De Medicina |
Translator: Walter George Spencer
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Cognitis indiciis , quae nos uel spe consolentur uel metu terreant , ad CVRATIONES morborum transeundum est . Ex his quaedam communes sunt , quaedam propriae . Communes , quae pluribus opitulantur morbis ; propriae , quae singulis . Ante DE COMMVNIBVS dicam : ex quibus tamen quaedam non aegros solum sed sanos quoque sustinent , quaedam in aduersa tantum ualetudine adhibentur . Omne uero auxilium corporis aut demit aliquam materiam aut adicit , aut euocat aut reprimit , aut refrigerat aut calefacit , simulque aut durat aut mollit : quaedam non uno modo tantum sed etiam duobus inter se non contrariis adiuuant . DEMITVR MATERIA sanguinis detractione , cucurbitula , deiectione , uomitu , frictione , gestatione omnique exercitatione corporis , abstinentia , sudore ; de quibus protinus dicam .
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9 Having recognized the indications which either console us with hope, or terrify us with fear, we must pass to the methods of treating Diseases. Of these some are general aids, some special. General Aids are those which are beneficial in most diseases, Special Aids in particular ones. I shall speak first of the general, some of which, however, sustain not alone the sick but also those in health; some are applied against illness only. Now every corporeal aid either diminishes substance or adds to it, either draws it out or represses it, either cools or warms, either hardens or softens; some act, not merely in one way, but even in two ways, not contrary the one to the other. Substance is withdrawn by blood-letting, cupping, purging, vomiting, rubbing, rocking, and by bodily exercises of all kinds, by abstinence, by sweating; of these I shall now speak. |
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Sanguinem incisa uena mitti nouum non est : sed nullum paene esse morbum , in quo non mittatur , nouum est . Item mitti iunioribus feminis uterum non gerentibus uetus est : in pueris uero idem experiri et in senioribus et in grauidis quoque mulieribus uetus non est : siquidem antiqui primam ultimamque aetatem sustinere non posse hoc auxilii genus iudicabant , persuaserantque sibi mulierem grauidam , quae ita curata esset , abortum esse facturam . Postea uero usus ostendit nihil in his esse perpetuum , aliasque potius obseruationes adhibendas esse , ad quas derigi curantis consilium debeat . Interest enim , non quae aetas sit , neque quid in corpore intus geratur , sed quae uires sint . Ergo si iuuenis inbecillus est , aut si mulier , quae grauida non est , parum ualet , male sanguis emittitur : emoritur enim uis , si qua supererat , hoc modo erepta . At firmus puer et robustus senex et grauida mulier ualens tuto curatur . Maxime tamen in his medicus inperitus falli potest , quia fere minus roboris illis aetatibus subest ; mulierique praegnati , post curationem quoque , uiribus opus est , non tantum ad se , sed etiam ad partum sustinendum . Non quicquid autem intentionem animi et prudentiam exigit protinus faciendum est , cum praecipua in hoc ars sit , quae non annos numeret , neque conceptionem solam uideat , sed uires aestimet , et eo colligat , possit necne superesse , quod uel puerum uel senem uel in una muliere duo corpora simul sustineat . Interest etiam inter ualens corpus et obesum , inter tenue et infirmum : tenuioribus magis sanguis , plenioribus magis caro abundat . Facilius itaque illi detractionem eiusmodi sustinent : celeriusque ea , si nimium est pinguis , aliquis adfligitur ; ideoque uis corporis melius ex uenis quam ex ipsa specie aestimatur . Neque solum haec consideranda sunt , sed etiam morbi genus quod sit , utrum superans an deficiens materia laeserit , corruptum corpus sit an integrum . Nam si materia uel deest uel integra est , istud alienum est : at si uel copia sui male habet , uel corrupta est , nullo modo melius succurritur . Ergo uehemens febris , ubi rubet corpus , uenaeque plenae tument , sanguinis detractionem requirit ; item uiscerum morbi , neruorum et resolutio et rigor et distentio , quicquid denique fauces difficultate spiritus strangulat , quicquid supprimit subito uocem , quisquis intolerabilis dolor est , et quacumque de causa ruptum aliquid intus atque collisum est ; item malus corporis habitus omnesque acuti morbi , qui modo , ut supra dixi , non infirmitate sed onere nocent . Fieri tamen potest , ut morbus quidem id desideret , corpus autem uix pati posse uideatur : sed si nullum tamen appare at aliud auxilium , periturusque sit qui laborat , nisi temeraria quoque uia fuerit adiutus , in hoc statu boni medici est ostendere , quam nulla spes sit sine sanguinis detractione , faterique , quantus in hac ipsa metus sit , et tum demum , si exigetur , sanguinem mittere . De quo dubitari in eiusmodi re non oportet : satius est enim anceps auxilium experiri quam nullum ; idque maxime fieri debet , ubi nerui resoluti sunt ; ubi subito aliquis ommutuit ; ubi angina strangulatur ; ubi prioris febris accessio paene confecit , paremque subsequi uerisimile est neque eam uidentur sustinere aegri uires posse . Cum sit autem minime crudo sanguis mittendus , tamen ne id quidem perpetuum est : neque enim semper concoctionem res expectat . Ergo si ex superiore parte aliquis decidit , si contusus est , si ex aliquo subito casu sanguinem uomit , quamuis paulo ante sumpsit cibum , tamen protinus ei demenda materia est , ne , si subsederit , corpus adfligat ; idemque etiam in aliis casibus repentinis , qui strangulabunt , dictum erit . At si morbi ratio patietur , tum demum nulla cruditatis suspicione remanente id fiet ; ideoque ei rei uidetur aptissimus aduersae ualetudinis dies secundus aut tertius . Sed ut aliquando etiam primo die sanguinem mittere necesse est , sic numquam utile post diem quartum est , cum iam spatio ipsa materia et exhausta est et corpus conr upit, ut detractio inbecillum id facere possit , non possit integrum . Quod si uehemens febris urget , in ipso impetu eius sanguinem mittere hominem iugulare est ; expectanda ergo remissio est : si non decrescit , sed crescere desiit , neque speratur remissio , tum quoque , quamuis peior , sola tamen occasio non omittenda est . Fere etiam ista medicina , ubi necessaria est , in biduum diuidenda est : satius est enim in primo leuare aegrum , deinde perpurgare , quam simul omni ui effusa fortasse praecipitare . Quod si in pure quoque aquaque , quae inter cutem est , ita respondet , quanto magis necesse est in sanguine respondeat . Mitti uero is debet , si totius corporis causa fit , ex brachio ; si partis alicuius , ex ea ipsa parte aut certe quam proxima , quia non ubique mitti potest , sed in temporibus , in brachiis , iuxta talos . Neque ignoro quosdam dicere quam longissime sanguinem inde , ubi laedit , esse mittendum : sic enim auerti materiae cursum : at illo modo in id ipsum , quod grauat , euocari . Sed id falsum est : proximum enim locum primum exhaurit , ex ulterioribus autem eatenus sanguis sequitur , quatenus emittitur ; ubi is suppressus est , quia non trahitur , ne uenit quidem . Videtur tamen usus ipse docuisse , si caput fractum est , ex brachio potius sanguinem esse mittendum ; si quod in umero uitium est , ex altero brachio : credo quia , si quid parum cesserit , opportuniores hic eae partes iniuriae sunt , quae iam male habent . Auertitur quoque interdum sanguis , ubi alia parte prorumpens alia emittitur . Desinit enim fluere qua nolumus , inde obiectis quae prohibeant , alia dato itinere . Mittere autem sanguinem cum sit expeditissimum usum habenti , tum ignaro difficillimum est : iuncta enim est uenae arteria , his nerui . Ita , si neruum scalpellus attingit , sequitur neruorum distentio , eaque hominem crudeliter consumit . At arteria incisa neque coit neque sanescit ; interdum etiam , ut sanguis uehementer erumpat , efficit . Ipsius quoque uenae , si forte praecisa est , capita comprimuntur , neque sanguinem emittunt . At si timide scalpellus demittitur , summam cutem lacerat neque uenam incidit : nonnumquam etiam ea latet neque facile reperitur . Ita multae res id difficile inscio faciunt , quod perito facillimum est . Incidenda ad medium uena est . Ex qua cum sanguis erumpit , colorem eius habitumque oportet attendere . Nam si is crassus et niger est , uitiosus est , ideoque utiliter effunditur : si rubet et perlucet , integer est ; eaque missio sanguinis adeo non prodest , ut etiam noceat ; protinusque is supprimendus est . Sed id euenire non potest sub eo medico , qui scit , ex quali corpore sanguis mittendus sit . Illud magis fieri solet , ut aeque niger adsidue ac primo die profluat ; quod quamuis ita est , tamen si iam satis fluxit , supprimendus est , semperque ante finis faciendus est , quam anima deficiat , deligandumque brachium superinposito expresso ex aqua frigida penicillo , et postero die auerso medio digito uena ferienda , ut recens coitus eius resoluatur iterumque sanguinem fundat . Siue autem primo siue secundo die sanguis , qui crassus et niger initio fluxerat , et rubere et perlucere coepit , satis materiae detractum est , atque quod superest sincerum est ; ideoque protinus brachium deligandum habendumque ita est , donec ualens cicatricula sit ; quae celerrime in uena confirmatur .
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10 To let blood by incising a vein is no novelty; what is novel is that there should be scarcely any malady in which blood may not be let. Again, to let blood in young women who are not pregnant is an old practice; but it is not an old practice for the same to be tried in children and in the elderly and also in pregnant women: for indeed the ancients were of opinion that the first and last years could not sustain this kind of treatment, and they were persuaded that a pregnant woman, so treated, would abort. Practice subsequently showed indeed that in these matters there is no unvarying rule, and that other observations are rather to be made, to which the consideration of the practitioner ought to be directed. For it matters not what is the age, nor whether there is pregnancy, but what may be the patient's strength. So, then, if a youth is weakly, or a woman, although not pregnant, has little strength, it is bad to let blood; for any remaining strength dies out if it is thus stripped away. But a strong child, or a robust old man, or a pregnant woman in good health, may be so treated with safety. It is mostly, however, in such cases that an inexperienced practitioner can be deceived, because at the above ages there is usually a less degree of strength; and a pregnant woman has need also, after the blood-letting, of forces to sustain, not merely herself, but also her unborn child. Not that we should be in a hurry to do anything that demands anxious attention and care; for in that very point lies the art of medicine, which does not count years, or regard only the pregnancy, but calculates the strength of the patient, and infers from that whether possibly or no there is a superfluity, enough to sustain either a child or an old man or simultaneously two beings within one woman. There is a difference between a strong and an obese body, between a thin and an infirm one: thinner bodies have more blood, those of fuller habit more flesh. The more easily, therefore, do the former sustain this sort of depletion; and the more quickly is he who is over-fat distressed by it; hence it is that the body's strength may be estimated better by its blood-vessels than by its actual appearance. And the foregoing are not the sole considerations, but there is also the kind of disease, whether a superabundance or a deficiency of bodily material has done the harm, whether the body is corrupted or sound. For if the material of the body is either deficient, or is sound, blood-letting in unsuitable; but if the harm is its copiousness, or the material has become corrupted, there is no better remedy. Therefore severe fever, when the bodily surface is reddened, and the blood-vessels full and swollen, requires withdrawal of blood; so too diseases of the viscera, also paralysis and rigor and spasm of sinews, in fact whatever strangulates the throat by causing difficulty of breathing, whatever suppresses the voice suddenly, whenever there is intolerable pain, and whenever there is from any cause rupture and contusion of internal organs; so also a bad habit of body and all acute diseases, provided, as I have stated above, they are doing harm, not by weakness, but by overloading. But it may happen that some disease demands blood-letting, although the body seems scarcely able to bear it; if, however, there appears to be no other remedy, and if the patient is likely to die unless he be helped even at some risk — that being the position, it is the part of a good practitioner to show that without the withdrawal of blood there is no hope, and to confess how much fear there may be in that step, and then at length, if the attempt is demanded, to let blood. In such a case there should be no hesitation about it; for it is better to try a double-edged remedy than none at all; and in particular it should be done: when there are paralyses; when a man becomes speechless suddenly; when angina causes choking; when the preceding paroxysm of a fever has been almost fatal, and it is very probable that a like paroxysm is about to set in which it seems impossible for the patient's strength to sustain. Further although it is least proper to let blood whilst food is undigested, yet that is not an invariable precept; for the case will not always wait for digestion. Thus if a man falls from a height, if there is contusion, or something else happening suddenly has caused vomiting of blood, although food may have been taken but a short while before, yet at once the bodily material should be depleted, lest, if it forms a congestion, it should harm the body; and the same rule will hold good also in other sudden accidents which cause suffocation. But if the character of the affection permits, it should be done then only when there remains no suspicion of undigested food; and therefore the second or third day of the illness may seem the most fitting for the procedure. But whilst there is sometimes a necessity for blood-letting even on the first day, it is never of service after the fourth day, for within that interval the material itself has both been sucked up and corrupted the body, so that then depletion can make it weak but cannot make it sound. But if there is the oppression of a vehement fever, to let blood during the actual paroxysm is to cut the man's throat; the remission is therefore to be awaited: if the fever does not decrease, but merely stops increasing, and there is no hope of remission, then also the opportunity, bad as it is, as it is the only one, should not be missed. When the measure is necessary it should generally be divided between two days; on the first it is better to relieve, and later to deplete the patient, rather than perchance to precipitate his end by dissipating his strength all at once. But if this answers in the case of pus, or of the water in dropsy, all the more necessarily should it answer in the letting out of blood. If the cause affects the body as a whole, blood should be let from the arm; if some part, then actually from that part, or at any rate from a spot as near as may be, for it is not possible to let blood from everywhere, but only from the temples, arms and near the ankles. Nor am I ignorant that some say blood should be let from a place the furthest away from the damaged part, for that thus the course of the material of the disease is diverted, but that otherwise it is drawn into the very part which is damaged. Yet this is erroneous, for blood-letting draws blood out of the nearest place first, and thereupon blood from more distant parts follows so long as the letting out of blood is continued; when put a stop to, no more blood comes to the part diseased, because it is no longer drawn to the opened vein. Practice itself, however, seems to have taught that for a broken head blood should be let preferably from the arm; when the pain is situated in one upper limb, then from the arm opposite; I believe because, if anything goes wrong, those parts are more liable to take harm which are already in a bad state. Blood is also at times diverted when, having burst out at one place, it is let out at another. For bleeding from a place where it is not desired ceases after something is applied to stop it there, when the blood is given another exit. Now blood-letting, whilst it may be very speedily done by one practised in it, yet for one without experience is very difficult, for to the vein is joined an artery, and to both sinews. Hence should the scalpel strike a sinew, spasm follows, and this makes a cruel end to the patient. Again, when an artery is cut into, it neither coalesces nor heals; it even sometimes happens that a violent outburst of blood results. As to the actual vein, when completely divided by a forceful cut, its two ends are pressed together, and do not let out the blood. Yet if the scalpel is entered timidly, it lacerates the skin but does not enter the vein; at times, indeed, the vein is concealed and not readily found. Thus many things make difficult to one who is unskilled what to one experienced is very easy. The vein ought to be cut half through. As the blood streams out its colour and character should be noted. For when the blood is thick and black, it is vitiated, and therefore shed with advantage, if red and translucent it is sound, and that blood-letting, so far from being beneficial, is even harmful; and the blood should be stopped at once. But this cannot happen under that practitioner who knows from what sort of body blood should be let. It more often happens that the flow of blood continues as black as on the first day; although this be so, nevertheless, if enough has flowed out, blood-letting should be stopped, and always an end should be put to it before the patient faints, and the arm should be bandaged after superimposing a pad squeezed out of cold water, and the next day the vein is to be flicked open by the tip of the middle finger so that, its recent coalescence being undone, it may again let out blood. Whether it be on the first or on the second day that the blood, which has at first flowed out thick and black, begins to become red and translucent, a sufficient quantity has been withdrawn, and the rest of the blood is pure; and so at once the arm should be bandaged and kept so until the little scar is strong, and this, in a vein, becomes firm very quickly. |
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Cucurbitularum duo uero genera sunt , aeneum et corneum . Aenea altera parte patet , altera clausa est : altera cornea parte aeque patens altera foramen habet exiguum . In aeneam linamentum ardens coicitur , ac sic os eius corpori aptatur inprimiturque , donec inhaereat . Cornea corpori per se inponitur , deinde , ubi ea parte , qua exiguum foramen est , ore spiritus adductus est , superque cera cauum id clausum est , aeque inhaerescit . Vtraque non ex his tantum materiae generibus , sed etiam ex quolibet alio recte fit : ac si cetera defecerunt , caliculus quoque aut pultarius oris compressioris ei rei commode aptatur . Vbi inhaesit , si concisa ante scalpello cutis est , sanguinem extrahit , si integra est , spiritum . Ergo ubi materia , quae intus est , laedit , illo modo , ubi inflatio , hoc inponi solet . Vsus autem cucurbitulae praecipuus est , ubi non in toto corpore sed in parte aliqua uitium est , quam exhauriri ad confirmandam ualetudinem satis est . Idque ipsum testimonium est etiam scalpello sanguinem , ubi membro succurritur , ab ea potissimum parte , quae iam laesa est , esse mittendum , quod nemo cucurbitulam diuersae parti inponit , nisi cum profusionem sanguinis eo auertit , sed ei ipsi , quae dolet quaeque liberanda est . Opus etiam esse cucurbit ula potest in morbis longis , quamuis iam eis spatium aliquod accessit , siue corrupta materia siue spiritu male habente : in acutis quoque quibusdam , si et leuari corpus debet et ex uena sanguinem mitti uires non patiuntur ; idque auxilium ut minus uehemens , ita magis tutum neque umquam periculosum est , etiamsi in medio febris impetu , etiamsi in cruditate adhibetur . Ideoque ubi sanguinem mitti opus est , si incisa uena praeceps periculum est , aut si in parte corporis etiam num uitium est , huc potius confugiendum est , cum eo tamen , ut sciamus hic ut nullum periculum , ita leuius praesidium esse , nec posse uehementi malo nisi aeque uehemens auxilium succurrere .
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11 Now there are two kinds of cups, one made of bronze, the other of horn. The bronze cup is open at one end, closed at the other; the horn one, likewise at one end open, has at the other a small hole. Into the bronze cup is put burning lint, and in this state the mouth is applied and pressed to the body until it adheres. The horn cup is applied as it is to the body, and when the air is withdrawn by the mouth through the small hole at the end, and after the hole has been closed by applying wax over it, the horn cup likewise adheres. Either form of cup may be made, not only of the above materials, but also of anything else suitable; when others are lacking, a small drinking-cup or porridge bowl with a narrowish mouth may be adapted conveniently for the purpose. If the skin upon which the cup is to be stuck is cut beforehand with a scalpel, the cup extracts blood; when the skin is intact, wind. Therefore when it is some matter inside which is doing the harm, the former method of cupping should be employed, when it is flatulency, then the latter. Now the use of a cup is the rule for a disease, not of the body as a whole, but of some part, the sucking out of which suffices for the re-establishment of health. And this same fact is a proof that with a scalpel, when a part is being relieved, blood must be let from that very part where the injury already exists; since unless it be to divert haemorrhage in that direction, nobody applies a cup to a part distant from the disease, but to that which is actually affected and has to be relieved. Further there may be need for cupping in chronic maladies, although already of somewhat long duration, if there is corrupted material or an unhealthy condition of wind; in certain acute cases also, if the body ought to be depleted and at the same time the patient's strength does not admit of cutting a vein; and cupping, as it is a less severe remedy, so it is a safer one; nor is it ever dangerous, even if adopted in the midst of the attack of a fever, or even with food undigested. Therefore, when blood-letting is needed, if cutting a vein is an instant danger, or if the mischief is still localised, recourse is to be had rather to cupping, not forgetting that whilst we recognize the absence of danger, its efficacy is thus the less, and it is impossible to remedy a severe malady unless by a remedy likewise severe. |
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Deiectionem autem antiqui uariis medicamentis crebraque alui ductione in omnibus paene morbis moliebantur ; dabantque aut nigrum ueratrum aut filiculam aut squamam aeris , quam ΛΕΠΙΔΑ ΧΑΛΚΟΥ Graeci uocant , aut lactucae marinae lac , cuius gutta pani adiecta abunde purgat , aut lac uel asininum aut bubulum , uel caprinum , eique salis paulum adiciebant , decoquebantque id et sublatis is , quae coierant , quod quasi serum supererat , bibere cogebant . Sed medicamenta stomachum fere laedunt : aluus si uehementius fluit aut saepius ducitur , hominem infirmat . Ergo numquam in aduersa ualetudine medicamentum eius rei causa recte datur , nisi ubi is morbus sine febre est , ut cum ueratrum nigrum aut atra bile uexatis aut cum tristitia insanientibus aut iis , quorum nerui parte aliqua resoluti sunt , datur . At ubi febres sunt , satius est eius rei causa cibos potionesque adsumere , qui simul et alant et uentrem molliant ; suntque ualetudinis genera , quibus ex lacte purgatio conuenit . Plerumque uero aluus potius ducenda est ; quod ab Asclepiade quoque sic temperatum , ut tamen seruatum sit , uideo plerumque saeculo nostro praeteriri . Est autem ea moderatio , quam is secutus uidetur , aptissima , ut neque saepe ea medicina temptetur , et tamen semel , summum uel bis non omittatur : si caput graue est ; si oculi caligant ; si morbus maioris intestini est , quod Graeci colum nominant ; si in imo uentre aut si in coxa dolores sunt ; si in stomachum quaedam biliosa concurrunt , uel etiam pituita eo s e umorue aliquis aquae similis confert ; si spiritus difficilius redditur ; si nihil per se uenter excernit , utique si iuxta quoque stercus est et intus remanet , aut si stercoris odorem nihil deiciens aeger ex spiritu suo sentit , aut si corruptum est quod excernitur ; aut si prima inedia febrem non sustulit ; aut si sanguinem mitti , cum opus sit , uires non patiuntur tempusue eius rei praeterit , aut si multum ante morbum aliquis potauit ; aut si is , qui saepe uel sponte uel casu purgatus est , subito habet aluum suppressam . Seruanda uero illa sunt , ne ante tertium diem ducatur ; ne ulla cruditate substante ; ne in corpore infirmo diuque in aduersa ualetudine exhausto , neue in eo , cui satis aluus cottidie reddit quiue eam liquidam habebit ; ne in ipso accessionis impetu , quia quod tum infusum est , aluo continetur , regestumque in caput multo grauius periculum efficit . Pridie uero abstineri debet aeger , ut aptus tali curationi sit , eodem die ante aliquot horas aquam calidam bibere , ut superiores eius partes madescant ; tum inmittenda in aluum est , si leui medicina contenti sumus , pura aqua , si paulo ualentiore , mulsa ; si leni , ea , in qua faenum Graecum uel tisana uel malua decocta sit , [ si reprimendi causa , ex uerbenis ] acris autem est marina aqua uel alia sale adiecto ; atque utraque decocta commodior est . Acrior fit adiecto uel oleo uel nitro uel melle : quoque acrior est , eo plus extrahit , sed minus facile sustinetur . Idque , quod infunditur , neque frigidum esse oportet neque calidum , ne alterutro modo laedat . Cum infusum est , quantum fieri potest , continere se in lecticulo debet aeger , nec primae cupiditati deiectionis protinus cedere : ubi necesse est , tum demum desidere . Fereque eo modo dempta materia , superioribus partibus leuatis , morbum ipsum mollit . Cum uero , quotiens res coegit , desidendo aliquis se exhausit , paulisper debet conquiescere ; et ne uires deficiant , utique eo die cibum adsumere ; qui plenior an exiguus sit , ex ratione eius accessionis , quae expectabitur aut in metu non erit , aestimari oportebit .
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12 Now purging was promoted by the ancients in almost all diseases by various medicaments, and by frequent clysters; they administered either black hellebore root, or polypody fern root, or the copper scales which the Greeks call lepida chalkou, or the milky juice of seaside spurge, of which one drop on bread purges freely, or milk, whether from an ass or cow, or goat, to which a little salt was added, which they boiled, and having removed the solidified skin, they obliged their patients to drink the whey-like remainder. But medicaments generally irritate the stomach; a motion when excessively liquid, or a clyster often repeated, weakens the patient. Never, therefore, in illness is a medicament which causes such a motion rightly given, unless when that malady is without fever, as when black hellebore root is given either to those with black bile and to those suffering from insanity with melancholy, or to those who have their sinews in some part paralysed. But in the presence of fevers, it suffices for the purpose of a purge to take such food and drink as both nourish and at the same time soften the belly; and there are sorts of illness in which purgation by milk is suitable. Still, for the most part the bowel preferably is to be clystered; the practice was limited by Asclepiades though still kept, but I see that in our time it is usually neglected. But the limitation which he seems to have adopted is most fitting: that this remedy should not be tried often, and yet we should not omit to use it once, or at most twice: if the head is heavy; if the eyes are dim; if the disease is in the larger intestine, which the Greeks call colon; if there are pains in the lower belly or in the hips; if bilious fluid collects in the stomach, or even phlegm or other water-like humor forms there; if wind is passed with undue difficulty; if there is no spontaneous motion, and especially if the faeces remain inside although close to the anus, or if the patient who fails to pass anything perceives a foul odour in his breath, or if the motions have become corrupted; or if abstinence does not at once get rid of the fever; or if the patient's strength does not allow of blood-letting when it is needed, or the time for that measure has passed; or if previous to the malady the patient has been drinking freely; or if a patient who has been purged repeatedly, whether that has been intentional or casual, has suddenly a suppression of motions. However, the following rules are to be observed: that the clyster is not to be administered before the third day, nor whilst there is any undigested food; nor in a case of weakness due to exhaustion by a long illness; nor to a patient who has daily a sufficient motion, nor to one whose stools are liquid; nor during the acme of the paroxysm of a fever, for what is then injected is retained in the bowel and mounting up into the head brings about a much graver danger. On the day too before the clyster the patient ought to fast, in order to fit himself for such a treatment, and on the actual day, some hours beforehand, he should drink warm water to moisten his upper parts; there should then be introduced into the bowel simply water when we are content with a gentle remedy, or hydromel as one a little stronger; or as a soothing enema a decoction of fenugreek, or of pearl barley, or of mallow, or as an astringent clyster a decoction of vervains, but a drastic one is sea-water or ordinary water with salt added; and the better in both instances for boiling. A clyster is made more drastic by the addition of olive oil, or soda, or honey: the more drastic the clyster, the more it extracts, but the less easily it is borne. The fluid injected should be neither cold nor hot, lest either way it should do harm. Following upon the injection the patient ought to keep in bed as long as he can, and not give way to his first desire to defaecate; then go to stool only when he must. In this way generally when the material is extracted, and the upper parts relieved, the disease itself is mollified. But when the patient has become exhausted owing to forced calls to stool, he ought for a while to keep quiet; and lest his strength fail, he should certainly take food that day, but whether it should be abundant or scanty, should be regulated according to the strength of the paroxysm anticipated, or the absence of such apprehension. |