Chapter XV: Preface (5)

But if the distemper be what is called leucophlegmatia, it is fit to expose the swelled parts to the sun; but not too much, lest it inflame the fever. If the sun is too powerful, the head must be covered, and friction made use of, the hands being only moistened with water mixed with salt, and nitre, and a little oil; and that by the hands either of a child or a woman, as their touch is softer: and if the strength will allow, it may be continued a whole hour in the forenoon; in the afternoon for half an hour. Restringent cataplasms also are good; especially if the body be pretty tender. An incision must likewise be made on the inside of the leg, about four fingers breadth above the ancle; from which for some days a good quantity of water may be discharged, and it is proper also to make deep gashes in the tumours: and the body must be well agitated by frequent gestation; and when the wounds are cicatrized, the exercise and food must be increased, till the body return to its former habit. The food ought to be strong and glutinous, and chiefly flesh. The wine pretty sweet, if the stomach will bear it; but in this course, that alternately for two or three days together, sometimes water and sometimes wine be drunk. It is proper also to give the seed of sea spurge, which grows large near the sea, to drink with water. If the person be strong, boiled squills may be tied upon his belly at the same time. And many authors advise, that the tumours be beat with inflated bladders.

But if the disease be of that kind, in which there is a large collection of water within the abdomen, it is fit to walk, but more moderately; to keep a discutient malagma applied to the part, with a triple cloth above it, and to bind it on with a roller, though not too tight. Which practice, introduced by Tharrias, I observe is still continued by the greatest number of physicians. If it is evident, that the liver or spleen is affected, it is proper to apply over it a mellow fig bruised, with the addition of honey. If by such remedies the belly is not dried, but the water notwithstanding abounds, a more speedy method must be taken to relieve, that is, to discharge it by the belly itself. Nor am I ignorant, that Erasistratus disapproved of this method of cure: for he imagined this to be a distemper of the liver; and therefore that means should be used to restore that part to a sound state, and that it was to no purpose to draw off the water, which, while that bowel is distempered, Would be presently collected again. But in the first place, this bowel is not only the seat of this disease: for it arises both in the case of an affected spleen, and a bad habit of the whole body. And secondly, supposing it to have begun thence, yet unless the water be discharged, which stagnates there preternaturally, it hurts both the liver and the other internal parts. And it is granted, that care should be taken nevertheless to cure the whole body. For discharging of the water does not work a cure, but makes room for the operation of medicine, which that obstructs, while it remains there. Neither does this admit of any dispute, that all in this disease are not to be thus treated: but robust young men may, who are either entirely free of a fever, or at least have pretty long intermissions: for those, who have a vitiated stomach, or have fallen into this disorder from the atrabilis, or those, who are in a bad habit of body, are not fit subjects for this treatment. On the day, that the water is first discharged, giving of food is improper, unless the patient feels a want of strength. In the following days indeed wine not much diluted ought to be given, but not in a large quantity, and the patient must be again gradually accustomed to exercises, frictions, the heat of the sun, sweatings, fatigues, and proper food, till he be entirely well. The case requires seldom bathing, and frequent vomits when fasting. If it be the summer-time, it is proper to swim in the sea. For a long time after his recovery venery is hurtful.

CHAP. XXII.

OF THE SEVERAL KINDS OF CONSUMPTION AND THEIR CURE.

A consumption is a distemper often of longer continuance, and attended with greater danger. And of this also there are several species. One of them is, where the body is not nourished, and as something is naturally always flying off, and nothing comes in to supply its place, the person becomes extremely emaciated, and unless it be removed, it proves mortal. This the Greeks call atrophia[BQ]. It commonly proceeds from one of two causes: for one man through excessive fear takes less, another from too great voraciousness takes more food, than he ought to do: so that either the defect of aliment weakens, or what is redundant is corrupted.

[BQ] ἀτροφία.

There is another species, which the Greeks call cachexia[BR], where the habit of the body is bad, and therefore all the aliments are corrupted: which commonly happens, when bodies depraved by a long distemper, although they have got quite rid of it, yet do not receive any recruit; or when the body has been disordered by bad medicines; or when one has long wanted the necessaries of life; or has made use of victuals to which he is not accustomed, and bad, or from some such accident. In this last case besides the consumption it sometimes happens, that the skin is exasperated with frequent pimples(34), or ulcers, or some parts of the body swell.

[BR] καχεξία.

The third and by far the most dangerous species is that, to which the Greeks give the name of phthisis[BS]. It generally takes its rise from the head(35): and thence falls down upon the lungs. From this an exulceration proceeds, and there comes a slight fever, which, although it may have abated, yet returns; in this also there is a frequent cough, and pus expectorated, and sometimes something bloody. Whatever comes up, if it be thrown upon the fire, has a bad smell. Therefore those, that are doubtful of the distemper, try it by this mark.

[BS] φθίσις.

As these are the several species of a consumption, it is necessary first to consider, which of them is the disease of the patient. Then if it appears, that the body is only not supplied with nourishment, to attend to the cause of that; and if the person has taken less food, than he ought to have done, it is proper to make an addition: but gradually, lest, if he overload the body unaccustomed to it by too great a quantity at once, the stomach be oppressed, and and that retard concoction. If a person has been used to take more than what was proper, he should fast for one day; then begin with a little food; making every day some small addition, till he come to a just measure. It is like-wise proper to walk in places as cold as possible, and avoid the heat of the sun; to use those exercises, which employ the hands: if he is weaker, to use gestation, unction, and friction, by his own hands rather than other if he be able, frequently in the day, both before meat and after it; and sometimes to add some of the warming medicines to the oil, till he sweats. It does service too when he is fasting to take hold of his skin in many parts, and to draw it out, that it may be relaxed; or to do the same by often impressing a bit of resin upon it, and quickly pulling it away again. Bathing also is sometimes good, but after a small meal; and even in the bath itself, some food is properly given; or if without the bath friction has been used, it may be immediately after. The food ought to be of that kind, which is easily concocted and most nourishing. Therefore the use of wine also, but austere, is necessary to promote urine.

But if the habit of the body is bad, the first thing to be done is to fast; then a clyster must be administered; next we should give food, adding exercises, unctions, and frictions. Frequent bathing is more beneficial to such, but when they are fasting, even till they sweat. Their diet should be plentiful and varied, of good juices, and such as does not very easily corrupt, and austere wine. If these methods do not relieve, blood must be let; but by small quantities, and every day for some days together, the other rules above laid down being also observed.

But if the distemper is more violent, and there is a true phthisis, it is necessary to oppose its beginnings: for if this distemper continue long, it is not easily overcome. If the patient’s strength allow, he must take a long voyage, change his climate, taking care to remove into a grosser air, than that he leaves; and therefore from Italy to Alexandria is a very agreeable change. And generally at the beginning the body may be well supposed able to stand that fatigue, since this distemper generally comes on at the strongest age, that is, from the eighteenth year to the thirty-fifth. If the weakness will not admit of that, it is very proper however to sail in a ship, but not far. But if any circumstance render the sailing unfit, the body must be moved in a litter or some other way; then business must be laid aside, and every thing, which disturbs the mind; sleep must be indulged; catarrhs avoided, lest they exasperate, what may have been mitigated by care; and for that reason crudity must be guarded against, and at the same time both the heat of the sun and cold, the face defended, the throat wrapped up, and the cough removed by its peculiar remedies. And as long as the fever continues to attack, it must be treated sometimes by abstinence, sometimes also by seasonable food: and at such time water must be drunk. Milk likewise, which is poison in pains of the head, and acute fevers, and excessive thirst, occasioned by these, and when the præcordia are swelled, or the urine is bilious, or in hæmorrhages; yet in a phthisis, as well as in all tedious and obstinate febriculas, it may very well be given.

But if a fever does not yet come on, or has already remitted, recourse must be had to moderate exercise, and especially walking and gentle friction. The bath is hurtful. The food at first ought to be pungent, such as garlick, leeks, and the same in vinegar, or in the same way endive, basil, lettuce; afterwards mild, as gruel(36) made from ptisan, or alica, or from starch, with the addition of milk. Rice also, and, if there is nothing else, far will answer the same end. Then these two sorts of food are to be alternately used; and something of the middle kind is to be added, and especially brains(37), and small fish, and such like. Flour also mixed with mutton or goat’s suet, and boiled, serves for a medicine. Wine ought to be taken light and austere.

Thus far the distemper is combated with no great difficulty. If it is more grievous, and neither the fever nor the cough abate, and the body appears to be wasting, there is a necessity for more powerful remedies. An ulcer must be made with a hot iron in one place under the chin, another in the throat, two at both breasts, and under the extremity of the blade-bones, which the Greeks call omoplatæ[BT]; and these ulcers must not be allowed to heal, unless the cough should cease: which, it is plain, must also require a distinct method of cure. Then the extremities are to be brushed briskly three or four times a day; the chest must be rubbed gently with the hand; after meat, at the interval of an hour, the legs and arms must also be rubbed. After ten days the patient is to be put into a bath consisting of warm water and oil. On the other days he is to drink water; at that time wine must be given to drink cold, if the cough is gone; if it is not, with the cold taken off. It is proper also in the remissions to give food every day; to make use of friction and gestation in like manner; on the fourth or fifth day to take sometimes the blood herb with vinegar, or to eat plantain. The juice of plantain alone, or that of horehound boiled up with honey, is a remedy; of the first of which a cyathus may be supped, and a spoonful of the other may be licked at times; or one part of turpentine, and another of butter and honey, mixed together and boiled. But the most material of all these things, are the diet, gestation, sailing, and gruel. A loose belly is particularly to be avoided. A frequent vomiting in this distemper, and especially of blood, is pernicious. When a person begins to grow a little better, he ought to increase his exercises, friction and food; and then keeping in his breath to rub himself; to abstain long from wine, the bath, and venery.

[BT] ὠμοπλάται.

CHAP. XXIII.

OF THE EPILEPSY AND ITS CURE.

Amongst the best known distempers is that, which is called comitial(38), or the greater. A man falls suddenly down, foams at the mouth; then after some time returns to himself, and rises of his own accord. This disorder more frequently attacks men than women; and it commonly continues long, even to the dying day, and is not dangerous to life. Sometimes however, when it is recent, it kills a person; and if it has not been removed by remedies, it is often cured in boys by their first venereal liberties, in females by the first appearance of the menses. Sometimes a person falls down with a convulsion of the limbs or nerves, sometimes without it.

Some endeavour to rouze these by the same means as lethargic people; which is quite needless: both because even a lethargic person is not cured by this method; and because he may never awake, and thus perish for want, whereas the other returns to himself.

When one falls down, if _the fit_ be not attended with a convulsion, blood ought to be let immediately: if it is, that is not to be done, unless other circumstances also encourage it. But it is necessary to give clysters, or to purge with black hellebore, or to do both, if the strength will allow; then to clip the hair of the head _close_, and anoint it over with oil and vinegar; to give food the third day after, as soon as the hour, at which the patient fell down, is past. Neither are gruels, or victuals otherwise soft and easy of digestion, or flesh, and least of all pork, fit for such persons; but diet of the middle kind: for the case requires strength; and crudities are to be guarded against. At the same time they should avoid the heat of the sun, the bath, fire, and every thing heating; also cold, wine, venery, the sight of a precipice, and every thing that terrifies, vomiting, lassitude, anxieties, all business; and when food has been given on the third day, they should intermit the fourth, and so on every other day; observing the same hour for food for fourteen days. When the distemper has proceeded so far, it has lost the force of an acute one; and if it continues, it must be treated as a chronic.

But if a physician has not been called on the day, that the person first fell, but has a man recommended to his care, who is already used to these falling fits; first of all the regimen above prescribed being followed, the day is to be expected, on which the fit may return: and then either bleeding must be used, or a clyster, or black hellebore, as has been already directed. Then in the following days, he is to be nourished by the food mentioned before, omitting all such as I said were to be avoided.

If the distemper should not be removed by these means, recourse must be had to the white hellebore; and that must be used three or four times, at the distance of a few days betwixt doses; provided however that he never repeat it, unless the fit have recurred. On the intermediate days his strength must be supported by adding some other things to those, which have been mentioned before. When he has waked in the morning, his body may be gently rubbed over with old oil, excepting his head and belly; then let him take a walk, as long and as straight as possible; after the walk let him be rubbed, in a tepid place briskly and long, and not less than two hundred times; unless he be infirm; then let a good quantity of cold water be poured over his head; let him eat a little; and rest; take a walk again before night; be briskly rubbed a second time, without touching either his belly or head; afterwards let him take supper, and with intervals of three or four days, let him for a day or two together make use of a pungent diet.

If the patient should not be cured even by these means, let his head be shaved, anointed with old oil, adding to it vinegar and nitre, and salt water poured upon it; when he is fasting, let him drink castor and water; make use of no water for drink, unless it has been boiled. Some have cured themselves of such a disorder by drinking the warm blood of a gladiator slain. With such people a miserable remedy is rendered tolerable by a more miserable distemper. As to the assistance of medicine, the last remedy is to let a little blood from both legs near the ancle; to make an incision on the back of the head, and apply cucurbitals; with a hot iron also to make an eschar in two places, in the back of the head, and below, where the first vertebra is joined to the head; that by these the noxious humour may be discharged. If by this method the distemper has not been removed, it will probably continue for life. To alleviate it, exercise must only be used, and such food, as has been directed above; and especially every thing avoided, against which we have given cautions.

CHAP. XXIV.

OF THE JAUNDICE AND ITS CURE.

The distemper is equally known, which is called sometimes arquatus(39), sometimes regius. If this comes on after the seventh day of a fever, Hippocrates pronounces the patient to be safe, provided only the præcordia be soft. Diocles declares without reserve, that if it comes after a fever, it even does good; if a fever follows it, it is mortal. Now this distemper is discovered by the colour, especially of the eyes, in which, what ought to be white, becomes yellow. And it is generally attended by a thirst, pain of the head, frequent hiccough, hardness of the præcordia on the right side; and upon violent motion, a difficulty of breathing, and relaxation of the limbs: and when the distemper continues long, the whole body turns white, with a certain sickly paleness.

For the first day it is proper to enjoin the patient to abstinence; on the second to give a clyster; then if there is a fever, to remove it by proper diet; if there is not, to give scammony to drink, or white betes shred in water, or in hydromel bitter almonds, wormwood, anise, but of the last the smallest quantity. Asclepiades ordered also the drinking of salt water, and that for two days, with an intention to purge, rejecting the use of diuretics. Some omitting the former, by the latter and extenuating diet affirm they obtain the same purpose.

For my part if there be sufficient strength, I prefer the stronger medicines; if but little, the weaker remedies. If the patient has been purged, after that it is fit for the three first days to eat sparingly food of the middle kind, and drink Greek salt wine, that the belly may continue lax; then for other three days to eat more substantial food and some flesh too; and hold to the use of water for drink; then to return to the former diet, only eating more freely of it; and omitting the Greek, to drink black austere wine; and vary this course by using sometimes acrid food, sometimes returning to the salt wine. But through the whole time exercise and friction must be used, and if it be winter, the bath, if summer, swimming in cold water; a bed and room elegant, company, place, diversions, frolicks, and every thing else, that has a tendency to exhilarate the mind: upon which accounts it seems to be called the royal distemper. A discutient malgama also applied to the præcordia has a good effect; or a dry fig laid on there, if the liver or spleen be affected.

CHAP. XXV.

OF THE ELEPHANTIASIS, AND ITS CURE.

That distemper, which the Greeks call elephantiasis[BU], is almost entirely unknown in Italy, but in some countries is very common, and is ranked amongst the chronic kind. The whole body is affected with it in such a manner, that even the bones are said to be spoilt. Upon the surface of the body are spots and tumours. Their redness by degrees degenerates into a black colour, the skin is unequally thick and thin, hard and soft, and is roughened with something resembling scales, the body wastes, the face, legs, and feet swell. When the distemper is inveterate, the fingers and toes are hid under the swelling; a slight fever comes on, which easily destroys the person sunk under so many maladies.

[BU] ἐλεφαντίασις.

Wherefore without delay, at the beginning of the disease, blood ought to be let two days successively; or the belly purged with black hellebore. For three days the person should fast, or eat no more than is necessary to support him; then the strength is to be recruited a little, and a clyster administered. After that, when he is somewhat relieved, exercise must be used, especially running; sweat must be procured, first by pure labour, and then by dry sweating-rooms; friction applied; but these with such moderation, that the strength may be preserved; bathing should be rare; the food without any thing fat, or glutinous, or flatulent. It is fit to allow wine, but not in the first days of the disorder. Plantain bruised and rubbed upon the body seems to be an excellent defence for it.

CHAP. XXVI.

OF APOPLECTIC PATIENTS, AND THEIR CURE.

In this country we _sometimes_, _though_ rarely see apoplectic people, who are stupified both in body and mind. It happens sometimes from being thunderstruck, sometimes from a distemper. The last case the Greeks call apoplexia[BV]. Such people must be bled. And either white hellebore be made use of, or a clyster given. Then friction is to be applied; and food taken of the middle kind, by no means fat; some of the acrid kinds too; and wine must be refrained.

[BV] ἀποπληξία.

CHAP. XXVII.

OF THE PALSY, AND ITS CURE.

But a relaxation of the nerves is a distemper every where common. But sometimes it attacks the whole body, sometimes particular parts. Ancient authors called the first apoplexia, the other paralysis: now I observe the name of paralysis is given to both. And it is common for those, who have all their limbs extremely relaxed, to be quickly carried off. And if they are not snatched away, they live indeed for some time, but yet seldom recover their health; and for the most part draw out a miserable life, with the loss of their memory too. When it is partial, it is sometimes an acute distemper, often chronic, generally incurable.

If all the limbs are greatly affected, bleeding either kills or cures. Any other method scarcely ever restores health; often only delays death; in the mean time renders life uneasy. After bleeding, if both motion and the judgment don’t return, there is no hope left: if they do return, there is a prospect of recovery.

But where a particular part is relaxed, either blood is to be let, or a clyster administered, according to the strength of the body and the distemper. All the other methods to be pursued are the same in both cases. For the principal thing is to avoid cold: and the patient must return gradually to exercise, so as immediately to apply to walking, if he can. If the weakness of his legs be too great for that, he may either use gestation, or be agitated by moving his bed _to and fro_: then that member, which is diseased, may be moved of itself if possible; if that cannot be done, let another person move it, and so return it to its ordinary habit by a kind of force. It does good also to irritate the skin of the benumbed limb, either by beating it with nettles, or keeping mustard upon it, till the part begins to grow red; when they may be removed. Bruised squills likewise, or bulbous roots bruised with frankincense, are proper applications. Neither is it amiss, to vellicate the skin with resin for some time every third day, and that in several places; and sometimes to make use of cupping without scarification. Old oil is fittest for unction, or nitre mixed with vinegar and oil. Further, it is highly necessary to foment with warm sea-water; or if that is not to be got, with salt-water at least. And if any where there is a natural or artificial place for swimming in this kind of water, by all means to make use of it; and the limbs, which are most disordered, are to be principally agitated there. If that conveniency cannot be had, nevertheless the bath is useful. The food ought to be of the middle kind, and chiefly venison; the drink warm water, without wine. But if the distemper is of long standing, Greek salt wine may be given as a purge every fourth or fifth day. A vomit after supper is good.

[Sidenote: _Of pain of the nerves._]

Sometimes there occurs also a pain of the nerves. In this case it is not convenient, either to vomit, or promote urine by medicines, or sweats by exercise, a practice advised by some _physicians_. Water must be drunk twice a day. The body must be rubbed all over gently in bed for a pretty long time; then the upper parts especially are to be moved, keeping in the breath even in the time of the exercise. Bathing must be seldom practised. The air must be changed now and then by travelling. If there is a pain in any part, it must be anointed with nitre and water without oil, then wrapped up, and a small quantity of live coals with sulphur held below it; and thus it is to be fumigated; and this is to be continued for some time, but when the patient is fasting, and after he has concocted well. Cucurbitals also are to be often applied to the part pained, and the same place is to be beat gently with inflated ox-bladders. It is good also to mix suet with the powdered seed of cummin or nettle, in equal quantities, and apply that; to foment with a decoction of sulphur in water. Bottles filled with warm water are also proper to be clapped on, or bitumen mixed with barley. Violent gestation must be used, especially in the very article of the pain, which in other pains is very pernicious.

[Sidenote: _Of a tremour of the nerves._]

A tremour of the nerves is equally increased by vomiting, and diuretic medicines. The bath and dry sweatings also are hurtful. Water must be drunk; the patient must walk briskly, also anoint, use friction, chiefly performed by himself; his superior parts must be opened by playing at the ball and the like exercises. He may take any food he chuses, only consulting the concoction. After meat he must avoid cares; make very little use of venery. If at any time he falls into that, after it he ought to be rubbed for a long time in his bed with oil, by the hands of a boy rather than a man.

[Sidenote: _Of internal suppurations._]

As for suppurations(40), which happen in any internal part, when they begin, our first business is to endeavour by repellent cataplasms to prevent a hurtful collection of matter; and then, if these have no effect, to disperse it by discutient malagmas. If we fail in that, it follows that it be encouraged; next, that it be maturated. And then the end of every vomica is, that it breaks; and the symptom of this is an evacuation of matter, either by the mouth or anus. But nothing ought to be done, by which a full discharge of the pus may be prevented. Gruels and warm water must be chiefly used. When the pus has ceased to be discharged, we are to change to such food, as is indeed of easy _concoction_, but yet more substantial and cold; also cold water, but beginning with taking the cold off both: and at first some things may be eaten with honey, as pine-nuts, or sweet almonds, or hazel-nuts. Afterwards even the honey must be omitted, that a cicatrix may be the sooner formed. At that time the proper medicine for the ulcer is taking the juice of leeks or horehound, and adding leeks to every meal. It will be convenient also to use frictions in those parts, that are not affected, and gentle walks. And care must be taken not to irritate the healing ulcers either by struggling or running, or any other means; for in this distemper, a vomiting of blood is destructive, and therefore by all means to be guarded against.

A. CORNELIUS CELSUS

OF

MEDICINE.

_BOOK IV._

CHAP. I.

OF THE INTERNAL PARTS OF THE HUMAN BODY.

Thus far we have spoken of those kinds of distempers, which so affect the whole body, that no certain seats can be assigned to them: I shall now treat of those which belong to particular parts. Now the diseases of all the internal parts, and their method of cure will be more easily understood, when I shall have first given a short description of the parts they afflict.

The head then and what is contained in the mouth are bounded not only by the tongue and palate, but by the external parts, which lie exposed to view. On the right and left side about the throat are large veins, which are called sphagitides[BW]; and arteries, named carotides[BX], running upwards, which reach beyond the ears. And in the neck itself are placed small glands, which sometimes swell, and are painful. Then two passages begin: one of which is called the aspera arteria, or wind-pipe; the other the gullet. The wind-pipe is more external, and goes to the lungs; the gullet more internal, and leads to the stomach. The former receives the breath, the latter the food. Their courses being different, where they meet there is something like a small tongue(1) in the wind-pipe at the entrance of the fauces: when we breathe this stands erect; when we take meat or drink, it shuts the wind-pipe. Now the wind-pipe being hard and cartilaginous, is prominent in the throat; and elsewhere falls back. It is composed of certain circles formed like the vertebræ in the spine, yet so, that it is rough on the external part, on the internal smooth like the gullet; and thus descending to the præcordia it is connected with the lungs: these are of a spongy nature, and therefore capacious of air; and behind being joined to the spine, they are divided into two lobes like an ox’s hoof. With these the heart is connected, being muscular, situated in the thorax under the left breast: and it has what we may call two ventricles. But under the heart and lungs is the transverse septum, consisting of a strong membrane equally nervous, which divides the abdomen from the præcordia, many vessels also being dispersed over it: it separates from the superior parts not only the intestines, but the liver and spleen too. These bowels are next to it, but placed below it, the one on the right side, and the other on the left. The liver having its origin under the præcordia from the very septum itself, on the inside is concave, and the outside gibbous. This projecting rests gently upon the stomach, and is divided into four lobes. On the lower part, the gall-bladder adheres to it. But in the left side the spleen is not connected with the septum, but to an intestine; it is of a soft and loose texture, of a moderate length and thickness; and this proceeding a little beyond the region of the ribs into the abdomen, is chiefly covered by them. And these indeed are joined. But the kidneys are divided: which adhere to the loins below the last ribs(2), and the sides next these are round, on the other they turn inward; they are both stocked with vessels, and covered over with coats(3). These then are the situations of the bowels. But the gullet, which is the beginning of the intestines, arises nervous from the seventh vertebra of the spine, and about the præcordia is united with the stomach. The stomach, which is the receptacle of food, consists of two coats, and is placed betwixt the spleen and liver, each of these going a little over it. There are also some fine membranes, by which these three are connected together, and are joined to the transverse septum above-mentioned. After that the lower part of the stomach turning a little to the right side grows narrower, till it meet the first intestine. This juncture the Greeks call pylorus[BY]; because like a gate it emits into the lower parts, what we are to discharge by excrement. There begins the intestine jejunum, not much folded: this name is given to it, because it never retains what it has received; but immediately transmits it into the lower parts. Next to this, is the smaller intestine, very much folded into sinuses: each of whose rings are by small membranes connected with the more internal, which being turned toward the right side, and ending at the right hip, yet fill more the superior parts. Then this intestine is joined with another thicker, and running across; which beginning on the right side, towards the left is open and long; to the right is not so; and therefore it is called cæcum. But that, which is open, is of large compass and sinuous, and less nervous than the former intestines, on both sides rolled different ways, but occupying more of the left and lower parts, it touches the liver and stomach: then it is joined with some small membranes, that come from the right kidney; and there turning to the right, it is directed downward, where it discharges the excrements: and therefore at that place it takes the name of the intestinum rectum. All these parts are covered by the omentum, which on the lower part is smooth and contracted, and on the upper softer. Fat also grows to it, which like the brain and marrow is insensible. From each kidney proceeds a tube of a white colour to the bladder; the Greeks call them ureteres[BZ], because by them they believe the urine to be distilled into the bladder. The bladder in its sinus is nervous and double; in the neck full and fleshy, and joined by veins to the intestine and to that bone, which is under the pubes: itself is loose, and more at liberty. It is differently placed in men and in women: for in men it is close to the intestine rectum, rather inclined to the left side: in women it is situated above their genital parts, and as it hangs, is sustained by the womb. Then in men the passage of the urine is extended longer and narrower from its neck to the penis: in women it is shorter, and wider, and shows itself above the neck of the womb. Now the womb in virgins is very small: in women, when not pregnant, not much larger, than to be held in the hand. It begins with a straight and small neck, which is called the vagina[CA], in a line with the middle of the belly, then is turned a little to the right hip; then mounting above the intestine rectum, its sides are connected to the ilia of the woman. The ilia are situated betwixt the hips and pubes in the lower belly. From which and the pubes the abdomen reaches upwards to the præcordia; on the external side the skin appears; on the inside it is lined by a thin membrane, which is joined to the omentum, and is called by the Greeks peritonæum[CB].

[BW] σφαγίτιδες.

[BX] χαρωτίδες.

[BY] πυλωρὸς.

[BZ] οὐρητ̃ηρες.

[CA] _Canalis_ is our author’s word.

[CB] περιτόναιος.

CHAP. II.

OF THE DISORDERS OF THE HEAD, AND THEIR CURE.

Having as it were presented these parts to view, as far as it is necessary for a physician to know them, I shall proceed to the remedies of the disorders of each, beginning with the head: under which name I now intend that part, which is covered with hair: for pains of the eyes, ears, and teeth, and such like, will be treated of elsewhere.

[Sidenote: _Of pains of the head, and a hydrocephalus._]

Now in the head there is sometimes an acute and dangerous distemper, which the Greeks call cephalæa[CC]. The marks of which are a strong shuddering, relaxation of the nerves(4), dimness of the eyes, delirium, vomiting, and withal a suppression of the voice; or an hæmorrhage from the nose, and with that a coldness of the body, and fainting; besides these an intolerable pain, especially about the temples, or occiput. Sometimes too there is a long weakness of the head, but neither severe nor dangerous, through the whole life. Sometimes the pain is more violent, but short, yet not fatal; which is contracted either by drinking wine, or crudity, or cold, or heat of a fire or the sun. And all these pains are sometimes accompanied with a fever, and sometimes not: sometimes they afflict the whole head, at other times a part of it; sometimes the pain extends to a contiguous part of the face. Besides these there occurs another disorder, which may continue long: where a humour inflates the skin, and it swells, and yields to the impression of the finger. This the Greeks call hydrocephalus[CD].

[CC] κεφαλαία.

[CD] ὑδροκέφαλος.

I have already spoken of the treatment of the second of these kinds, while it is slight, where I laid down rules to be observed by men in health, troubled with a weakness in any part. What remedies also are proper, when the pain is attended with a fever, has been shewn in that place, where the cure of fevers was considered. Now I shall treat of the rest.

That, which is acute, and that, which rises to an unusual height, and that, which proceeds from some sudden cause, and though not mortal, yet is very violent, demands venesection for the first step in the cure. But unless the pain be intolerable, that is needless. And it is better to abstain from food; if possible, from drink too; if not, to drink water. If the pain continues the following day, to give a clyster, to procure sneezings, to take nothing but water: for this discipline often removes it in a day or two, especially if the origin be from wine, or crudity.

But if these methods afford small relief, it is proper to clip the hair close to the skin: then it must be considered, what was the cause of the pain. If heat, it is expedient to pour a great quantity of cold water over the head, to apply a concave sponge frequently dipped in cold water and squeezed, to anoint with rose-oil and vinegar, or rather to apply sordid wool dipped in these, or some other cooling cataplasms. But if cold has brought on the disorder, it is proper to pour upon the head sea water, or at least salt water warm, or a decoction of laurel; then to rub the head briskly; next to embrocate it with warm oil, and to cover it. Some even bind it up; others clap on cervicalia(5) and cloaths, and thus are relieved; others are assisted by hot cataplasms. And therefore, where the cause is not known, it is proper to try, whether cooling things, or heating give most relief, and to use those, which upon experiment shall be found best.

But if the cause cannot be discovered, it is proper to pour over the head first warm water, as has been prescribed, or salt water, or a decoction of laurel, then cold vinegar and water. The following methods are of general use in all inveterate pains of the head: to excite sneezings, to rub the lower parts briskly, to use gargarisms of such things as promote saliva, to apply cucurbitals to the temples and back of the head, to sollicit an hæmorrhage from the nose, to vellicate the temples now and then with resin, and by applying mustard to ulcerate those parts, that are affected, first putting linen below, that it may not corrode too severely, or to make ulcers where the pain is, by hot irons, to eat always moderately, and drink water; when the pain is abated, to go into the bath, there to pour over the head first a great quantity of hot water, and then cold. If the pain is wholly removed, to return even to the use of wine; but ever after to drink water before any thing else.

That kind is different, where a humour is collected within the head. In this it is necessary to clip to the skin; then to apply mustard, so as to ulcerate it; if that does not prove effectual, the knife must be made use of. The management must be so far the same with dropsical cases, that the patient must be exercised, sweated, briskly rubbed, and take such food and drink, as are powerful diureticks.

[Sidenote: _Of the cynicus spasmus._]

There is a distemper incident to the face, which the Greeks call cynicus spasmus[CE]. It comes on an acute fever. The mouth is turned aside with a kind of grin, and therefore it is nothing else than a distortion of the mouth. There is also a frequent change of colour in the face and the whole body, and a great propensity to sleep.

[CE] κυνικὸς σπασμὸς.

It is very proper to let blood in this disorder. If it is not removed by this, to give a clyster. If it does not yield even to that, to vomit by white hellebore. Besides it is necessary to avoid the heat of the sun, fatigue, and wine. But if it is not cured by these methods, running must be used, and gentle and long friction upon that part, which is diseased; in the other parts shorter, but brisk. It does service also to procure sneezings, to shave the head, and to pour upon it hot, either sea water, or at least salt water, with sulphur added to it: after this bathing, to rub again, to chew mustard, and at the same time to apply cerate to the parts of the face that are affected, and to the sound parts mustard, till it corrode them. The most proper diet is of the middle kind.

[Sidenote: _Of a palsy of the tongue._]

But if the tongue be paralytick, which sometimes happens of itself, sometimes is occasioned by distemper, so that the pronunciation is indistinct; it is necessary to use a gargarism of a decoction of thyme, or hyssop, or catmint; to drink water; to rub briskly the head, mouth, and the parts under the chin, and the neck; to rub the tongue itself with laser; to chew the most acrid things, such as mustard, garlick, onion; to make strong efforts to articulate words clearly; to take exercise, keeping in the breath; to pour cold water upon the head often; sometimes to eat plentifully of radishes, and then to vomit.

[Sidenote: _Of a catarrh and gravedo._]

A humour distils from the head sometimes into the nose, which is a slight disorder; sometimes upon the fauces, which is worse; sometimes even upon the lungs, which is worst of all. If it have fallen upon the nose, a thin rheum flows from the nostrils, the head is slightly pained, a weight is felt in it, and there are frequent sneezings. If upon the fauces, it irritates them, and raises a slight cough. If upon the lungs, beside the sneezings and cough, there is also a weight in the head, lassitude, thirst, heat, and bilious urine.

Another (though not very different) disorder is a gravedo. This obstructs the nostrils, blunts the voice, raises a dry cough: at the same time the saliva is salt, there is a sounding in the ears, the veins of the head move, and the urine is turbid. All these disorders Hippocrates calls coryzæ[CF]. I observe that this is now by the Greeks appropriated to the gravedo: and catarrhs are called by them catastagmi[CG]. These are common, and of short continuance; but if they be neglected, are usually lasting. None of them is dangerous, but such as ulcerate the lungs.

[CF] κορύζαι.

[CG] κατασταγμοὶ.

When we perceive any such symptoms, we ought immediately to avoid the heat of the sun, the bath, and venery(6). And at the same time nevertheless unction may be used, and the ordinary diet. The patient should take a straight, but not too quick walk; and after it the head and face must be rubbed above fifty times. And it seldom happens, if we have restricted ourselves for two days or three at most, that the disorder is not mitigated. When it is abated, if in the catarrh the phlegm turns thicker, or in a gravedo, if the nostrils are more open(7), the bath is to be used, and the face and head fomented plentifully first with hot water, and then with egelid; after that, the patient may eat heartily and drink wine. But if on the fourth day the phlegm is equally thin, or the nostrils appear equally obstructed, austere Arminæan wine(8) is to be taken; then again for two days successively water; after which the person may return to the bath, and his usual way of living.

Neither even on these days, in which some things are to be refrained, is it proper to live like sick people; but in all other respects the same liberties may be taken as in health, except by one, who uses to be long and severely afflicted with these disorders; for such a person requires a management somewhat nicer. Therefore if the defluxion be upon his nose or fauces, besides what I mentioned before, he ought immediately in the first days of his indisposition to walk much, to rub the inferior parts briskly, the friction must be more gentle upon the thorax, and gentler still upon the head, the ordinary diet must be diminished to half the quantity, eggs must be used, starch, and such like things, which generate a thicker phlegm; thirst, as much as he can bear, must be one part of the cure. When by these means one has been rendered fit for the bath, and has used it, a small fish, or flesh is to be added to his diet; with this caution however, that he do not immediately take his ordinary quantity of victuals. Pure wine must be used pretty plentifully.

But if it distils also upon the lungs, there is a much greater necessity for walking and friction, still observing the same rules in diet. If these have not the desired effect, he must use the more acrid kinds, indulge sleep more, and abstain from all business, sometimes try the bath, but not soon.

In a gravedo it is necessary for the first day to rest, neither to eat nor drink, to cover the head, and put wool round the throat; the day following to rise, to abstain long from drinking, or if he is obliged to do it, not to take above a hemina of water; on the third day to take a little soft bread with a small fish or some light flesh, and to drink water. If a person should not be able to forbear eating heartily, he must vomit: when he comes into the bath, he is to foment his head and face plentifully with warm water, till he sweat, then return to the use of wine. After which it can scarcely happen, that the same indisposition will continue. But if it remain, use must be made of cold, dry, and light food, as little moisture as possible, friction and exercise being still continued, which are necessary in every indisposition of this nature.

CHAP. III.

OF THE DISEASES OF THE NECK, AND THEIR CURE.

From the head we proceed to the neck, which is liable to very severe diseases. Nor is there a more troublesome or more acute distemper than that, which by a kind of spasm of the nerves draws sometimes the head to the shoulders, sometimes the chin to the breast, sometimes stretches the neck _and holds it_ straight and immoveable. The first the Greeks call opisthotonus[CH], the second emprosthotonus[CI], and the last tetanus[CJ], although some with less accuracy make use of these names indiscriminately. They often kill within four days: if the patients have escaped that time, they are out of danger.

[CH] ὀπισθότονος.

[CI] ἐμπροσθότονος.

[CJ] τέτανος.

All these are cured by the same method; so far physicians agree. But Asclepiades believed, that blood should be let: some again affirmed that ought by all means to be avoided: for this reason, that the body then stood most in need of heat; and that this resides in the blood of the veins. This indeed is false. For it is not the nature of the blood to be peculiarly hot; but amongst the several things, which compose the human body, it most quickly grows either hot or cold. Whether or no it be proper to make this discharge, may be understood from the general directions, which were given about bleeding. But it is evidently proper to give castor, and with it pepper or laser. Then a moist and hot fomentation is needful. Therefore most physicians pour warm water frequently upon the neck. That relieves for the present; but renders the nerves more liable to cold, which is to be particularly avoided.

It is more proper then first to anoint the neck over with liquid cerate(9): next to apply ox-bladders or bottles filled with hot oil, or a hot cataplasm made of meal, or pepper bruised with a fig. But it is most suitable to foment with moist salt; the manner of doing which I have already shewn. When any of these has been done, it is fit to bring the patient to the fire, or if it be the summer-time to the sun; and to rub his neck, and shoulders, and spine with old oil, which is fittest for that purpose; if that cannot be had, with Syrian(10); if that cannot be got neither, with the oldest fat.

As friction is serviceable to all the vertebræ, so it is particularly to those of the neck. Wherefore day and night, but at proper intervals, this remedy must be used. When it is intermitted, some heating malagma must be applied. And cold is of all things to be avoided. And upon that account there ought to be a constant fire in the chamber, where the patient is nursed, and especially in the morning before day-light, when the cold is most intense. Neither will it be improper to keep the head close clipped, and to moisten it with hot ointment of iris, or the cyprine, and to keep it covered with a cap; sometimes to dip the whole body in warm oil, or in a warm decoction of fenugreek, with the addition of a third part of oil. A clyster also often relaxes the superior parts.

But if notwithstanding the pain has grown more severe, cucurbitals are to be applied to the neck, and an incision made in the skin. Eschars are to be made either by irons, or mustard. When the pain has abated, and the neck has begun to move, we may know, that the disease yields to the remedies. But all food that requires chewing must be long avoided. Gruels must be used, also sorbile eggs, or broth made of chickens, or some other tender flesh. If this has succeeded, and the neck shall appear to be entirely well, we must begin with pulse or intrita well moistened. But the patient may sooner venture to chew bread than taste wine; for the use of this is very dangerous, and therefore to be deferred for a longer time.

CHAP. IV.

OF THE DISEASES IN THE FAUCES, AND THEIR CURE.