The disease of the smaller intestine, unless resolved, kills within seven days.
Morbus intestini tenuioris * * nisi resolutus est, intra septimum diem occidit.
A woman after childbirth is in danger of death, if also oppressed by violent and persistent pain in the head along with fever.
Mulier ex partu si cum febre uehementibus etiam et adsiduis capitis doloribus premitur, in periculo mortis est.
To breathe rapidly is a bad sign if there is pain and inflammation in those parts which contain viscera.
Si dolor atque inflammatio est in iis partibus, quibus uiscera continentur, frequenter spirare signum malum est.
A prolonged pain in the head, if without cause it shifts to the neck and shoulders, and again returns to the head, or if it spreads from the head to reach the neck and shoulders, is most pernicious, unless it induces some abscess so that pus is coughed up, or unless there is an outburst of blood from some part, or unless there is upon the head an eruption of much scurf or of pimples all over the body. Equally severe is this malady when a numbness or an itching wanders, now all over the head, now over part of it, or there is felt there a sensation as of something cold, and when these symptoms extend to the tip of the tongue. And since the abscesses described above are beneficial, recovery is more difficult, in proportion as they supervene less often upon such maladies.
Si sine causa longus dolor capitis est, et in ceruices ac scapulas transit, rursusque in caput reuertitur, aut a capite ad ceruices scapulasque peruenit, perniciosus est, nisi uomicam aliquam excitauit, sic ut pus extussiretur, aut nisi sanguis aliqua parte prorupit, aut nisi in capite multa porrigo totoue corpore pustulae ortae sunt. Aeque magnum malum est, ubi torpor atque prurigo peruagantur, modo per totum caput, modo in parte, aut sensus alicuius ibi quasi frigoris est, eaque ad summam quoque linguam perueniunt. Et cum in isdem abscessibus auxilium sit, eo difficilior sanitas est, quo minus saepe sub his malis illi subsecuntur.
When there are pains in the hips, if there is great numbness, and both the leg and hip become cold, if there is no movement of the bowel except forced, and the stool passed is mucous, and if the patient is already over forty, there will be a very prolonged illness, lasting at least a year, nor will it possibly come to an end except either in spring or in autumn.
In coxae uero doloribus si uehemens torpor est, frigescitque crus et coxa, aluus nisi coacta non reddit, idque quod excernitur muccosum est, iamque aetas eius hominis XL annum excessit, is morbus erit longissimus minimeque ann⟨u⟩us, neque finiri poterit nisi aut uere aut autumno.
Treatment is likewise difficult at that age when pain in the shoulders either spreads to the hands or extending to the shoulder-blades gives rise to numbness and pain there, which is not relieved by a vomit of bile.
Difficilis aeque curatio est in eadem aetate, ubi umerorum dolor uel ad manus peruenit uel ad scapulas tendit torporemque et dolorem creat, neque bilis uomitu leuatur.
Whatever too the part of the body, any limb which becomes paralysed if it is not moved and wastes, will not be restored to its former state, and the less so the longer the paralysis has been, and the older the patient. And for the cure of all cases of paralysis, winter and autumn are not favourable seasons; there is possibly hope in spring and summer; even when mild this disease is scarcely curable, a severe attack cannot be cured. All pain also becomes less amenable to treatment as it spreads upwards.
Quacumque uero corporis parte membrum aliquod resolutum est, si neque mouetur et emacrescit, in pristinum habitum non reuertitur, eoque minus, quo uetustius id uitium est, et quo magis in corpore senili est. Omnique resolutioni neruorum ad medicinam non idonea tempora sunt hiemps et autumnus: aliquid sperari potest uere et aestate; is morbus mediocris uix sanatur, uehemens sanari non potest.Omnis etiam dolor minus medicinae patet, qui sursum procedit.
In a pregnant woman, if the breasts suddenly shrivel up, there is danger of abortion. A woman has a defective menstruation who has milk in her breasts, not having just borne a child, or being pregnant.
Mulieri grauidae si subito mammae emacuerunt, abortus periculum est. Quae neque peperit neque grauida est, si lac habet, a menstruis defecta est.
Quartan fever, whilst brief in summer, is generally prolonged in autumn, and especially so when beginning at the approach of winter. There is danger of death if haemorrhage is followed by dementia and by spasm; the same is the case when, after purgation by medicaments, and, with the bowel still empty, there is an attack of spasm, as also if with great pain in the bowel the extremities become cold.
Quartana ⟨aestiua breuis,⟩ autumnalis fere longa est maximeque quae coepit hieme adpropinquante. Si sanguis profluit, dein secuta est dementia cum distentione neruorum, periculum mortis est, itemque si medicamentis purgatum et adhuc inanem neruorum distentio oppressit, ⟨item⟩ si in magno ⟨alui⟩ dolore extremae partes frigent.
He does not return to life who has been taken down from hanging with foam around the mouth.
Neque is ad uitam redit, qui ex suspendio spumante ore detractus est.
A black stool resembling black blood, passed suddenly, whether accompanied by fever, or even without fever, is dangerous.
Aluus nigra, sanguini atro similis, repentina, siue cum febre siue etiam sine hac est, perniciosa est.
9. 9 Having recognized the indications which either console us with hope, or terrify us with fear, we must pass to the methods of treating Diseases. Of these some are general aids, some special. General Aids are those which are beneficial in most diseases, Special Aids in particular ones. I shall speak first of the general, some of which, however, sustain not alone the sick but also those in health; some are applied against illness only. Now every corporeal aid either diminishes substance or adds to it, either draws it out or represses it, either cools or warms, either hardens or softens; some act, not merely in one way, but even in two ways, not contrary the one to the other. Substance is withdrawn by blood-letting, cupping, purging, vomiting, rubbing, rocking, and by bodily exercises of all kinds, by abstinence, by sweating; of these I shall now speak.
9. Cognitis indiciis, quae nos uel spe consolentur uel metu terreant, ad CVRATIONES morborum transeundum est. Ex his quaedam communes sunt, quaedam propriae. Communes, quae pluribus opitulantur morbis; propriae, quae singulis. Ante DE COMMVNIBVS dicam: ex quibus tamen quaedam non aegros solum sed sanos quoque sustinent, quaedam in aduersa tantum ualetudine adhibentur. Omne uero auxilium corporis aut demit aliquam materiam aut adicit, aut ⟨e⟩uocat aut reprimit, aut refrigerat aut calefacit, simulque aut durat aut mollit: quaedam non uno modo tantum sed etiam duobus inter se non contrariis adiuuant. DEMITVR MATERIA sanguinis detractione, cucurbitula, deiectione, uomitu, frictione, gestatione omnique exercitatione corporis, abstinentia, sudore; de quibus protinus dicam.
10. 10 To let blood by incising a vein is no novelty; what is novel is that there should be scarcely any malady in which blood may not be let. Again, to let blood in young women who are not pregnant is an old practice; but it is not an old practice for the same to be tried in children and in the elderly and also in pregnant women: for indeed the ancients were of opinion that the first and last years could not sustain this kind of treatment, and they were persuaded that a pregnant woman, so treated, would abort. Practice subsequently showed indeed that in these matters there is no unvarying rule, and that other observations are rather to be made, to which the consideration of the practitioner ought to be directed. For it matters not what is the age, nor whether there is pregnancy, but what may be the patient's strength. So, then, if a youth is weakly, or a woman, although not pregnant, has little strength, it is bad to let blood; for any remaining strength dies out if it is thus stripped away. But a strong child, or a robust old man, or a pregnant woman in good health, may be so treated with safety. It is mostly, however, in such cases that an inexperienced practitioner can be deceived, because at the above ages there is usually a less degree of strength; and a pregnant woman has need also, after the blood-letting, of forces to sustain, not merely herself, but also her unborn child. Not that we should be in a hurry to do anything that demands anxious attention and care; for in that very point lies the art of medicine, which does not count years, or regard only the pregnancy, but calculates the strength of the patient, and infers from that whether possibly or no there is a superfluity, enough to sustain either a child or an old man or simultaneously two beings within one woman. There is a difference between a strong and an obese body, between a thin and an infirm one: thinner bodies have more blood, those of fuller habit more flesh. The more easily, therefore, do the former sustain this sort of depletion; and the more quickly is he who is over-fat distressed by it; hence it is that the body's strength may be estimated better by its blood-vessels than by its actual appearance. And the foregoing are not the sole considerations, but there is also the kind of disease, whether a superabundance or a deficiency of bodily material has done the harm, whether the body is corrupted or sound. For if the material of the body is either deficient, or is sound, blood-letting in unsuitable; but if the harm is its copiousness, or the material has become corrupted, there is no better remedy. Therefore severe fever, when the bodily surface is reddened, and the blood-vessels full and swollen, requires withdrawal of blood; so too diseases of the viscera, also paralysis and rigor and spasm of sinews, in fact whatever strangulates the throat by causing difficulty of breathing, whatever suppresses the voice suddenly, whenever there is intolerable pain, and whenever there is from any cause rupture and contusion of internal organs; so also a bad habit of body and all acute diseases, provided, as I have stated above, they are doing harm, not by weakness, but by overloading. But it may happen that some disease demands blood-letting, although the body seems scarcely able to bear it; if, however, there appears to be no other remedy, and if the patient is likely to die unless he be helped even at some risk — that being the position, it is the part of a good practitioner to show that without the withdrawal of blood there is no hope, and to confess how much fear there may be in that step, and then at length, if the attempt is demanded, to let blood. In such a case there should be no hesitation about it; for it is better to try a double-edged remedy than none at all; and in particular it should be done: when there are paralyses; when a man becomes speechless suddenly; when angina causes choking; when the preceding paroxysm of a fever has been almost fatal, and it is very probable that a like paroxysm is about to set in which it seems impossible for the patient's strength to sustain. Further although it is least proper to let blood whilst food is undigested, yet that is not an invariable precept; for the case will not always wait for digestion. Thus if a man falls from a height, if there is contusion, or something else happening suddenly has caused vomiting of blood, although food may have been taken but a short while before, yet at once the bodily material should be depleted, lest, if it forms a congestion, it should harm the body; and the same rule will hold good also in other sudden accidents which cause suffocation. But if the character of the affection permits, it should be done then only when there remains no suspicion of undigested food; and therefore the second or third day of the illness may seem the most fitting for the procedure. But whilst there is sometimes a necessity for blood-letting even on the first day, it is never of service after the fourth day, for within that interval the material itself has both been sucked up and corrupted the body, so that then depletion can make it weak but cannot make it sound. But if there is the oppression of a vehement fever, to let blood during the actual paroxysm is to cut the man's throat; the remission is therefore to be awaited: if the fever does not decrease, but merely stops increasing, and there is no hope of remission, then also the opportunity, bad as it is, as it is the only one, should not be missed. When the measure is necessary it should generally be divided between two days; on the first it is better to relieve, and later to deplete the patient, rather than perchance to precipitate his end by dissipating his strength all at once. But if this answers in the case of pus, or of the water in dropsy, all the more necessarily should it answer in the letting out of blood. If the cause affects the body as a whole, blood should be let from the arm; if some part, then actually from that part, or at any rate from a spot as near as may be, for it is not possible to let blood from everywhere, but only from the temples, arms and near the ankles. Nor am I ignorant that some say blood should be let from a place the furthest away from the damaged part, for that thus the course of the material of the disease is diverted, but that otherwise it is drawn into the very part which is damaged. Yet this is erroneous, for blood-letting draws blood out of the nearest place first, and thereupon blood from more distant parts follows so long as the letting out of blood is continued; when put a stop to, no more blood comes to the part diseased, because it is no longer drawn to the opened vein. Practice itself, however, seems to have taught that for a broken head blood should be let preferably from the arm; when the pain is situated in one upper limb, then from the arm opposite; I believe because, if anything goes wrong, those parts are more liable to take harm which are already in a bad state. Blood is also at times diverted when, having burst out at one place, it is let out at another. For bleeding from a place where it is not desired ceases after something is applied to stop it there, when the blood is given another exit. Now blood-letting, whilst it may be very speedily done by one practised in it, yet for one without experience is very difficult, for to the vein is joined an artery, and to both sinews. Hence should the scalpel strike a sinew, spasm follows, and this makes a cruel end to the patient. Again, when an artery is cut into, it neither coalesces nor heals; it even sometimes happens that a violent outburst of blood results. As to the actual vein, when completely divided by a forceful cut, its two ends are pressed together, and do not let out the blood. Yet if the scalpel is entered timidly, it lacerates the skin but does not enter the vein; at times, indeed, the vein is concealed and not readily found. Thus many things make difficult to one who is unskilled what to one experienced is very easy. The vein ought to be cut half through. As the blood streams out its colour and character should be noted. For when the blood is thick and black, it is vitiated, and therefore shed with advantage, if red and translucent it is sound, and that blood-letting, so far from being beneficial, is even harmful; and the blood should be stopped at once. But this cannot happen under that practitioner who knows from what sort of body blood should be let. It more often happens that the flow of blood continues as black as on the first day; although this be so, nevertheless, if enough has flowed out, blood-letting should be stopped, and always an end should be put to it before the patient faints, and the arm should be bandaged after superimposing a pad squeezed out of cold water, and the next day the vein is to be flicked open by the tip of the middle finger so that, its recent coalescence being undone, it may again let out blood. Whether it be on the first or on the second day that the blood, which has at first flowed out thick and black, begins to become red and translucent, a sufficient quantity has been withdrawn, and the rest of the blood is pure; and so at once the arm should be bandaged and kept so until the little scar is strong, and this, in a vein, becomes firm very quickly.
10. Sanguinem incisa uena mitti nouum non est: sed nullum paene esse morbum, in quo non mittatur, nouum est. Item mitti iunioribus feminis uterum non gerentibus uetus est: in pueris uero idem experiri et in senioribus et in grauidis quoque mulieribus uetus non est: siquidem antiqui primam ultimamque aetatem sustinere non posse hoc auxilii genus iudicabant, persuaserantque sibi mulierem grauidam, quae ita curata esset, abortum esse facturam. Postea uero usus ostendit nihil in his esse perpetuum, aliasque potius obseruationes adhibendas esse, ad quas derigi curantis consilium debeat. Interest enim, non quae aetas sit, neque quid in corpore intus geratur, sed quae uires sint. Ergo si iuuenis inbecillus est, aut si mulier, quae grauida non est, parum ualet, male sanguis emittitur: emoritur enim uis, si qua supererat, hoc modo erepta. At firmus puer et robustus senex et grauida mulier ualens tuto curatur. Maxime tamen in his medicus inperitus falli potest, quia fere minus roboris illis aetatibus subest; mulierique praegnati, post curationem quoque, uiribus opus est, non tantum ad se, sed etiam ad partum sustinendum. Non quicquid autem intentionem animi et prudentiam exigit protinus faciendum est, cum praecipua in hoc ars sit, quae non annos numeret, neque conceptionem solam uideat, sed uires aestimet, et eo colligat, possit necne superesse, quod uel puerum uel senem uel in una muliere duo corpora simul sustineat. Interest etiam inter ualens corpus et obesum, inter tenue et infirmum: tenuioribus magis sanguis, plenioribus magis caro abundat. Facilius itaque illi detractionem eiusmodi sustinent: celeriusque ea, si nimium est pinguis, aliquis adfligitur; ideoque uis corporis melius ex uenis quam ex ipsa specie aestimatur. Neque solum haec consideranda sunt, sed etiam morbi genus quod sit, utrum superans an deficiens materia laeserit, corruptum corpus sit an integrum. Nam si materia uel deest uel integra est, istud alienum est: at si uel copia sui male habet, uel corrupta est, nullo modo melius succurritur. Ergo uehemens febris, ubi rubet corpus, uenaeque plenae tument, sanguinis detractionem requirit; item uiscerum morbi, neruorum et resolutio et rigor et distentio, quicquid denique fauces difficultate spiritus strangulat, quicquid supprimit subito uocem, quisquis intolerabilis dolor est, et quacumque de causa ruptum aliquid intus atque collisum est; item malus corporis habitus omnesque acuti morbi, qui modo, ut supra dixi, non infirmitate sed onere nocent. Fieri tamen potest, ut morbus quidem id desideret, corpus autem uix pati posse uideatur: sed ⟨si⟩ nullum tamen appare⟨a⟩t aliud auxilium, periturusque sit qui laborat, nisi temeraria quoque uia fuerit adiutus, in hoc statu boni medici est ostendere, quam nulla spes sit sine sanguinis detractione, faterique, quantus in hac ipsa metus sit, et tum demum, si exigetur, sanguinem mittere. De quo dubitari in eiusmodi re non oportet: satius est enim anceps auxilium experiri quam nullum; idque maxime fieri debet, ubi nerui resoluti sunt; ubi subito aliquis ommutuit; ubi angina strangulatur; ubi prioris febris accessio paene confecit, paremque subsequi uerisimile est neque eam uidentur sustinere aegri uires posse. Cum sit autem minime crudo sanguis mittendus, tamen ne id quidem perpetuum est: neque enim semper concoctionem res expectat. Ergo si ex superiore parte aliquis decidit, si contusus est, si ex aliquo subito casu sanguinem uomit, quamuis paulo ante sumpsit cibum, tamen protinus ei demenda materia est, ne, si subsederit, corpus adfligat; idemque etiam in aliis casibus repentinis, qui strangulabunt, dictum erit. At si morbi ratio patietur, tum demum nulla cruditatis suspicione remanente id fiet; ideoque ei rei uidetur aptissimus aduersae ualetudinis dies secundus aut tertius. Sed ut aliquando etiam primo die sanguinem mittere necesse est, sic numquam utile post diem quartum est, cum iam spatio ipsa materia et exhausta est et corpus conr⟨u⟩pit, ut detractio inbecillum id facere possit, non possit integrum. Quod si uehemens febris urget, in ipso impetu eius sanguinem mittere hominem iugulare est; expectanda ergo remissio est: si non decrescit, sed crescere desiit, neque speratur remissio, tum quoque, quamuis peior, sola tamen occasio non omittenda est. Fere etiam ista medicina, ubi necessaria est, in biduum diuidenda est: satius est enim in primo leuare aegrum, deinde perpurgare, quam simul omni ⟨ui⟩ effusa fortasse praecipitare. Quod si in pure quoque aquaque, quae inter cutem est, ita respondet, quanto magis necesse est in sanguine respondeat. Mitti uero is debet, si totius corporis causa fit, ex brachio; si partis alicuius, ex ea ipsa parte aut certe quam proxima, quia non ubique mitti potest, sed in temporibus, in brachiis, iuxta talos. Neque ignoro quosdam dicere quam longissime sanguinem inde, ubi laedit, esse mittendum: sic enim auerti materiae cursum: at illo modo in id ipsum, quod grauat, euocari. Sed id falsum est: proximum enim locum primum exhaurit, ex ulterioribus autem eatenus sanguis sequitur, quatenus emittitur; ubi is suppressus est, quia non trahitur, ne uenit quidem. Videtur tamen usus ipse docuisse, si caput fractum est, ex brachio potius sanguinem esse mittendum; si quod in umero uitium est, ex altero brachio: credo quia, si quid parum cesserit, opportuniores hic eae partes iniuriae sunt, quae iam male habent. Auertitur quoque interdum sanguis, ubi alia parte prorumpens alia emittitur. Desinit enim fluere qua nolumus, inde obiectis quae prohibeant, alia dato itinere. Mittere autem sanguinem cum sit expeditissimum usum habenti, tum ignaro difficillimum est: iuncta enim est uenae arteria, his nerui. Ita, si neruum scalpellus attingit, sequitur neruorum distentio, eaque hominem crudeliter consumit. At arteria incisa neque coit neque sanescit; interdum etiam, ut sanguis uehementer erumpat, efficit. Ipsius quoque uenae, si forte praecisa est, capita comprimuntur, neque sanguinem emittunt. At si timide scalpellus demittitur, summam cutem lacerat neque uenam incidit: nonnumquam ⟨etiam⟩ ea latet neque facile reperitur. Ita multae res id difficile inscio faciunt, quod perito facillimum est. Incidenda ad medium uena est. Ex qua cum sanguis erumpit, colorem eius habitumque oportet attendere. Nam si is crassus et niger est, uitiosus est, ideoque utiliter effunditur: si rubet et perlucet, integer est; eaque missio sanguinis adeo non prodest, ut etiam noceat; protinusque is supprimendus est. Sed id euenire non potest sub eo medico, qui scit, ex quali corpore sanguis mittendus sit. Illud magis fieri solet, ut aeque niger adsidue ac primo die profluat; quod quamuis ita est, tamen si iam satis fluxit, supprimendus est, semperque ante finis faciendus est, quam anima deficiat, deligandumque brachium superinposito expresso ex aqua frigida penicillo, et postero die auerso medio digito uena ferienda, ut recens coitus eius resoluatur iterumque sanguinem fundat. Siue autem primo siue secundo die sanguis, qui crassus et niger initio fluxerat, et rubere et perlucere coepit, satis materiae detractum est, atque quod superest sincerum est; ideoque protinus brachium deligandum habendumque ita est, donec ualens cicatricula sit; quae celerrime in uena confirmatur.
11. 11 Now there are two kinds of cups, one made of bronze, the other of horn. The bronze cup is open at one end, closed at the other; the horn one, likewise at one end open, has at the other a small hole. Into the bronze cup is put burning lint, and in this state the mouth is applied and pressed to the body until it adheres. The horn cup is applied as it is to the body, and when the air is withdrawn by the mouth through the small hole at the end, and after the hole has been closed by applying wax over it, the horn cup likewise adheres. Either form of cup may be made, not only of the above materials, but also of anything else suitable; when others are lacking, a small drinking-cup or porridge bowl with a narrowish mouth may be adapted conveniently for the purpose. If the skin upon which the cup is to be stuck is cut beforehand with a scalpel, the cup extracts blood; when the skin is intact, wind. Therefore when it is some matter inside which is doing the harm, the former method of cupping should be employed, when it is flatulency, then the latter. Now the use of a cup is the rule for a disease, not of the body as a whole, but of some part, the sucking out of which suffices for the re-establishment of health. And this same fact is a proof that with a scalpel, when a part is being relieved, blood must be let from that very part where the injury already exists; since unless it be to divert haemorrhage in that direction, nobody applies a cup to a part distant from the disease, but to that which is actually affected and has to be relieved. Further there may be need for cupping in chronic maladies, although already of somewhat long duration, if there is corrupted material or an unhealthy condition of wind; in certain acute cases also, if the body ought to be depleted and at the same time the patient's strength does not admit of cutting a vein; and cupping, as it is a less severe remedy, so it is a safer one; nor is it ever dangerous, even if adopted in the midst of the attack of a fever, or even with food undigested. Therefore, when blood-letting is needed, if cutting a vein is an instant danger, or if the mischief is still localised, recourse is to be had rather to cupping, not forgetting that whilst we recognize the absence of danger, its efficacy is thus the less, and it is impossible to remedy a severe malady unless by a remedy likewise severe.
11. Cucurbitularum duo uero genera sunt, aeneum et corneum. Aenea altera parte patet, altera clausa est: altera cornea parte aeque patens altera foramen habet exiguum. In aeneam linamentum ardens coicitur, ac sic os eius corpori aptatur inprimiturque, donec inhaereat. Cornea corpori per se inponitur, deinde, ubi ea parte, qua exiguum foramen est, ore spiritus adductus est, superque cera cauum id clausum est, aeque inhaerescit. Vtraque non ex his tantum materiae generibus, sed etiam ex quolibet alio recte fit: ac si cetera defecerunt, caliculus quoque aut pultarius oris compressioris ei rei commode aptatur. Vbi inhaesit, si concisa ante scalpello cutis est, sanguinem extrahit, si integra est, spiritum. Ergo ubi materia, quae intus est, laedit, illo modo, ubi inflatio, hoc inponi solet. Vsus autem cucurbitulae praecipuus est, ubi non in toto corpore sed in parte aliqua uitium est, quam exhauriri ad confirmandam ualetudinem satis est. Idque ipsum testimonium est etiam scalpello sanguinem, ubi membro succurritur, ab ea potissimum parte, quae iam laesa est, esse mittendum, quod nemo cucurbitulam diuersae parti inponit, nisi cum profusionem sanguinis eo auertit, sed ei ipsi, quae dolet quaeque liberanda est. Opus etiam esse cucurbit⟨ul⟩a potest in morbis longis, quamuis iam ⟨e⟩is spatium aliquod accessit, siue corrupta materia siue spiritu male habente: in acutis quoque quibusdam, si et leuari corpus debet et ex uena sanguinem mitti uires non patiuntur; idque auxilium ut minus uehemens, ita magis tutum neque umquam periculosum est, etiamsi in medio febris impetu, etiamsi in cruditate adhibetur. Ideoque ubi sanguinem mitti opus est, si incisa uena praeceps periculum est, aut si in parte corporis etiam⟨num⟩ uitium est, huc potius confugiendum est, cum eo tamen, ut sciamus hic ut nullum periculum, ita leuius praesidium esse, nec posse uehementi malo nisi aeque uehemens auxilium succurrere.
12. 12 Now purging was promoted by the ancients in almost all diseases by various medicaments, and by frequent clysters; they administered either black hellebore root, or polypody fern root, or the copper scales which the Greeks call lepida chalkou, or the milky juice of seaside spurge, of which one drop on bread purges freely, or milk, whether from an ass or cow, or goat, to which a little salt was added, which they boiled, and having removed the solidified skin, they obliged their patients to drink the whey-like remainder. But medicaments generally irritate the stomach; a motion when excessively liquid, or a clyster often repeated, weakens the patient. Never, therefore, in illness is a medicament which causes such a motion rightly given, unless when that malady is without fever, as when black hellebore root is given either to those with black bile and to those suffering from insanity with melancholy, or to those who have their sinews in some part paralysed. But in the presence of fevers, it suffices for the purpose of a purge to take such food and drink as both nourish and at the same time soften the belly; and there are sorts of illness in which purgation by milk is suitable. Still, for the most part the bowel preferably is to be clystered; the practice was limited by Asclepiades though still kept, but I see that in our time it is usually neglected. But the limitation which he seems to have adopted is most fitting: that this remedy should not be tried often, and yet we should not omit to use it once, or at most twice: if the head is heavy; if the eyes are dim; if the disease is in the larger intestine, which the Greeks call colon; if there are pains in the lower belly or in the hips; if bilious fluid collects in the stomach, or even phlegm or other water-like humor forms there; if wind is passed with undue difficulty; if there is no spontaneous motion, and especially if the faeces remain inside although close to the anus, or if the patient who fails to pass anything perceives a foul odour in his breath, or if the motions have become corrupted; or if abstinence does not at once get rid of the fever; or if the patient's strength does not allow of blood-letting when it is needed, or the time for that measure has passed; or if previous to the malady the patient has been drinking freely; or if a patient who has been purged repeatedly, whether that has been intentional or casual, has suddenly a suppression of motions. However, the following rules are to be observed: that the clyster is not to be administered before the third day, nor whilst there is any undigested food; nor in a case of weakness due to exhaustion by a long illness; nor to a patient who has daily a sufficient motion, nor to one whose stools are liquid; nor during the acme of the paroxysm of a fever, for what is then injected is retained in the bowel and mounting up into the head brings about a much graver danger. On the day too before the clyster the patient ought to fast, in order to fit himself for such a treatment, and on the actual day, some hours beforehand, he should drink warm water to moisten his upper parts; there should then be introduced into the bowel simply water when we are content with a gentle remedy, or hydromel as one a little stronger; or as a soothing enema a decoction of fenugreek, or of pearl barley, or of mallow, or as an astringent clyster a decoction of vervains, but a drastic one is sea-water or ordinary water with salt added; and the better in both instances for boiling. A clyster is made more drastic by the addition of olive oil, or soda, or honey: the more drastic the clyster, the more it extracts, but the less easily it is borne. The fluid injected should be neither cold nor hot, lest either way it should do harm. Following upon the injection the patient ought to keep in bed as long as he can, and not give way to his first desire to defaecate; then go to stool only when he must. In this way generally when the material is extracted, and the upper parts relieved, the disease itself is mollified. But when the patient has become exhausted owing to forced calls to stool, he ought for a while to keep quiet; and lest his strength fail, he should certainly take food that day, but whether it should be abundant or scanty, should be regulated according to the strength of the paroxysm anticipated, or the absence of such apprehension.
12. Deiectionem autem antiqui uariis medicamentis crebraque alui ductione in omnibus paene morbis moliebantur; dabantque aut nigrum ueratrum aut filiculam aut squamam aeris, quam ΛΕΠΙΔΑ ΧΑΛΚΟΥ Graeci uocant, aut lactucae marinae lac, cuius gutta pani adiecta abunde purgat, aut lac uel asininum aut bubulum, uel caprinum, eique salis paulum adiciebant, decoquebantque id et sublatis is, quae coierant, quod quasi serum supererat, bibere cogebant. Sed medicamenta stomachum fere laedunt: aluus si uehementius fluit aut saepius ducitur, hominem infirmat. Ergo numquam in aduersa ualetudine medicamentum eius rei causa recte datur, nisi ubi is morbus sine febre est, ut cum ueratrum nigrum aut atra bile uexatis aut cum tristitia insanientibus aut iis, quorum nerui parte aliqua resoluti sunt, datur. At ⟨ubi⟩ febres sunt, satius est eius rei causa cibos potionesque adsumere, qui simul et alant et uentrem molliant; suntque ualetudinis genera, quibus ex lacte purgatio conuenit. Plerumque uero aluus potius ducenda est; quod ab Asclepiade quoque sic temperatum, ut tamen seruatum sit, uideo plerumque saeculo nostro praeteriri. Est autem ea moderatio, quam is secutus uidetur, aptissima, ut neque saepe ea medicina temptetur, et tamen semel, summum uel bis non omittatur: si caput graue est; si oculi caligant; si morbus maioris intestini est, quod Graeci colum nominant; si in imo uentre aut si in coxa dolores sunt; si in stomachum quaedam biliosa concurrunt, uel etiam pituita eo s⟨e⟩ umorue aliquis aquae similis confert; si spiritus difficilius redditur; si nihil per se uenter excernit, utique si iuxta quoque stercus est et intus remanet, aut si stercoris odorem nihil deiciens aeger ex spiritu suo sentit, aut si corruptum est quod excernitur; aut si prima inedia febrem non sustulit; aut si sanguinem mitti, cum opus sit, uires non patiuntur tempusue eius rei praeterit, aut si multum ante morbum aliquis potauit; aut si is, qui saepe uel sponte uel casu purgatus est, subito habet aluum suppressam. Seruanda uero illa sunt, ne ante tertium diem ducatur; ne ulla cruditate substante; ⟨ne⟩ in corpore infirmo diuque in aduersa ualetudine exhausto, neue in eo, cui satis aluus cottidie reddit quiue eam liquidam habebit; ne in ipso accessionis impetu, quia quod tum infusum est, aluo continetur, regestumque in caput multo grauius periculum efficit. Pridie uero abstineri debet aeger, ut aptus tali curationi sit, eodem die ante aliquot horas aquam calidam bibere, ut superiores eius partes madescant; tum inmittenda in aluum est, si leui medicina contenti sumus, pura aqua, si paulo ualentiore, mulsa; si leni, ea, in qua faenum Graecum uel tisana uel malua decocta sit, [si reprimendi causa, ex uerbenis] acris autem est marina aqua uel alia sale adiecto; atque utraque decocta commodior est. Acrior fit adiecto uel oleo uel nitro uel melle: quoque acrior est, eo plus extrahit, sed minus facile sustinetur. Idque, quod infunditur, neque frigidum esse oportet neque calidum, ne alterutro modo laedat. Cum infusum est, quantum fieri potest, continere se in lecticulo debet aeger, nec primae cupiditati deiectionis protinus cedere: ubi necesse est, tum demum desidere. Fereque eo modo dempta materia, superioribus partibus leuatis, morbum ipsum mollit. Cum uero, quotiens res coegit, desidendo aliquis se exhausit, paulisper debet conquiescere; et ne uires deficiant, utique eo die cibum adsumere; qui plenior an exiguus sit, ex ratione eius accessionis, quae expectabitur aut in metu non erit, aestimari oportebit.
13. 13 Again, a vomit, as it is often quite a necessity for one who in health is bilious, so is it also in those diseases which bile has occasioned. It is the more necessary, therefore, for all who are troubled by shivering and trembling before fevers, for all suffering from cholera, even for all suffering from insanity accompanied by a kind of hilarity, and also for those afflicted by epilepsy. But if the disease is an acute one, as in the case of cholera, if there is fever, during the shivering fits, then the sharper medicaments are out of place, as mentioned above in relation to purgations, and for the purpose of a vomit it is sufficient to take the emetics which I have prescribed to be taken by those in health. But when there are chronic and violent diseases without fever, such as epilepsy and insanity, white hellebore root should also be used. But it is not right to give it either in winter or in summer; the spring is the best time, and autumn tolerably good. Whoever is going to administer it ought to take care beforehand that the body of the prospective recipient is rendered more humid. This should be recognized, that all such medicaments given as a drink do not always benefit the sick, and are always harmful to those in health.
13. At uomitus ut in secunda quoque ualetudine saepe necessarius biliosis est, sic etiam in is morbis, quos bilis concitauit. Ergo omnibus, qui ante febres horrore et tremore uexantur, omnibus, qui cholera laborant, omnibus etiam cum quadam hilaritate insanientibus, et comitiali quoque morbo oppressis necessarius est. Sed si acutus morbus est, sicut in cholera, si febris est, ut inter horrores, asperioribus medicamentis opus non est, sicut in deiectionibus quoque supra dictum est; satisque est ea uomitus causa sumi, quae sanis quoque sumenda esse proposui. At ubi longi ualentesque morbi sine febre sunt, ut comitialis, ut insania, ueratro quoque albo utendum est. Id neque hieme ⟨neque⟩ aestate recte datur, optime uere, tolerabiliter autumno. Quisquis daturus erit, id agere ante debebit, ut accepturi corpus umidius sit. Illud scire oportet, omne eiusmodi medicamentum, quod potui datur, non semper aegris prodesse, semper sanis nocere.
14. 14 Now concerning rubbing, Asclepiades as if he were the inventor of the practice has treated it in his volume, entitled "Common aids," at such great length, that, though making mention only of three such aids, namely, Rubbing, Water-drinking, and Rocking, yet he has taken up the greatest part with the first-named subject. Now on such matters recent writers ought to have credit where they have made discoveries, or where they have rightly followed others; yet we must not omit to attribute to their true authors teaching found among the more ancient writers. And it cannot be disputed that Asclepiades has taught when and how rubbing should be practised, with a wider application, and in a clearer way, although he has discovered nothing which had not been comprised in a few words by that most ancient writer Hippocrates, who said that rubbing, if strenuous, hardens the body, if gentle, relaxes; if much, it diminishes, if moderate, fills out. It follows, therefore, that in the following cases rubbing should be employed, when either a feeble body has to be toned up, or one indurated has to be softened, or a harmful superfluity is to be dispersed, or a thin and infirm body has to be nourished. Yet when examined with attention (although this no longer concerns the medical man) the various species of rubbing may be easily recognized as all dependent on causing one thing, depletion. For an object is toned up when that is removed, which, by its presence was the cause of the laxness; and is softened when that which has been producing induration is abstracted; and it is filled up, not by the rubbing itself, but by the nutriment, which subsequently penetrates by some sort of dispersal to the very skin itself after it has become relaxed. The cause of the different results lies in the degree. Now there is a great difference between anointing and rubbing. For it is desirable that even in acute and recent diseases the body should be anointed and then gently stroked, but only during remissions and before food. But prolonged rubbing is unsuitable in acute and increasing troubles, unless it be in madness to procure sleep. Yet a prolonged illness and one declining from its primary vehemence loves this aid. I am quite aware that some say that the need for any aid is during the increase of diseases, not when diseases are tending to end of themselves. But this is not the case. For a disorder, even although it will end of itself, may be expelled yet more speedily by adopting the aid. An aid is necessary on two accounts, both that health may be regained at the earliest possible moment, and that what remains of the disease may not again become exacerbated from however slight a cause. Possibly the disease may have become less grave than it had been, yet is not completely got rid of, but some remnants of it persist, which the application of a remedy disperses. But while rubbing is rightly applied after a disorder has been lessened, yet it should never be applied whilst a fever is increasing: but if possible after the fever has entirely left the body, or if not, at least when it has remitted. Sometimes, moreover, rubbing should be applied to the body all over, as when a thin man ought to put on flesh; sometimes to a part only, either because weakness of the limb actually rubbed demands it, or that of some other part. For both prolonged headaches are relieved by rubbing of the head, although not at the height of the pain, and any partially paralysed limb is strengthened by itself being rubbed. Much more often, however, some other part is to be rubbed than that which is the seat of the pain; and especially when we want to withdraw material from the head or trunk, and therefore rub the arms and legs. Neither should we listen to those who would fix numerically how many times a patient is to be stroked; for that is to be regulated by his strength; and if he is very infirm fifty strokes may possibly be enough, if more robust possibly two hundred may be made; then an intermediate number according to his strength. Hence it is that the hand is to be passed even fewer times over a woman than over a man, fewer over a child or old man, than over a young adult. Finally, if particular limbs are rubbed, many strokes are re-quired and forcible rubbing; both because the body cannot be as a whole quickly rendered weak through a part, and it is necessary that as much as possible of the diseased matter should be dispersed, whether our aim is to relieve the limb actually rubbed, or through it another limb. When, however, general bodily weakness requires that the rubbing should be applied all over, it should be shorter and more gentle, just to the extent of softening the skin, so that the body may be more easily capable of forming new material from food recently consumed. As I have stated above (II.6.7), a patient is already in a bad way, when the exterior of the body is cold, whilst his interior is hot and there is thirst. But even then rubbing is the only remedy; if it draws the heat outwards into the skin, it makes possible an opportunity for other treatment.
14. De frictione uero adeo multa Asclepiades tamquam inuentor eius posuit in eo uolumine, quod COMMVNIVM AVXILIORVM inscripsit, ⟨ut,⟩ cum trium faceret tantum mentionem, huius et aquae et gestationis, tamen maximam partem in hac consumpserit. Oportet autem neque recentiores uiros in is fraudare, quae uel reppererunt uel recte secuti sunt, et tamen ea, quae apud antiquiores aliquos posita sunt, auctoribus suis reddere. Neque dubitari potest, quin latius quidem et dilucidius, ubi et quomodo frictione utendum esse⟨t,⟩ Asclepiades praeceperit, nihil tamen reppererit, quod ⟨non⟩ a uetustissimo auctore Hippocrate paucis uerbis comprehensum sit, qui dixit frictione, si uehemens sit, durari corpus, si lenis, molliri: si multa, minui, si modica, inpleri. Sequitur ergo, ut tum utendum sit, cum ⟨aut⟩ adstringendum corpus sit, quod hebes est, aut molliendum, quod induruit, aut digerendum in eo, quod copia nocet, aut alendum id, quod tenue et infirmum est. Quas tamen species si quis curios⟨i⟩us aestimet (quod iam ad medicum non pertinet), facile intelleget omnes ex una causa pendere, quae demit. Nam et adstringitur aliquid eo dempto, quod interpositum, ut id laxaretur, effecerat, ⟨et⟩ mollitur eo detracto, quod duritiem creabat, et inpletur non ipsa frictione sed eo cibo, qui postea usque ad cutem digestione quadam relaxatam penetrat. Diuersarum uero rerum in modo causa est. Inter unctionem autem et frictionem multum interest. Vngui enim leuiterque pertractari corpus etiam in acutis et recentibus morbis oportet, in remissione tamen et ante cibum. Longa uero frictione uti ⟨ne⟩que in acutis morbis neque increscentibus conuenit, praeterquam cum phreneticis somnus ea quaeritur. Amat autem hoc auxilium ualetudo longa et iam a primo inpetu inclinata. Neque ignoro quosdam dicere omne auxilium necessarium esse increscentibus morbis, non cum iam per se finiuntur. Quod non ita se habet. Potest enim morbus, etiam qui per se finem habiturus est, celerius tamen adhibito auxilio pelli. Quod duabus de causis necessarium est, et ut quam primum bona ualetudo contingat, et ne morbus, qui remanet, iterum, quamuis leui de causa, exasperetur. Potest morbus minus grauis esse quam fuerit, neque ideo tamen solui, sed reliquiis quibusdam inhaerere, quas admotum aliquod auxilium discutit. Sed ut leuata quoque aduersa ualetudine recte frictio adhibetur, sic numquam adhibenda est fe⟨b⟩re increscente: uerum, si fieri potest, cum ex toto corpus ea uacabit; si minus, certe cum ea remiserit. Eadem autem modo in totis corporibus esse debet, ut cum infirmus aliquis implendus est, modo in partibus, aut quia ipsius eius membri inbecillitas id requirit aut quia alterius. Nam et capitis longos dolores ipsius frictio leuat, non in inpetu tamen doloris, et membrum aliquod resolutum ipsius frictione confirmatur. Longe tamen saepius aliud perfricandum est, cum aliud dolet; maximeque cum a summis aut a mediis partibus corporis euocare materiam uolumus, ideoque extremas partes perfricamus. Neque audiendi sunt qui numero finiunt, quotiens aliquis perfricandus sit: id enim ex uiribus hominis colligendum est; et si is perinfirmus est, potest satis esse quinquagies, si robustior, potest ducenties esse faciendum; inter utrum⟨que⟩ deinde, prout uires sunt. Quo fit, ut etiam minus saepe in muliere quam in uiro, minus saepe in puero uel sene quam iuuene manus dimouendae sint. Denique si certa membra perfricantur, multa ualentique frictione opus est: nam neque totum corpus infirmari cito per partem potest, et opus est quam plurimum materiae digeri, siue id ipsum membrum siue per id aliud leuamus. At ubi totius corporis inbecillitas hanc curationem per totum id exigit, breuior esse debet et lenior, ut tantummodo summam cutem emolliat, quo facilius capax ex recenti ⟨ci⟩bo nouae materiae fiat. In malis iam aegrum esse, ubi exterior pars corporis friget, interior cum siti calet, [ut] supra posui. Sed tunc quoque unicum in frictione praesidium est; quae si calorem in cutem euocauit, potest alicui medicinae locum facere.
15. 15 Rocking also is very suitable for chronic maladies which are already abating; it is also of service both for those who are now entirely free from fever, but cannot as yet themselves take exercise, and also for those in whom persist sluggish remnants of maladies, not otherwise to be got rid of. Asclepiades has stated that use is to be made of rocking even for dispersal of a recent and severe fever, especially an ardent fever. But that gives rise to danger; an attack of that sort is better sustained by keeping quiet. If anyone, however, wants to give it a trial, let him try it when the tongue is not furred, when there is no swelling, no induration, no pain, either in the viscera or head or about the heart. And on the whole a body in pain should never be rocked, whether the pain be general or local, except, however, when sinews alone are in pain, and never during the rise of a fever, but only during its remission. But there are many sorts of rocking, and they are to be regulated both by the patient's strength and by his resources, lest either a weak patient undergo overmuch depletion, or a poor man come short. The gentlest rocking is that on board ship either in harbour or in a river, more severe is that aboard ship on the high seas, or in a litter, even severer still in a carriage: but each of these can either be intensified or mitigated. Failing any of the above, the bed should be so slung as to be swayed; if not even that, at any rate a rocker should be put under its foot so that the bed may be moved from side to side by hand. And this sort of exercise of the lighter kinds suits the infirm, the stronger kinds again those who have already become free from fever for several days, or those who, whilst feeling the commencement of grave disorders, as yet are free from fever (which happens in the case both of phthisis and of stomach disease, and of dropsy, also, at times, of jaundice), or when certain diseases such as epilepsy and madness persist without fever, for however long. In which affections also those kinds of exercises are necessary, which we have included in the passage where we prescribed what healthy, yet not strong, men should carry out.
15. Gestatio quoque longis et iam inclinatis morbis aptissima est; utilisque est et iis corporibus, quae iam ex toto febre carent sed adhuc exerceri per se non possunt, et iis, quibus lentae morborum reliquiae remanent neque aliter eliduntur. Asclepiades etiam in recenti uehementique praecipueque ardente febre ad discutiendam eam gestatione dixit utendum. Sed id periculose fit, meliusque quiete eiusmodi impetus sustinetur. Si quis tamen experiri uolet, sic experiatur: si lingua non erit aspera, si nullus tumor, nulla durities, nullus dolor uisceribus aut capiti aut praecordiis suberit. Et ex toto numquam gestari corpus dolens debet, siue id in toto siue in parte est, nisi tamen solis neruis dolentibus, neque umquam increscente febre sed in remissione eius. Genera autem gestationis plura sunt adhibendaque sunt et pro uiribus cuiusque et pro opibus, ⟨ne⟩ aut inbecillum hominem nimis digerant, aut humili desint. Lenissima est naui uel in portu uel in flumine, uehementior uel in alto mari naui uel lectica, etiamnum acrior uehiculo: atque haec ipsa et intendi et leniri possunt. Si nihil eorum est, suspendi lectus debet et moueri: si ne id quidemst, at certe uni pedi subiciendum fulmentum est, atque ita lectus huc et illuc manu inpellendus. Et leuia quidem genera exercitationis infirmis conueniunt, ualentiora uero iis, qui iam pluribus diebus febre liberati sunt, aut iis, qui grauium morborum initia sic sentiunt, ut adhuc febre uacent (quod et in tabe et in stomachi uitiis, et cum aqua cutem subit, et interdum in regio fit), aut ubi quidam morbi, qualis comitialis, qualis insania est, sine febre quamuis diu manent. In quibus adfectibus ea quoque genera exercitationum necessaria sunt, quae conprehendimus eo loco, quo, quemadmodum sani neque firmi homines se gererent, praecepimus.