De Medicina |
Translator: Walter George Spencer
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Alter quoque morbus est aliter phrenetico contrarius . In eo difficilior somnus , prompta ad omnem audaciam mens est : in hoc marcor et inexpugnabilis paene dormiendi necessitas . Lethargum Graeci nominarunt . Atque id quoque genus acutum est , et nisi succurritur , celeriter iugulat .—Hos aegros quidam subinde excitare nituntur admotis is , per quae sternumenta euocentur , et is , quae odore foedo mouent , qualis est pix cruda , lana sucida , piper , ueratrum , castoreum , acetum , alium , cepa . Iuxta etiam galbanum incendunt , aut pilos aut cornu ceruinum ; si id non est , quodlibet aliud : haec enim cum conburuntur , odorem foedum mouent . Tharrias uero quidam accessionis id malum esse dixit , leuarique , cum ea decessit ; itaque eos , qui subinde excitant , sine usu male habere . Interest autem , in decessione expergiscatur aeger , an aut febris non leuetur aut leuata quoque ea somnus urgue at . Nam si expergiscitur , adhibere †eum sopito superuacuum est : neque enim uigilando melior fit , sed per se , si melior est , uigilat . Si uero continens ei somnus est , utique excitandus est , sed iis temporibus , quibus febris leuissima est , ut et excernat aliquid et sumat . Excitat autem ualidissime repente aqua frigida infusa . Post remissionem itaque perunctum multo oleo corpus tribus aut quattuor amphoris totum per caput perfundendum est . Sed hoc utemur , si aequalis aegro spiritus erit , si mollia praecordia : sin aliter haec erunt , ea potiora , quae supra comprehensa sunt . Et quod ad somnum quidem pertinet , commodissima haec ratio est . Medendi autem causa caput radendum , deinde posca fouendum est , in qua laurus aut ruta decocta sit . Altero die inponendum castoreum , aut ruta ex aceto contrita aut lauri bacae aut hedera cum rosa et aceto ; praecipueque proficit et ad excitandum hominem naribus admotum et ad morbum ipsum depellendum capiti frontiue inpositum sinapi . Gestatio etiam in hoc morbo prodest , maximeque oportune cibus datus , id est in remissione , quanta maxime inueniri poterit . Aptissima autem sorbitio est , donec morbus decrescere incipiat , sic ut , si cotidie grauis accessio est , haec cotidie detur ; si alternis , post grauiorem sorbitio , post leuiorem mulsa aqua . Vinum quoque cum tempestiuo cibo datum non mediocriter adiuuat . Quod si post longas febres eiusmodi torpor corpori accessit , cetera eadem seruanda sunt : ante accessionem autem tribus quattuorue horis castoreum , si uenter adstrictus est , mixtum cum scamonea ; si non est , per se ipsum cum aqua dandum est . Si praecordia mollia sunt , cibis utendum plenioribus ; si dura , in isdem sorbitionibus subsistendum , inponendumque praecordiis quod simul et reprimat et molliat .
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20 There is also another disease, a contrast in a different way to the phrenetic. In the latter sleep is got with great difficulty, and the mind is disposed to any foolhardiness; in this disease there is a pining away, and an almost insurmountable need of sleep. The Greeks name it lethargy. And it also is an acute sort, and unless remedied, quickly kills. Some strive to excite these patients by applying at intervals medicaments to promote sneezing, and those which stimulate by their offensive odour, such as burning pitch, unscoured wool, pepper, hellebore, castoreum, vinegar, garlic, onion. Moreover, they burn near them galbanum, hair or hartshorn, or when that is not at hand, some other kind of horn, for these when burnt give out an offensive odour. One Tharrias said, indeed, that this affection is a sort of feverish paroxysm, and that the patient is relieved when that remits, hence those without keep on irritating such patients do harm uselessly. But the important point is whether the patient wakes up with the remission; or whether the fever is either not relieved, or else it is relieved and yet sleep still oppresses him. For if the patient wakes up, it is needless to treat him as if in a stupor; for he is not made better by keep in him awake, but if he is better he keeps awake of himself. If the sleepiness in us interrupted the patient must certainly be aroused, but only at those times when the fever is of the slightest, in order that he may both make a natural evacuation and take food. Now a most powerful excitant is cold water poured suddenly over him; therefore when the fever has remitted, and he has been anointed freely, he should have three or four jarfuls poured over his head. But this measure should be employed only when the patient's breathing is regular, and the parts below the ribs soft: otherwise those are to be preferred which have been mentioned above. Such is the most suitable procedure, so far as concerns sleeplessness. But in order to cure, the head is to be shaved, and then fomented with vinegar and water in which laurel or rue leaves have been boiled. On the following day castoreum may be applied, or rue pounded up in vinegar, or laurel berries or ivy with rose oil and vinegar; mustard put to the nostrils is particularly efficacious both for arousing the patient, and when put on the head or forehead for driving out the disease itself. Rocking is also advantageous in this malady; and most of all food given opportunely, that is in the greatest degree of remission that can be found. Now gruel is most fitting until the disease begins to decrease; so if there is a severe paroxysm every day, it is given daily; if every other day, after a more severe paroxysm, gruel, and after a slighter paroxysm, hydromel. Wine is also of no mean service, when given at the proper time all with suitable food. But if this kind of torpor attacks the body after prolonged fevers, all the other measures are to be carried out, in the same way, and in addition three or four hours before the paroxysm castoreum is administered, mixed with scammony if the bowels are costive, if not, then by itself in water. If the parts below the ribs are soft, food should be given more freely; if hard, the patient must subsist on the gruel mentioned above, whilst something is to be applied to the parts below the ribs to repress and mollify at the same time. |
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Sed hic quidem acutus est morbus . Longus uero fieri potest eorum , quos aqua inter cutem male habet , nisi primis diebus discussus est : hydropa Graeci uocant . Atque eius tres species sunt . Nam modo uentre uehementer intento creber intus ex motu spiritus sonus est ; modo corpus inaequale est tumoribus aliter aliterque per totum id orientibus ; modo intus in unum aqua contrahitur et moto corpore ita mouetur , ut impetus eius conspici possit . Primum ΤΥΜΠΑΝΕΙΤΗΝ , secundum ΛΕΥΚΟΦΛΕΓΜΑΤΙΑΝ uel ΥΠΟ ΣΑΡΚΑ , tertium ΑΣΚΕΙΤΗΝ Graeci nominarunt . Communis tamen omnium est umoris nimia abundantia , ob quam ne ulcera quidem in his aegris facile sanescunt . Saepe uero hoc malum per se incipit , saepe alteri uetusto morbo maximeque quartanae superuenit . Facilius in seruis quam in liberis tollitur , quia , cum desideret famem , sitim , mille alia taedia longamque patientiam , promptius is succurritur , qui facile coguntur , quam quibus inutilis libertas est . Sed ne i quidem , qui sub alio sunt , si ex toto sibi temperare non possunt , ad salutem perducuntur . Ideoque * non ignobilis medicus , Chrysippi discipulus , apud Antigonum regem , amicum quendam eius , notae intemperantiae , mediocriter eo morbo inplicitum , negauit posse sanari ; cumque alter medicus Epirotes Philippus se sanaturum polliceretur , respondit illum ad morbum aegri respicere , se ad animum . Neque eum res fefellit . Ille enim cum summa diligentia non medici tantummodo , sed etiam regis custodiretur , tamen malagmata sua deuorando bibendoque suam urinam in exitium se praecipitauit . Inter initia tamen non difficilis curatio est , si inperata sunt corpori sitis , requies , inedia : at si malum inueterauit , non nisi magna mole discutitur . Metrodorum tamen Epicuri discipulum ferunt , cum hoc morbo temptaretur , nec aequo animo necessariam sitim sustineret , ubi diu abstinuerat , bibere solitum , deinde euomere . Quod si redditur quicquid receptum est , multum taedio demit ; si a stomacho retentum est , morbum auget ; ideoque in quolibet temptandum non est . Sed si febris quoque est , haec in primis summouenda est per eas rationes , per quas huic succurri posse propositum est . Si sine febre aeger est , tum demum ad ea ueniendum est , quae ipsi morbo mederi solent . Atque hic quoque , quaecumque species e st , si nondum nimis occupauit , isdem auxiliis opus est . Multum ambulandum , currendum aliquid est , superiores maxime partes sic perfricandae , ut spiritum ipse contineat . Euocandus est sudor non per exercitationem tantum , sed etiam in harena calida uel Laconico uel clibano similibusque aliis ; maximeque utiles naturales et siccae sudationes sunt , quales super Baiias in murtetis habemus . Balineum atque omnis umor alienus est . Ieiuno recte catapotia dantur , facta ex apsinthi duabus , murrae tertia parte . Cibus esse debet ex media quidem materia , sed tamen generis durioris : potio non ultra danda est quam ut uitam sustineat , optimaque est , quae urinam mouet . Sed id ipsum tamen moliri cibo quam medicamento melius est . Si tamen res coget , ex is aliquid , quae id praestant , erit decoquendum , eaque aqua potui danda . Videntur autem hanc facultatem habere iris , nardum , crocum , cinnamomum , casia , murra , balsamum , galbanum , ladanum , oenanthe , panaces , cardamomum , hebenus , cupressi semen , uua t aminia quam ΣΤΑΦΙΔΑ ΑΓΡΙΑΝ Graeci nominant , habrot onum , rosae folia , acorum , amarae nuces , tragoriganum , styrax , costum , iunci quadrati et rotundi semen : illud cyperon , hoc ΣΧΟΙΝΟΝ Graeci uocant ; quae quotiens posuero , non quae hic nascuntur , sed quae inter aromata adferuntur , significabo . Primo tamen quae leuissima ex his sunt id est rosae folia uel nardi spica temptanda est . Vinum quoque utile est austerum , sed quam tenuissimum . Commodum est etiam lino cotidie uentrem metiri et , qua conprehendit aluum , notam imponere , posteroque die uidere , plenius corpus sit an extenuetur : id enim , quod extenuatur , medicinam sentit . Neque alienum est metiri et potionem eius et urinam : nam si plus umoris excernitur quam insumitur , ita demum secundae ualetudinis spes est . Asclepiades in eo , qui ex quartana in hydropa deciderat , se abstinentia bidui et frictione usum , tertio die iam et febre et aqua liberato cibum et uinum dedisse memoriae prodidit . Hactenus communiter de omni specie praecipi potest : si uehementius malum est , diducenda ratio curandi est . Ergo si inflatio et ex ea dolor creber est , utilis cotidianus aut altero quoque die post cibum uomitus est ; fomentis siccis calidisque utendum est . Si per haec dolor non finitur , necessariae sunt sine ferro cucurbitulae : si ne per has quidem tormentum tollitur , incidenda cutis est ; tum his utendum est . Vltimum auxilium est , si cucurbitulae nihil profuerunt , per aluum infundere copiosam aquam calidam eamque recipere . Quin etiam cotidie ter quaterque opus est uti frictione uehementi , cum oleo et quibusdam calefacientibus . Sed in hac frictione a uentre abstinendum est : inponendum uero in eum crebrius sinapi , donec cutem erodat ; ferramentisque candentibus pluribus locis uenter exulcerandus est ; seruanda ulcera diutius . Vtiliter etiam scilla cocta delinguitur ; sed diu post has infl ationes abstinendum est ab omnibus inflantibus . At si id uitium est , cui ΛΕΥΚΟΦΛΕΓΜΑΤΙΑ nomen est , eas partes , quae tument , subicere soli oportet , sed non nimium , ne febricula incidat . Si is uehementior est , caput uelandum est , utendumque frictione , madefactis tantum manibus aqua , cui sal et nitrum et olei paululum sit adiectum , sic ut aut pueriles aut muliebres manus adhibeantur , quo mollior earum tactus sit ; idque , si uires patiuntur , ante meridiem tota hora , post meridiem semihora fieri oportet . Vtilia etiam sunt cataplasmata , quae reprimunt , maximeque si corpora teneriora sunt . Incidendum quoque super talum quattuor fere digitis ex parte interiore , qua per aliquot dies frequens umor feratur , atque ipsos tumores incidere altis plagis oportet ; concutiendumque multa gestatione corpus est ; atque ubi inductae uulneribus cicatrices sunt , adiciendum et exercitationibus et cibis , donec corpus ad pristinum statum reuertatur . Cibus ualens esse debet et glutinosus , maximeque caro . Vinum , si per stomachum licet , dulcius , sed ita ut inuicem biduo triduoue modo aqua , modo id bibatur . Prodest etiam lactucae marinae , quae grandis iuxta maria nascitur , semen cum aqua potui datum . Si ualens est qui id accipit , et scilla cocta , sicut supra dixi , delinguitur . Auctoresque multi sunt inflatis uesicis pulsandos tumores esse . Si uero id genus morbi est , quo in uterum multa aqua contrahitur , ambulare , sed magis modice , oportet , malagma quod digerat inpositum habere , idque ipsum superimposito triplici panno fascia , non nimium tamen uehementer , adstringere ; quod a Tharria profectum esse seruatum a pluribus uideo . Si iecur aut lienem adfectum esse manifestum est , ficum pinguem contusam adiecto melle superponere : si per talia auxilia uenter non siccatur , sed umor nihilo minus abundat , celeriore uia succurrere , ut is per uentrem ipsum emittatur . Neque ignoro displicuisse Erasistrato hanc curandi uiam : morbum enim hunc iocineris putauit : ita illud esse sanandum , frustraque aquam emitti , quae uitiato illo subinde nascatur . Sed primum non huius uisceris unius hoc uitium est : nam et liene adfecto et in totius corporis malo habitu fit ; deinde ut inde coeperit , tamen aqua , nisi emittitur , quae contra naturam ibi substitit , et iocineri et ceteris partibus interioribus nocet . Conuenitque corpus nihilo minus esse curandum : neque enim sanat emissus umor , sed medicinae locum facit , quam intus inclusus impedit . Ac ne illud quidem in controuersiam uenit , quin non omnes in hoc morbo sic curari possint , sed iuuenes robusti , qui uel ex toto carent febre , uel certe satis liberales intermissiones habent . Nam quorum stomachus corruptus est , quiue ex atra bile in hoc deciderunt , quiue malum corporis habitum habent , idonei huic curationi non sunt . Cibus autem , quo die primum umor emissus est , superuacuus est , nisi si uires desunt . Insequentibus diebus et is et uinum meracius quidem , sed non ita multum dari debet ; paulatimque euocandus aeger est ad exercitationes , frictiones , solem , sudationes , nauigationes et idoneos cibos , donec ex toto conualescat . Balneum rarum res amat , frequentiorem in ieiunio uomitum . Si aestas est , in mari natare commodum est . Vbi conualuit aliquis , diu tamen alienus ei ueneris usus est .
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21 Now the foregoing is indeed an acute disease. But a chronic malady may develop in those patients who suffer from a collection of water under the skin, unless this is dispersed within the first days. The Greeks call this hydrops. And of this there are three species: sometimes the belly being very tense, there is within a frequent noise from the movement of wind; sometimes the body is rendered uneven by swellings rising up here and there all over; sometimes the water is drawn all together within, and is moved with the movement of the body, so that its movement can be observed. The Greeks call the first tympanites, the second leukophlegmasia or hyposarka, the third ascites. The characteristic common to all three species is an excessive abundance of humour, owing to which in these patients ulcerations even do not readily heal. This is a malady which often begins of itself, often it supervenes upon a disease of long standing, upon quartan fever especially (III.15, 16). It is relieved more easily in slaves than in freemen, for since it demands hunger, thirst, and a thousand other troublesome treatments and prolonged endurance, it is easier to help those who are easily constrained than those who have an unserviceable freedom. But even those who are in subjection, if they cannot exercise complete self-control, are not brought back to health. Hence a not undistinguished physician, a pupil of Chrysippus, at the court of King Antigonus, held that a certain friend of the king, noted for intemperance, could not be cured, although but moderately affected by that malady; and when another physician, Philip of Epirus, promised that he would cure him, the pupil of Chrysippus replied that Philip was regarding the disease, he the patient's spirit. Nor was he mistaken. For although the patient was watched with the greatest diligence, not only by his physician but by the king as well, by devouring his poultices and by drinking his own urine, he hurried himself headlong to his end. At the beginning, however, cure is not difficult, if there is imposed upon the body thirst, rest, and abstinence; but if the malady has become of long standing, it is not dispersed except with great trouble. They say, however, that Metrodorus, a pupil of Epicurus, when afflicted with this disease, and unable to bear with equanimity necessary thirst, after abstaining for a long while, was accustomed to drink and then to vomit. Now if what has been drunk is then returned, distress is much reduced; but if retained in the stomach, it increases the disorder; and so it must not be tried in every case. But if there is also fever, this is first of all to be overcome by the methods which have been prescribed concerning possible relief in such cases (III.4‑17). If the patient has become free from fever, then at length we must go on to those measures by which the disorder itself is usually treated. And here, whatever the species, so long as the disease has not taken too firm a hold, the same remedies are required. The patient should walk much, run a little, and his upper parts in particular are to be rubbed while he holds his breath. Sweating is also to be procured, not only by exercise, but also by heated sand, or in the Laconicum, or with a clibanus and such-like; especially serviceable are the natural and dry sweating places, such as we have in the myrtle groves above Baiae. The bath and moisture of every kind is wrong. Pills composed of wormwood two parts, myrrh one part, are given on an empty stomach. Food should be of the middle class indeed, but, of the harder kind; no more of drink is to be given than to sustain life, and the best is that which stimulates urine. But that, however, is better brought about by diet than by medicament. If, nevertheless, the matter is urgent, one of those drugs which are efficacious is to be made into a decoction, and that given as a draught. Now this faculty seems to belong to iris root, spikenard, saffron, cinnamon, cassia, myrrh, balsam, galbanum, ladanum, oenanthe, opopanax, cardamomum, ebony, cypress seeds, the Taminian berry which the Greeks call staphis agria, southernwood, rose leaves, sweet flag root, bitter almonds, goat's marjoram, styrax, costmary, seeds of rush, square and round (the Greeks call the former cyperon, the latter schoinon): whenever I use these terms I refer, not to native plants, but to such as are imported among spices. The mildest of these, however, are to be tried first, such as rose leaves or spikenard. A dry wine is beneficial, but it must be very thin. It is good besides to measure every day with string the circumference of the abdomen, and to put a mark where it surrounds the belly, then the day following to see whether the body is fuller or thinner, for the thinning shows a yielding to the treatment. Nor is it unserviceable to take the measure of his drink, and of his urine; for if more humour is evacuated than taken in, then at least there is hope of recovery. Asclepiades has put it on record that for a patient who had lapsed from a quartan into dropsy, he employed for two days abstinence and rubbing, on the third day, the patient having all become freed from both the fever and the water, he gave food and wine. So far the prescription can be common to all the species; if the disease is more severe, the method of treatment must be different. For instance, if there is flatulence and owing to that pain is frequent, a vomit is beneficial, either daily or on alternate days, after food; hot and dry foments are to be applied. If the pain is not ended by these, dry cuppings are needed, but if the torment is not relieved even by these, skin incisions are made and then the cups applied. If cupping does no good, the last resource is to infuse hot water copiously into the rectum and draw it out again. Nay even vigorous rubbing with oil and any one of the heating agents should be carried out three or four times a day, but in this rubbing the abdomen is to be left out; but to this mustard should be applied repeatedly until the skin is excoriated; and ulcerations are to be set up in many places upon the abdominal wall by means of the red hot cautery, and the ulcers to be kept open for some time. It is useful also to suck a boiled squill bulb; but for a long while after such attacks of flatulence the patient should abstain from everything that causes it. But if the affection is that named leukophlegmasia, the swollen parts should be exposed to the sun, but not too much lest feverishness ensue. If the sun is over-strong, the head is to be covered, and rubbing is to be used with hands just moistened with water to which salt and soda and a little oil is added, taking care that the hands of children or of women are employed, for theirs is a softer touch; and this ought to be done, should the patient's strength allow of it, for a whole hour before noon, or for half an hour after noon. Repressing poultices are of benefit, especially for the more delicate. Also an incision should be made our fingers' breadth above the ankle on the inner side through which humour may discharge freely for some days, and the actual swellings ought to be incised by deep cuts; the body also is to be shaken up by much rocking (II.15); then after the incisions have formed a scab, both exercises and food must be increased, until the patient is restored to his former state of health. The food should be nutritious and glutinous, mostly meat. The wine, when the stomach permits of it, should be rather sweet, but should be drunk alternately with water every two or three days. The seeds of the wolf's-milk plant, which grows to a large size on the seacoast, may be advantageously administered in a draught with water. If the patient is strong enough, he should suck a boiled squill bulb as noted above. There are many authorities who would have the swelling beaten with inflated ox-bladders. But if the form of the affection is that in which much water is drawn into the belly, the patient should take walks, but with much more moderation, and have applied a dispersive poultice, covered with three folds of linen, bandaged on not too tightly; a practice begun by Tharrias, which I see many have followed. If the liver or spleen is plainly affected, a fatty fig bruised with honey should be put on over it: if the belly is not dried up by such remedies, and in spite of them the humour is in large amount, aid must be given in a quicker way, by giving issue to it through the belly itself (VII.15). I am quite aware that such a way of treatment was disapproved of by Erasistratus, for he deemed the disease to be one of the liver, that therefore it was the liver which had to be rendered sound, and that it was of no use to let out water which, if that organ is diseased, will continually be reproduced. But firstly, the disease is not primarily one of that organ alone; for it occurs when the spleen is affected, and there is a general diseased condition of the body; further, granted that it begins from the liver, the water unnaturally collected there, unless evacuated, injures both the liver and all the rest of the internal organs. And it is agreed, nevertheless, that the body generally has to be treated; for the mere evacuation of the humour does not restore health, but it affords an opportunity for medicaments which the accumulation within impedes. And indeed it is not in dispute that not everybody with this affection can be so treated, but only the young and robust, in whom fever is wholly absent, or who have sufficiently long intermissions. For those are unfitted for this treatment whose stomach is corrupted, or who have lapsed into the malady owing to black bile, or who have a diseased condition of body. But food on the day the humour is first let out is not needed unless strength fails. On the days following, both food and wine, undiluted indeed, but not overmuch in quantity, should be given; little by little the patient should be submitted to exercise, rubbing, sun-heat, sweating, a sea voyage, along with a suitable diet, until he has completely recovered. Such a case requires a bath seldom, more often an emetic on an empty stomach; in summer a swim in the sea is beneficial. For a long while after his recovery, however, the practice of venery is unsuitable. |
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Diutius saepe et periculosius tabes eos male habet , quos inuasit . Atque huius quoque plures species sunt . Vna est , qua corpus non alitur , et naturaliter semper aliquis decedentibus , nullis uero in eorum locum subeuntibus , summa macies oritur , et nisi occurritur , tollit : ΑΤΡΟΦΙΑΝ Graeci uocant . Ea duabus fere de causis incidere consueuit : aut enim nimio timore aliquis minus , aut auiditate nimia plus quam debet adsumit : ita quod uel deest infirmat , uel quod superat corrumpitur . Altera species est quam Graeci † ΚΑΚΕΞΙΑΝ appellant , ubi malus corporis habitus est , ideoque omnia alimenta corrumpuntur . Quod fere fit , quom longo morbo uitiata corpora , etiamsi illo uacant , refectionem tamen non accipiunt ; aut cum malis medicamentis corpus adfectum est ; aut cum diu necessaria defuerunt ; aut cum inusitatos aut inutiles cibos aliquis adsumpsit , aliquidue simile incidit . Hic praeter tabem illud quoque nonnumquam accidere solet , ut per adsiduas pusulas aut ulcera summa cutis exasperetur , uel aliquae corporis partes intumescant . Tertia est longeque periculosissima species , quam Graeci pthisin nominarunt . Oritur fere a capite , inde in pulmonem destillat ; huic exulceratio accedit ; ex hac febricula leuis fit , quae etiam cum quieuit , tamen repetit ; frequens tussis est , pus excreatur , interdum cruentum aliquid . Quicquid excreatum est , si in ignem impositum est , mali odoris est . Itaque qui de morbo dubitant , hac nota utuntur . Cum haec genera tabis sint , animaduertere primum oportet , quid sit , qui laboretur ; deinde , si tantum non ali corpus apparet , causam eius attendere , et si cibi minus aliquis quam debet adsumpsit , adicere , sed paulatim , ne , si corpus insuetum subita multitudine onerauerit , concoctionem impediat . Si uero plus iusto qui adsumere solitus est , abstinere uno die , deinde ab exiguo cibo incipere , cotidie adicere , donec ad iustum modum perueniat . Praeter haec conuenit ambulare locis quam minime frigidis , sole uitato ; per manus quoque exerceri : si infirmior est , gestari , ungui , perfricari , si potest , maxime per se ipsum , saepius eodem die , et ante cibum et post eum , sic ut interdum oleo quaedam adiciantur calfacientia , donec insudet . Prodestque in ieiuno prendere per multas partes cutem et adtrahere , ut relaxetur ; aut inposita resina et abducta subinde idem facere . Vtile est etiam interdum balneum , sed post cibum exiguum . Atque in ipso solio recte cibi aliquid adsumitur , aut si sine hoc frictio fuit , post eam protinus . Cibi uero esse debent ex iis , quae facile concoquantur : qui maxime alunt . Ergo uini quoque , sed austeri , necessarius usus est ; mouenda urina . At si malus corporis habitus est , primum abstinendum est , deinde aluus ducenda , tum paulatim cibi dandi , adiectis exercitationibus , unctionibus , frictionibus . Vtilius his frequens balineum est , sed ieiunis , etiam usque sudorem . Cibis uero opus est copiosis , uariis , boni suci , quique etiam minus facile corrumpantur , uino austero . Si nihil reliqua proficiunt , sanguis mittendus est , sed paulatim cotidieque pluribus diebus , cum eo ut cetera quoque eodem modo seruentur . Quod si mali plus est et uera pt hisis est , inter initia protinus occurrere necessarium est : neque enim facile is morbus , cum inueterauit , euincitur . Opus est , si uires patiuntur , longa nauigatione , caeli mutatione , sic ut densius quam id est , ex quo discedit aeger , petatur : ideoque aptissime Alexandriam ex Italia itur . Fereque id posse inter principia corpus pati debet , cum hic morbus aetate firmissima maxime oriatur , id est ab anno XIIX ad annum XXXV . Si id inbecillitas non sinit , naue tamen non longe gestari commodissimum est . Si nauigationem aliqua res prohibet , lectica uel alio modo corpus mouendum est ; tum a negotiis abstinendum est omnibusque rebus , quae sollicitare animum possunt ; somno indulgendum ; cauendae destillationes , ne , si quid cura leuarit , exasperent ; et deuitanda cruditas , simulque et sol et frigus ; os obtegendum ; fauces uelandae ; tussicula suis remediis finienda ; et quamdiu quidem febricula incursat , huic interdum abstinentia , interdum etiam tempestiuis cibis medendum ; eoque tempore bibenda aqua . Lac quoque , quod in capitis doloribus et in acutis febribus et per eas facta nimia siti , ac , siue praecordia tument , siue biliosa urina est , siue sanguis fluxit , pro ueneno est , in pt hisi tamen , sicut in omnibus longis difficilibusque febriculis recte dari potest . Quod si febris aut nondum incursat , aut iam remisit , decurrendum est ad modicas exercitationes , maximeque ambulationes , item lenes frictiones . Balineum alienum est . Cibus esse debet primo acer , ut alium , porrum , idque ipsum ex aceto , uel ex eodem intubus , ocimum , lactuca , dein lenis , ut sorbitio ex tisana uel ex halica uel ex amulo , lacte adiecto . Idem oriza quoque et , si nihil aliud est , far praestat . Tum in uicem modo his cibis , modo illis utendum est ; adiciendaque quaedam ex media materia , praecipueque uel ex pruna cerebellum uel pisciculus et his similia . Farina etiam cum sebo ouillo caprinoue mixta , deinde incocta pro medicamento est . Vinum adsumi debet leue , austerum . Hactenus non magna mole pugnatur . Si uehementior noxa est , ac neque febricula neque tussis quiescit , tenuarique corpus apparet , ualidioribus auxiliis opus est . Exulcerandum est ferro candenti , uno loco sub mento , altero in gutture , duobus ad mammam utramque , item sub imis ossibus scapularum , quas ΩΜΟΠΛΑΤΑΣ Graeci uocant , sic , ne sanescere ulcera sinas nisi tussi finita ; cui per se quoque medendum esse manifestum est . Tum ter quaterue die uehementer extremae partes perfricandae ; thorax leui manu pertractandus ; post cibum intermittenda hora , et perfricanda crura brachiaque . Interpositis denis diebus demittendus aeger in solium , in quo sit aqua calida et oleum . Ceteris diebus bibenda aqua ; tum uinum ; si tussis non est , potui frigidum dandum ; si est , egelidum . Vtile est etiam cibos in remissionibus cotidie dari , frictiones gestationesque similiter adhibere , eadem acri a quarto aut quinto die adsumere , interdum herbam sanguinalem ex aceto uel plantaginem esse . Medicamentum etiam est uel plantaginis sucus per se , uel marrubii cum melle incoctus , ita ut illius cyathus sorbi lo sumatur huius cocleare plenum paulatim delingatur , uel inter se mixta et incocta resinae terebenthinae pars dimidia , buturi et mellis pars altera . Praecipua tamen ex his omnibus sunt uictus , uehiculum et nauis , et sorbitio . Aluus cita utique uitanda est . Vomitus in hoc morbo frequens perniciosus est , maximeque sanguinis . Qui meliusculus esse coepit , adicere debet exercitationes , frictiones , cibos , deinde ipse se suppresso spiritu perfricare , diu abstinere a uino , balneo , uenere .
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22 Longer and more dangerous is the illness which follows when wasting disease attacks a patient. This also has several species. There is one in which the body is not nourished enough, and as there is some natural loss going on all the time without replacement, extreme emaciation ensues, which unless countered, kills. The Greeks call it atrophia. It proceeds commonly from two causes: for either from excessive dread the patient consumes less, or from excessive greed more, than he ought: thus either the deficiency weakens, or the superfluity undergoes decomposition. There is another species which the Greeks call cachexia, in which owing to bad habit of body all the aliments undergo decomposition. This occurs generally in those whose bodies have become vitiated by prolonged disease, and even if they have rid themselves of this, yet they do not regain health; or when the system has become affected by bad medicaments; or for a long while necessaries of life have been deficient; or unusual or unserviceable food has been consumed; or something similar has happened. In this case besides the wasting, it not unfrequently occurs that the skin surface undergoes irritation by persistent pustulation or ulceration, or else some parts of the body become swollen. The third species, which the Greeks call phthisis, is the most dangerous by far. The malady usually arises in the head, thence it drips into the lung; there ulceration supervenes, from this a slight feverishness is produced, which even after it has become quiescent nevertheless returns; there is frequent cough, pus is expectorated, sometimes blood-stained. When the sputum is thrown upon a fire, there is a bad odour, hence those who are in doubt as to the disease employ this as a test. As these are the species of wasting, the first consideration should be, which the patient is suffering from: next, if it is only that the body is not being sufficiently nourished, we must look to the cause of this, and if the patient has been consuming less food than he ought, addition is to be made, but only a little at a time, lest if the system becomes overloaded suddenly by an unaccustomed quantity, it may hinder digestion. On the other hand, if the patient has been consuming more than he ought, he should first fast for a day, then begin with a scanty amount of food, increasing daily until he reaches the proper amount. Further, he should walk in places as little cold as possible, whilst avoiding the sun; he should also use the hand exercises; if he is weaker, he should be rocked, anointed and then rubbed, doing as much as possible of this himself, several times each day, before and after meals, until he sweats — sometimes adding heating agents to the oil. It is advantageous on an empty stomach to pinch up and pull on the skin in a number of places, in order to relax it, or to do the same by applying a pitch plaster and at once pulling it off. The bath also is sometimes beneficial, but only after a scanty meal. And whilst actually in the solium, some food may properly be taken, also immediately after a rubbing, when applied without the bath. The food too should be of the kinds easily digested, which are most nutritious. Hence also the use of wine is necessary, but it should be dry; urination is to be stimulated. But if there is a bad habit of body, the patient should abstain at first, next have the bowels moved by a clyster, then take food a little at a time, with exercise, anointing and rubbing. A frequent bath is useful for these cases, but on an empty stomach, prolonged till there is sweating. Abundant and varied and succulent food is necessary, such as will less readily decompose, and dry wine. If there is no relief from anything else, blood should be let, but only a little each day for several days; with this proviso, that the other remedies also should be employed as described. But if there is more serious illness and a true phthisis, it is necessary to counter it forthwith at the very commencement; for when of long standing it is not readily overcome. If the strength allows of it a long sea voyage is requisite with a change of air, of such a kind that a denser climate should be sought than that which the patient quits; hence the most suitable is the voyage to Alexandria from Italy. And the body ought generally to be able to bear this in the early stages, since this disease arises especially during the most stable part of life, namely between eighteen and thirty-five years of age. If the patient's weak state does not allow of the above, the best thing for him is to be rocked in a ship without going far away. If anything prevents a sea voyage, the body is to be rocked in a litter, or in some other way. Further, the patient should keep away from business, and everything disturbing to his spirit; he should indulge in sleep; he is to be warned against catarrh, lest that should make worse what the treatment is relieving; indigestion should be avoided, also the sun and cold; the mouth should be covered, the neck wrapped up, any cough put a stop to by its appropriate remedies; and whenever there is an intercurrent fever, it is countered, sometimes by abstinence, sometimes by timely meals, at which water is to be drunk. Milk also, which in headaches, in acute fevers and for the excessive thirst they occasion, also when the chest swells, or there is bilious urine, or a flux of blood, is as bad as a poison, can nevertheless be given appropriately in phthisis, as also in all prolonged feverishness. But if there has either been no intercurrent fever yet, or if it has already remitted, recourse should be had to moderate exercise, walking in particular, also to gentle rubbing. The bath is unsuitable. The food should at first be acrid, such as garlic and leeks, also this latter or endive, basil or lettuce after soaking in vinegar; later the food should be bland, such as a gruel made with pearl barley, or spelt flour, or starch to which milk is added. Rice also, and if there is nothing else, parched groats of spelt answer. Subsequently use is to be made of the above foods in turn, with some additions from food of the middle class, especially grilled brains, small fish and such like. Flour mixed with mutton- or goat-fat and then boiled serves for a medicament. The wine taken ought to be light and dry. So far there is no great difficulty in countering the disease. But if it is more severe, and the body is evidently wasting, stronger remedies are required. Ulceration is to be set up by cautery, at one spot under the chin, at another on the neck, two upon each breast, and the same below the shoulder-blades which the Greeks call omoplatae. The ulcerations are not to be allowed to heal until the cough has stopped, and for this there must clearly be a special treatment also. Then three or four times a day the extremities should be rubbed vigorously, the chest being merely stroked with the hands; an hour after food both legs and arms are to be rubbed. At intervals of ten days the patient should be immersed in the solium contain in oil with the hot water. On other days he should drink first water, then wine; if there is no cough, the drink should be cold, if there is cough lukewarm. It is also of advantage to give food every day during the remission; rubbing and rocking should be employed likewise. On the fourth or fifth day he should take the above mentioned acrid food, now and then polygonum or plantain juice in vinegar. A further remedy is either plantain juice by itself, or horehound juice cooked with honey; of the former a cupful may be sipped, of the latter a spoonful, a little at a time, put upon the tongue, or one half part of turpentine resin, and another part of butter and honey may be mixed together and cooked. But of all these measures the principal ones are the diet, rocking in a litter or on a ship, and the gruel. Loose motions must be especially obviated. Frequent vomiting in this affection is a sign of danger, especially when blood is vomited. A patient who is beginning to improve a little should resume exercises, rubbing, and increase of food, next rub himself while holding his breath, but for a long while abstain from wine, the bath and venery. |
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Inter notissimos morbos est etiam is , qui comitialis uel maior nominatur . Homo subito concidit , ex ore spumae mouentur , deinde interposito tempore ad se redit , et per se ipse consurgit . Id genus saepius uiros quam feminas occupat . Ac solet quidem etiam longum esse usque mortis diem et uitae non periculosum : interdum tamen cum recens est , hominem consumit . Et saepe eum , si remedia non sustulerunt , in pueris ueneris , in puellis menstruorum initium tollit . Modo cum distentione autem neruorum prolabitur aliquis , modo sine illa . Quidam hos quoque isdem quibus lethargicos excitare conantur ; quod admodum superuacuum est , et quia ne letharg icus quidem his sanatur , et quia , cum possit ille numquam expergisci atque ita fame interire , hic ad se utique reuertitur . Vbi concidit aliquis , si nulla neruorum distentio accessit , utique sanguis mitti non debet : si accessit , non utique mittendus est , nisi alia quoque hortantur . Necessarium autem est ducere aluum , uel nigro ueratro purgare , uel utrumque facere , si uires patiuntur ; tunc caput tondere oleoque et aceto perunguere ; cibum post diem tertium , simul transit hora , qua concidit , dare . Neque sorbitiones autem his aliique molles et faciles cibi neque caro , minimeque suilla , conuenit , sed media materia : nam et uiribus opus est et cruditates cauendae sunt ; cum quibus fugere oportet solem , balneum , ignem omniaque calfacientia ; item frigus , uinum , uenerem , loci praecipitis conspectum omniumque terrentium , uomitum , lassitudines , sollicitudines , negotia omnia . Vbi tertio die cibus datus est , intermittere quartum et inuicem alterum quemque , eadem hora cibi seruata , donec quattuordecim dies transeant . Quos ubi morbus excessit , acuti uim deposuit ; a t si manet , curandus iam ut longus est . Quod si non , quo die primum incidit , medicus accessit , sed is , qui cadere consueuit , ei traditus est , protinus eo genere uictus adhibito , qui supra conprehensus est , expectandus est dies , quo prolabatur ; utendumque tum uel sanguinis missione uel ductione alui uel nigro ueratro , sicut praeceptum est . Insequentibus deinde diebus per eos cibos , quos proposui , uitatis omnibus , quae cauenda dixi , nutriendus . Si per haec morbus finitus non fuerit , confugiendum erit ad album ueratrum , ac ter quoque aut quater eo utendum non ita multis interpositis diebus , sic tamen ne iterum umquam sumat , nisi conciderit . Mediis autem diebus uires eius erunt nutriendae , quibusdam praeter ea , quae supra scripta sunt , adiectis . Vbi mane experrectus est , corpus eius leuiter ex oleo uetere , cum capite , excepto uentre , permulceatur ; tum ambulatione quam maxime recta et longa utatur ; post ambulationem loco tepido uehementer et diu , ac non minus ducenties , nisi infirmus erit , perfricetur ; deinde per caput multa aqua frigida perfundatur ; paulum cibi adsumat ; conquiescat ; rursus ante noctem ambulatione utatur ; iterum uehementer perfricetur , sic ut neque uenter neque caput contingatur ; post haec cenet , interpositisque tribus aut quattuor diebus uno aut altero acria adsumat . Si ne per haec quidem fuerit liberatus , caput radat ; unguatur oleo ueteri , adiecto aceto et nitro ; perfundatur aqua salsa ; bibat ieiunus ex aqua castoreum ; nulla aqua nisi decocta potionis causa utatur . Quidam iugulati gladiatoris calido sanguine epoto tali morbo se liberarunt ; apud quos miserum auxilium tolerabile miserius malum fecit . Quod ad medicum uero pertinet , ultimum est iuxta talum ex utroque crure paulum sanguinis mittere , occipitium incidere et cucurbitulas admouere , ferro candenti in occipitio quoque et infra , qua summa uertebra cum capite committitur , adurere duobus locis , ut per ea perniciosus umor euadat . Quibus si finitum malum non fuerit , prope est , ut perpetuum sit . Ad leuandum id tantummodo utendum erit exercitatione , multa frictione , cibisque , qui supra conprehensi sunt , praecipueque uitanda omnia , quae ne fierent excepimus .
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23 That malady which is called comitialis, or the greater, is one of the best known. The man suddenly falls down and foam issues out of his mouth; after an interval he returns to himself, and actually gets up by himself. This kind affects men oftener than women. And usually it persists even until the day of death without danger to life; nevertheless occasionally, whilst still recent, it is fatal to the man. And often if remedies have been ineffectual, in boys the commencement of puberty, in girls of menstruation, has removed it. Now sometimes there is a spasm of the sinews when the man falls down, sometimes there is none. Some try to rouse the patients as is done in the case of those affected by lethargy; which is quite useless, both because not even the lethargic patient is cured by this method, and because, though it may be impossible to waken him and he may thus die of starvation, the epileptic, on the other hand, returns to himself. If a man falls in a fit without the addition of spasms, certainly he should not be bled; if there are spasms, at any rate he should not be bled unless there are other indications for the bleeding. But it is necessary to move the bowels by a clyster, or by a purge of black hellebore, or by both if the strength allows of it. Next the head should be shaved and oil and vinegar poured over it, the patient should be given food on the third day, as soon as the hour has passed at which he had a fit. But neither gruels, nor other soft and easily digested food, nor meat, least of all pork, are suitable for such patients, but food materials of the middle class: for there is need to give strength and indigestion is to be avoided; in addition he should avoid sunshine, the bath, a fire, all heating agents; also cold, wine, venery, overlooking a precipice, and everything terrifying, vomiting, fatigue, anxiety, and all business. When food has been given upon the third day, it should be omitted on the fourth, and then on alternate days, observing the same hour for the meal, until fourteen days have elapsed. When the malady lasts beyond this period, it loses its acute character, and if it persists, it is now to be treated as chronic. But if the practitioner has not been in attendance from the day of the first fit, but a patient who is liable to fits has been handed over to of him, the class of diet given above should straightway be adhered to, and the day awaited upon which the patient may have a fit; than there is to be used either blood-letting, or clystering, or purgation by black hellebore, as prescribed above. Next on the following days the patient is to be supported by those foods I have mentioned, avoiding everything which I have said must be avoided. If the malady has not been brought to an end by these measures recourse should be had to white hellebore, administering it three or four times, without many days between, never, however, repeating it unless he has had a fit. Moreover, on intermediate days his strength must be supported by additions to what has been prescribed above. On awakening in the morning, his body should be lightly rubbed with old oil, including the head, but excluding the stomach; he should then walk as straight and as far as he can; after the walk he should be rubbed vigorously for a long while in a warm place, and with not less than two hundred hand-strokings, unless he is weak (II.14); next plenty of cold water should be poured over his head; he should take a little food; rest; again before night take a walk; and once more be vigorously rubbed, yet without touching either his stomach or his head; after this he may have dinner, and at intervals of three or four days he should eat for a day or two acrid foods. If not freed by these measures, his head should be shaved; anointed with old oil, to which vinegar and nitre have been added; have salt water poured over it; next upon an empty stomach he should take castoreum in water; no water should be used for drinking unless it has been boiled. Some have freed themselves from such a disease by drinking the hot blood from the cut throat of a gladiator: a miserable aid made tolerable by a malady still most miserable. But as to what is really the concern of the practitioner, the last resources are: to let a left blood from both legs near the ankle, to incise the back of the scalp and apply cups, to burn in two places with a cautery, at the back of the scalp and just below where the highest vertebra joins the head, in order that pernicious humour may exude through the burns. If the disease has not been brought to an end by the foregoing measures, it is probable that it will be lifelong. To mitigate it to some extent all you can do is to use exercise, plenty of rubbing, and the food which has been mentioned above, particularly avoiding what we have declared to be harmful. |