IN chronic diseases, the postponement of medical treatment is a bad thing; for, by procrastination, they pass into incurable affections, being of such a nature that they do not readily go off if they once attack; and if protracted by time, they will become strong, and end only in death. Small diseases also are succeeded by greater, so that although devoid of danger at first, their progeny proves deadly. Wherefore neither should the patient conceal his complaint, from the shame of exposure, nor shrink from fear of the treatment; nor should the physician be inactive, for thus both would conspire to render the disease incurable. Some patients, from ignorance of the present and what will come at last, are content to live on with the disease. For since in most cases they do not die, so neither do they fear death, nor, for this reason, do they entrust themselves to the physician. Cephalæa, of which I am about to treat in the first place, is a proof of these statements.

THE head, inasmuch as it is necessary towards life, so is it also very dangerous in disease. And the onset of diseases about it is quite tolerable, being attended with slight pain, noises in the ears, and heaviness; but if they acquire increase, they become fatal at last. Wherefore even slight pains should not be overlooked, and, in certain cases, they have been cured by slight remedies. But if prolonged for a longer space, as greater sufferings supervene, we must open the vein at the elbow. But, for two days previous, the patient must get wine to drink, and the quantity of blood abstracted must be regulated by the strength; and it is best not to make the whole evacuation at once, so that the strength may bear the amount thereof; and the disease is rather removed by the repetition of the means. The same rule applies to all chronic diseases. During an interval of three or four days, a fuller diet is to be given, and then the purgative hiera is to be taken in a draught; for it, in an especial manner, draws the pabulum of the disease from the head. The quantity of the medicine given is to be to the amount of four or five drams. And if well purged, we are to administer the bath, give wine, and improve the strength. Then again we are to open the straight vein ( temporal?) on the forehead, for abstraction by it is most efficacious; the amount, about a hemina ( half-pint?) or a little more. But we must not evacuate further, for we must avoid emptying the vessels. Then, having removed the hair with a razor, we are first to apply one cupping-instrument to the vertex, and another between the scapulæ, without drawing blood; but along with the instrument applied to the vertex, we are to scarify unsparingly, for the purpose of attracting the redundant fluid and of making an incision in the deep-seated parts. For remedial means applied even to the bones are beneficial in cephalæa. When the wounds are cicatrised, we are to excise a portion of the arteries; ¹ (of these there are two, one behind the ears, at a little distance from them, being obvious from their pulsations; the others in front of the ear, and close to it, for they lie close to the antitragus; and these also are discovered by their pulsations); we are to incise the larger ones at the bones, for they afford relief. Adjacent to them are others, very slender, which there is no benefit from excising. The mode of operating has been described under operative surgery. This is the great remedy in cephalæa, epilepsy, vertigo, and, in fine, in all the diseases of the head.

In all cases we are to bring off phlegm, first evacuating the bowels, either by a purgative draught, or by a clyster; and sometimes from the nostrils by sternutatories; and sometimes from the mouth by sialogogues. Among the kinds of sternutatories are pepper, the root of soapwort, and the testicle of the beaver; these may all be used together; having levigated and sifted them, we are to blow the powder in, either with a reed or the thick stalk of a goose quill. Euphorbium is more active and stronger than these when mixed with any of them. It is also mixed up with the oils, such as gleucinum, the Sicyonian, or the ointment from storax. It is made into a liquid form as an injection, and it is injected by means of a nasal pipe; the instrument consists of two pipes united together by one outlet, so that we can inject by both at the same time. For to dilate each nostril separately is a thing which could not be borne, as the head gets quickly filled, and thus contracts a sharp pain. The medicines which evacuate phlegm from the mouth are, mustard, the granum cnidium, pepper, stavesacre, these either together or separately; and one may masticate these substances and spit out constantly; and give them mixed up with water or honeyed-water, rinse the mouth, and press them back to the tonsils with stretching of the neck, thus wash out along with the breath in expiration; ² and when you have evacuated phlegm as much as you think proper, you must bathe and foment the head with a very large quantity of hot water to promote perspiration, for the obstructions become strong.

Supper should be spare; but wine also is to be given, to restore the tone of the stomach, for it also suffers in this complaint. When, in the meantime, you have re-established the strength, you will require to give a common clyster having sprinkled upon it much natron, or dissolving it in two drams of the resin of the turpentine tree. On the next day we are to abstract blood from the inside of the nostrils, and for this purpose push into them the long instrument named Katidion, or the one named Toryne, or, in want of these, we must take the thick quill of a goose, and having scooped the nervous part of it into teeth like a saw, we are to push it down the nostrils as far as the ethmoid cells, then shake it with both hands so that the part may be scarified by its teeth. Thus we shall have a ready and copious flow of blood; for slender veins terminate there, and the parts are soft and easily cut. The common people have many modes of scarification, by rough herbs, and the dried leaves of the bay, which they introduce with the fingers and move strongly. ³ Having evacuated to a sufficient amount—say to the amount of half a hemina—we are to wipe the parts with sponges and oxycrate, or blow in some styptic powder, gall, fissil alum, or the flower of the wild pomegranate.

Whether the pain remain, or cease after these things, we must go on to the conclusion of the system of treatment; for the mischief is apt to return, and frequently lurks in the seat of the disease. Wherefore, having removed the hair with a razor (and this also is beneficial to the head), we are to burn with heated cauteries, superficially, down to the muscles; or if you wish to carry the burning to the bone, you must avoid the muscles, for the muscles when burnt occasion convulsions. And if you burn superficially you must foment the part with plenty of fragrant sweet wine, along with rose-oil; a linen cloth wetted with this is to be spread over the eschars until the third day. But, if the eschars be deep, having pounded the hairy leaves of leeks with salt, and spread upon a linen rag, we are to apply it. On the third day, we are to put the cerate from rose-oil upon the superficial eschars, and lentil with honey upon the deeper. The medicinal applications to be made to the wound will be described in another place. Some have made an incision in the skin above the forehead, at the coronal suture, down to the bone, and having scraped it, or cut out a portion down to the diploe, have afterwards brought the part to incarnation. Some have perforated the bone, even to the meningx. These are bold remedies, but are to be used, if, after all, the cephalæa continue, and the patient be courageous, and the tone of the body good. ⁴

But, if they progress gradually, they are to take exercises in the erect state of the body for the benefit of the chest and shoulders; the chironomy, ⁵ the throwing of the halteres; leaping, and the well-regulated contortions of the body accompanying it; friction, first and last of the limbs, of the head in the middle of the process.

The process of pitching ⁶ is to be frequently applied to the head; and also rubefacients, sometimes rubbing in mustard with double quantity of bread, so that the heat may not be intolerable; and sometimes other medicines are to be so used, like the compound from lemnestis, euphorbium, and pellitory. The juice of thapsia, and the medicines made with it which produce swelling of the skin, and an eruption resembling vari, are beneficial both for allaying present pain and contributing to eradicate the evil.

The diet in both kinds of the complaint should be light; little drink, water for drink, especially before giving any medicine; complete abstinence from acrid things, such as onions, garlic, the juice of silphium, but not altogether from mustard, for its acrimony, in addition to its being stomachic, is not unpleasant to the head, dissolving phlegm, and exhaling or discharging downwards. Of pulse, the worst is the common bean and its species, the common peas, and the species called ochrys, ⁷ and the common kidney-beans; next to them are the lentils, which have indeed certain good properties for promoting digestion and secretion, but induce fulness of the head and occasion pain; only when boiled with pepper they are not to be rejected. Granulated spelt ( alica) when washed, is pleasant along with wine and honey, so as to sweeten, and, in like manner, their soups, and with plain broths. The seeds of carui, coriander, anise, and parsley, in the Lydian sauce ⁸ are excellent. But, of these articles, the best are the herbs mint and penny-royal, with the fragrant things which have some diuretic and carminative properties. Of fleshes, all such as are old are bad; of the recently killed, that of the hen is good; of birds, the wood pigeon, the common pigeon, and such others as are not very fat; the extremities of the swine; the roasted hare; that of the ox and of the sheep is incrassant and fills the head; the kid is not altogether bad. Milk and cheese occasion headache. Of fishes, those found among rocks, and those things that are best in each particular country. Of potherbs, such as promote the urinary and alvine discharges, the mallow, the blite, the beet, and asparagus; but the kale is also acrid. Among raw articles, the lettuce is the best of all. Roots are bad, even when boiled, such as radishes, navews, and parsnips, which are diuretic, but occasion repletion; the garden parsnip indeed is flatulent and swells up the stomach. Wine which is white, thin, and sweet, is to be admitted, if it have some astringency, so as not to bind the bowels. All articles of the dessert occasion headache, except dates of every species. In autumn the fig and grape are wholesome, and whatever other fruit is very good at any particular season. Repletion of all things, even of such as are proper, is bad; and so, also, indigestion is bad. Lassitude is less injurious than indigestion, but still it is hurtful. The morning walk after evacuation of the bowels, but so as not to affect the breathing nor induce weariness; and it is also very good after supper. Prolonged gestation, not exposed to wind or sun, is good for the head; but the dog-star is bad for it. Sexual intercourse is a self-inflicted evil to the head and nerves. A journey from a cold to a warmer climate, or from a humid to a drier, is proper; also a sea-voyage, and passing one’s life at sea; and if one lives by the sea-side it is a good thing to bathe in the sea-water, to tumble on the sands, and to reside close by the sea.

The remedies for heterocrania are the same; for it is well to apply to a portion of the head the same remedies as are proper for the whole of it. In all cases in which the disease is not removed by these means, we are to use hellebore, as being the last and most potent of all methods of treatment.

VERTIGO arises as the successor of cephalæa; but also springs up as a primary affection from certain causes, as the suppression of the hemorrhoidal flux; and if blood which used to flow from the nose has ceased to flow; or if the body has not perspired properly, either by sweating, or labour, when it had been used to labour. If then it arise as the consequence of cephalæa, we must do for its cure those things which have been described under cephalæa; and I will afterwards state certain other more powerful means which must be tried ultimately. But if the disease happen from the suppression of any of the humours, we must excite the customary secretion; for the recurrence of nature promotes recovery. If it be delayed, and the disease increases, in the other suppressions, those by the nose or sweats, we are to open the vein at the elbow; but in plethora of the liver, spleen, or any of the viscera in the middle of the body, cupping affords relief, but as much blood as is taken from a vein, so much is to be thus abstracted from them; for it is the nutriment of the exciting cause, in like manner as the belly. After this the remedies of the head are to be applied, opening the straight vein on the forehead, or those at the canthi on either side of the nose; a cupping-instrument is to be fastened to the vertex, the ( temporal?) arteries are to be excised, the head shaven, rubefacients applied to it, phlegm evacuated from the nostrils by sternutatories, or from the mouth as I have stated—all these things are to be done in the order described under cephalæa, except that the juice of sow-bread or of pimpernel is to be used as an injection into the nose.

But when you have exhausted all the remedies for cephalæa, the more violent means which are applicable for vertigo are to be used; we must use the emetics after supper, and those from radishes, which is also required as a preparation for the hellebore; for the stomach is to be trained beforehand to the more violent emetics. But the phlegm now becomes thinner, and fit for solution in the hellebore. There are several modes of giving the hellebore; to the stronger sort of patients it is to be given to the size of a sesame, ⁹ or a little larger; or, in slices, with washed chondrus or lentil, the dose, about two drams. In the case of feebler and more slender persons, the decoction with honey, to the amount of two or three spoonfuls, is to be given. The manner of preparing it will be described else-where. In the interval between each remedy, the patient is to be supported, in order that he may be able to endure what is to be given in the intermediate periods.

The patient is to be assisted during the paroxysms thus:—The legs are to be bound above the ankles and knees; and the wrists, and the arms below the shoulders at the elbows. The head is to be bathed with rose-oil and vinegar; but in the oil we must boil wild-thyme, cow-parsnip, ivy, or something such. Friction of the extremities and face. Smelling to vinegar, penny-royal, and mint, and these things with vinegar. Separation of the jaws, for sometimes the jaws are locked together; the tonsils to be tickled to provoke vomiting; for by the discharge of phlegm they are sometimes roused from their gloom. These things, then, are to be done, in order to alleviate the paroxysm and dispel the gloomy condition.

With regard to the regimen during the whole period of the treatment and afterwards, I hold as follows:—Much sleep is bad, and likewise insomnolency; for truly much sleep stupefies the senses of the head. From a redundance of vapours there is disinclination to every exertion; and these are also the cause of the weight in the head, the noises, and the flashes of light, which are the marks of the disease. Insomnolency induces dyspepsia, atrophy, and wearies out the body; the spirits flag, and the understanding is unsettled; and for these reasons such patients readily pass into mania and melancholy. Moderate sleep is suitable for the proper digestion of the food and refreshment from the labours of the day; care and perseverance in these respects; and particular attention is to be paid to the evacuation of the bowels, for the belly is the greater source of the bodily perspiration. Next, friction of the limbs, by means of rough towels, so as to produce rubefaction; then, of the back and sides; last, of the head. Afterwards, exercise in walking, gentle at first and in the end; carried to running in the middle; rest and tranquillity of the breathing ( pneuma) after the walking. They are to practise vociferation, using grave tones, for sharp occasion distension of the head, palpitation of the temples, pulsatory movements of the brain, fulness of the eyes, and noises in the ears. Sounds of medium intensity are beneficial to the head. Then the season of gestation should be regulated so as to promote the expulsion of the weight in the head; it should be prolonged, yet not so as to induce fatigue; neither should gestation be made in tortuous places, nor where there are frequent bendings of the road, for these are provocative of vertigo. But let the walks be straight, long, and smooth. If then the patients have been in the habit of taking lunch, we must only allow of a little bread, so as to be no impediment to the exercises; for digestion should take place previously. The head and the hands, and the frictions thereof, are to be attended to; in the latter it is to be gently performed for the restoration of the heat, for plumpness, and strength. Then the head is to be rubbed while the patient stands erect below a person of higher stature than himself. Gymnastics skilfully performed which tend to distension of the neck, and strong exercise of the hands. It is proper, also, by raising the head, to exercise the eyes at chironomy, or at throwing the quoit, or contending at boxing. The exercise both with the large and the small ball is bad, for the rolling of the head and eyes, and the intense fixing of them, occasion vertigo. Leaping and running are very excellent; for everything that is keen is beneficial to the limbs, and gives tone to the general system. ¹⁰ The cold bath is better than no bath at all; no bath at all is better than the hot bath: the cold bath is very powerful as an astringent, incrassant, and desiccant of the head, which is the condition of health; while the warm bath is most powerful to humectate, relax, and create mistiness; for these are the causes of disease of the head, and such also are south winds, which occasion dulness of hearing. There should be rest after exercises, to allay the perturbation. Pinching of the head, even to the extent of producing excoriation of the skin.

Whetters made of water, or of wine diluted with water, should be given before a meal. Lunch should be slight: laxatives from the capillary leaves of pot-herbs,—of mallow, of beet, and of blite. A condiment of a stomachic nature, which is pleasant to the mouth, laxative of the bowels, and not calculated to induce heaviness of the head, is made of thyme, or of savory, or of mustard. Eggs, hot in winter, and cold in summer, stripped of their shell, not roasted; olives, dates, pickled meat in season. Granulated spelt washed, with some of the sweet things, so as to give it a relish, is to be chosen; and, with these, salts. Solitude, rest as regards hearing and speaking. Promenades in a well-ventilated place, rendered agreeable by trees or herbs. But if it be come to supper-time, they are again especially to take the cold bath, having been slightly anointed with oil; or, otherwise, the limbs only. The supper should be of frumentaceous articles, such as pastry, or a soup from chondrus (granulated spelt), or a carminative ptisan, rendered easy of digestion by boiling. The medicines used for seasoning of the ptisan, pepper, penny-royal, mint, a small proportion of onions or of leeks, not so much as to float on the stomach; the acrid part of vinegar is suitable; of fleshes, the parts of fat animals which are not fat; of swine, the feet and head; all winged animals—you must select from the great variety of them what is suitable; the hare and the other kinds of venison are proper; the hen is easily procured, and suitable. All articles of the dessert create headaches, except the date, or figs in the summer season, or the grape if the patient be free from flatulence; and of sweetmeats, such as are well seasoned, without fat, and light. Walking, exhilaration; in solitude, resignation to sleep.

OF remedies, whatever is great and most powerful is needed for epilepsy, so as to find an escape not only from a painful affection, and one dangerous at each attack, but from the disgust and opprobrium of this calamity. For it appears to me, that if the patients who endure such sufferings were to look at one another in the paroxysms, they would no longer submit to live. But the want of sensibility and of seeing conceals from every one what is dreadful and disgusting in his own case. It is best that the method of cure should follow the alleviation of nature, when, with the changes of age, she changes greatly the man. For if the diet akin to the ailment, and on which the disease subsisted, be changed, the disease no longer seizes the man, but takes its departure along with that in which it delighted. ¹¹

If, then, it seize on the head, it settles there; to it, therefore, we are to do those things which have been described by me under cephalæa, regarding the abstraction of blood (and also the purgings) from the veins at the elbow, the straight vein at the forehead, and by cupping; but the abstraction is not to be carried the length of deliquium animi; for deliquium has a tendency to induce the disease; we are to open all the ordinary arteries before and behind the ears, and we are also to practise purgings, which are more potent than all these things, by the purgative hiera and those medicines which draw off phlegm from the head; but the medicines should be particularly powerful, for the habit of such persons renders them tolerant of pains, and their goodness of spirits and good hopes render them strong in endurance. It is necessary, also, to apply heat to the head, for it is effectual. In the first place, we must perforate the bone as far as the diploe, and then use cerates and cataplasms until the meninx separate from the bone. The exposed bones are to be perforated with the trepan if still any small portion prevent its spontaneous removal, when the meninx there is found black and thickened; and when, having gone through the process of putrefaction and cleansing under the bold treatment of the physician, the wound comes to complete cicatrization, the patients escape from the disease. In all cases we are to use rubefacient applications to the head; namely, the common ones, as described by me formerly; and a still more powerful one is that from cantharides, but for three days before using it the patient must drink milk as a protection of the bladder, for cantharides are very injurious to the bladder. These are the remedies when the head is the part affected.

But if the cause be seated in the middle parts, and if these induce the disease (this, however, very rarely happens, for, as in a mighty ailment, the middle parts of the body rather sympathise with the head, which is the origin of the disease), but however it may be, we must open the vein at the elbow in these cases also; for the flow by it is from the viscera. But such patients, more than the others, are to be purged with the hiera, cneoron, ¹² and the granum cnidium, ¹³ for these are phlegmagogues. But the most suitable remedy in these cases is cupping. Of epithemes and cataplasms the components are well known, and it would be superfluous to describe them on all occasions, except in so far as to know the powers of them; namely, that by such means we must attenuate, promote exhalation, and render the secretions and perspirations healthy. We are also to use digestive, heating, desiccant, and diuretic articles, both in food and in medicine. But the best of all things is castor, taken frequently during the month in honeyed-water, and the compound medicines which possess the same powers, as the compound medicine from vipers, and the still more complex one of Mithridates, and also that of Vestinus; for these things promote digestion, form healthy juices, and are diuretic; for whatever simple medicines you could describe are contained in these powerful compositions — cinnamon. cassia, the leaves of melabathrum, pepper, and all the varieties of seseli; and which of the most potent medicines will you not find in them? It is told, that the brain of a vulture, and the heart of a raw cormorant, and the domestic weasel, when eaten, remove the disease; but I have never tried these things. However, I have seen persons holding a cup below the wound of a man recently slaughtered, and drinking a draught of the blood! O the present, the mighty necessity, which compels one to remedy the evil by such a wicked abomination! And whether even they recovered by this means no one could tell me for certain. There is another story of the liver of a man having been eaten. However, I leave these things to be described by those who would bear to try such means.

It is necessary to regulate the diet, in respect to everything that is to be done either by others or by the patient himself. Now nothing must be omitted, nor anything unnecessarily done; and more especially we must administer everything which will do the slightest good, or even that will do no harm; for many unseemly sights, sounds, and tastes, and multitudes of smells, are tests of the disease. Everything, therefore, is to be particularly attended to. Much sleep induces fatness, torpor, and mistiness of the senses, but moderate sleep is good. An evacuation of the bowels, especially of flatulence and phlegm, is very good after sleep. Promenades long, straight, without tortuosities, in a well ventilated place, under trees of myrtle and laurel, or among acrid and fragrant herbs, such as calamint, penny-royal, thyme, and mint; so much the better if wild and indigenous, but if not, among cultivated; in these places, prolonged gestation, which also should be straight. It is a good thing to take journeys, but not by a river side, so that he may not gaze upon the stream (for the current of a river occasions vertigo), nor where he may see anything turned round, such as a rolling-top, for he is too weak to preserve the animal spirits ( pneuma) steady, which are, therefore, whirled about in a circle, and this circular motion is provocative of vertigo and of epilepsy. After the gestation, a gentle walk, then rest so as to induce tranquillity of the agitation created by the gestation. After these, the exercises of the arms, their extremities being rubbed with a towel made of raw flax. Not much oil to be used in the inunction. The friction to be protracted, and harder than usual for condensation, since most of them are bloated and fat: the head to be rubbed in the middle of the process, while the patient stands erect. The exercises of the neck and shoulders, chironomy, and the others mentioned by me under the treatment of Vertigo, with sufficient fulness of detail; only the exercises should be sharper, so as to induce sweat and heat, for all these attenuate. During the whole of his life he should cultivate a keen temper without irascibility.

All kinds of food derived from gross pulse are bad; but we are to give frumentaceous things, the drier sorts of bread, washed alica, and the drinks prepared from them. The medicines added for relish the same as before; but there should be more of acrid things, such as pepper, ginger, and lovage. Sauces of vinegar and cumin are both pleasant and useful. From fleshes in particular the patient is to be entirely restricted, or at least during the cure; for the restoration, those things are to be allowed which are naturally light, such as all sorts of winged animals, with the exception of the duck, and such as are light in digestion, such as hares, swines’ feet, and pickled fish, after which thirst is good. A white, thin, fragrant, and diuretic wine is to be drunk in small quantity. Of boiled pot-herbs, such as are possessed of acrid powers, attenuate and prove diuretic, as the cabbage, asparagus, and nettle; of raw, the lettuce in the season of summer. The cucumber and ripe melon are unsuitable to a strong man; but certain persons may have just a tasting of them. But being of a cold and humid nature, much of them is bad. The seasonable use may be granted of the green fig and the grape. Promenades; after these, recreation to dispel grief.

Passion is bad, as also sexual enjoyment; for the act itself bears the symptoms of the disease. Certain physicians have fallen into a mistake respecting coition; for seeing that the physical change to manhood produces a beneficial effect, they have done violence to the nature of children by unseasonable coition, as if thus to bring them sooner to manhood. Such persons are ignorant of the spontaneous law of nature by which all cures are accomplished; for along with every age she produces that which is proper for it in due seasons. At a given time there is the maturity of semen, of the beard, of hoary hairs; for on the one hand what physician could alter Nature’s original change in regard to the semen, and, on the other, the appointed time for each? But they also offend against the nature of the disease; for being previously injured by the unseasonableness of the act, they are not possessed of seasonable powers at the proper commencement of the age for coition.

The patients ought to reside in hot and dry places, for the disease is of a cold and humid nature.

IN cases of melancholy, there is need of consideration in regard to the abstraction of blood, from which the disease arises, but it also springs from cacochymy in no small amount thereof. When, therefore, the disease seizes a person in early life, and during the season of spring we are to open the median vein at the right elbow, so that there may be a seasonable flow from the liver; for this viscus is the fountain of the blood, and the source of the formation of the bile, both which are the pabulum of melancholy. We must open a vein even if the patients be spare and have deficient blood, but abstract little, so that the strength may feel the evacuation but may not be shaken thereby; for even though the blood be thick, bilious, coagulated, and black as the lees of oil, yet still it is the seat and the pabulum of Nature. If, then, you abstract more than enough, Nature, by the loss of nourishment, is ejected from her seat. But if the patient has much blood, for the most part in such cases it is not much vitiated, but still we must open a vein, and not abstract all the blood required the same day, but after an interval, or, if the whole is taken the same day, the strength will indicate the amount. During the interval, the patient is to be allowed a fuller diet than usual, in order to prepare him for enduring the evacuation; for we must assist the stomach, it being in a state of disease, and distress from the black bile lodging there. Wherefore, having kept the patient on a restricted diet for one day previously, we must give black hellebore to the amount of two drams with honeyed-water, for it evacuates black bile. And likewise the capillary leaves of Attic thyme, for it also evacuates black bile. But it is best to mix them together, and give a part of each, to the amount of two drams altogether. After the purging we are to administer the bath, and give a little wine and any other seasoner in the food; for purging fatigues the powers of the stomach. We are, then, to come down to the middle parts, and having first relaxed by cataplasms and bathing, we are to apply a cupping-instrument over the liver and stomach, or the mouth of it; for this evacuation is much more seasonable than venesection. We are also to apply it to the back between the scapulæ, for to this place the stomach is adjacent. Then again we are to recruit; and if the strength be restored by the regimen, we are to shave the head, and afterwards apply the cupping-instrument to it, for the primary and greatest cause of the disease is in the nerves. But neither are the senses free from injury, for hence are their departure and commencement. Wherefore these also are changed, by participating in the affection. Some, likewise, from alienation of the senses have perverted feelings. It is necessary, then, especially to cure the stomach as being disordered of itself, and from black bile being lodged in it. Wherefore we must give to drink continuously of the juice of wormwood from a small amount to a cupful ( cyathus), for it prevents the formation of bile. Aloe also is a good thing, for it brings down the bile into the lower gut. If, then, the disease be of recent origin, and the patient be not much changed, he will require no other treatment in these circumstances. There is a necessity, however, for the remaining part of the regimen to the restoration of the habits, and the complete purification of the affection, and the strengthening of the powers, so that the diseases may not relapse. I will explain afterwards the course of life during convalescence.

But if the disease, having yielded a little to these means, should be seen relapsing, there will be need of greater remedies. Let there, then, be no procrastination of time, but if the disease appear after suppression of the catamenial discharge in women, or the hemorrhoidal flux in men, we must stimulate the parts to throw off their accustomed evacuation. But if it is delayed and does not come, the blood having taken another direction, and if the disease progress rapidly, we must make evacuations, beginning from the ankles. And if you cannot get away from this place so much blood as you require, you must also open the vein at the elbow. And after pursuing the restorative process for three or four days, we are to give the purgative medicine, the hiera. Then we are to apply the cupping-instrument to the middle parts of the body, bringing it near to the liver, and do those things which speedily prove effectual; for melancholy does not yield to small remedies, and, if long continued, it remains fixed in a spot. And if the disease lodge in all parts of the body,—in the senses, the understanding, the blood, and the bile,—and if it seize on the nerves, and turn to an incurable condition, it engenders in the system a progeny of other diseases,—spasms, mania, paralysis. And if they arise from melancholy, the newly-formed diseases are incurable. Wherefore we are to use hellebore for the cure of the ailment. But before the administration of the hellebore, we must train the stomach to vomiting, attenuate the humours, and render the whole system freely perspirable; emetics will accomplish these things sometimes those which are given with an empty stomach, and sometimes those which consist of radishes. I will describe the mode and materials of it; and I will also describe the species of hellebore and the modes of using it; and how we ought to judge of everything beforehand, and how to render assistance during the operation of the emetics. It cannot be doubted that by these means the disease has either been entirely removed or had intervals of several years. For generally melancholy is again engendered. But if it be firmly established, we are no longer to hesitate, but must have recourse to everything relating to the hellebore. It is impossible, indeed, to make all the sick well, for a physician would thus be superior to a god; but the physician can produce respite from pain, intervals in diseases, and render them latent. In such cases, the physician can either decline and deny his assistance, alleging as an excuse the incurable nature of the disease, or continue to the last to render his services. The hiera from aloe is to be given again and again; for this is the important medicine in melancholy, being the remedy for the stomach, the liver, and the purging of bile. But experience has proved, that the seed of mallow, to the amount of a dram, when taken in a drink with water answers excellently. But there are many other simple medicines which are useful, some in one case, and some in another.

After these sufferings, the patient is to be recruited. For, in certain cases, during the time of this treatment, the disease has been removed; but if the patient come to a renewal of his flesh and of his strength, all traces of the disease become eradicated. For the strength of nature produces health, but her weakness, disease. Let the patient, then, proceed to the process of restoration by frequenting the natural hot baths; for the medicinal substances in them are beneficial, such as bitumen, or sulphur, or alum, and many others besides these which are possessed of remedial powers. For, after the parching heat of the disease, and the annoyance of the treatment, dilution is a good thing. Moreover, rare and soft flesh most readily throws off the disease; but in melancholy the flesh is dry and dense. An oily liniment, by gentle friction, with much oil containing . . . . . . . . . . . . washed bread, with something sweet, as the Cretan must, and the Scybelitic from Pamphylia, or wine and honey which have been mixed up together for some time. Eggs, both cold and hot, which have been stripped of their shells. Of fleshes, such as are not fatty, and are detergent. Of swine, the feet and the parts about the head. Of fowls, the wings, which are not fatty. Of wild animals, hares, goats, and deer. Of autumnal fruits, whatever is excellent in its kind. When the stomach rejects the food, we must consider beforehand that what is taken be not vomited up. Wherefore, before giving food, we are to administer honeyed-water to the amount of half a cyathus, which, being drunk, is vomited up again for cleansing the stomach. For, in this way, the food remains in the stomach. Medicines which are purgative of the necessary discharges are—the fruit of the pine, of the nettle, and seeds of the coccalus, ¹⁴ and pepper; bitter almonds; and let honey give it consistence. But if you wish to dry, the best thing is myrrh, or the root of iris, the medicine from vipers, and that of Vestinus, of Mithridates, and many others. For the epithemes, the materiel of cataplasms, melilot and poppies, and the tear (gum?) of turpentine, and hyssop, and the oil of roses, or of vine-flowers; wax should give consistence to all these. Liniments of oil; gestation, promenades, and whatever promotes the reproduction of flesh, and the strength of the powers, and the restoration of nature to its pristine state of * * * * * * * * * * * * * * * * * * * * * * * * * * *

. . . . . as in a ship and in a calm. And if the patient have it fortunately at his command, gestation and living on the sea will be beneficial. For the sea-water contributes something desiccant to the ulcers. After the gestation, having rested, the patient is now to be anointed with fat oil. After the frictions . . . . . . . . . . . from a small dose gradually up to five or six heminæ, or even much more; or if not, as much as one can, for often this alone sufficeth in place of all food. For milk is pleasant to take, is easy to drink, gives solid nourishment, and is more familiar than any other food to one from a child. In colour it is pleasant to see: as a medicine it seems to lubricate the windpipe, to clean, as if with a feather, the bronchi, and to bring off phlegm, improve the breathing, and facilitate the discharges downwards. To ulcers it is a sweet medicine, and milder than anything else. If one, then, will only drink plenty of this, he will not stand in need of anything else. For it is a good thing that, in a disease, milk should prove both food and medicine. And, indeed, the races of men called Galactophagi use no food from grain. But yet it is a very good thing to use porridge, pastry, washed groats of spelt ( alica), and the other edibles prepared with milk. And if other food is required, let it be of the same nature, as the juice of ptisan, well-concocted and plain; but it is to be so seasoned as that it may become easy to swallow; or if anything be added as a seasoner, let it be something medicinal, as the hair ( capillary leaves?) of lovage, penny-royal, mint, and a little of salts, vinegar, or honey. If the stomach suffer from dyspepsia, this is to be given; but if there be no such necessity, ptisan is of all things the best. One may also change the ptisan for alica, for this is less flatulent, and of easier digestion, and becomes detergent if, when used in the ptisan, the grain be bruised. When the sputa are unusually fluid, the bean cleanses the ulcers, but is flatulent. The pea and the pisum ochrys, in so far as they are less flatulent, are in the same degree inferior as cleansers of the ulcers. Forming a judgment, then, from present symptoms, select accordingly. Their condiments are to be such as described respecting the ptisan. Eggs from the fire, in a liquid state, but hot; they are best when newly laid, before the * * * * * * * * * * * * * * * * * * * * * *

. . . in the liver the ulcer may be dangerous. But the most troublesome is a defluxion of pus on the stomach, when it makes the stomach its route in the course of being distributed upwards. For the food is the cause of life, but the stomach is the leader in the process of nutrition, and it also sometimes conveys medicines to the internal parts. If, then, in addition to all the other evils, a difficulty of deglutition come on, the patient must speedily die of disease and famine. But the indications by which it is discovered in what direction the pus will be diverted are diversified. If it pass by the intestines, there are tormina, watery discharges from the bowels, phlegm, and bile; then clots of blood floating in a fluid, or a thin discharge like the washings of raw flesh. But, if it pass by the bladder, there is a weight in the kidneys and loins; at first, therefore, the evacuations are copious, and tinged with bile; then turbid, which do not deposit their sediment, nor get settled. In all cases the sediment should become white. But if it be determined upwards to the stomach, nausea, loss of appetite, vomitings of phlegm or of bile, deliquium, and vertigo supervene, until it burst.

This, then, is to be especially avoided, as being a bad course. But if the defluxion of pus be more violent, we must take every means, assisting the stomach by food, and medicines, and regimen, all in a mild way. We must administer the medicines for bursting the abscess; give to drink of the herb hyssop with honeyed-water, and the juice of the hair of horehound, and this with honeyed-water and the juice of the wormwood. These things must be given before food to dilute the fluids, to lubricate the parts, and facilitate the rupture of the abscesses. We are also to give the milk of an ass, which is soft, not bilious, nutritious, does not admit of being made into cheese, which is the perfection of milk. We should gratify the patient in regard to food and drink. And we are even to give things inferior to other more beneficial articles (for we thereby afford a passage to the fluid which occasions nausea and loathing of food, and many are hurt by the transit of the pus), lest they should come to loathe their food. And if they should take anything, they readily vomit. It is necessary, also, in the other defluxions, to have especial care of the stomach, for it is the passage to all sorts of medicine. It is necessary to keep in mind the liver, which is the root of the ulcerations. ¹⁵ But if the defluxion be to the bladder, we are to promote it by diuretics, as the root of asarabacca, valerian, maiden-hair, spignel, in drinks; for these things are to be given to drink in honeyed-water. The compound medicine of Vestinus is also very good, and that from alkekengi, and such others as from trial have acquired reputation. But if you determine to draw off the discharge by the bowels, you can do this with milk, especially that of the ass, or otherwise of the goat or sheep. Give, also, juices of a lubricating nature and detergent, as the juice of ptisan; condiments, as pepper, ginger, and lovage. In a word, with regard to every method of diet in any case of abscess tending to rupture, the food should consist of things having wholesome juices, of savoury things, things of easy digestion, either juices, or the gruels with milk, starch, pastry with milk * * * * * * * * * * *

RESOLUTION of scirrhus of the spleen is not easy to accomplish. But if the diseases engendered by it come on, as dropsy and cachexia, the ailment tends to an incurable condition . . . . . . . the physician to cure the scirrhus; we must try then to avert it when it is coming on, and to remove it when just commencing; and attend to the inflammations, and if the scirrhus be the substitute . . . . . . . . are brought by suppuration . . . . . the abscess. For these, if the inflammation . . . . . we are to use the remedies described by me among the acute diseases. But if, while you are doing everything, the scirrhus remain in an inflammatory state, you must use also the means resembling fire to soften the hardness; lotions of vinegar, oil, and honey; but, instead of wool, use compresses of linen; add to them, in powder, nut-ben sifted; and to the most emollient cataplasms * * * * * * * * * * * *