17. 17 But if a quotidian has been made out of a quartan fever, since this may have happened from mismanagement, the patient ought to fast for two days, make use of rubbing, and be given only a drink of water in the evening: it often happens that on the third day there is no paroxysm. But whether or not, food should be given after the time for the paroxysm. But if this fever persists, a two days' fast should be enjoined so far as the system can bear it, and rubbing used every day.
17. At si ex quartana facta cotidiana est, cum id uitio inciderit, per biduum abstinere oportet, et frictione uti, uespere tantummodo aquam potui dare: tertio die saepe fit, ne febris accedat. Sed siue fuit siue non fuit, cibus post accessionis tempus est dandus. At si manet, per biduum abstinentia, quanta maxime imperari corpori potest, frictione cotidie utendum est.
18. 18 The regimen of fevers has now been expounded; there are, however, other affections of the body which follow upon this, among which I subjoin in the first place those which cannot be assigned to any definite part.
18. Et febrium quidem ratio exposita est. Supersunt uero alii corporis adfectus, qui huic superueniunt, ex quibus eos, qvi certis partibvs adsignari non possvnt, protinus iungam.
I shall begin with insanity, and first that form of it which is both acute and found in fever. The Greeks call it phrenesis. Before all things it should be recognized, that at times, during the paroxysm of a fever, patients are delirious and talk nonsense. This is indeed no light matter, and it cannot occur unless in the case of a severe fever; it is not, however, always equally dangerous; for commonly it is of short duration, and when the onslaught of the paroxysm is relieved, at once the mind comes back. This form of the malady does not require other remedy than that prescribed for the curing of the fever. But insanity is really there when a continuous dementia begins, when the patient, although up till then in his sanity in his senses, yet entertains certain vain imaginings; the insanity becomes established when the mind becomes at the mercy of such imaginings. But there are several sorts of insanity; for some among insane persons are sad, others hilarious; some are more readily controlled and rave in words only, others are rebellious and act with violence; and of these latter, some only do harm by impulse, others are artful too, and show the most complete appearance of sanity while seizing occasion for mischief, but they are detected by the result of their acts. Now that those who merely ave in their talk, or who make but trifling misuse of their hands, should be coerced with the severer forms of constraint is superfluous; but those who conduct themselves more violently it is expedient to fetter, lest they should do harm either to themselves or to others. Anyone so fettered, although he talks rationally and pitifully when he wants his fetters removed, is not to be trusted, for that is a madman's trick. The ancients generally kept such patients in darkness, for they held that it was against their good to be frightened, and that the very darkness confers something towards the quieting of the spirit. But Asclepiades said that they should be kept in the light, since the very darkness was terrifying. Yet neither rule is invariable: for light disturbs one more, darkness another; and some are met with in whom no difference can be observed, either one way or the other. It is best, therefore, to make trial of both, and to keep that patient in the light who is frightened by darkness, and him in darkness who is frightened by light. And when there is no such difference, the patient if strong should be kept in a light room, if not strong he should be kept in a dim one. Now it is useless to adopt remedies when the delirium is at its height; for simultaneously fever is also increasing. So then there is nothing else to do than to restrain the patient, but when circumstances permit, relief must be given with haste. Asclepiades said that in such cases to let blood is to commit murder; following the line of reasoning, that there was no insanity unless with high fever, and that properly blood was let only during the stage of remission. But he himself in these cases sought to bring on sleep by prolonged rubbing, though it is the intensity of the fever which hinders sleep, and it is only during the remission that rubbing is of service. Hence he ought to have passed over this remedy also. What then is there to do? Many things may be rightly done in imminent danger, which otherwise ought to be omitted. And fever also, when continuous, has times during which, although it does not remit, yet it does not increase, and this time, although not the best, yet is the second best time for remedies; and at this time blood ought to be let, if the patient's strength allow it. There can be less question as to whether a motion should be induced. Next, after a day's interval, the head should be shaved bare and then fomented with water in which vervains or other repressive herbs have been boiled; alternatively it is proper first to foment, then to shave, and again to foment; and lastly to pour rose oil over the head and into the nostrils; also to hold to the nose rue pounded up in vinegar, and to excite sneezing by drugs efficacious for the purpose. Such things, however, should be done only in the case of those who are not lacking in strength; but if there is weakness, the head is merely moistened by rose oil to which thyme or something similar has been added. Whatever the patient's strength, the two herbs, bitter-sweet and pellitory, are beneficial, if the head is wetted with the juice expressed from both simultaneously. When the fever has remitted, recourse should be had to rubbing, more sparingly, however, in those who are over-cheerful, than in those who are too gloomy. But in dealing with the spirits of all patients suffering from this type of insanity, it is necessary to proceed according to the nature of each case. Some need to have empty fears relieved, as was done for a wealthy man in dread of starvation, to whom pretend legacies were from time to time announced. Others need to have their violence restrained as is done in the case of those who are controlled even by flogging. In some also untimely laughter has to be put a stop to by reproof and threats; in others, melancholy thoughts are to be dissipated, for which purpose music, cymbals, and noises are of use. More often, however, the patient is to be agreed with rather than opposed, and his mind slowly and imperceptibly is to be turned from the irrational talk to something better. At times also his interest should be awakened; as may be done in the case of men fond of literature, to whom a book may be read, correctly when they are pleased by it, or incorrectly if that very thing annoys them; for by making corrections they begin to divert their mind. Moreover, they should be pressed to recite anything they can remember. Some who did not want to eat were induced to do so, by be placed on couches between other diners. But certainly for all so affected sleep is both difficult and especially necessary; for under it many get well. Beneficial for this, as also for composing the mind itself, is saffron ointment with orris applied to the head. If in spite of this the patients are wakeful, some endeavour to induce sleep by draughts of decoction of poppy or hyoscyamus; others put mandrake apples under the pillow; others smear the forehead with cardamomum balsam or sycamine tears. This name I find used by practitioners, but there are no tears on the mulberry, although the Greeks call the mulberry sycaminon. What in fact is meant are the tears of a tree growing in Egypt, which they call in that country sycamoros. Many foment the face and head at intervals with a sponge dipped in a decoction of poppy heads. Asclepiades said that these things were of no benefit, because they often produced a change into lethargy (III.20); but he prescribed for the patient that during the first day he should keep from food, drink and sleep, in the evening water should be given him to drink, after which he should be rubbed with gentleness, but the rubber must not press hard even with the hand (II.14); during the day following the same was to be done, then in the evening gruel and water should be given and rubbing again applied: for by this he said we should succeed in bringing on sleep. This does happen sometimes, and to such a degree that Asclepiades allowed that excess of rubbing may even cause danger of lethargy. But if sleep does not thus occur, then at length it is to be procured by the above medicaments, having regard, of course, to the same moderation, which is necessary here also, for fear we may afterwards not be able to wake up the patient whom we wish to put to sleep. Sleep is also assisted by the sound of falling water near by, also rocking after food and at night, and especially the motion of a slung hammock (II.15). If blood has not been let before, and the patient's mind is unstable and sleep does not occur, it is not unfitting to apply a cup over an incision into the occiput, which can produce sleep because it relieves the disease. Now moderation in food is also to be observed: for the patient ought not to be surfeited lest it madden him, and he should certainly not be tormented by fasting lest he collapse through debility. The food should be light, in particular gruel, and hydromel for drink, of which three cups are enough, given twice a day in winter, and four times in summer.
Incipiam ab insania, primamque huius ipsius partem adgrediar, quae et acuta et in febre est: ΦΡΕΝΗΣΙΝ Graeci appellant. Illud ante omnia scire oportet, interdum in accessione aegros desipere et loqui aliena. Quod non quidem leue est neque incidere potest nisi in febre uehementi; non tamen aeque pestiferum est: nam plerumque breue esse consueuit leuatoque accessionis impetu protinus mens redit. Neque id genus morbi remedium aliud desiderat, quam quod in curanda febre praeceptum est. Phrenesis uero tum demum est, cum continua dementia esse incipit, cum aeger, quamuis adhuc sapiat, tamen quasdam uanas imagines accipit: perfecta est, ubi mens illis imaginibus addicta est. Eius autem plura genera sunt: siquidem ex phreneticis alii tristes sunt; alii hilares; alii facilius continentur et intra uerba desipiunt; alii consurgunt et uiolenter quaedam manu faciunt; atque ex his ipsis alii nihil nisi impetu peccant, alii etiam artes adhibent summamque speciem sanitatis in captandis malorum operum occasionibus praebent, sed exitu deprenduntur. —Ex his autem eos, qui intra uerba desipiunt, aut leuiter etiam manu peccant, onerare asperioribus coercitionibus superuacuum est: eos, qui uiolentius ⟨s⟩e gerunt, uincire conuenit, ne uel sibi uel alteri noceant. Neque credendum est, si uinctus aliqui, dum leuari uinculis cupit, quamuis prudenter et miserabiliter loquitur, quoniam is dolus insanientis est. Fere uero antiqui tales aegros in tenebris habebant, eo quod is contrarium esset exterreri, et ad quietem animi tenebras ipsas conferre aliquid iudicabant. At Asclepiades, tamquam tenebris ipsis terrentibus, in lumine habendos eos dixit. Neutrum autem perpetuum est: alium enim lux, alium tenebrae magis turbant; reperiunturque, in quibus nullum discrimen deprehendi uel hoc uel illo modo possit. Optimum itaque est utrumque experiri, et habere eum, qui tenebras horret, in luce, eum qui lucem, in tenebris. At ubi nullum tale discrimen est, aeger, si uires habet, loco lucido; si non habet, obscuro continendus est. Remedia uero adhibere, ubi maxime furor urget, superuacuum est: simul enim febris quoque increscit. Itaque tum nihil nisi continendus aeger est: ubi uero res patitur, festinanter subueniendum est. Asclepiades perinde esse dixit his sanguinem mitti ac si trucidentur: rationem hanc secutus, quod neque insania esset, nisi febre intenta, neque sanguis nisi in remissione eius recte mitteretur. Sed ipse in his somnum ⟨multa frictione quaesiuit, cum et intentio febris somnum⟩ impediat et frictio non nisi in remissione eius utilis sit. Itaque hoc quoque auxilium debuit praeterire. Quid igitur est? Multa in praecipiti periculo recte fiunt alias omittenda. Et continuata quoque febris habet tempora, quibus, etsi non remittit, non tamen crescit, estque hoc ut non optimum, sic tamen secundum remediis tempus, quo, si uires aegri patiuntur, sanguis quoque mitti debet. Minus deliberari potest, an aluus ducenda sit. Tum interposito die conuenit caput ad cutem tondere, aqua deinde fouere, in qua uerbenae aliquae decoctae sint [uel ex reprimentibus]; aut prius fouere, deinde radere, et iterum fouere; ac nouissime rosa caput naresque implere, offerre etiam naribus rutam ex aceto contritam, mouere sternumenta medicamentis in id efficacibus. Quae tamen facienda sunt in is, quibus uires non desunt: si uero inbecillitas est, rosa tantum caput adiecto serpullo similique aliquo ⟨m⟩adefaciendum est. Vtiles etiam in quibuscumque uiribus duae herbae sunt, solanum et muralis, ⟨si⟩ simul ex utraque suco expresso caput impletur. Cum febris remisit, frictione utendum est, parcius tamen in is, qui nimis hilares quam in is, qui nimis tristes sunt. Aduersus autem omnium sic insanientium animos gerere se pro cuiusque natura necessarium est. Quorundam enim uani metus leuandi sunt, sicut in homine praediuite famem timente incidit, cui subinde falsae hereditates nuntiabantur. Quorundam audacia coercenda est, sicut in is fit, in quibus continendis plagae quoque adhibentur. Quorundam etiam intempestiuus risus obiurgatione et minis finiendus: quorundam discutiendae tristes cogitationes; ad quod symphoniae et cymbala strepitusque proficiunt. Saepius tamen adsentiendum quam repugnandum et paulatim et non euidenter ab iis, quae stulte dicentur, ad meliora mens eius adducenda. Interdum etiam elicienda ipsius intentio; ut fit in hominibus studiosis litterarum, quibus liber legitur ⟨a⟩ut recte, si delectantur, aut perperam, si id ipsum eos offendit: emendando enim conuertere animum incipiunt. Quin etiam recitare, si qua meminerunt, cogendi sunt. Ad cibum quoque quosdam non desiderantes reduxerunt i, qui inter epulantes eos conlocarunt. Omnibus uero sic adfectis somnus et difficilis et praecipue necessarius est: sub hoc enim plerique sanescunt. Prodest ad id atque etiam ad mentem ipsam conponendam crocinum unguentum cum irino in caput additum. Si nihilo minus uigila⟨n⟩t, quidam somnum moliuntur potui dando aquam, in qua papauer aut hyoscyamos decocta si⟨n⟩t, alii mandragorae mala puluino subiciunt, alii uel amomum uel sycamini lacrimam fronti inducunt. Hoc nomen apud medicos reperio. Sed cum Graeci morum sycaminon appellant, mori nulla lacrima est. Sic uero significatur lacrima arboris in Aegypto nascentis, quam ibi sycomoron appellant. Plurimi, decoctis papaueris corticibus, ex ea aqua spongia os et caput subinde fouent. Asclepiades ea superuacua esse dixit, quoniam in lethargum saepe conuerterent: praecepit autem, ut primo die a cibo, potione, somno abstineretur, uespere ei daretur potui aqua, tum frictio admoueretur lenis, ut ne manum quidem qui perfricaret uehementer inprimeret; postero deinde die isdem omnibus factis uespere ei daretur sorbitio et aqua, rursusque frictio adhiberetur: per hanc enim nos consecuturos, ut somnus accedat. Id interdum fit, et quidem adeo, ut illo confitente nimia frictio etiam lethargi periculum adferat. Sed si sic somnus non accessit, tum demum illis medicamentis arcessendus est, habita scilicet eadem moderatione, quae hic quoque necessaria est, ne, quem obdormire uolumus, excitare postea non possimus. Confert etiam aliquid ad somnum silanus iuxta cadens, uel gestatio post cibum et noctu, maximeque suspensi lecti motus. Neque alienum est, si neque sanguis ante missus est, neque mens constat, neque somnus accedit, occipitio inciso cucurbitulam admouere; quae quia leuat morbum, potest etiam somnum facere. Moderatio autem in cibo quoque adhibenda est: nam neque aeger implendus est, ne insaniat, neque ieiunio utique uexandus, ne inbecillitate in cardiacum incidat.
There is another sort of insanity, of longer duration because it generally begins without a fever, but later excites a slight feverishness. It consists in depression which seems caused by black bile. Blood-letting is here of service; but if anything prohibit this, then comes firstly abstinence, secondly a clearance by white hellebore and a vomit. After either, rubbing twice a day is to be adopted; if the patient is strong, frequent exercise as well: vomiting on an empty stomach. Food of the middle class should be given without wine; but as often as I indicate this class of food, it should be understood that some of the weakest class of food also may be given, provided that this is not used alone; and that it is only the strongest class of food which is excluded. In addition to the above: the motions are to be kept very soft, causes of fright excluded, good hope rather put forward; entertainment sought by story-telling, and by games, especially by those with which the patient was wont to be attracted when sane; work of his, if there is any, should be praised, and set out before his eyes; his depression should be gently reproved as being without cause; he should have it pointed out to him now and again how in the very things which trouble him there may be a cause of rejoicing rather than of solicitude. When there is fever besides, it is to be treated like other fevers.
Opus est cibo infirmo maximeque sorbitione, potione aquae mulsae, cuius ternos cyathos bis hieme, quater aestate dedisse satis est. Alterum insaniae genus est, quod spatium longius recipit, quia fere sine febre incipit, leues deinde febriculas excitat. Consistit in tristitia, quam uidetur bilis atra contrahere.—In hac utilis detractio sanguinis est: si quid hanc ⟨poterit⟩ prohibere, prima est abstinentia, secunda per album ueratrum uomitumque purgatio, post utrumlibet adhibenda bis die frictio est; si magis ualet, frequens etiam exercitatio: in ieiuno uomitus. Cibus sine uino dandus ex media materia est; quam quotiens posuero, scire licebit etiam ex infirmissima dari posse, dum ne ⟨illa sol⟩a quis utatur: ualentissima tantummodo esse remouenda. Praeter haec seruanda aluus est quam tenerrima, remouendi terrores, et potius bona spes offerenda; quaerenda delectatio ex fabulis ludisque, maxime quibus capi sanus adsuerat; laudanda, si qua sunt, ipsius opera et ante oculos eius ponenda; leuiter obiurganda uana tristitia; subinde admonendus, in is ipsis rebus, quae sollicitant, cur potius laetitiae quam sollicitudinis causa sit.
The third kind of insanity is of all the most prolonged whilst it does not shorten life, for usually the patient is robust. Now of this sort there are two species: some are duped not by their mind, but by phantoms, such as the poets say Ajax saw when mad or Orestes; some become foolish in spirit.
Si febris quoque accessit, sicut aliae febres curanda est. Tertium genus insaniae ⟨est⟩ ex his longissimum, adeo ut uitam ipsam non impediat; quod robusti corporis esse consueuit.
If phantoms mislead, we must note in the first place whether the patients are depressed or hilarious. For depression black hellebore should be given as a purge, for hilarity white hellebore as an emetic; and if the patient will not take the hellebore in a draught, it should be put into his bread to deceive him the more easily; for if he has well purged himself, he will in great measure relieve himself of his malady. Therefore even if one does of the hellebore has little effect, after an interval another should be given. It should be known that a madman's illness is less serious when accompanied by laughter than by gravity. This also is an invariable precept in all disease, that when a patient is to be purged downwards, his belly is to be loosened beforehand, but confined when he is to be purged upwards.
Huius autem ipsius species duae sunt: nam quidam imaginibus, non mente falluntur, quales insanientem Aiacem uel Orestem percepisse poetae ferunt: quidam animo desipiunt. Si imagines fallunt, ante omnia uidendum est, tristes an hilares sint. In tristitia nigrum ueratrum deiectionis causa, in hilaritate album ad uomitum excitandum dari debet; idque si in potione non accepit, in pane adiciendum est, quo facilius fallat: nam si bene se purgauerit, ex magna parte morbum leuabit. Ergo etiamsi semel datum ueratrum parum profecerit, interposito tempore iterum dari debet. Neque ignorare oportet leuiorem esse morbum cum risu quam cum serio insanientium.
If, however, it is the mind that deceives the madman, he is best treated by certain tortures. When he says or does anything wrong, he is to be coerced by starvation, fetters and flogging. He is to be forced both to fix his attention and to learn something and to memorize it; for thus it will be brought about that little by little he will be forced by fear to consider what he is doing. To be terrified suddenly and to be thoroughly frightened is beneficial in this illness and so, in general, is anything which strongly agitates the spirit. For it is possible that some change may be effected when the mind has been withdrawn from its previous state. It also makes a difference, whether from time to time without cause the patient laughs, or is sad and dejected: for the hilarity of madness is better treated by those terrors I have mentioned above. If there is excessive depression light and prolonged rubbing twice a day is beneficial, as well as cold water poured over the head, and immersion of the body in water and oil. The following are general rules: the insane should be put to fatiguing exercise, and submitted to prolonged rubbing, and given neither fat meat nor wine: after the clearance the lightest food of the middle class is to be used; they should not be left alone or among those they do not know, or among those whom either they despise or disregard; they ought to have a change of scene, and if the mind returns, they should undergo the tossing incident to travel (II.15), once a year.
Illud quoque perpetuum est in omnibus morbis, ubi ab inferiore parte purgandus aliquis est, uentrem eius ante soluendum esse; ubi a superiore, comprimendum. Si uero consilium insanientem fallit, tormentis quibusdam optime curatur. Vbi perperam aliquid dixit aut fecit, fame, uinculis, plagis coercendus est. Cogendus est et attendere et ediscere aliquid et meminisse: sic enim fiet, ut paulatim metu cogatur considerare quid faciat. Subito etiam terreri et expauescere in hoc morbo prodest, et fere quicquid animum uehementer turbat. Potest enim quaedam fieri mutatio, cum ab eo statu mens, in quo fuerat, abducta est. Interest etiam, ipse sine causa subinde rideat, an maestus demissusque sit: nam demens hilaritas terroribus iis, de quibus supra dixi, melius curatur. Si nimia tristitia, prodest lenis sed multa bis die frictio, item per caput aqua frigida infusa, demissumque corpus in aquam et oleum. Illa communia sunt, insanientes uehementer exerceri debere, multa frictione uti, neque pinguem carnem neque uinum adsumere; cibis uti post purgationem ex media materia quam leuissimis; non oportere esse uel solos uel inter ignotos, uel inter eos, quos aut contemnant aut neglegant; mutare debere regiones et, si mens redit, annua peregrinatione esse iactandos.
Rarely, yet now and then, however, delirium is the produce of fright; this class of insanity, has similar sub-divisions, and is to be treated by the same species of dietetic regimen, except that, in this form of insaneness alone, wine is properly given.
Raro sed aliquando tamen ex metu delirium nascitur. Quod genus insanientium specie * * * similique uictus genere curandum est, praeterquam quod in hoc insaniae genere solo recte uinum datur.
19. 19 That kind of affection which the Greeks call cardiac is a complete contrast to the foregoing diseases, although insane persons often pass over into it; in those the mind gives way, in this it holds firm. Indeed the illness is nothing other than excessive weakness of the body, which, while the stomach is languid, wastes away through immoderate sweating. And it may be recognized at once by the exiguous and weak pulsation of the blood vessels, while sweat, at once unaccustomed and excessive and untimely, breaks out all over the chest and neck, and even over the head, the feet and legs remaining more dry and cold; and it is a form of acute disease. The primary treatment is the application over the chest of repressant plasters; the secondary, to stop sweating. The latter is accomplished by bitter olive oil, or rose or quince or myrtle oil, with any of which the body is to be lightly anointed, then a salve made up of any of them is to be applied. If the sweating wins, the patient is to be smeared over with gypsum or litharge or cimolian chalk, or even powdered over with the same at intervals. A powder consisting of the pounded leaves of dried myrtle or of blackberry, or of the dried lees of dry and good wine, attains the same end; there are many simple materials, and if these are not at hand, it is useful enough to scatter on any dust from the road. In addition to this, moreover, in order that he may sweat less, the patient should be lightly covered and lie in a cool room, with the windows open, so that some breeze reaches him. A third aid is to help his weakness whilst in bed by food and wine. The food, whilst not much in quantity, should be given often, as well by night as by day, so as to nourish without becoming onerous. It should consist of the weakest class of materials and should be suitable to the stomach. Unless there is necessity, it is not well to hurry on to wine. But when fainting is apprehended, then there is given both bread crumbled into the wine and wine by itself dry indeed yet thin, undiluted, lukewarm, at intervals liberally, and if the patient is taking but little food, polenta may be scattered into the wine; and that wine should not be lacking in strength, yet not over-strong the patient may properly drink three quarters of a litre, and even more if of large build, in the course of a day and night: if he does not take his food, the patient should be anointed, should have cold water poured over him, and after that be given food. But if the stomach has become relaxed and retains but little, let the patient vomit as he will, whether before or after food, and after vomiting take food again. If even after that food is not retained, he should sip a cupful of wine, and another after the interval of an hour. If the stomach returns this wine also, he should be rubbed all over with pounded onions, which as they dry cause the stomach to retain the wine, and as a result, cause heat to return throughout the body, and a forceful pulsation to the blood vessels. The last resource is the introduction into the bowel from below of barley or spelt gruel, since that too supports the patient's strength. Should he feel hot, it is not inappropriate to hold to his nostrils a restorative such as rose oil in wine; if he has cold extremities, they should be rubbed by hands anointed and warmed. If we can by these measures obtain a diminution in the severity of the sweating, and a prolongation of life, time itself now begins to come to our aid. When the patient appears to have reached safety, rapid release into the same state of weakness is still to be feared; hence along with a gradual withdrawal of wine, the patient ought each day to take stronger food, until a sufficiency of bodily strength is gained.
19. His morbis praecipue contrarium est id genus, quod cardiacum a Graecis nominatur, quamuis saepe ad eum phrenetici transeunt: siquidem mens in illis labat, in hoc constat. Id autem nihil aliud est quam nimia inbecillitas corporis, quod stomacho languente inmodico sudore digeritur. Licetque protinus scire id esse, ubi uenarum exigui inbecillique pulsus sunt, sudor autem et supra consuetudinem et modo * et tempore ex toto thorace et ceruicibus atque etiam capite prorumpit, pedibus tantummodo et cruribus siccioribus atque frigentibus; acutique id morbi genus est. Curatio prima est supra praecordia imponere quae reprimant cataplasmata, secunda sudorem prohibere. Id praestat acerbum oleum uel rosa uel melinum aut myrteum, quorum aliquo corpus leuiter perunguendum, ceratumque ex aliquo horum tum inponendum est. Si sudor uincit, delinendus homo est uel gypso uel spuma argentea uel Cimolia creta, uel etiam subinde horum puluere respergendus. Idem praestat puluis ex contritis aridi myrti uel rubi foliis, aut ex austeris et boni uini arida faece; pluraque similia sunt, quae si desunt, satis utilis est quilibet ex uia puluis iniectus. Super haec uero, quo minus corpus insudet, leui ueste debet esse contectus, loco non calido, fenestris patentibus, sic ut perflatus quoque aliquis accedat. Tertium auxilium est inbecillitati iacentis cibo uinoque succurrere. Cibus non multus quidem, sed saepe tamen nocte ac die dandus est, ut nutriat, neque oneret. Is esse debet ex infirmissima materia et stomacho aptus. Nisi si necesse est, ad uinum festinare non oportet. Si uerendum est, ne deficiat, tum et intrita ex hoc, et hoc ipsum austerum quidem, sed tamen tenue, meraculum, egelidum subinde et liberaliter dandum est, adiecta polenta, si modo is aeger parum cibi adsumit; idque uinum esse debet neque nullarum uirium, neque ingentium: recteque toto die ac nocte uel tres heminas aeger bibet; si uastius corpus est, plus etiam: si cibum non accipit, perunctum perfundere aqua frigida ante conueniet, et tunc dare. Quod si stomachus resolutus parum continet, et ante cibum et post eum sponte uomere oportet, rususque post uomitum cibum sumere. Si ne id quidem manserit, sorbere uini cyathum, interpositaque hora sumere alterum. Si id quoque stomachus reddiderit, totum corpus bulbis contritis superinlinendum est; qui ubi inaruerunt, efficiunt, ut uinum in stomacho contineatur, exque eo toti corpori calor, uenisque uis redeat. Vltimum auxilium est in aluum tisanae uel halicae cremorem ex inferioribus partibus indere, siquidem id quoque uires tuetur. Neque alienum est naribus quoque aestuantis admouere quod reficiat [id est rosa et uinum]: si qua in extremis partibus frigent, unctis et calidis manibus fouere. Per quae si consequi potuimus, ut et sudoris impetus minuatur, et uita prorogetur, incipit iam tempus ipsum esse praesidio. Vbi esse in tuto uidetur, uerendum tamen, ne in eandem infirmitatem cito recidat; itaque uino tantummodo remoto cotidie ualidiorem cibum debet adsumere, donec satis uirium corpori redeat.
20. 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.
20. 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 sternu[ta]menta 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⟨a⟩t. 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.
21. 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.
21. 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⟨s⟩t, 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⟨a⟩minia quam ΣΤΑΦΙΔΑ ΑΓΡΙΑΝ Graeci nominant, habrot⟨o⟩num, 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.
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.
Hactenus communiter de omni specie ⟨prae⟩cipi 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⟨a⟩tiones abstinendum est ab omnibus inflantibus.