an article of food. Plenty of the milk of an ass which has just had a foal is to be given, and to two cupfuls of the milk one of water is to be added. That of the cow is also very good; and, thirdly, that of a goat. The articles of food should be of easy digestion; for the most part juices, such as that from the juice of the fennel; and let parsley seed be added to it, and honey. And the water which is drunk should contain these things.

But we must also promote sweats, and in every way make the perspiration moist and free. Lotions to the head, as in cases of causus. An epitheme to the chest and left mamma, such as in syncope. To lie in bed with the head elevated, so that everything may be alike as in causus. Gestation to a small extent, so as to provoke sweats; a bath, also, if he be burned up within. For these affections do not pass off by crises, even though they be forms of causus.

INFLAMMATION in the kidneys is of an acute nature; for the veins passing from the liver to the kidneys are inflamed at the same time, and with these the liver; for these veins are not very long, but are very broad, so as to give the kidneys the appearance of being suspended near the liver. But suppression of urine takes place along with the inflammation, thereby contributing to the intensity of the inflammation; for the cavity of the kidneys is filled by the overflow of the urine which fails to escape. The same happens also with stones, provided one larger than the breadth of the ureters be formed in the kidneys: it then becomes seated there, and, not passing through, it occasions a stoppage of the urine. But we will treat of the formation of calculi among the chronic diseases; how they may either be prevented from forming, or how they may be broken when formed. With regard to heat and obstruction, such of these affections as prove quickly fatal will be described by me in this place.

Whether it be impaction of stones, or whether it be inflammation, we must open the vein at the elbow, unless a particular period of life prove an obstacle, and blood must be taken in a full stream and in large quantity. For not only are inflammations alleviated by evacuation, but also impacted stones are slackened by the evacuation of the vessels, and thus the stones escape during the passing of the urine. Then the parts are to be relaxed by bathing them with oil of must or of privet, and by fomentations and cataplasms. The herb southernwood, the schœnus, and calamus aromaticus, should form the ingredients of the cataplasms. Then we are to apply the cupping-instrument over the kidneys, in the loins, more especially if the evacuation from this place has been of service. The bowels are to be softened by lubricating clysters, rather of a viscid than of an acrid nature, such as the juiees either of mallows or of fenugreek. Sometimes, also, diuretic medicines are to be given before food, such as are described respecting the liver, and also similar food of easy digestion: for in such cases indigestion is bad. Milk is a most excellent article, especially that of an ass; next, of a mare; even that of an ewe or a goat is useful, as being a kind of milk. If, then, they be free of fever, it is better also to prescribe the bath; but if not, they are to be placed in a sitz-bath formed of the decoction of herbs, filling the vessel up to their navel. But if it be turned to suppuration, what cataplasms and other medicines we are to use have formerly been laid down by us on many occasions.

But, if the stone stick, we are to use the same fomentations and cataplasms, and try to break the stones with medicines taken in the form of drink. The simples are the herbs waterparsnip and prionitis, ¹¹ boiled with oil or edible vinegar, and the juice of it taken for drink: the compound ones are, that named from Vestinus, that from vipers and the reptile the skink, and such as from experience appear to be best. Gestation and succussion are calculated to promote the movement and protrusion of the calculi; for the passage of calculi into the bladder is very painful. But if the stones drop out, the patients become free from pain, which they have not been accustomed to be, not even in their dreams; and, as if escaped from inevitable evils, they feel relieved both in mind and in body.

ACUTE affections, resembling those of the kidneys, form also in the bladder; namely, inflammations, ulcerations, calculi, and the obstructions from clots, and, along with these, suppression of urine and strangury. But in this part the pain is more acute, and death most speedy; for the bladder is a broad nerve, whereas the kidneys are like a concretion of blood, of the same species as the liver. But, moreover, the sufferings are most dreadful and most lamentable:

for there, by far,

On wretched men most cruel pains inflicts the god of war.

We must, therefore, straightway make an incision in the flanks, and soothe the bladder by means of a fomentation of much oil, with rue and dill. But if grumous blood be the cause of the pains and stoppage of the urine, we are to give oxymel to drink, or a little quantity of lime with honeyedwater for the solution of the clots, and also such other things, both herbs and seeds, as promote the secretion of urine. But if there be danger from hemorrhage, it is to be stopped without delay, more than in the other cases; for the danger from it is not small. We must remedy it by the medicines which stop bleeding. In this case refrigeration of the bladder is beneficial; bathing with rose-oil and wine, and wrapping the parts in cloths made of unwashed wool. ¹² An epitheme may be formed with dates soaked in wine, with pomegranate or the juice of sumach. But if the patient is averse to the weight of the epithemes and the great cooling, they must both be given up; for we must not cool greatly a part naturally thin and cold like the bladder. But we are to anoint the parts with oil of must, or acacia, or hypocistis with wine. But we must not use sponges, unless the hemorrhage be very urgent. The food should be farinaceous, of easy digestion, wholesome, diuretic, such as have been described by me under the head of the kidneys; milk, sweet wine, the Theræan and Scybelitic. Medicines should be drunk which are diuretic, fragrant, and diffusible, and other such things. A very excellent thing for the bladder is cicadœ; roasted, in season, as an article of food; and out of season, when dried and triturated with water. Let also a little of the root of nard be boiled up with the cicadœ. The same things may be used for preparing a bath to sit in for relaxation of the bladder.

But, if it be the impaction of calculi which stops the urine, we must push away the calculus and draw off the urine, with the instrument, the catheter, unless there be inflammations; for, in inflammations, neither do the passages well admit the instrument, and in addition they are hurt by the catheter. But if this treatment be inadmissible, and the patient is nearly killed with the sufferings, we must make an incision in the part under the glans penis, and the neck of the bladder, in order to procure an outlet for the stone and the expulsion of the urine. And we must particularly endeavour to cure the part by bringing the wound to cicatrization. But if not, it is better that the patient should have a flux of urine for the remainder of his life, than that he should die most miserably of the pain.

THE uterus in women has membranes extended on both sides at the flanks, and also is subject to the affections of an animal in smelling; for it follows after fragrant things as if for pleasure, and flees from fetid and disagreeable things as if for dislike. If, therefore, anything annoy it from above, it protrudes even beyond the genital organs. But if any of these things be applied to the os, it retreats backwards and upwards. Sometimes it will go to this side or to that,—to the spleen and liver, while the membranes yield to the distension and contraction like the sails of a ship.

It suffers in this way also from inflammation; and it protrudes more than usual in this affection and in the swelling of its neck; for inflammation of the fundus inclines upwards; but if downwards to the feet, it protrudes externally, a troublesome, painful and unseemly complaint, rendering it difficult to walk, to lie on the side or on the back, unless the woman suffer from inflammation of the feet. But if it mount upwards, it very speedily suffocates the woman, and stops the respiration as if with a cord, before she feels pain, or can scream aloud, or can call upon the spectators, for in many cases the respiration is first stopped, and in others the speech. It is proper, then, in these cases, to call the physician quickly before the patient die. Should you fortunately arrive in time and ascertain that it is inflammation, you must open a vein, especially the one at the ankle, and pursue the other means which prove remedial in suffocation without inflammation: ligatures of the hands and feet so tight as to induce torpor; smelling to fetid substances—liquid pitch, hairs and wool burnt, the extinguished flame of a lamp, and castor, since, in addition to its bad smell, it warms the congealed nerves. Old urine greatly rouses the sense of one in a death-like state, and drives the uterus downwards. Wherefore we must apply fragrant things on pessaries to the region of the uterus—any ointment of a mild nature, and not pungent to the touch, nard, or Ægyptian bacchar, or the medicine from the leaves of the malabathrum, the Indian tree, ¹³ or cinnamon pounded with any of the fragrant oils. These articles are to be rubbed into the female parts. And also an injection of these things is to be thrown into the uterus. The anus is to be rubbed with applications which dispel flatus; and injections of things not acrid, but softening, viscid, and lubricant, are to be given for the expulsion of the fæces solely, so that the region of the uterus may be emptied,—with the juice of marsh-mallow, or of fenugreek, but let melilot or marjoram be boiled along with the oil. But, if the uterus stands in need of support rather than evacuation, the abdomen is to be compressed by the hands of a strong woman, or of an expert man, binding it round also with a roller, when you have replaced the part, so that it may not ascend upwards again. Having produced sneezing, you must compress the nostrils; for by the sneezing and straining, in certain cases, the uterus has returned to its place. We are to blow into the nostrils also some of the root of soapwort, ¹⁴ or of pepper, or of castor. We are also to apply the instrument for dry-cupping to the thighs, loins, the ischiatic regions, and groins, in order to attract the uterus. And, moreover, we are to apply it to the spine, and between the scapulæ, in order to relieve the sense of suffocation. But if the feeling of suffocation be connected with inflammation, we may also scarify the vein leading along the pubes, and abstract plenty of blood. Friction of the countenance, plucking of the hair, with bawling aloud, in order to arouse. Should the patient partially recover, she is to be seated in a decoction of aromatics, and fumigated from below with fragrant perfumes. Also before a meal, she is to drink of castor, and a little quantity of the hiera with the castor. And if relieved, she is to bathe, and at the proper season is to return to her accustomed habits; and we must look to the woman that her menstrual discharges flow freely.

INFLAMMATION of the nerves in the genital organs occasions erection of the member with desire and pain in re venerea: there arise spasmodic strainings which at no time abate, since the calamity is not soothed by the coition. They also become maddened in understanding, at first as regards shamelessness in the open performance of the act; for the inability to refrain renders them impudent; but afterwards . . . . . . . . when they have recovered, their understanding becomes quite settled.

For all these causes, we must open the vein at the elbow, and also the one at the ankle, and abstract blood in large quantity and frequently, for now it is not unseasonable to induce deliquium animi, so as to bring on torpor of the understanding and remission of the inflammation, and also mitigation of the heat about the member; for it is much blood which strongly enkindles the heat and audacity; it is the pabulum of the inflammation, and the fuel of the disorder of the understanding, and of the confusion. The whole body is to be purged with the medicine, the hiera; for the patients not only require purging, but also a gentle medication, both which objects are accomplished by the hiera. The genital organs, the loins, the perineum and the testicles, are to be wrapped in unwashed wool; but the wool must be moistened with rose-oil and wine, and the parts bathed, so much the more that no heating may be produced by the wool, but that the innate heat may be mitigated by the cooling powers of the fluids. Cataplasms of a like kind are to be applied; bread with the juice of plantain, strychnos, ¹⁵ endive, the leaves of the poppy, and the other narcotics and refrigerants. Also the genital organs, perineum, and ischiatic region, are to be rubbed with similar things, such as cicuta with water, or wine, or vinegar; mandragora, and acacia; and sponges are to be used instead of wool. In the interval we are to open the bowels with a decoction of mallows, oil, and honey. But everything acrid . . . . . . Cupping-instruments are to be fixed to the ischiatic region, or the abdomen; leeches also are very good for attracting blood from the inner parts, and to their bites a a cataplasm made of crumbs of bread with marsh-mallows. Then the patient is to have a sitz bath medicated with worm-wood, and the decoction of sage, and of flea-bane. But when the affection is protracted for a considerable time without any corresponding intermission, there is danger of a convulsion (for in this affection the patients are liable to convulsions), we must change the system of treatment to calefacients, there is need of oil of must or of Sicyonian oil instead of oil of roses, along with clean wool and warming cataplasms, for such treatment then soothes the inflammations of the nerves,—and we must also give castor with honeyed-water in a draught. Food containing little nourishment, in a cold state, in small quantity, and such as is farinaceous; mostly pot-herbs, the mallow, the blite, the lettuce, boiled gourd, boiled cucumber, ripe pompion. Wine and fleshes to be used sparingly until convalescence have made considerable progress; for wine imparts warmth to the nerves, soothes the soul, recalls pleasure, engenders semen, and provokes to venery.

Thus far have I written respecting the cures of acute diseases. One must also be fertile in expedients, and not require to apply his mind entirely to the writings of others. Acute diseases are thus treated of, so that you may avail yourself of what has been written of them, in their order, either singly or all together.